INTERNAL REVENUE SER TCE
P. O. BOX 2508
CINCINNATI, OH 45201
Date:
DEC 1rt2l3
GARDENWORKSFORXIDS
C/O DONNA SOLOMON
Dear Applicant:
DEPARTMENT OF THE TREASURY
Employer Identification Number:
46-2428869
DLN:
17053240328033
Contact Person:
SHERRY Q WAN ID* 31052
Contact Telephone Number:
(877) 829-5500
Accounting Period Ending:
December 31
Public rha rity Status:
170 (b) (1) (A) (vi)
Form 990 Required:
Yes
Effective Date of Exemption:
February 13, 2013
Contribution Deductibility:
Yes
Addendum Applies:
No
We are pleased to inform you that fin review of your application for raY exempt status we have determined that you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records.
Organizations exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations_ We determined that you are a public charity under the Code section(s) listed in he heading of this letter.
Please see enclosed Publication 4221-PC, Compliance Guide for 501 (c) (3) Public e'harities, for some helpful information about your responsibilities as an -- exempt organization.
Letter 947 ; . : C_
ATTACHMENT 15
COMMUNITY ACTIVITY GRANT
FINANCIAL / IN -KIND / FEE WAIVER
APPLICATION
COMMUNITY ACTIVITY GRANT APPLICATION INSTRUCTIONS
Fiscal Year:
Date Application submitted:
2024-2025
5/21/2024
Submit to:
City of Yucaipa
General Services/City Clerk Department
34272 Yucaipa Blvd.
Yucaipa, CA 92399
Attn: Kimberly Metzler
Received
City of Yucaipa.
MAY 2 20Z4
c l ' .rrvices/
partment
All sections of the application must be returned complete, and a I supporting documentation must be included as part of the submittal. Incomplete applications received will be returned to the applicant.
Note: Beginning with the FY2025/26 grant cycle, financial grant awarded funds will require 100% financial match by the applicant. For example, if your total program/project cost is $1,000, your financial grant request should be for no more than $500.
Be prepared to show proof of program/project cost in your Wrap-up Report (Accountability Report), detailing the applicants financial match of S500.
SECTION 1 — GENERAL INFORMATION
Name of Applicant/Organization:
Applicant/Organization Mailing Address:
Applicant/Organization Phone Number:
Contact (1)
Contact (2)
Redlands Bicycle Classic, Inc
P.O. Box 7880 Redlands, CA 92375
( )
Ed Purves
Name Phone Number
[email protected]
E-mail address
Marc Shaw
Name
Phone Number
[email protected]
E-mail address
SECTION 2 - ELIGIBILITY REQUIREMENTS:
Yes
Is your organization located in another community?
Will the program/event take place in another community? Are you aware of any other City program providing this service? If so, which one?
No
*If you answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.
SECTION 3 — ORGANIZATION INFORMATION/APPLICANT BACKGROUND How long has your 501(c) organization been in existence? Number of Employees working for organization:
Number of Volunteers working for organization:
Is a current City Council Member on your board?
How many Yucaipa residents does your organization currently serve? Does the organization charge admission, membership fees, dues, etc.? If yes, please describe:
Your organization must be an established 501(c) to be considered for Community Activity Grant funding.
Please submit documentation verifying organization 501(c) status along with this application.
Yes
Is your organization a 501(c)?
If yes, please provide Tax ID# 33-0231753 and attach all supporting documents.
Does this application include submittal of documentation verifying 501(c) status? 25+
0 350+
All
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Marc Shaw President
Craig Kundig
Ed Purves
Eric Reiser
Colleen Gamboa
Melissa Valdez
Gary Fagan
No
n
Vice President
Vice President
Vice President
Vice President
Treasurer
Secretary
SECTION 4 - PROGRAM DESCRIPTION/SCOPE: (PLEASE USE ADDITIONAL PAGES IF NECESSARY) Name of the program/event:
Date(s) of program/event:
Redlands Bicycle Classic
April 9-13, 2025
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) The Redlands Bicycle Classic, Yucaipa Road Race, would occur as part of the 2025 Redlands Bicycle Classic. The event is a five day professional bicycle race, which has been held for the past 38 years.
It is known as the top professional cycling event in the country.
Describe how the program/event benefits the residents and/or community of Yucaipa:
The events' core virtues of Health, Diversity, and the Environment are vital to our community. The race includes cycling and youth events for local children. Leading up to the event, professional cyclists visit local schools to promote healthy lifestyle habits and encourage kids to be active and practice safe bicycle riding habits. Each year, cyclists visit approximately 36 schools and see over 8,000 students.
The Redlands Bicycle Classic brings national attention to local communities, including an influx of guests who patronize local hotels, eating establishments, grocery stores, etc.
Program/Event Primary Target Population (check all that apply):
Children or Youth
Low Income
Persons with Disabilities
Number of Residents Projected to Serve: 500
Seniors
Victims
Welfare Recipients
Women
Homeless
Entire Community
SECTION 5 — GRANT FUNDING REQUEST
Please identify what your organization is seeking:
Financial Support: nYes ✓ No $
$200 SEP Fee
Waiver:
es Elko
Public
In -kind Support: Police $ 1o,000 Fire $ 250 Works $ 250 CS/Rental $ OT/Reassigned
Staff $ Other $ Explain
$200 SEP Financial Total Overall
In -Kind Financial Support Fee Waiver Match Request
Total Amount of Request: $10,500 $ $ 200 $ 300,000 = $ 10,700 Provide a detailed description of how the financial support will be used:
Police support will be used to control traffic at various key intersections on the course and officers who will provide escort for the rolling enclosure of the professional races.
Public works support will be for the placement of warning signs prior to event.
SECTION 6 — FINANCIAL CAPABILITIES/BUDGET:
What other in-kind/financial contributions has your organization received to fund this event/program (separate from City funding)?
In -Kind
Amount
Various sponsors (2024 event data) $ 300,000
$
$
$
$
$
$
Remaining Balance That Will Be Funded By $
Organization:
Total Funds Received To Date:
Total Funds Requested Via Grant Application:
Financial
Support Amount
$ 200,000
SECTION 6 — FINANCIAL CAPABILITIES/BUDGET (CONTINUED):
Provide City funding received by organization in the past three years (required):
Program
2023 Event
2022 Event
2019 Event
In -Kind Financial $200 SEP Date
Support Fee Waiver Received
✓
Total Received
$ 9691.25
$ 9691.25
$9687.00
SECTION 7 — CERTIFICATION
I, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand that the awarded financial grant amount needs to be spent prior to submitting another grant request.
Digitally signed by Marc Shaw
Date: 2024.05.21 08:52:19 -07'00'
Signature
Executive Director
Title
5/21/2024
Date
TO BE COMPLETED BY CITY
Date Received:
Amount Funded:
Type of Grant:
$
E In -Kind
Date Reviewed:
City Council Meeting:
II
Financial Support n Fee Waiver
Date City Council received follow up report:
Yucaipa Police Request Form (Exhibit A)
Attachment to the Community Activity Grant Application/SEP Process Fiscal Year: 2024-2025
Date Application submitted: 5/21/2024
SECTION 1 — GENERAL INFORMATION
Name of Applicant / Organization
Mailing Address:
Phone Number:
Contact:
Applicant Signature:
Redlands Bicycle Classic, Inc.
