Item 12 - Review and Consider FY 2024-2025 Community Activity Grant Applications — Yucaipa City Council, June 10, 2024 (part 1 of 2)

Agenda Item No. 12

CITY OF YUCAIPA

AGENDA REPORT
TO: Honorable Mayor and City Council
FROM: Jennifer Crawford, Assistant City Manager
FOR: City Council Meeting of June 10, 2024
SUBJECT: Review and Consider Fiscal Year 2024/2025 Community Activity Grant Applications
RECOMMENDATION:

That the City Council:

1. Review and consider the Fiscal Year 2024/2025 Community Activity Grant awards recommended by the Community Activity Grant Application Review Ad -Hoc Committee as follows:

Applicant
Description ofEvent/Program
FY 2024/25
Financial
Support
Requested
FY 2024/25
In-kind/Fee
Waiver
Support
Requested
CAG Ad -Hoc Committee
Recommended Awards
Recommended
Financial
Recommended
In-kind/Fee
waiver
Al -Anon Family Groups
Weekly Meetings
$3,304
$3,304
Family Service Association of Redlands/Yucaipa Outreach Housing Assistance and Advocacy Program
$3,500
$2,500
Rotary Club of Yucaipa
Weekly Meetings
$9,576
S9,576
Childhood Cancer Foundation of So. Cal
Annual SpringFggstravaganza
$1,000
$1,000
Yucaipa BMX
Replacement of Loaner BMX Bikes
$3,500
$3,000
Yucaipa Wornan's Club
Building Maintenance
$3,000
$3,000
Smiles for Seniors Foundation
Low Income Senior Assistance Program
$3,000
$3,000
Yucaipa Pickleball Inc.

Pickleball in Schools, Pickleball Day and Clinics
$4,500
S2,820
Yucaipa Valley Art Association
Weekly Art Painting Sessions
$4,212
$4,212
Yucaipa Valley Art Association
Twice Monthly Art and Photography Meetings
$3,543
$3,543
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
$I,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 REMAINLNG
_$24,680
$49,855
$20,000
$39,155
$20,000
S40,000
$20,000
S40,000
-$4,680
-$9,855
S0
$845

2. Determine that the Childhood Cancer Foundation of Southern California should be exempt from the Grant Guideline that requires the organization to be located in Yucaipa if their Community Activity Grant is awarded.

DISCUSSION:

On April 8, 2024, City Council reviewed the Community Activity Grant (CAG) program guidelines and funding levels for Fiscal Year (FY) 2024/2025 and approved the following:
• Fiscal Year 2024/2025 Budget funding levels:
o $20,000 for financial grant requests
o $40,000 for in-kind/fee waiver requests
• Maintain the current guidelines for FY 24/25 and amend FY 25/26 guidelines requiring a 100% financial match for all applicants receiving CAG financial awards.

On April 22, 2024, the City issued email notices to past applicants and new contacts, announcing the FY 2024/2025 CAG program, the firm deadline of May 22, 2024, for applicants seeking financial support, and that all in -kind and fee waiver requests would be reviewed and considered as received. The announcement of the CAG was also posted on the City website, social media platforms and in the Yucaipa News Mirror.

A total of seventeen applications requesting in -kind and/or financial support were received by the deadline. The Community Activity Grant Application Review Ad -Hoc Committee (Committee), met on Monday, June 3, 2024, to review and recommend financial and/or in -kind support for City Council review and approval. The table on the following page includes the name of the requesting applicant, a brief description of their proposed project scope, the total amount of in -kind funding and/or financial support requested, and the Community Activity Grant Application Review Ad - Hoc Committee recommended awards.

Community Activity Grant
FY 2024/2025 Applications
Attachment 1
Al -Anon Family Groups (Yucaipa) — Weekly Meetings
Scope
Applicant is seeking in -kind support to cover the costs associated with the use of the Yucaipa Community Center Meeting Room/Kids Club Room to hold weekly meetings through June 2025. Total residents projected to serve: 10- 20 wkly.

Requested In -kind Amount
$3,304
Committee Recommended In -Kind Award
$3,304
Attachment 2
Family Service Association of Redlands — Yucaipa Outreach Program Scope
Applicant is seeking financial support to provide housing assistance and advocacy for low income households with children & the elderly with disabilities. Total residents projected to serve: 10-15.

Additional financial support in the amount of $5,000 is included in the FY 2024/2025 Non -Department Not -For -Profit Approved Budget Requested Financial Amount
$3,500
Committee Recommended Financial Award
$2,500

Community Activity Grant
FY 2024/2025 Applications
(Continued)
Attachment 3
Rotary Club of Yucaipa — Weekly Club Meetings
Scope
Applicant is seeking in -kind support to cover the costs associated with the use of the Senior Nutrition Center to hold weekly Club meetings through June 2025. Total residents projected to serve: 30-50 weekly.

Requested In -kind Amount
$9,576
Committee Recommended In -Kind Award
$9,576
Attachment 4
Childhood Cancer Foundation of Southern California — 2025 Spring Eggstravaganza
Scope
Applicant is seeking in -kind support to cover the costs associated with the use of the Yucaipa Community Park Amphitheater and Shelter #2, and to waive the special event permit fee to host a Spring Eggstravaganza on April 5, 2025, for families experiencing childhood cancer. Total residents projected to serve:

50. Requested In -kind Amount
$1,000
Committee Recommended In -Kind Award
$1,000
Attachment 5
Strada Corsa dba Yucaipa BMX — BMX Bike Replacement
Scope
Applicant is seeking financial support to cover the costs associated with replacement of BMX loaner bikes fleet. The loaner bikes are loaned out at no charge for interested in trying BMX. Total residents projected to serve:
1,000-2,5000 annually.

Requested Financial Amount
$3,500
Committee Recommended Financial Award
$3,000
Attachment 6
Yucaipa Woman's Club — On -going Maintenance of Building Scope
Applicant is seeking financial support to cover the costs associated with installing new gutters replacement of tiles in the tea room and interior painting on some walls. Total residents projected to serve: community -wide.

Requested Financial Amount
$3,000
Committee Recommended Financial Award
$3,000
Attachment 7
Smiles for Seniors Foundation —Low Income Senior Assistance Fund Scope
Applicant is seeking financial support to assist low-income seniors (65 years & older) with emergency financial assistance safety net services and basic necessities needed to survive, such as food, housing, utility assistance, lifesaving medication and medical equipment. Total residents projected to serve: 40+.

Requested Financial Amount
$3,000
Committee Recommended Financial Award
$3,000

Community Activity Grant
FY 2024/2025 Applications
(Continued)
Attachment 8
Yucaipa Pickleball, Inc. — Purchase of Equipment & Supplies Scope
Applicant is seeking financial support to purchase equipment and supplies for clinics and pickleball day. Total residents projected to serve: 2000.

Requested Financial Amount
$4,500
Committee Recommended Financial Award
$2,820
Attachment 9
Yucaipa Valley Art Association (YVAA) — Weekly Art Painting Sessions Scope
Applicant is seeking in -kind support to cover the costs associated with the use of the Scherer Senior Center Room B to hold weekly art meetings from Sept. through May 2025, to encourage local artists to collaborate in painting sessions. This event is open to the public. Total residents projected to serve:
5-15/Wkly.

Requested In -kind Amount
$4,212
Committee Recommended In -Kind Award
$4,212
Attachment 10
Yucaipa Valley Art Association (YVAA) — Twice Monthly Art & Photography Meetings
Scope
Applicant is seeking in -kind support to cover the costs associated with the use of the Scherer Senior Center to hold twice monthly art and photography meetings from Sept. through May 2025. This event is open to the public. Total residents projected to serve: 80.