P.O. Box 7880 Redlands, CA 92375
Marc Shaw
Name
Phone Number
[email protected]
E-mail address
Title: Executive Director
SECTION 2 — EVENT INFORMATION
Event Name:
Event Location:
Event Date:
Estimated Event Attendance Number:
Redlands Bicycle Classic
Yucaipa
4/10/2025
800
Event Time:
0600-1600
SECTION 3 — YUCAIPA POLICE SERVICES REQUESTED
Number of Officers Requested: Sworn Officers: TBD
Dates Officers/COPS Requested: 4/1 0/2025
Equipment Requested
Additional Information:
Citizen Patrol (COPS): TBD
Times Officers/COPS Requested: 0600-1600
Patrol Car: ❑� Motorcycle: Other: ❑
Total number of personnel to be determined once a
course is finalized and meetings occur with Yucaipa PD, CHP and RBC staff. Anticipated number of Deputies required is 6-8.
TO BE COMPLETED BY YUCAIPA POLICE
Reviewed by:
Signature:
Title:
Date
Total Cost for In -Kind Request:
CITY OF
Public Works Department Request Form (Exhibit C)
Attachment to the Community Activity Grant Application/SEP Process Fiscal Year: 2024-2025
Date Application submitted: 5/21 /2024
SECTION 1— GENERAL INFORMATION
Name of Applicant / Organization
Mailing Address:
Phone Number:
Contact:
Applicant Signature:
Redlands Bicycle Classic, Inc.
P.O. Box 7880 Redlands, CA 92375
Marc Shaw
Name
Phone Number
[email protected]
R-mail address
Title: Executive Director
SECTION 2 — EVENT INFORMATION
Event Name:
Event Location:
Event Date:
Estimated Event Attendance Number:
Redlands Bicycle Classic
Yucaipa
4/11/2025
800
Event Time: 0600-1 600
SECTION 3 — PUBLIC WORKS SERVICES REQUESTED
Number of Public Works Staff Requested:
Equipment Rentals and Quantity Requested:
❑ Cones
Dates Requested:
❑ Delineators
4/10/2025
❑ Street Closures
Projected Staff Time Expense: $
Times Requested:
❑ Signage
0600-1600
Equipment Expense: $
Additional Information: The City of Yucaipa normally has Public Works staff available on the day of the event, however, all cones, barricades, and signage will be provided by RBC's contracted traffic management company.
TO BE COMPLETED BY PUBLIC WORKS DEPARTMENT
Reviewed by:
Signature:
Title:
Date
Total Cost for In -Kind Request:
e4Ceth4f
BICYCLE CLASSIC
City of Yucaipa
34272 Yucaipa Boulevard
Yucaipa, CA 92399
Dear Elected Officials and City Staff:
On behalf of the Redlands Bicycle Classic Committee, we are excited to approach the City of Yucaipa with our request for in -kind funding, so that we may bring the Redlands Bicycle Classic back to your city on April 10, 2025, and throughout the region from April 9-13, 2025.
For many years, the Redlands Bicycle Classic staff has worked diligently with city staff to execute a professional bicycle race in Yucaipa, and each year, we have improved traffic flow and overall logistics. We are very pleased with the progress we achieved, and we certainly could not have done it without the help of city staff. We look forward to the opportunity to plan for a race in 2025 and will design a course that is exciting and amicable to city staff.
We remain committed to hosting this nationally renowned cycling competition and community event in a safe and responsible manner, while bringing recognition and revenue to the city. In exchange, we are soliciting the support of the City's leadership through their waiver of the costs and fees associated with our event. We fully understand and support the City Council's focus on fiscal responsibility. With that, we remain confident that you will continue to see that the value of the Classic far exceeds the costs incurred. In terms of value, we realize it is very difficult to quantify a specific dollar amount associated with many of the benefits this event provides. However, I would like to take a moment to share the following perspective on what the Classic means to our communities.
Value to the City
The positive exposure to the city is extensive and difficult to measure. Marketing the Classic translates into marketing the City of Yucaipa. Our in -kind media sponsor partnerships include a large cross section of all media capacities, and our message reaches hundreds of thousands of viewers, with total media impressions in the millions. Our partnerships with twelve inland area radio stations and local news groups, including the Redlands Community News, Yucaipa News Mirror, San Bernardino Sun and Redlands Magazine focus on inviting spectators to come to the region to enjoy our famous hospitality, while watching an exciting world -class event and inviting them to patronize our local hotels, restaurants and stores.
Additionally, the Classic is covered by every local news organization in an editorial capacity with stories and images from each day's events. It is well known throughout the media circles, and it is a "must cover" event. We have worked diligently to increase the exposure for the City of Yucaipa through the Classic.
P.O. Box 7880 Redlands, CA 92375 www.redlandsclassic.com
Value to local businesses
Many Yucaipa businesses benefit from the participants, their families and spectators who travel here from out of the area. Whether they are staying with local host families, dining in restaurants, purchasing fuel, or shopping in local stores, Yucaipa businesses enjoy an uptick in business when the Classic comes to town.
Value to the community
In addition to providing the United States with a top-notch professional cycling event, the Classic provides so much more. We offer the opportunity for people of all ages to experience the thrill of an exceptionally organized event. Our school visit program allowed professional cycling teams to visit 36 schools and see nearly 8,500 children in 2024.
Our partnership with the city of Yucaipa has been tremendous over the years and we sincerely appreciate the relationship we have developed. We have worked diligently with each of the city departments to minimize the impact the event has on their operations. We provide Race Marshals to reduce traffic control expenses by the Police Department. We provide doctors from Loma Linda Medical Center to lessen the impact on the Fire Department. Lastly, we coordinate with Public Works in order to have signs, barricades and traffic control at key locations.
As we embark upon planning for the 39ti, edition of this event, your support and investment are key in the continued success of the Classic. We feel strongly that the Classic is a part of what makes our communities special, and we are very proud to have a small part of making this community a wonderful place to call home. In closing, on behalf of the 350 community volunteers that make up our team, I thank you for your continued support as we plan for 2025.
Sincerely,
Marc Shaw, Executive Director
Redlands Bicycle Classic, Inc.
September
38th RBCYear
50 Committee members
107 Race staff volunteers
532Youth racers
425 Plain Wrap riders
122 Runners/Walkers
26 Cash sponsors
50 In -kind sponsors
2024
REDLANDS
BICYCLE CLASSIC
Facts and Figures
sr
April
5 Fun Filled Days
Countless Hours of Dedication
Endless Joy of another GREAT Year!