Requested In -kind Amount
$3,543
Committee Recommended In -Kind Award
$3,543
Attachment 11
Rotary Club of Yucaipa — 69t" Annual Christmas Parade
Scope
Applicant is seeking in -kind support to cover the costs associated with conducting the 2024 Christmas Parade on December 14, 2024. Total residents projected to serve: +/-10,000
Additional financial support in the amount of $1,000 is included in the FY 2024/25 Non -Department Not -for -Profit Approved Budget Requested In -kind Amount
$16,200
Committee Recommended In -Kind Award
$16,200
Attachment 12
The Well Outreach Center — Provide Clothing Needs to At -risk Secondary Students
Scope
Applicant is seeking financial support to cover the costs associated with providing basic clothing needs to at -risk (middle & high school) students living in the community. Total residents projected to serve: 350.

Requested Financial Amount
$3,000
Committee Recommended Financial Award
$2,000

Community Activity Grant
FY 2024/2025 Applications
(Continued)
Attachment 13
Yucaipa Elks #2389 — Annual Hoop Shoot
Scope
Applicant is seeking in -kind support for the use of the Community Center Gym and financial support to purchase basketballs, t-shirts, trophies and miscellaneous items needed for the competition. Total residents projected to serve: all school children are eligible.

Requested In -kind Amount
$600
Requested Financial Amount
$1,000
Committee Recommended In -Kind Award
$500
Committee Recommended Financial Award
$600
Attachment 14
Gardenworksforkids — Construct Sidewalk for Special Needs Sensory Area Scope
Applicant is seeking financial support to cover the costs associated with pouring a cement sidewalk to the special needs sensory area for wheelchair access. Total residents projected to serve: 20,000 annually.

Requested Financial Amount
$1,500
Committee Recommended Financial Award
$1,500
Attachment 15
Redlands Bicycle Classic, Inc. — 2025 Yucaipa Road Race Scope
Applicant is seeking in -kind support to cover the costs associated with police support for traffic control at key intersections and public works support for the placement of warning signs prior to the event in April 2025. Total residents projected to serve: 500.

Requested In -kind Amount
$10,700
Committee Recommended In -Kind Award
0 Attachment 16
Yucaipa/Calimesa Family Assistance — Purchase Computer Hardware & Support Services
Scope
Applicant is seeking financial support to cover the costs associated with the purchase of computer hardware and support services. Total residents projected to serve: 285.

Requested Financial Amount
$1,680
Committee Recommended Financial Award
$1,680
Attachment 17
Yucaipa Calimesa Veterans Committee — 202 Veterans Day Ceremony Scope
Applicant is seeking in -kind support to cover the costs associated with the use of the Yucaipa Community Park Amphitheater and Shelter #2 to host the 2024 Veterans Day Ceremony on November 11, 2024. Total residents projected to serve: 200+.

Additional financial support in the amount of $500 is included in the FY 2024/2025 Non -Department Not -For -Profit Approved Budget Requested In -kind Amount
$720
Committee Recommended Award
$720

FISCAL IMPACT:

Upon adoption of the FY 2024/2025 Budget, the fund for in-kind/fee waiver requests will have a balance of $40,000. The total amount requested for in -kind assistance from the CAG applications submitted with this staff report is $49,855, exceeding the total funds available by the amount of $9,855 if all nine in -kind grant applications are approved.

Upon adoption of the FY 2024/2025 Budget, the fund for financial requests will have a balance of $20,000. The total amount requested for financial assistance from the CAG applications submitted with this staff report is $24,680, exceeding the total funds available by the amount of $4,680 if all nine financial grant applications are approved.

Attachments:

1. Al -Anon Family Groups Application

2. Family Service Association of Redlands/Yucaipa Outreach Application

3. Rotary Club of Yucaipa Application

4. Childhood Cancer Foundation of So. Cal Application

5. Strada Corsa dba Yucaipa BMX Application

6. Yucaipa Woman's Club Application

7. Smiles for Seniors Foundation Application

8. Yucaipa Pickleball Inc. Application

9. Yucaipa Valley Art Association Application

10. Yucaipa Valley Art Association Application

11. Rotary Club of Yucaipa Application

12. The Well Outreach Center Application

13. The Elks Club Lodge #2389

14. Gardenworksforkids Application

15. Redlands Bicycle Classic Application

16. YucaipalCalimesa Family Assistance Application

17. Yucaipa/Calimesa Veterans Committee Application

18. Prioritization Worksheet

19. Financial Award Grant Tracker Fiscal years 2010/11 through 2023/24 Approved by:
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ATTACHMENT 1

CITY OF

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION

COMMUNITY ACTIVITY GRANT APPLICATION INSTRUCTIONS
Fiscal Year:

Date Application submitted:
2024-2025
04/16/2024
Submit to:

City of Yucaipa
General Services/City Clerk Department
34272 Yucaipa Blvd.

Yucaipa, CA 92399
Attn: Kimberly Metzler
Received
City of Yucaipa
APR 22 2024
General Services/
City Clerk's Department
All sections of the application must be returned complete, and all 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 I00% 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 match of $500.

SECTION 1— GENERAL INFORMATION
Name of Applicant/Organization:

Applicant/Organization Mailing Addres.

Applicant/Organization Phone Number:

Contact (1)
Contact (2)
Al -Anon Family Groups
Megan Paredes
Name Phone Number
E-mail address
John Muller
Name
Phone Number
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.

City of Yucaipa Community Activity Grants Application, Rev. 04/2024

Page 1 ends

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:

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)?
Yes
If yes, please provide Tax ID# 95-342451 7 and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? 2007
2 3
15+
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Cindy T.; Sectretary
Megan Paredes; Business Chair
Hope H.; Treasurer
No
SECTION 4 - PROGRAM DESCRIPTION/SCOPE: (PLEASE USE ADDITIONAL PAGES IF NECESSARY) Name of the program/event:

Date(s) of program/event:

1.5 hour weekly Al -Anon Meeting
Saturdays 10 AM-11:30 AM
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) Please see the attached brochure and outreach posters. Also attached is a letter written on behalf of our Al -Anon group. Thank you for your consideration!
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:

We provide support to those effected by the disease of alcoholism. Many suffer in our communities, who may never find the help they need. Our group exists to ensure that when anyone, anywhere reaches out for help, the hand of Al -Anon will always be there to welcome them and assist them in finding the direction and hope they so desperately need.

Program/Event Primary Target Population (check all that apply):

Children or Youth
Low Income
Persons with Disabilities
Number of Residents Projected to Serve:

Seniors
Victims
Welfare Recipients
Women
Homeless
Entire Community
We have an average of 10-20 weekly participants. Some are regular attendees, and we welcome "newcomers" reguarly.