5,590
'g6
S
( 192 Men's racers
26 Men's teams
133 Women's racers
21 Women's teams
286 Amateur racers
:�$: i1 1) L. �{
75 Host families
325 Racers housed
1000 Race banners
534 Radio spots
18 Billboard Ads
124,729 Website hits (during race week)
8 Newspaper ads
20 Press releases
160 Yard signs posted
36 Kegs of beer served
1,100 Pancake breakfasts served
145 Vendor booths
30 Cornhole competitors
3 Live Bands
/robed
36 School visits
8360 Students
62 Porta potties
300 Barricades
7,000 Zip ties
87 Insulation bales
45 EZ Ups
500 No parking signs
500 Trash bags
4 miles of temporary fencing
29 Race vehicles
278 Race marshals
27 Race physicians
d
ro
a
657 Volunteer lunches
served
INTERNAL REVENUE SERVICE
P. 0. BOX 2508
CINCINNATI, OH 45201
Date: r r7 / ✓„
REDLANDS BICYCLE CLASSIC INC
PO BOX 7880
REDLANDS, CA 92375
Dear Applicant:
DEPARTMENT OF THE TREASURY
Employer Identification Number:
33-0231753
DLN:
17053004307002
Contact Person:
PAUL F CAPPEL II ID# 31665
Contact Telephone Number:
(877) 829-5500
Accounting Period Ending:
June 30
Form 990 Required:
Yes
Effective Date of Exemption:
December 30, 2011
Contribution Deductibility:
No
Addendum Applies:
Yes
We are pleased to inform you that upon review of your application for tax- exempt status we have determined that you are exempt from Federal income tax under section 501(c) (4) of the Internal Revenue Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records.
Please see enclosed Publication 4221-NC, Compliance Guide for Tax -Exempt Organizations (Other than 501(c)(3) Public Charities and Private Foundations), for some helpful information about your responsibilities as an exempt organization.
Contributions to you are not deductible by donors under section 170(c) (2) of the Code.
We have sent a copy of this letter to your representative as indicated in your power of attorney.
Enclosure: Publication 4221-NC
Sincerely,
n.
Holly 0. Paz
Director, Exempt organizations
Rulings and Agreements
Letter 948 (DO/CG)
-2-
REDLANDS BICYCLE CLASSIC INC
Based on the information submitted with your application, we approved your request under Notice 2011-44 and the effective date of exemption is December 30, 2011, the postmark date of your application.
Letter 948 (DO/CG)
ATTACHMENT 16
CITY OF
COMMUNITY ACTIVITY GRANT
FINANCIAL / IN -KIND / FEE WAIVER
APPLICATION
COMMUNITY ACTIVITY GRANT APPLICATION INSTRUCTIONS
Fiscal Year:
Date Application submitted:
2024-2025
Submit to:
City of Yucaipa
General Services/City Clerk Department
34272 Yucaipa Blvd.
Yucaipa, CA 92399
Attn: Kimberly Metzler
Received
City of Yucaipa
MAY 22 2024
General Services/
City Clerk's Department
All sections of tiuc application must be returned complete, and all supporting documentation must be included as part of the submittal. luacomplete applications received will be returned to the applicant.
Note: Beginning with the FY2025/26 grant cycle, financial grant awarded funds will require 100% financial match by the applicant. For example, if yam. total program/project cost is `01,000, your financial grant request should be for no more isaan a 500.
Be prepared to show proof of program/project cost in your Wrap-up Report (Accountability Report), detailing the applicants fizauaeial match of DS00.
SECTION 1 — GENERAL INFORMATION
Name of Applicant/Organization:
Applicant/Organization Mailing Address:
Applicant/Organization Phone Number:
Contact (1)
Contact (2)
Yucaipa/Calimesa Family Assistance
PO Box 130, Yucaipa CA 92399
Paul Kielhold
Name Phone Number
E-mail address
Melissa Brunken
Name
Phone Number
E-mail address
SECTION 2 - ELIGIBILITY REQUIREMENTS:
Is your organization located in another community?
Will the program/event take place in another community? Are you aware of any other City program providing this service? If so, which one?
Yes
n
No
*If you answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.
City of Yucaipa Community Activity Grants Application, Rev. 04/2024
SECTION 3 — ORGANIZATION INFORMATION/APPLICANT BACKGROUND Your organization must be an established 501(c) to be considered for Community Activity Grant funding.
Please submit documentation verifying organization 501(c) status along with this application.
Is your organization a 501(c)? �" v
If yes, please provide Tax ID# ct LC( 0 ^ b and attach all supporting documents.
Does this application include submittal of documentation verifying 501(c) status? 75 yrs
How long has your 501(c) organization been in existence? Number of Employees working for organization:
Number of Volunteers working for organization:
Is a current City Council Member on your board?
How many Yucaipa residents does your organization currently serve? Does the organization charge admission, membership fees, dues, etc.? If yes, please describe:
NA
1 (half time)
18 1400 visits/mo
Yes
✓
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Debbie Wilson, President
Paul Kielhold, Vice President
Jackie Kloft, Treasurer
Margaret Vanckleleer, Director
Diane O'Conner, Director
No
SECTION 4 - PROGRAM DESCRIPTION/SCOPE: (PLEASE USE ADDITIONAL PAGES IF NECESSARY) Name of the program/event:
Date(s) of program/event:
Computer hardware and service contracts
As soon as funded
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) Replace antiquated computer hardware and obtain service contracts for the computer system.
City of Yucaipa Community Activity Grants Application, Rev. 04/2024 Page 2
Describe how the program/event benefits the residents and/or community of Yucaipa:
YCFA consists of a small thrift store and food distribution area. The computer is used for typical office functions (payroll, cash flow, taxes, monitor secuity etc). The proposed hardware and service would be provided by a local contractor. The current system is antiquated and can no longer adequately support the office functions.
Program/Event Primary Target Population (check all that apply):
Children or Youth
Low Income
Persons with Disabilities
Number of Residents Projected to Serve: 1400 visits/mo
Seniors
Victims
Welfare Recipients
Women
Homeless
Entire Community
SECTION 5 — GRANT FUNDING REQUEST
Please identify what your organization is seeking:
Financial Support:
es
$200 SEP Fee
Waiver: nYes
In -kind Support: Police $
No
$1,679.37
Fire $
OT/Reassigned
Staff $ Other $
Public
Works $
Explain None
CS/Rental $
$200 SEP Financial Total Overall
In -Kind Financial Support Fee Waiver Match Request
Total Amount of Request: $ $1,679.37 $ $ 1,679.37 = $1;67 337 Provide a detailed description of how the financial support will be used:
The support would be used to purchase computer hardware and services per the attached proposal (HCC Technology, 2/23/24)
City of Yucaipa Community Activity Grants Application, Rev. 04/2024 Page 3
SECTION 6 — FINANCIAL CAPABILITIES/BUDGET:
What other in-kind/financial contributions has your organization received to fund this event/program (separate from City funding)?
��� FA _S i'Cr-�t. r� C(e c f c�i 0 r 1 c i O 11 �Y cU 3 , �• nC2 Cl l _ ° r i S -Ft) r-:?
In -Kind
CO ►rt
Financial
Amount Support Amount
$ $
$ $
$ $
$ $
$ $
$ $
Total Funds Requested Via Grant Application: $
Remaining Balance That Will Be Funded By $
Organization:
Total Funds Received To Date:
$ 1,679.37
$ 1,679.37
SECTION 6 — FINANCIAL CAPABILITIES/BUDGET (CONTINUED):
Provide City funding received by organization in the past three years (required):
Program
Repair and add fencing
Repair and add to counter
Security cameras
In -Kind Financial $200 SEP Date
Support Fee Waiver Received
Total Received
2021 $1875
2022 $2500
2023 $2000
SECTION 7 — CERTIFICATION
I, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand that the awarded financial grant amount needs to be spent prior to submitting another grant request. signature
Title
-517-2—/ :2-41
Date
TO BE COMPLETED BY CITY
Date Received:
Amount Funded:
Type of Grant:
—
❑ In -Kind
Date City Council received follow up report:
Date Reviewed:
City Council Meeting:
❑ Financial Support
❑ Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 04/2024
,PO Box 1819
Yucaipa, California 92399
hcctechnology.com
909.790.9338
rh
Yucaipa Calimesa Family Assistance Estimate # 1535
35075 Avenue B Estimate Date 02-23-24
Yucaipa, CA, United States 92399
Total
Item Description Unit Cost Quantity Line Total
Misc Yucaipa Calimesa Family Assistance (YCFA) needs the $0.00 1.0 $0.00 following functionality:
- Word Processing
Spreadsheets
Quickbooks Online Access
Data sharing between staff
Printing services for users
Scanning services for users
Security System video display
Access to data, remotely
Ample Security for data
Remote support from a local IT Provider
Domain Name reservation and Email Services
- Local printing and scanning capabilities
Misc HCC Proposes the following: $0.00 1.0 $0.00
A: Assist Staff with Domain Name Reservation
B: Setup Google Workspace for Business (Non -Profits)
C: Create two user profiles with email, drive space, and App access
D: Deliver and Install two new systems complete with
Mouse, Monitor, and Keyboard.
E: Systems to be ChromeBox devices with Intel CPU, 8 GB RAM, and 64 GB Storage
F: Utilize existing Network devices (Modem and Router)
from ISP.
G: Run new cable from Router to north desk.
H: Router has four ports: W/S1, W/S2, Printer/Scanner,
NVR/DVR
I: Upload data to Google Drive from existing Workstation (Setup permissions for sharing)
J: Update NVR Firmware, configure for access on new
systems.
K: Setup Printer for use by users
L: Setup Scanner for use by users
M: Setup Remote access software on two workstations
N: Re -purpose existing monitor on Security System
Misc ChromeBox, Intel CPU with 8 GB RAM and 64 GB Storage $625.00 2.0 $1,250.00 24" LCD monitor 24" LCD Monitor $179.99 2.0 $359.98
Keyboard Keyboard and mouse, USB wired $35.00 2.0 $70.00
Cable, ` Cable, $20.00 1.0 $20.00
Nt.n Contract Labor Labor, Non -Contract $96.00 14.0 $1,344.00 Originally $120.00, Tess discount of 20%
Misc Note: $0.00 1.0 $0.00
1: According to NVR Manufacturer the system needs a
firmware update and then should communicate with
Chrome Browser. Therefore, the NVR is able to be viewed on the ChromeBox System.
2: Existing Officejet Printer is Chrome OS compatible.
THIS IS AN ESTIMATE
Disclaimer
HCC provides this Proposal/Estimate for budgetary purposes. This Proposal/Estimate is not binding until accepted by both parties.
Subtotal $3,043.98
Tax $131.75
Estimate Total $3,175.73
Signed: Date:
September 2023 HCC Technology Services Guide Current
Yucaipa Calimesa Family
Assistance
Plan Services - Managed Services
Included
Items
Cost
Total
1 no
0 $99.00
$0.00
1. Proactive Server
0 Servers
• 24 x 7 Advanced Performance Monitor
• Key Application Maintenance
• Microsoft and 3rd Party Patch Management
• Scheduled Preventive Maintenance
• Client Portal to Monitoring system
• Manage and Monitor.
• Maintain Hardware Inventory
• Maintain Software Inventory
• Client notification in Real -Time
• Remote Remediation when possible
• Priority Support Service
• Help Desk Support included
2 yes
2 $49.00
$98.00
2. Proactive Workstation
2 Workstations
• Patch Management
• Scheduled Preventive Maintenance
• Availability Monitoring
• Remote Workstation Monitoring
• Client Portal to Monitoring system
• Maintain Hardware Inventory
• Maintain Software Inventory
• Client notification in Real -Time capable
• Remote Remediation when possible
• System Recovery after Hardware failure
• Priority Support Service
• Help Desk Support included
• Azure Cloud Management
3 yes
1 $85.00
$85.00
3. Backup Services
• Define Backup Strategy with client
• Backup Deployment and Configuration
• Backup Performance Monitoring
• Backup Software and Hardware
• Schedule Backup Tasks
• Workstation Backup Services
10 no
0 $0
$0
10. Software Support
• Identify Software Solution/Applications to be
included
• Provide Liaison Services between Client and
Provider
• Verify Data location and backup requirements
11 no
0 $0
$0
11. Proactive Printer
Support
• Support to connects to user systems
• Support Scan -to feature
• Provide 3rd Party liaison Support with copier
Vendor
• Maintain Network settings for printers
12 no
1 $0
$0
12. Proactive Security
System Mgmt
• Review Security System Plan
• Provide DVR/NVR managment
• Provide Viewing Access
• Provide Logs of Activity
13 yes
7 included
0 13. Help Desk Triage and
Primary Response
• Provide dedicated Help Desk contact info
• Assist end user with inquiries
• Provide Response to On -Contract Issues
• Document Off -Contract Issues
• Provide Proposal for Off -Contract Issues
14 no
1 $0
$0
14. NAS Drive Support
• Verify Redundancy Function
• Enable and Monitor Status Reports
• Verify Data Shares and Access Rights
• Maintain Security Settings
15 no
0 $0
$0
14. Hosted Services
• Maintain Cloud Hosting Account
• Maintain Users, Shares, and Email accts.
• Provide Portal for Account Mgmt
• Provide Portal for Workstation Mgmt
/
Total
$183.00
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ATTACHMENT 17
CITY OF
COMMUNITY ACTIVITY GRANT
FINANCIAL / IN -KIND / FEE WAIVER
APPLICATION
I,COMMUNITY ACTIVITY GRANNT.A1 LICATION INSTRUCTIONS
Fiscal Year:
Date Application submitted:
Submit to:
City of Yucaipa
General Services/City Clerk Department
34272 Yucaipa Blvd.
Yucaipa, CA 92399
Attn: Kimberly Metzler
2024-2025
Received
City of Yucaipa
MAY 2.2 2024
General Services/
City Clerk's Department
All sections of the application must be returned complete, and a 1 supporting documentation must be included as part of the submittal. Incomplete applications received will be returned to the applicant.
Note: Beginning with the FY2025/26 grant cycle, financial grant awarded funds will require 100%1 financial match by the applicant. For example, if your total program/project cost is $1,000, your financial grant request should be for no more than $500.
Be prepared to show proof of program/project cost in your Wrap-up Report (Accountability Report), detailing the applicants financial match of 5500.
SECTION 1— GENERAL INFORMATION
Name of Applicant/Organization:
Applicant/Organization Mailing Address:
Applicant/Organization Phone Number:
Contact 1
Name
Contact (2)
CAL i 1-7e ll
lI c r1,(,-G (-6)/11//i ( 7
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L--I IICIII uuul I�JJ
(?/ //1t:/- C-6,sr-6(5v
Name
E-mail address
Phone Number
Phone Number
SECTION 2 - ELIGIBILITY REQUIREMENTS:
Is your organization located in another community?
Will the program/event take place in another community? Are you aware of any other City program providing this service? If so, which one?
Yes
No
*If you answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.
City of Yucaipa Community Activity Grants Annlicntinn Rev nal?noa
SECTION 3 — ORGANIZATION INFORMATION/APPLICANT BACKGROUND Your organization must be an established 501(c) to be considered for Community Activity Grant funding.