SECTION 5 — GRANT FUNDING REQUEST
Please identify what your organization is seeking:

Financial Support:

Yes
$200 SEP Fee
Waiver: [lies
❑ o
In -kind Support: Police $
OT/Reassigned
Staff $
In -Kind
No $
Our group is requesting an in -kind grant in the amount of $3,304.00 (the total cost of rent to our group to rent the small room at the Community Center for the year is $3,844.00, and the $3,304.00 we're requesting reflects the $540.00 contribution that our group can afford tr contribute annually. public
Fire $ Works $
CS/Rental_$ 3,244 nr,
Other $ Explain
Financial Support
Total Amount of Request: $ 3,304.00 $
$200 SEP
Fee Waiver
Provide a detailed description of how the financial support will be used:

Financial
Match
Total Overall
Request
= $ 3,304.000 It-
,!
J �
This will be used to make the cost of renting the small room at the Yucaipa Community Center tenable for our group. Our group is fully self-supporting, and all our contributions are given voluntarily, and go towards rent, cost of literature,
City of Yucaipa Community Activity Grants Application, Rev. 04/2024 Page 3

SECTION 6 -- FINANCIAL CAPABILITIESBUDGET:

What other in-kind/financial contributions has your organization received to fund this event/program (separate from City funding)?
N/A
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
Al -Anon Family Group
Al -Anon Family Group
AI -Anon Family Group
In -Kind
Financial $200 SEP Date
Support Fee Waiver Received
Total Received
03/17/2021 $ 54.00
04/25/2022 $1,052.00
04/28/2023 $ 2,962.00
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.

Business Chair 04/16/2024
J1,"�.ii LUL;
Title
Date

TO BE COMPLETED BY CITY
Date Received:

Amount Funded:

Type of Grant:
h1-Kind
Date City Council received follow up report:

Date Reviewed:

City Council Meeting:
111 Financial Support
❑ Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 04/2024

Page 4 ends

City of Yucaipa (City Council)
34272 Yucaipa Blvd
Yucaipa CA 92399
Re: Alanon Family Group Meeting at the Community Center ("in -kind" rent assistance) Dear Members of the Yucaipa City Council,
March 25, 2024
My name is Megan Paredes, and I am the Business Chairperson of the Saturday, 10:00 AM Al -Anon Family group. I'm writing on behalf of our group, which has met at the Yucaipa Community Center for the past three years (interrupted by Covid in 2020), to respectfully request your consideration of an in -kind grant for the coming year. Two of the three years that our group has met at the Community Center, we've successfully applied for and received full "in -kind" rent assistance. For the current period we received partial rent assistance and have been paying $582, plus insurance, for our one -hour meetings. City and Community Center staff have been very helpful, kind, and courteous, for which we are most grateful.

Our group has been informed that the current (new for us) policy will be enforced going forward, requiring us to reserve our usual room (small meeting room — capacity of 20) for a minimum of TWO-HOUR periods of use, which amounts to $80.00 per week. Our average weekly attendance is 12-18 people. Our weekly collection of voluntary contributions from our group members averages $15 - $20. Our expenses are rent, literature, and contributions to our district and national offices. We hold one fundraiser per year which generates around $100. As Al -Anon doesn't require dues or fees for membership, and our group doesn't generate enough in contributions to pay the full amount of the room rent. We would not be able to pay rent in excess of the $48.50 per month we currently contribute.

About Al -Anon, our Preamble states:

The Al -Anon Family Group if a fellowship of relatives and friends of alcoholics who share their experience, strength and hope in order to solve their common problems. We believe alcoholism is a family illness and that changed attitudes can aid recovery.

Al -Anon is not allied with any sect, denomination, political entity, organization, or institution; does not engage in any controversy; neither endorses nor opposes any cause. There are no dues for membership. Al - Anon is self-supporting through its own voluntary contributions.

Al -Anon has but one purpose: to help families of alcoholics. We do this by practicing the Twelve Steps, by welcoming and giving comfort to the families of alcoholics, and by giving understanding and encouragement to the alcoholic.

There are only two AI -Anon meetings being held per week in Yucaipa. Redlands has 8. In contrast, there are nearly 40 meetings of Alcoholics Anonymous that meet weekly in the city of Yucaipa alone. The need for this Al -Anon meeting to succeed, to offer hope and help to the family of friends of alcoholics, is great. We humbly request your continued assistance in making this possible. Please grant either our full request, or enough "in - kind" assistance, to allow our group to continue to support the city of Yucaipa and surrounding communities.

With gratitude and respect,
Megan Paredes, Al -Anon Business Chair
Yucaipa, CA 92399

YONt"

TRAPPED

BY ALCOHOL IS AN

ALCOHOLIC
Families and friends
are suffering too.
.

AI -Anon and Alateen
can help.

A
Al -Anon =amilyGroups
Help and hope For families and friends of alcoholics

AI Anon Family Groups
Help and hope for families and friends of alcoholics

NOT EVERYONE PED

BY ALCOHOL IS AN
ALCOHOLIC.

Do you worry
about how much
someone drinks?
Al -Anon and Alateen
can help.
-888-4AL-ANON
AL-ANON.ORG

Permit
--, _- COMMUNITY [ce
ices', SERVICES ;
C1 Better:

City of Yucaipa Community PHONE:(909) 790-7460
Services FAX:(909) 790-2589
34272 Yucaipa Blvd EMAIL:communityservicesgyucaipa.org
Yucaipa, CA 92399
Organization Name Al Anon Family Groups - 368
Customer Type Non -Profit (NR)
Organization Address
Agent Name John Muller
System User Julia Basa
Al -Anon Family Group Meeting
Booking Summary
Organization Phone 1
Number
Organization Phone 2
Number
Home Phone Number
Email Address
Permit # R6397
Status Tentative
Date Apr 3, 2024 3:50 PM
Expiration Date Apr 3, 2025
Rental Fee $4,160.00
Discounts -$416.00
Subtotal $3,744.00
Deposits $100.00
Deposit Discounts $0.00
Total Permit Fee $3,844.00
Total Payment $0.00
Refunds $0.00
Balance $3,844.00
1 resource(s) 52 booking(s) Subtotal: $3,844.00
Community Meeting Room (Indoor Reservations) Center: Yucaipa Community Center

START DATE/TIME
Sat, Jul 6, 202410:00 AM

END DATE/TIME
Sat, Jun 28, 202512:00 PM
Occurs every Saturday effective 07/06/2024 until 06/28/2025 from 10:00 AM to 12:00 PM.

Sat, Jul 6, 202410:00 AM
Sat, Jul 6, 202412:00 PM

ATTENDEE

AMT W/O TAX
$3,744.00
20 $72.00
Rental - Saturday Event Assistant (SP-I2A) $40.00 / Hour x 2 S80 00 Resident Discount - 10% -10% x 1 -$8.00
Sat, Jul 13, 2024 10:00 AM Sat, Jul 13, 202412:00 PM 20 $72.00 Rental - Saturday Event Assistant (8P-I2A) a40 00 !Hour x 2 $80.00 Resident Discount - 10"/ -10' x 1 -`;8 00
Sat, Jul 20, 202410:00 AM Sat, Jul 20, 202412:00 PM 20 $72.00 Rental - Saturday Event Assistant (3P-12A) $40 00 % Hour x 2 C30.00 Resident Discount -10% -i0':: x 1 -$8.00
Sat, Jul 27, 202410:00 AM Sat, Jul 27, 202412:00 PM 20 $72.00 Rental - Saturday Event Assistant (8P-I2A) $40 00 ' Hour x 2 380.00 Resident Discaunt -10% -10% X 1 -$3 00
Sat, Aug 3, 202410:00 AM Sat, Aug 3, 2024 12:00 PM 20 $72.00 # R6397 Status Tentative