Please submit documentation verifying organization 501(c) status along with this application.
Is your organization a 501(c)?
If yes, please provide Tax ID# 99 46274 3 O and attach all supporting documents.
Does this application include submittal of documentation verifying 501(c) status? How long has your 501(c) organization been in existence? Number of Employees working for organization:
Number of Volunteers working for organization:
Is a current City Council Member on your board?
How many Yucaipa residents does your organization currently serve? Does the organization charge admission, membership fees, dues, etc.? If yes, please describe:
Yes
No
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) kiaCF h1 &L 60s771S0A/ - (* (2 0 }
Cre f C Rt9 775e / - St r' /2yz
f 6 c- A�'/J i Sc4k/
.SECTION 4 - PROGRAM DESCRIPTION/SCOPE: (PLEASE'USE ADDITIONAL PAGES IF NECESSARY) Name of the program/event:
Date(s) of program/event:
e- b 9 b/9 L( C c2&v ;/
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) e40-( y'c412-. THE CO rpm i r7 c l 4ikS 10- % Q 96 £i e/'I t4Ni) ` /1g%A- (�/r
'SECTION 6 — FINANCIAL CAPABILITIESBUDGET:
What other in-kind/financial contributions has your organization received to fund this event/program (separate from City funding)?
Total Funds Received To Date:
Total Funds Requested Via Grant Application:
$
$
Remaining Balance That Will Be Funded By $
Organization:
In -Kind
Amount
Financial
Support Amount
SECTION 6 — FINANCIAL CAPABILITIESBUDGET (CONTINUED):
Provide City funding received by organization in the past three years (required):
Program
i E1zA,vs Dr1 y
ut-r ii Dry;
In -Kind
Financial $200 SEP Date
Support Fee Waiver Received
U
�v 2�
�v3
Total Received
$ q-C17
SECTION 7 — CERTIFICATION
I, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand that the awarded financial grant amount needs to be spent prior to submitting another grant request.
Signature
Title
Date
TO BE COMPLETED BY CITY
Date Received:
Amount Funded:
Type of Grant:
❑ In -Kind
Date City Council received follow up report:
Date Reviewed:
City Council Meeting:
❑ Financial Support
-34
❑ Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 04/2024
Describe how the program/event benefits the residents and/or community of Yucaipa:
11 l /4 iV t1 en T 7` 671 T -c" d G kJ / cS e) tJ t2 >
7 1-! 6-72. -5 it..<0 < /t c I- t) pd ,�',L_/C /a T 7-0 tJ/ZirCrm E
Program/Event Primary Target Population (check all that apply):
Children or Youth
Low Income
Persons with Disabilities
Number of Residents Projected to Serve: :2CC
Seniors
I I Victims
Welfare Recipients
Women
Homeless
Entire Community
SECTION 5 — GRANT FUNDING REQUEST
Please identify what your organization is seeking:
Financial Support: 'Yes ENo $
$200 SEP Fee
Waiver: Ves o
X In -kind Support: Police $
OT/Reassigned
Staff $
Fire $
Other $
Public
Works $
Explain
CS/Rental $
$200 SEP Financial Total Overall
In Kind Financial. Support Fee Waiver Match Request
Total Amount of Request: $ $ $ $ = $ 1 r)--o
Provide a detailed description of how the financial support will be used:
G4 Si /1 Cc)[1,(117V /21-2 (WO r�
11ic1&-7?�iv(/I-//-(9q) 2D,fl 9A° pa)
AOL Mail - Community Park Reservation - Veterans Day Event - 11-11-24 5/22/24, 10:56 Afv Community Park Reservation - Veterans Day Event - 11-11-24 From: Julia Basa ([email protected])
To:
Cc: [email protected]
Date: Tuesday, April 9, 2024 at 05:25 PM PDT
Good afternoon Mr. Sardeson,
Thank you for stopping by the Community Center and completing the shelter reservation application for the 2024 Veteran's Day Event on Monday, November 11th, 2024, at the amphitheater and shelter #2.
Attached to this email the tentative permit indicating the tentative reservation for Shelter #2 and the amphitheater at the Community Park with a total of $907.00. As a friendly reminder, the amphitheater has a $100.00 deposit that is refundable after the event. In addition, this balance also includes the required liability insurance of $87.00. Please note that the Community Activity Grant does not cover deposit or insurance fees. If you are applying for a grant, you can list the total amount of $720.00 (this amount excludes the deposit and insurance fee) as the requested amount.
Please feel free to contact me or the Community Center if you have any questions.
Thank you,
Julia Basa
Community Services Coordinator
City of Yucaipa
Community Center • 34900 Oak Glen Rd • Yucaipa, CA 92399 Office: 909-797-2489 Ext. 328
NVww.vucaipa.gov-
Permit#R6421 - 2024 Veterans Day Event - 11-11-24.pdf
51.2kB
https://mail.aol.com/d/folders/1/messages/AFIRpy875TwLZhXcaALmMF2tOz0 Page 1 of 1
Permit
City of Yucaipa Community PHONE:(909) 790-7460
Services FAX:(909) 790-2589
34272 Yucaipa Blvd EMAIL:communityservicesi yucaipa.org Yucaipa, CA 92399
Customer Name George Sardeson - 46909
Customer Type General Public
Mailing Address
System User Julia Basa
2024 Veterans Day Ceremony
Booking Summary
COMMUNITY
A sPiec SERVICES
Home Phone Number
Email Address
Make
Bet -(et..
Permit # R6421
Status Tentative
Date Apr 9, 2024 5:03 PM
Expiration Date Apr 9, 2025
Rental Fee $887.00
Discounts -$80.00
Subtotal $807.00
Deposits $100.00
Deposit Discounts $0.00
Total Permit Fee $907.00
Total Payment $0.00
Refunds $0.00
Balance $907.00
2 resource(s) 2 booking(s) Subtotal: $907.00
AmphttheateriSti Ftedittles)
ce t Yuca • Cgittimuh }r Center
START DATE/TIME
Mon, Nov 11, 2024 7:00 AM
Resource level fees
Deposit
Rental - Daily
Resident Discount- 10`:v
$100.00 / Each x 1
S500.00 / Day x 1
-10% x 1
END DATE/TIME
Mon, Nov 11, 2024 8:00 PM
$100.00
$500.00
-$50.00
ATTENDEE
200
AMT W/O TAX
$0.00
$550.00
Shelter #2 Large (Shelter Facilities)
Center. Yucaipa Community Center
START DATE/TIME
Mon, Nov 11, 2024 7:00 AM
Resource level fees
END DATE/TIME
Mon, Nov 11, 2024 8:00 PM
Liability Insurance $87.00 / Each x 1 $87.00
Rental - Daily $300.00 / Day x 1 $300.00
Resident Discount -10% -10% x 1-$30.00
Custom Questions
QUESTION
ANSWER
ATTENDEE
AMT W/O TAX
$0.00
$357.00
# R6421 Status Tentative
All vendors used by the renter are required to have a City of Yucaipa Business License Acknowledged submitted to [email protected] no less than 5 days prior to rental.
I understand that a signed application must be submitted to jbasaOyucaipa.gov no later than 5ekcknowledged days prior to rental.
Please be aware that fees do not always automatically add to permits and will have to be Acknowledged added by staff and paid by the renter before you may receive an approved permit. We are working on having this resolved soon.
Deposit
EVENT RESOURCE 'DEPOSIT FEE CHARGE TAX AMOUNT PAID REFUNDS BALANCE 2024 Amphitheater Deposit $100.00 $0.00 $0.00 $0.00 $100.00 Veterans
Day
Ceremony
Payment Schedules
DUE DATE AMOUNT DUE
Origin& Balance: $907.00 Current Balance: $907.00
AMOUNT PAID WITHDRAWAL ADJUSTMENT BALANCE
Oct 28, 2024 $907.00 $0.00 $0.00 $907.00
...... ... _......
# R6421 Status Tentative
DEPARTME
OF
T
/pp IRS INTERNALNREVENUEESERVICERY
CINCINNATI OH 45999-0023
YCVC
% RACHAEL GUSTUSON
Date of this notice: 03-01-2024
Employer Identification Number:
99-1674306
Form: SS-4
Number of this notice: CP 575 A
For assistance you may call us at:
1-800-829-4933
IF YOU WRITE, ATTACH THE
STUB AT THE END OF THIS NOTICE.
WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER
Thank you for applying for an Employer Identification Number (EIN). We assigned you EIN 99-1674306. This EIN will identify you, your business accounts, tax returns, and documents, even if you have no employees. Please keep this notice in your permanent records.
Taxpayers request an EIN for their. business. Some taxpayers receive CP575 notices when another person has stolen their identity and are opening a business using their information.
If you did not apply for this EIN, please contact us at the phone number or address listed on the top of this notice.
When filing tax documents, making payments, or replying it is very important that you use your EIN and complete name above. Any variation may cause a delay in processing, result your account, or even cause you to be assigned more than one nct correct as shown above, please make the correction using and return it to us.
to any related correspondence,
and address exactly as shown
in incorrect information in
EIN. If the information is
the attached tear -off stub
Based on the information received from you or your representative, you must file the following forms by the dates shown.
Form 1120 04/15/2025
If you have questions about the forms or the due dates
the phone number or write to us at the address shown at the need help in determining your annual accounting period (tax Accounting Periods and Methods.
shown, you can call us at
top of this notice. If you
year), see Publication 538,
We assigned you a tax classification (corporation, partnership, etc..) based on information obtained from you or your representative. It is not a legal determination of your tax classification, and is not binding on the IRS. If you want a legal determination of your tax classification, you may request a private letter ruling from the IRS under the guidelines in Revenue Procedure 2020-1, 2020-1 I.R.B. 1 (or superseding Revenue Procedure for the year at issue). Note: Certain tax classification elections can be requested by filing Form 8832, Entity Classification Election.
See Form 8832 and its instructions for additional information. ]IMPORTANT INFORMATION E'OR S CORPORATION ELECTION:
If you intend to elect to file your return as a small business corporation, an election to file a Form 1120-S, U.S. Income Tax Return for an S Corporation, must be made within certain timeframes and the corporation must meet certain tests.
All of this information is included in the instructions for Form 2553, Election by a Small Business Corporation.
(IRS USE ONLY) 575A 03-01-2024 YCVC B 9999999999 SS-4
If you are required to deposit for employment taxes (Forms 941, 943, 940, 944, 945, CT-1, or 1042), excise taxes (Form 720), or income taxes (Form 1120), you will receive a Welcome Package shortly, which includes instructions for making your deposits electronically through the Electronic Federal Tax Payment System (EFTPS). A Personal Identification Number (PIN) for EFTPS will also be sent to you under separate cover.
Please activate the PIN once you receive it, even if you have requested the services of a tax professional or representative. For more information about EFTPS, refer to Publication 966, Electronic Choices to Pay All Your Federal. Taxes. If you need to make a deposit immediately, you will need to make arrangements with your Financial Institution to complete a wire transfer.
The IRS is committed to helping all taxpayers comply with their tax filing obligations. If you need help completing your returns or meeting your tax obligations, Authorized e-file Providers, such as Reporting Agents or other payroll service providers, are available to assist you. Visit www.irs.gov/mefbusproviders for a list of companies that offer IRS e-file for business products and services.
IMPORTANT REMINDERS:
* Keep a copy of this notice in your permanent records. This notice is issued only one time and the IRS will not be able to generate a duplicate copy for you. You may give a copy of this document to anyone asking for proof of your EIN. * Use this EIN and your name exactly as they appear at the top of this notice on all your federal tax forms.
* Refer to this EIN on your tax -related correspondence and documents. * Provide future officers of your organization with a copy of this notice.
Your name control associated with this EIN is YCVC. You will need to provide this information along with your EIN, if you file your returns electronically.
Safeguard your EIN by referring to Publication 4557, Safeguarding Taxpayer Data: A Guide for Your Business.
You can get any of the forms or publications mentioned in this letter by visiting our website at www.irs.gov/forms-pubs or by calling 800-TAX-FORM (800-829-3676) .
If you have questions about your EIN, you can contact us at the phone number or address listed at the top of this notice. If you write, please tear off the stub at the bottom of this notice and include it with your letter.
Thank you for your cooperation.
(IRS USE ONLY) 575A 03-01-2024 YCVC B 9999999999 SS-4
Keep this part for your records. CP 575 A (Rev. 7-2007) Return this part with any correspondence
so we may identify your account. Please
correct any errors in your name or address.
CP 575 A
9999999999
Your Telephone Number Best Time to Call DATE OF THIS NOTICE: 03-01-2024 ( ) - EMPLOYER IDENTIFICATION NUMBER: 99-1674306
FORM: SS-4 NOBOD
INTERNAL REVENUE SERVICE
CINCINNATI OH 45999-0023
YCVC
RACHAEL GUSTUSON
.Form 1023-EZ
(Rev. April 2021)
Department of the Treasury
Internal Revenue Service
Streamlined Application for Recognition of Exemption
Under Section 501(c)(3) of the Internal Revenue Code
Do not enter Social Security numbers on this form as it will be made public.
Information about Form 1023-EZ and its separate instructions is at www.irs.qov/form1023ez OMB No. 1545-0047
Note: IIexempt status ss approved,
this application will be open for
public inspection.
Check this box to attest that you have completed the Form 1023-EZ Eligibility Worksheet in the current instructions, are eligib e to apply for exemption using Form 1023-EZ, and have read and understand the requirements to be exempt under section 501(c)(3).
Have your annual gross receipts exceeded S50,000 in any of the past 3 years and/or do you project that your annual gross receipts will exceed Yes No 550,000 in any of the next 3 years? If yes, stop. Do not file Form 1023-EZ. See Instructions.
Do you have total assets the fair market value of which is in excess of S250,000? If yes, stop. Do not file Form 1023-EZ. See Instructions.