Page 1 of 6 ends

Rental - Saturday Event Assistant (3P-12A1 340 00 , Hour x 2 530.00 Resident Di=_•.::.rnt . 10' -IO%,c 1 -33 00
Sat, Aug 10, 2024 10:00 AM Sat, Aug 10, 202412:00 PM 20 572.00 Rental - Saturday Event Assistant (SP-12A) $40.00/ Hour 2 $80 00 Resident Discount - 10'. -10% < 1 -53 CO
Sat, Aug 17, 202410:00 AM Sat, Aug 17, 202412:00 PM 20 $72.00 Rental - Saturday Event Assistant (SP-12A) $40.00 / Hour x 2 $S0 00 Resident Discount -10% -10%, x 1 -$8.00
Sat, Aug 24, 202410:00 AM Sat, Aug 24, 2024 12:00 PM 20 $72.00 Rental - Saturday Event Assistant (22P-12A) $40 00 r Hour x 2 $20.00 Resident Discount - 10% -10% x 1 -$8.00
Sat, Aug 31, 202410:00 AM Sat, Aug 31, 202412:00 PM 20 $72.00 Rental - Saturday Event Assistant (3P-12A) $40 00 / Hour x 2 S30.00 Resident Discount - 10% -10% x 1 -S3.00
Sat, Sep 7, 2024 10:00 AM Sat, Sep 7, 202412:00 PM 20 S72.00 Rental - Saturday Event Assistant (BP-12A) $40.00 / Hour x 2 $80 00 Resident Discount -10% -10% x 1 -$8 00
Sat, Sep 14, 2024 10:00 AM Sat, Sep 14, 2024 12:00 PM 20 $72.00 Rental - Saturday Event Assistant (8P-12A) $40.00 / Hour x 2 $S0 00 Resident Discount-10%-10%:<1 -$8,00
Sat, Sep 21, 202410:00 AM Sat, Sep 21, 202412:00 PM 20 $72.00 Rental - Saturday Event Assistant (2P-12A) $40.00 / Hour x 2 $80 00 Resident Discount -10% -10% x I -$8.00
Sat, Sep 28, 2024 10:00 AM Sat, Sep 28, 202412:00 PM 20 $72.00 Rental - Saturday Event Assistant (8P-12A) $40 00 / Hour x 2 S30.00 Resident Discount -10% -10% x 1 -$8.00
Sat, Oct 5, 202410:00 AM Sat, Oct 5, 202412:00 PM 20 $72.00 Rental - Saturday Event Assistant (3P-12A) $40.00 / Hour x 2 S30 00 Resident Discount - 10% -10% x 1 -$3 00
Sat, Oct 12, 202410:00 AM Sat, Oct 12, 202412:00 PM 20 $72.00 Rental - Saturday Event Assistant (3P-I2A) S40,00 / Hour x 2 $80 00 Resident Discount -10% -'10''',: 1 -$S 00
Sat, Oct 19, 2024 10:00 AM Sat, Oct 19, 2024 12:00 PM 20 $72.00 Rentai - Saturday Event Assistant (8P-I2A) $40.00 / Hour x 2 S30 00 Resident Discount -10% -10% x 1 -$8.00
Sat, Oct 26, 2024 10:00 AM Sat, Oct 26, 202412:00 PM 20 $72.00 Rental - Saturday Event Assistant (3P-12A) $40 00 / Hour x 2 S30.00 Resident Discount -10% -10% tt. 1 -53.00
Sat, Nov 2, 2024 10:00 AM Sat, Nov 2, 2024 12:00 PM 20 $72.00 Renta! - Saturday Event Assistant (3P-12A) S40 00/Hour x 2 $20,00 Resident Discount - 10% -10-' x 1 -$3 00
Sat, Nov 9, 202410:00 AM Sat, Nov 9, 2024 12:00 PM 20 $72.00 Rental - Saturclay Event Assistant (8P-12A) $40.00 ' Hour x 2 S30 00 # R6397 Status Tentative Page 2 of 6

:dent Discount - 10%. -10... x 1 -S3 00
Sat, Nov 16, 2024 10:00 AM Sat, Nov 16, 202412:00 PM 20 $72.00 Rental - Saturday Event Assistant (8P-12A) $40.00 r Hour x 2 $80.00 Resident Discount - 10% -10', . -I0%x'I -$3.00
Sat, Feb 1, 202510:00 AM Sat, Feb 1, 2025 12:00 PM 20 $72.00 Rental - Saturday Event Assistant ($P-I2'A) S40.00 / Huur x 2 SSC 00 Resident Discount- 10% -10%x 1 -58 00
Sat, Feb 8, 202510:00 AM Sat, Feb 8, 2025 12:00 PM 20 $72.00 Rental - Saturday Event Assistant (3P-12A) $40.00 `Hour x 2 $80 00 Resident Discount - 10`i, -10% x 1 -$3 00
Sat, Feb 15, 202510:00 AM Sat, Feb 15, 2025 12:00 PM 20 $72.00 Rental - Saturday Event Assistant (8P-12A) 540.00 / Hour x 2 $80 00 Resident Discount - 10" -I0% x I -S3 00
# R6397 Status Tentative Page 3 of 6

Sat, Feb 22, 2025 10:00 AM Sat, Feb 22, 2025 12:00 PM 20 S72.00 Rental - Saturday Event Assistant (8P-12A) $40 00, Hour x 2 S30 00 Resident Discount - 10%0 -10°,; x 1 -53 00
Sat, Mar 1, 2025 10:00 AM Sat, Mar 1, 2025 12:00 PM 20 $72.00 Rental - Saturday Event Assistant (3P-12A) $40 00 / Hour x 2 S30 00 Resiclent Discount - 10'0 -10% x 1 -$3.00
Sat, Mar 8, 2025 10:00 AM Sat, Mar 8, 2025 12:00 PM 20 $72.00 Rental - Saturday Event Assistant (8P-12A) $40.00 / Hour x 2 580.00 Resident Discount - 10% -10%:< 1 -$3.00
Sat, Mar 15, 2025 10:00 AM Sat, Mar 15, 202512:00 PM 20 $72.00 Rental - Saturday Event Assistant (3P-12A) $40.00 / Hour x 2 $80.00 Resident Discount - 10% -10% x 1 -$8.00
Sat, Mar 22, 202510:00 AM Sat, Mar 22, 202512:00 PM 20 $72.00 Rental - Saturday Event Assistant (3P-12A) $40 00 / Hour x 2 $30.00 Resident Discount - 105. -10% x I -$3.00
Sat, Mar 29, 202510:00 AM Sat, Mar 29, 2025 12:00 PM 20 $72.00 Rental - Saturday Event Assistant (3P-12A) $40.00 / Hour x 2 580 00 Resident Discount - 10% -10% x I -$8.00
Sat, Apr 5, 2025 10:00 AM Sat, Apr 5, 2025 12:00 PM 20 $72.00 Rental - Saturday Event Assistant (8P-12A) $40.00 ! Hour x 2 $80 00 Resident Discount - 10% -10% x 1 -S8 00
Sat, Apr 12, 2025 10:00 AM Sat, Apr 12, 2025 12:00 PM 20 $72.00 Rental - Saturday Event Assistant (8P-12A) S40.00 / Hour x 2 $80.00 Resident Discount - 10% -10% x 1 -$8.00
Sat, Apr 19, 2025 10:00 AM Sat, Apr 19, 202512:00 PM 20 $72.00 Rental - Saturday Event Assistant (3P-12A) $40 00 ! Hour x 2 580.00 Resident Discount - 10°;-10`.:: x I -$3.00
Sat, Apr 26, 2025 10:00 AM Sat, Apr 26, 2025 12:00 PM 20 $72.00 Rental - Satui day Event Assistant (3P-I2A) $40.00 / Hour . 2 S30 00 Resident Discount - 10% -10% x 1 -$8.00
Sat, May 3, 202510:00 AM Sat, May 3, 202512:00 PM 20 $72.00 Rental - Saturday Event Assistant (8P-12A) $40.00 / Flow x 2 $80.00 Resident Discount - 107�, -10% x 1 -S3.00
Sat, May 10, 2025 10:00 AM Sat, May 10, 202512:00 PM 20 $72.00 Rental - Saturday Event Assistant (8P-12.A) $40.00 ; Hour '< 2 S80 00 Resident Discount - 10% -10"' x 1 -58.00
Sat, May 17, 202510:00 AM Sat, May 17, 2025 12:00 PM 20 $72.00 Rental - Saturday Event Assistant (3P-12A) 540 00 / Hour x 2 S30.00 Resident Discount - 10`'-. -10% x 1 -S3 00
Sat, May 24, 2025 10:00 AM Sat, May 24, 2025 12:00 PM 20 $72.00 Rental - Satin day Event Assistant (3P-12 A) $40 00 r Hour s 2 S30 00 Resident Discount - 10% -10% x 1 -S3 00
Sat, May 31, 2025 10:00 AM Sat, May 31, 2025 12:00 PM 20 $72.00 # R6397 Status Tentative Page 4 of 6