Part I
Yes
Identification of Applicant
1 a Full Name of Organization
YUCAIPA CALIMESA VETERANS COMMITTEE
b Care Of Name (if applicable)
RACHAEL GUSTUSON
c Mailing Address (number, street, and room/suite). if a P.O. box, see instructions. I d City I e State I f Zip code + 4 2 Employer Identification Number
99-1674306
3 Month Tax Year Ends (MM)
12 4 Person to Contact if More Information is Needed
RACHAEL GUSTUSON
5 Contact Telephone Number
6 Fax Number (optional)
7 User Fee Submitted
$275.00
8 List the names, titles, and mailing addresses of your officers, directors, and/or trustees. (If you have more than five, see instructions.) First Name:
RACHAEL
Last Name:
GUSTUSON
Title:
PRESIDENT
Street Address:
First Name: GEORGE
Last Name: SARDESON
Title: TREASURER
Street Address:
First Name: STEPHANIE
Last Name: ROBERTSON
Title: SECRETARY
Street Address:
First Name:
Last Name:
Title:
Street Address:
City:
I
State:
Zip code + 4:
First Name:
Last Name:
1 Title:
Street Address:
City:
State:
Zip code i 4:
9a Organization's Website (if available):
b Organization's Email (optional):
[email protected]
Organizational Structure
1 To file this form, you must be a corporation, an unincorporated association, or a trust. Select the box for the type of organization.
Corporation Unincorporated association Trust
2 Check this box to attest that you have the organizing document necessary for the organizational structure indicated above. (See the instructions for an explanation of necessary organizing documents.) 3 Date incorporated if a corporation, or formed if other than a corporation (MMDDYYYY):
4 State of Incorporation or other formation: California 03012024
5 Section 501(c)(3) requires that your organizing document must limit your purposes to one or more exempt purposes within section 501(c)(3).
Check this box to attest that your organizing document contains this limitation. 6 Section 501(c)(3) requires that your organizing document must not expressly empower you to engage, otherwise than as an insubstantial part of your activities, in activities that in themselves are not in furtherance of one or more exempt purposes.
Check this box to attest that your organizing document does not expressly empower you to engage, otherwise than as an insubstantial part of your activities, in activities that in themselves are not in furtherance of one or more exempt purposes. 7 Section 501(c)(3) requires that your organizing document must provide that upon dissolution, your remaining assets be used exclusively for section 501(c)(3) exempt purposes. Depending on your entity type and the state in which you are formed, this requirement may be satisfied by operation of state law.
Check this box to attest that your organizing document contains the dissolution provision required under section 501(c)(3) or that you do not need an express dissolution provision in your organizing document because you rely on the operation of state law in the state in which you are formed for your dissolution provision.
For Paperwork Reduction Act Notice, see the instructions Catalog No.66267N Form 1023-EZ (Rev 4-2021)
Form 1023-EZ (Rev. 4-2021)
Part III
1 Your Specific Activities
Briefly describe the organization's mission or most significant activities (limit 250 characters) YCVC is committed to honoring and supporting our veterans. Our mission is to create a sense of unity, gratitude and remembrance by providing meaningful ceremonies on Veterans Day and Memorial Day and provide support to veterans and their families 2 Enter the appropriate 3-character NTEE Code that best describes your activities (See the instructions):
A27
3 To qualify for exemption as a section 501(c)(3) organization, you must be organized and operated exclusively to further one or more of the following purposes. By checking the box or boxes below, you attest that you are organized and operated exclusively to further the purposes indicated. Check all that apply.
Charitable Religious Educational
Scientific Literary Testing for public safety
To foster national or international amateur sports competition Prevention of cruelty to children or animals 4 To qualify for exemption as a section 501(c)(3) organization, you must:
• Refrain from supporting or opposing candidates in political campaigns in any way. ■ Ensure that your net earnings do not inure in whole or in part to the benefit of private shareholders or individuals (that is, board members, officers, key management employees, or other insiders).
• Not further non-exempt purposes (such as purposes that benefit private interests) more than insubstantially. • Not be organized or operated for the primary purpose of conducting a trade or business that is not related to your exempt purpose(s), ■ Not devote more than an insubstantial part of your activities attempting to influence legislation or, if you made a section 501(h) election, not normally make expenditures in excess of expenditure limitations outlined in section 501(h). at Not provide commercial -type insurance as a substantial part of your activities.
Check this box to attest that you have not conducted and will not conduct activities that violate these prohibitions and restrictions. 5 Do you or will you attempt to influence legislation? _ _ _ Yes No (If yes, consider filing Form 5768. See the instructions for more details.) 6 Do you or will you pay compensation to any of your officers, directors, or trustees? Yes No (Refer to the instructions for a definition of compensation.) 7 Do you or will you donate funds to or pay expenses for individual(s)? Yes No 8 Do you or will you conduct activities or provide grants or other assistance to individual(s) or organization(s) outside the United States? -.--- __ Yes No
9 Do you or will you engage in financial transactions (for example, loans, payments, rents, etc.) with any of your officers, directors, or trustees, or any entities they own or control? _. _ _ _ Yes No 10 Do you or will you have unrelated business gross income of $1,000 or more during a tax year? Yes No 11 Do you or will you operate bingo or other gaming activities? Yes No 12 Do you or will you provide disaster relief? Yes _, No EliMa Foundation Classification
Part IV is designed to classify you as an organization that is either a private foundation or a public charity. Public charity status is a more favorable tax status than private foundation status.
1 Are you applying for recognition as a church, school, or hospital (described in section 170(b)(1)(A)(i), (ii), or (iii) of the Internal Yes No Revenue Code)? If yes, stop. Do not file Form 1023-EZ. See Instructions 2 If you qualify for public charity status, check the appropriate box (2a - 2c below) and skip to Part V below.
Select this box to attest that you normally receive at least one-third of your support from public sources or you normally receive at least 10 percent of your support from public sources and you have other characteristics of a publicly supported organization. Sections 509(a)(1) and 170(b)(1)(A)(vi). a
b Select this box to attest that you normally receive more than one-third of your support from a combination of gifts, grants, contributions, membership fees, and gross receipts (from permitted sources) from activities related to your exempt functions and normally receive not more than one-third of your support from investment income and unrelated business taxable income. Section 509(a)(2).
Select this box to attest that you are operated for the benefit of a college or university that is owned or operated by a governmental unit. Sections 509(a)(1) and 170(b)(1)(A)(iv).
3 If you are not described in items 2a - 2c above, you are a private foundation. As a private foundation, you are required by section 508(e) to have specific provisions in your organizing document, unless you rely on the operation of state law in the state in which you were formed to meet these requirements. These specific provisions require that you operate to avoid liability for private foundation excise taxes under sections 4941-4945.
Select this box to attest that your organizing document contains the provisions required by section 508(e) or that your organizing document does not need to include the provisions required by section 508(e) because you rely on the operation of state law in your particular state to meet the requirements of section 508(e). (See the instructions for explanation of the section 508(e) requirements.) Form 1023-EZ (Rev. 4-2021)
form 1023-EZ (Rev. 4-2021)
Part V
Reinstatement After Automatic Revocation
Complete this section only if you are applying for reinstatement of exemption after being automatically revoked for failure to file required annual returns or notices for three consecutive years, and you are applying for reinstatement under section 4 or 7 of Revenue Procedure 2014-11. (Check only one box.)
2 Part VI
Check this box if you are seeking retroactive reinstatement under section 4 of Revenue Procedure 2014-11. By checking this box, you attest that you meet the specified requirements of section 4, that your failure to file was not intentional, and that you have put in place procedures to file required returns or notices in the future. (See the instructions for requirements.) Check this box if you are seeking reinstatement under section 7 of Revenue Procedure 2014-11, effective the date you are filing this application.
Signature
I declare under the penalties of perjury that I am authorized to sign this application on behalf of the above organization and that I have examined this application, and to the best of my knowledge it is true, correct, and complete.
RACHAEL GUSTUSON PRESIDENT
(Type name of signer) (Type title or authority of signer) 03112024
(Date)
Form 1023-EZ (Rev. 4-2021)
ATTACHMENT 18
FY 2024/25 COMMUNITY ACTIVITY GRANT (CAG) REQUESTS
Financial and In-kind/Fee Waiver
Applicant
Description of Event/Program
FY 2024/25
Financial
Support
Requested
FY 2024/25
In-kind/Fee
Waiver
Support
Requested
CAG Ad -Hoc Committee
Recommended Awards
Alternative #1
Alternative #2
Recommended
Financial
Recommended
Recommended
Financial
Recommended
In-kind/Fee
Waiver
Recommended
Financial
Recommended
In-kind/Fee
Waiver
In-kind/Fee
Waiver
Al -Anon Family Groups
Weekly Meetings
$3,304
$3,304
Outreach
Housing Assistance and Advocacy Program
$3,500
$2,500
Rotary Club of Yucaipa
Weekly Meetings
$9,576
$9,576
Childhood Cancer Foundation of So. Cal.
Annual Spring Eggstravaganza
$1,000
$1,000
Yucaipa BMX
Replacement of Loaner BMX Bikes
$3,500
$3,000
Yucaipa Woman's Club
Building Maintenance
$3,000
$3,000
Smiles for Seniors Foundation
Low Income Senior Assistance Program
$3,000
$3,000
Yucaipa Pickleball Inc.
Clinics
$4,500
$2,820
Yucaipa Valley Art Association
Weekly Art Painting Sessions
$4,212
$4,212
Yucaipa Valley Art Association
Twice Monthly Art and Photography Meetings
$3,543
S3,543
Rotary Club of Yucaipa
69th Annual Christmas Parade
$16,200
$16,200
The Well Outreach Center
Assistance to Students and Families
$3,000
$2,000
The Elks Lodge #2389
Annual Hoop Shoot
$1,000
$600
$500
$600
Gardenworksforkids
Cement Walkway for Wheelchair Access
$1,500
$1,500
Redlands Bicycle Classic Inc.
2025 Redlands Bicycle Classic
$10,700
Yucaipa/Calimesa Family Assistance
Computer Hardware and Service Contracts
$1,680
$1,680
Yucaipa/Calimesa Veterans Committee
2024 Veterans Day Ceremony
$720
$720
TOTAL REQUESTED
BUDGETED AMOUNT
BALANCE REMAINING
$24,680
$49,855
$20,000
$39,155
$0
$0
$0
$0
$20,000
$40,000
$20,000
$40,000
$20,000
$40,000
$20,000
$40,000
-$4,680
-$9,855
$0
$845
$20,000
$40,000
$20,000
$40,000
ATTACHMENT 19
CITY OF
Community Activity Grant - TRACKER
Fiscal Yrs 2o1o/ii through 2o23/24
010/11 FY 2011/12 FY 2012/13 FY 2013/14, FY 2015 FY 2015/16 FY 2016/17 FY 2017/18 FY 2018/19 FY 2019/20 FY 2020/21 FY 2021/22 FY 2022/23 FY 2023/24 Grand Total Applicant
4th of July Celebration
Committee
Description of Event(s)
$6,000
Financial Awards
$6,000
4th of July Celebration
Audio Vision Radio Reading
Svcs For The Blind, Inc.
Radio Reading Services for the Blind
$3,000
$3,000
$6,000
Family Promise of
Yucaipa/Calimesa
Operational Expenses
$2,000
$2,000
Family Service Association of
Redlands
Yucaipa Outreach Project (also
Budgeted - Non -Department, Not -for -
Profit Funding Account)
$5,000
$4,000
$2,000
$5,000
$3,587
$3,500
$2,000
$25,087
Roof for Storage Shed
$1,000
$1,000
Gardenworksforkids
Children's Garden
$2,500
$2,500
$1,875
$2,000
$8,875
Autism Patio Cover
$1,000
$1,000
Mesa View Middle School
Destination Imagination Global Finals
$1,500
$1,500
Redlands Bicycle Classic, Inc.
Yucaipa Circuit Race
$165
$165
Rotary Club of Yucaipa
Christmas Parade
$740
$700
Smiles For Seniors
Foundation
Low Income Senior Assistance
$5,000
$4,000
$4,000
$4,000
$4,000
$3,587
$2,800
$3,000
$26,800
Spartans FC
YVYSO/Spartans Cup
$1,800
$1,800
The Well Outreach Center
Our Neighbors Clothing Closet
Program
$1,000
$1,000
Valley Elementary School
Leadership Day Event
$1,000
$750
$1,000
$1,500
$4,250
Yucaipa Animal Placement
Society (YAPS)
EZ-UP Tents and Tables
$1,200
$1,200
Yucaipa BMX
BMX Park Upgrades
$9,580
$9,580
Yucaipa Community
Foundation
Install Brick Pavers in Support of the
Arts
$4,000
$4,000
Yucaipa Elks Lodge #2389
Elks National Hoop Shoot Free Throw
Program
$1,000
$1,000
$1,300
$960
$47G00
$1,000
$1,200
$500
$5,960
Yucaipa/Calimesa Family
Assistance
Various Improvements
$2,500
$1,875
$2,500
$2,000
$8,875
Yucaipa High School
YHS Baseball Team to travel to NC for
NHS! Invitational
$1,000
$1,000
Yucaipa Pickleball Inc.
Clinics and Play
$2,450
$2,450
Yucaipa Valley Gem &
Mineral Society
Youth Classess for Sciences,
Silversmithing, Faceting, etc.
$2,500
$1,875
$4,375
Yucaipa Valley Historical
Society
Teaching Children About History
Program
$4,850
$4,850
Decades Book
$2 500
$2,500
Firestation Museum
$3,500
$3,500
Yucaipa Valley Lions Club
4th of July Celebration
$500
$500
ory or
Community Activity Grant - TRACKER
Fiscal Yrs 2olo/ii through 2°23/24
Applicant
Description of Event(s)
FY zoio/ii
$2,500
FY 2011/12
FY 2012/13
FY zoi3/1.4
FY 2014/15
FY 2015/16
FY 2°16/17
FY 2or7/18
FY 2o18/19
FY 2019/20
FY 2020/21
FY 2021/22
FY 2022/23
FY 2023/24
lirafa 1 Dial
Financial Awards
$2,500
Yucaipa Valley Welfare, Inc.
Security Cameras
Yucaipa Valley Wine Alliance
American Viticultural Area
$3,035
$3,035
Yucaipa Youth Basketball
2023/24 Basketball Season
$1,000
$1,000
Yucaipa Womans Club
Facility Improvements
$5,000
$10,000
$9,500
$6,500
$5,500
$4,000
$6,840
$3,935
$2,951
$3,500
$2,050
$59,776
Fiscal Year Totals
$11,500
$3,000
$6,350
$11,000
$19,580
$14,500
$17,500
$17,500
$17,500
$17,500
$17,435
$17,500
$17,500
$17,500
$201,278
Figures are rounded to the nearest dollar