Rented Saturday Event Assistant (3P-12A) $40 00 i Hour x 2 380.00 Resident Discount - 10°-, .i0m x 1 -SS 00
Sat, Jun 7, 2025 10:00 AM Sat, Jun 7, 2025 12:00 PM 20 $72.00 Rental - Saturday Event Assistant (SP-12A) $40 00 / Hour x 2 $30 00 Resident Discount - 10?.: -10% x 1 -$3 00
Sat, Jun 14, 202510:00 AM Sat, Jun 14, 2025 12:00 PM 20 $72.00 Rental - Saturday Event Assistant (SP-12A) $40.00 / Hour x 2 S30,00 Resident Discount - 10% -10', x 1 -38.00
Sat, Jun 21, 202510:00 AM Sat, Jun 21, 2025 12:00 PM 20 $72.00 Rental - Saturday Event Assistant (3P-12A) $40.00 ; How x 2 $80.00 Resident Discount - 10% •10% x 1 -$8.00
Sat, Jun 28, 202510:00 AM Sat, Jun 28, 202512:00 PM 20 $72.00 Rental - Saturday Event Assistant (3P-12A) $40 00 / Hour s 2 $30.00 Resident Discount - 10% -10°s x I -$3 00
Resource level fees $100.00
Deposit 3100.00 I Each x 1 $100.00
Waivers and Information

INFORMATION DESCRIPTION
Alcohol Sales Lic
Proof of Liability Insurance
Security Guard Contract
Proof of Non Profit Status

WAIVER NAME
Facility Usage Waiver

DUE DATE
Jul 6,2024
FOR

SIGNING STATUS
Checked
Checked
Checked
Checked

SIGNING STATUS
Waiver Signed
Facility user hereby agrees to indemnify, defend and hold harmless City of Yucaipa, its officers, officials, employees and volunteers from and against all claims, damages, losses and expenses that may arise during or be caused in any way by such occupancy or use of facilities, but the facility user shall not be liable for any claims, damages, losses and expenses caused by the sole negligence or willful misconduct of the City of Yucaipa.

Permittee shall have received any and all permission or license(s) as may be required to perform or use any protected materials in its use of the Premises. Permittee agrees to protect and save harmless the City, its elected officials, employees and agents from and against any and all claims, penalties, and/or damages which may accrue as a result of Permittee's failure to comply with this requirement.

I have read the rules and regulations relating to use of facilities and accept responsibility for meeting the requirements stated herein.

Signature
Deposit

EVENT RESOURCE DEPOSIT FEE CHARGE TAX AMOUNT PAID REFUNDS BALANCE Al -Anon Community Deposit $100.00 $0.00 $0.00 $0.00 $100.00 Family Meeting
Group Room
Meeting
# R6397 Status Tentative Page 5 of 6

Payment Schedules Original Balance: $3,844.00 Current Balance: $3,844.00

DUE DATE AMOUNT DUE AMOUNT PAID WITHDRAWAL ADJUSTMENT BALANCE Jun 22, 2024
$3,844.00 $0.00
$0.00 $3,844.00
# R6397 Status Tentative Page 6 of 6

ATTACHMENT 2

CITY OF
ii4a691111°.°

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION

COMMUNITY ACTIVITY GRANT APPLICATION 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
APR 2 C 2024
General Services/
City Clerk's Department
All sections of the application must be returned complete, and all 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 $500.

SECTION I — GENERAL INFORMATION
Name of Applicant/Organization:

Applicant/Organization Mailing Addres.,.

Applicant/Organization Phone Number:

Contact (I)
Contact (2)
Family Service Association of Redlands/Yucaipa Outreach Program ( 909) 793-2673 ext 134
Kyra Stewart
) same as above
Name Phone Number
kyra@redlandsfamiyservice,org
E-mail address
Corey Romo
Name
( 909) 793-2673 ext 120
Phone Number
[email protected]
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?
n/a
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 Application, Rev. 04/2024

Page 1 ends

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.

Yes
Is your organization a 501(c)?
If yes, please provide Tax ID# 95-1655614 and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? 125 years
How long has your 501(c) organization been in existence? Number of Employees working for organization:

Number of Volunteers working for organization:

Carol Snodgress, Board Pres.

Gary Fagan, Vice Pres.

Matt Miler, Chair of Resource
Diane Remy, Treasurer
Debbie Evans, Secretary
Pam Allen, Board Member
Marilyn Bean, Board Member
18 500
100
No
n n
❑ n
(Please attach an organization chart, if available)
Ann Bryan, Board Member
Stephanie Banks, Board member
George DeLange, Board member
Robert Heinze, Board member
Renee Kern, Board member
Rafael Larios, Board member
see attached for more info
SECTION 4 - PROGRAM DESCRIPTION/SCOPE: (PLEASE ('SE ADDITIONAL PAGES IF NECESSARY) Name of the program/event:

Date(s) of program/event:

Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) see attached - service count sheets and fliers and program description Housing Assistance and Advocacy Program
07/01 /2024-06/30/2024
City of Yucaipa Community Activity Grants Application, Rev. 04/2024

Page 2 ends

Describe how the program/event benefits the residents and/or community of Yucaipa:

The Housing Assistance/Advocacy Program benefits the residents of Yucaipa (and East and Central Valley of SB County) - by providing a layer of support for low income households with children and the elderly with disablilities.

The emergency financial assistance and case management practices work together to stabilize crisis and to fight against the imminent dangers of homelessness i.e sleeping in cars or unsafe conditions.

Also - we have bn partnering with the City of Yucaipa's Homeless Outreach team to provide vouchers for unhoused citizens who need emergency shelter at point of intake. Further, every participant also raroivoe teirnn rnIind ciinnnrfc el irh ne rInfhinn fnnrl hnvac nnrt rracc fn nrnnrnmminn Program/Event Primary Target Population (check all that apply):

Children or Youth
Low Income
nPersons with Disabilities
Number of Residents Projected to Serve: .0-15
Seniors I r l Women
nVictims ✓ Homeless
nWelfare Recipients n Entire Community
SECTION 5 — GRANT FUNDING REQUEST
Please identify what your organization is seeking:

Financial Support: ✓ Yes nNo
$200 SEP Fee
Waiver: [ Yes ✓ No
$ 3500
Public
In -kind Support: Police $ Fire $ Works $ CS/Rental $
OT/Reassigned
Staff $ Other $ Explain
$200 SEP Financial Total Overall
In -Kind Financial Support Fee Waiver Match Request
Total Amount of Request: $ $3500 $ _ $3500
Provide a detailed description of how the financial support will be used:

If funded, the financial support shall be allocated towards direct client services related to the Housing Assistance and Advocacy Program, and more specifically the motel voucher program which bills at $85.00 per night as well as the ability to provide financial assistance to clients who are facing eviction or already homeless.

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)?
HHAP 3 Funding SB County $
Emergency Food/ Shelter Prog $
ERF Grant - City of Redlands $
$
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
$ $243,500
$ $30,000
$ $350,000
$
$
$ 623,500
$ 3500.00
$ 150,000
SECTION 6 - FINANCIAL CAPAIILITIES/BUDGET (CONTINUED):

Provide City funding received by organization in the past three years (required):

In -Kind Financial $200 SEP
Support Fee Waiver
Program
n
FY p `� 3 ❑
12- ?see a shed- / P ❑
SECTION 7 — CERTIFICATION
n
Date
Received
Total Received
5/ v4 /2- ( $ 3, S 7
4/'�-� 7/ 2-$ 35 o
Le l'1e2 l:3$ ,a
I thu dersianed do hereby attest that the above information is true and correct to the best of my knowledge, and understand w ,....,,.,t1\i Anntirial meant a►nnnnt needs to be spent pr. to itting another grant requet.

ZL
Otgu4Lui 9
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 ❑ Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 04/2024

Page 4 ends

Statement of Need
According to the National Low Income Housing Coalitions' most recent report— California has a shortage of 972,083 affordable housing options available for extremely low-income households throughout the state. The average income for an extremely low-income household of four is $33,520 annually and studies show that 77% of extremely low income renter households have severe cost burden. (nlihc.org)
San Bernardino County's most recent Point in Time Count (PITC) shows an increase in homelessness throughout the region of 25.9%. Further, the cost of inflation, rent, gas and food has deeply affected low-income households throughout the nation as marginalized and vulnerable families are barely making it from month to month. (Office of Homeless Services/ SB County) Family Service Association of Redlands and the Yucaipa Outreach Project provide safety net services for households with children under 18 and elderly, disabled on fixed incomes in the East and Central Valley of SB County. Services include case management, food, clothing. Emergency rental assistance, transportation assistance and motel vouchers for households who have no other shelter options at point of intake. We are requesting support from the Community Activity Grant Program to assist with strengthening our work.

Program Description/Applicant Background
Family Service has been administering the Housing Assistance and Advocacy Program for decades.

We have experience overseeing and implementing Housing First and HUD funded programs with complex program rules such as Emergency Solutions, HHAP and EFSP to name only a few.

It is the face to face case management that assists in stabilizing low income households in crisis.

Each client at Family Service and Yucaipa Outreach Project— receives wrap around and case management support for clients in crisis.

Each client fills out an intake form and shows proof of income, expenses and crisis. We utilize government approved forms to assess eligibility. We meet face to face with the client and provide resources related to housing and employment and the overall wellness of the household.

Financial Capabilities
Family Service operates at an approximate 2.1-million-dollar annual budget piecemealed together through grant makers, contracts, fundraising events, fee -based services and private donations. We utilize QuickBooks software to manage daily accounting functions and we practice the General Accounting Principles for nonprofits. Board governance includes a monthly Finance team who reviews our financial statements and then the full Board approves monthly reports on behalf of the agency. We have never had an audit finding in the history of the agency and we manage very complex cost reimbursements for government -related contracts. We employ a full time Administrative Manager who holds a Certificate in Accounting Principles as well as a Part Time accounting clerk who is responsible for accounts payables and grant tracking.

Internal Revenue Service
P.O. Box 2508
Cincinnati, OH 45201
Date: August 22, 2014

FAMILY SERVICE ASSOCIATION OF REDLANDS
612 LAWTON ST
REDLANDS, CA 92374
Department of the Treasury
Person to Contact
Ms. Wiles
Toll Free Telephone Number:
877-829-5500
Employer Identification Number:
95-1655614
Dear Sir or Madam:

This is in response to your March 13, 2014 request for information regarding your tax-exempt status.

Our records indicate you were recognized as exempt under section 501(c)(3) of the Internal Revenue Code in a determination letter issued in September 1953.

Our records also indicate you are not a private foundation within the meaning of section 509(a) of the Code because you are described in section509(a)(2).

Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code.

Please refer to our website www.irs.00v/charities for information regarding filing requirements. Specifically, note that section 6033(j) of the Code automatically revokes the tax -exemption of any organization that fails to satisfy its filing requirement for three consecutive years. The automatic revocation of exemption is effective as of the due date of the third required annual filing or notice. The IRS maintains a list of organizations whose tax- exempt status was automatically revoked at IRS.gov.

If you have any questions, please call the phone number in the heading of this letter. _ Sincerely, ._ ....

Tamera Kipperaa
Director, Exempt Organizations

FANILY SERVICE ASSOCIATION OF RLIMANDS
TO ALLEVIATE POVERTY, ENCOURAGE SELF-SUFFICIENCY, AND PROMOTE THE DIGNITY OF ALL.

Executive Director
Kyra Stewart
Resource Development
Manager
Tennifer Watson
Volunteer/Marketing
Coordinator
Leah Rios
Office Manager
Samantha Morgan
Office Assistant
Donna Jones
Accounting Clerk
Adela Brown
Part Time Grant Writer
Andrea Laughlin
Volunteers and Interns;
Program/Site Director
Corey Romo
e Managers
Dote l4ead
aula get y
Hannah Rodriguez
Rotesha Anderson
znployrnent.
•Specialist/Case Manager
Jerinyfer Melgoza
Pr r4ssis ant
Lori via,
'revormiiitan
melt Fuqua (Vot' & FAA}
Donation Center Lead
Aundrea De La"Cruz'
Prograrn & Donation Center
Assistant
Ian McMa'hoit
Committees
Executive Committee'
Finance Committee
Strategic Planning Committee
Resource Committee
Housing/Facilities Conimiftee
Nominating Committee
Friends of the Family
Client Advisory Board

125 Years of
Serving the Community
Family Service Association of Redlands
2024 Board of Directors
612 Lawton Street, Redlands, California 92374
Office:: 90.9 793-2673 Fax: .909 793-7324 Website: redlandsIhrnilyservice. org Alleviate poverty, encourage sclf=sufliciencyand promote the dignity of all clients

EXECUTIVE COMMITTEE
President
Vice President, Strategic Planning
Vice President, Resource
Vice President, Housing & Facilities
Treasurer
Secretary
Carol Snodgress Cell
Gary Fagan Cell
Matt Miller Cell
Joseph Shaw Cell
Diane Remy Cell
Debbie Evans Cell
909 732-9989
909 771-8423
909 645-0802
909 725-0241
909 556-7760
909 815-2324
BOARD MEMBERS:

Pam Allen (Term Pt - 2025)
Director of Emergency Services RCH
Cell 760 445-5675
Email [email protected]
1624 Alesandro Rd
Redlands CA 92373-6945
Stephanie Banks(Term 1Sr 2027)
Provider Liaison Pacific Dermatology
Cell 909 800-0321,
Email stephanie:[email protected]
1338 La Loma Dr
Redlands, CA 92373-6944
Marilyn Bean (Term 2'd - 2027)
Retired Teacher
Home 909 793-4454
Email [email protected]
1320 Drake Ridge Crest
Redlands CA 92373-6519
Ann Bryan (Term 2nd - 2027)
Business Owner/Realtor
Cell 909-938-7725
Email [email protected]
1900 Country Club Dr
Redlands CA 92373-7408
George DeLange (Term 2"d - 2027)
Retired Healthcare Management
Cell 909 553-1605
Email [email protected]
1210 Fulbright Ave
Redlands, CA 92373-1605
Debbie Evans (Term 2nd - 2026)
Director of Social Services RCH
Cell 909 815-2324
Email [email protected]
7912 Santa Paula St
Highland, CA 92346-6308
Gary Fagan (Term 2nd - 2027)
Retired Prosecutor
Home 909 389-9166
Cell 909 771-8423
Email [email protected]
1573 Pala Bells Ct
Redlands, CA 92374-2707
Robert Heinze (Term 2nd - 2025)
CFP
Cell 909 307-8478
Home 909 798-8138
email [email protected]
30370 Copper Hill Ct
Redlands, CA 92373-7373
1 04/26/24

BOARD MEMBERS CONTINUED:

Renee Kern (Term l st —2026)
Business Owner
Cell 909 663-7696
Home 909 862-7939
Email [email protected]
6580 Applewood St
Highland, CA 92346-5210
Rafael Larios (Term 15' — 2027)
Business Owner
Cell 909 908-1246
Email [email protected]
1245 Columbia St
Redlands, CA 92374-3117
Janine Ledoux (Term 2°d - 2027)
Professor
Cell 909 838-7813
Email [email protected]
219 Grant St
Redlands, CA 92373-5116
Matt Miller (Term 2nd - 2025)
Executive Director, Cedars -Sinai
Cell 909 645-0802
Email [email protected]
6913 Clear Spring Ct
Highland, CA 92346-6203
Diane Remy (Term 2' - 2026)
Retired CPA;_
Cell 909 556-7760
Email [email protected]
515E Mariposa Dr
Redlands, CA 92373-7351
Barbara Rozema (Term - 2025)
Event Planner/Realtor
Cell 909 754-9717
Email [email protected]
6412 Seavey Ct
Highland, CA 92346-7758
Joseph Shaw (Term 1" - 2025)
Business Owner/Realtor
Cell 909-725-0241
Email [email protected]
1107 N Orange St
Redlands, CA 92374-3218
Lori Shelffo (Term 151- 2025)
AdministrativeAssistant
Cell 909-.239-8199
Email [email protected]
338 Sherwood St
Redlands, CA 92373-4964
David Shippee (Term is( - 2027)
CPA
Cell 909 747-5538
Email [email protected]
6843 N Huntington Dr
San Bernardino, CA 92407-5174
Carol Snodgress (Term 2"d - 2027)
Retired Bank Officer
Cell 909 732-9989
Email [email protected]
464 W Mariposa Dr
Redlands, CA 92373-7436
Shelli Stockton (Term 1St 2026)
U of R Director of Alumni &
Community Relations
Home 909 792-6410
Email [email protected]
510 S Buena Vista St
Redlands, CA 92373-5804
Terry Vines (Term - 2025)
Business Owner/Denist
Cell 951 415-5516
Email [email protected]
PO Box 1125
Redlands, CA 92373-0366
nni'14l')n

it
BOARD MEMBERS CONTINUED:

Joyce Volsch (Term 1st - 2027)
Vice President of Patient Care Services RCH
Home 909 379-5355
Email [email protected]
PO Box 11609
San Bernardino, CA 92423
Christopher Walker (Term 2nd - 2026)
Professor Emeritus U or R
Home 909 792-7715
Email [email protected]
616 Valley View Dr
Redlands, CA 92373-7358
STAFF
Kyra Stewart
Jennifer Watson
Samantha Morgan
Donna Olson Jones
Adela Brown
Andrea Laughlin
Corey Romo
Abi Pote
Paula Petty
Hannah Rodgriguez
Jennyfer Melgoza
Loretta Villarreal
Cornell Fuqua
Liliana Chau
Trevor Hamilton
Aundrea De La Cruz
Leah Rios
Tyler Waner('rerm ls` - 2025)
Financial Advisor
Work 909 798-8888
Cell 909 362-3300
Email [email protected]
300 E State St Ste 530
Redlands, CA 92373-5253
Ellen Weisser (2°d - 2025)
Retired Vice President
Home 909 792-0688
Cell 909`633-3616
email [email protected]
PO Box 7595
Redlands, CA 92375-0595
Executive Director
Resource Development Manager
Office Manager
Office Assistant
Accounting Clerk
Grant Writer
Program Director
Lead Case Manager
Case Manager
Case Manager
Case Manager/Employment Specialist
Program Assistant/Receptionist
Program Assistant YOP/FSA
Program Assistant
Program Assistant/Data Entry
Donation Center Lead
Volunteer Coordinator/Marketing
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
corey@redlandsfamilyservice. org
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
04/26/24

c2FAMII.,Y SERVICE ASSOCIATION OF REDLANDS
TO ALLEVIATE POVERTY, ENCOURAGE SELF-SUFFICIENCY, AND PROMOTE THE DIGNITY OF ALL. 2024 Committee Roster
Board of Director's Meetings - 4th Tuesday 8:00 am
Executive Committee:
(2nd Wednesday 9:00 am)
Finance Committee:
(3rd Tuesday 2:30 pm)
Strategic Planning:
(As needed)
Resource Development:
(3rd Wednesday 8:00 am)
Housing/Facilities:
(1st Tuesday 9:00 am)
Carol Snodgress
Gary Fagan
Matt Miller
Joseph Shaw
Diane Remy
Debbie Evans
Robert Heinze (Chair)
Diane Remy (Treasurer)
Deborah Crowley
George DeLange
Gary Fagan
Gary Fagan (Chair)
Kyra Stewart
Corey Romo
Matt Miller (Chair)
Ann Bryan
Deborah Crowley
Joseph Shaw (Chair)
Ann Bryan
Deborah Crowley
George DeLange
Debbie Evans
Sub Committees
President
Vice President, Strategic Planning
Vice President, Resource
Vice President, Housing
Treasurer
Secretary
Robin Maupin
Ann McMahon
Carol Snodgress
Chris Walker
Ann McMahon
Barbara Riordan
Carol Snodgress
Tyler Waner
Laura Houck
Ann McMahon
Andrea Nieto
Ellen Weisser
Andrea Laughlin (Staff)

Adopt A Family: Lori & Rod Shelffo (Chairs
Client Advisory Committee:

Dinner in the Grove:

Donor Reception:

Friends of the Family:

Hunger Walk:

LDS Food Drive:

Redlands Royalty:

Kyra Stewart
Debbie Evans
Char Burgess (Chair)
Pam Allen
Marilyn Bean
Ann Bryan
Yolanda Contreras
Lori Hatfield
Susan Martinez
Ann McMahon
Friends of the Family
Lowa Anderson (Chair)
Terry Vines (Chair)
Yolanda Contreras
Debbie Evans
Donna Ferracone
Renee Kern
Judy Cannon
Tyler Waner (Chair)
Tim Evans
Rafael Larios
Bobbie Neff
Clients
Shelli Stockton (Chair)
Diana Mclaughlin
Sue Morasco
Barbara Rozema
Lori Shelffo
Joyce Waner
Ellen Weisser
Rafael Larios
Susan Martinez
Sue Morasco
Carol Snodgress
Geneil Vines
Joyce Volsch
Joseph Shaw
Lorie Shelffo
David Shippee
Kyra Stewart
Jen Watson

City of Yucaipa Funding Received from 2021
Name of Funding
Source
Amount
Date Received
Comment
CDBG Yucaipa
$7776.51
10/2021
Allocated towards
staffing at YOP
City Line Item
$5000
8/2021
Allocated towards
direct client services
for Yucaipa
Community Activity
Grant
$3587
07/2021
Allocated for motel
vouchers and housing
City of Yucaipa Received in 2022
Name of Funding
Source
Amount
Date Received
Comment
CDBG Yucaipa —
Mortgage Program
$47682
01/2022-/12/2022
Allocated towards
staffing and mortgage
payments/COVID at
YOP
City Line Item
$5000
06/2022
Allocated towards
direct client services
for Yucaipa
Community Activity
Grant
$3500
07/2022
Allocated for motel
vouchers and housing
City of Yucaipa Received in 2023
Name of Funding
Source
Amount
Date Received
Comment
CDBG Yucaipa
$8506
08/31/2023
Allocated towards
staffing at YOP
City Line Item
$5000
07/2023
Allocated towards
direct client services
for Yucaipa
Community Activity
Grant
$2000
09/2023
Allocated for motel
vouchers and housing

6THE YUC.t1IPA OUTREACH PROJECT

A PROGRAM OF FAMILY SERVICE ASSOCIATION OF REDLANDS

A PROGRAM OF FAMILY SERVICE ASSOCIATION OF REDLANDS
2023 Service Counts
Total Families 38
Total Individuals 116
Housing Assistance:

Emergency Rental Assistance — number of families 11
Months of Rent Paid 18
Rapid Re -Housing — homeless families moved into stable housing 8 Motel Vouchers Issued 112
Food Distribution:

Emergency Food — number of visits
Bags of Food
91 270
Support Services:

Transportation — gas vouchers or bus passes 20
Holiday Distribution:

These events took place at the Redlands office, but were open to our Yucaipa clients:

Easter — children's baskets
Easter Food Boxes
Mother's Day Event
Father's Day Event
Halloween Costume Giveaway
Harvest Fest
Thanksgiving Food Boxes
Thanksgiving Adopt -A -Family
Christmas Food Boxes
Christmas Adopt -A -Family
Christmas — Client Party
Holiday Room Shopping
Summer Movies
Dia De Los Ninos Event
Education:

These classes took place at the Redlands office, but were open to our Yucaipa clients ESL Classes
Garner Holt STEAM Workshops
Drug Awareness Class
Financial Literacy Classes

FAMILY SERVICE ASSOCIATION OF REDLANDS
TO ALLEVIATE POVERTY, ENCOURAGE SELF-SUFFICIENCY, AND PROMOTE THE DIGNITY OF ALL. 2023 Service Counts
Total Families
Total Individuals
2,803
10,365
Housing Assistance:

Emergency Rental Assistance - families 108
Months of Rent Paid/Deposits 150
Rapid Re -Housing 47
Motel Vouchers Issued (that included 298 unhoused children 1,421 Food Distribution:

Meals Served 16,450
Drive Thru Food Boxes 1,702
Surplus Distribution - families (by no. of visits) 2,519 Surplus Distribution - individuals (by no. of visits) 9,031 Donated Food - weight by pounds 163,423
Clothing Distribution (by number of visits):

Families (by number of visits) 953
Individuals (by number of visits) 4,094
Support Services:

Transportation - gas vouchers or bus passes 142
Scholarship/Employment Assistance 24
Volunteer Services:

Volunteers
Volunteer Hours
757
15,620
Holiday Distribution:

Easter (children's baskets) 165
Easter Food Boxes 94
Mother's Day Event (families) 51
Father's Day Event (families) 37
Halloween Costume Giveaway 66
Harvest Fest - (families) 24
Thanksgiving Food Boxes 254
Thanksgiving Adopt -A -Family 124
Christmas Food Boxes 178
Christmas Adopt -A -Family 88
Christmas - Client Party (families) 28
Holiday Room Shopping (children) 355
Family Service Association also hosted 22 sessions of ESL classes, a Drug Awareness Class, four weeks of summer movies for children, three Garner Holt Workshops focused on STEAM, and three Financial Literacy Classes.

THE YUCAIPA OUTREACH PROJECT
ca

A PROGRAM OF FAMILY SERVICE ASSOCIATION OF REDLANDS

A PROGRAM OF FAMILY SERVICE ASSOCIATION REDLANDS

CITY OF
In partnership with the City of Yucaipa,
Yucaipa Outreach Project is helping the people
of Yucaipa who have been affected by
COVID-19. We want you to know there is relief!
Assistance Programs Include
Mortgage Assistance
Food Assistance
Employment Support Services
(ie. Uniform costs, job certification cost, etc.)
For more information on how to register for our programming, call (909)570-9132
V
yucaipaoutreachproject.org 11985 4th St, Suite 116, Yucaipa, CA 92399

CITY OF
BY: Complete Paperless Solutions (CPS)
5130 E La Palms Ave. #206
Anaheim, CA 92807
3/14/2024
Document Scanning Services
Lased iche
Premier Partner
LaserikM'
Solution
Provider
Awards
2022 WINNER

CUSTOMER'S

CHOICE AWARD

TECHNICAL APPROACH
All employees utilize security badges for access to the building which is also tracked and recorded. Our production imaging servers are air gapped and backed up daily only on an encrypted local drive which is purged in accordance with DoD Standard (DoD 5220.22-M) upon project completion. Our key employees are background verified, HIPPA Trained, CA Live Scanned, and CLETS Certified. (California Law Enforcement). Security, experience, and adherence to procedure is what makes our service offer unique.

We bear sole and complete responsibility for all work we execute.

Below is our procedure for tracking inventory once documents/boxes are picked up from a client's location.

Record Transfer Preparation —All boxes will have a Tamper Security Seal to ensure privacy immediately upon pickup. All boxes will be inventoried by folder and series within each box, provide a barcode label, and finalize the box count prior to departing.

Document Control and Manifest Creation — We use a specialized application to not only track all records, but we have a very stringent methodology policy we adhere to internally as well making sure all procedures are followed every step of the way. Tracking reports are generated to include all of the information pertaining to the job. The use of tamperproof seals provides an extra layer of security to keep your data safe.

Secure Record Transfer Service — All pickups and deliveries will be performed by at least 2 staff which have gone through a background check as well. In order to keep the chain of custody, delivery and pickup scenarios will not make any extra stops while transit with a client's data. If any issue arises with transport, a secondary team is on standby to assist right away.

Storage Center when Receiving — Our procedure is to have all boxes coming in to be counted and verified 2 times. Utilizing barcodes and our 2-person process ensures quality as soon as client data arrives. Any damage or discrepancies will be reported immediately and addressed immediately.

Chain of Custody Verification — Once the data is received, another check is done on all seals of the boxes.

Once security seals are removed, we verify contents again. If at any time any security issues happen to arise, clients will be notified immediately.

Audit Tracking & Quality Control Reporting — Every employee is mandated to enter all quality control, monitoring, and progress into our tracking system. Reporting is constantly being done to ensure job is on track.

All scanning is done with an operator standing next to the scanner to make sure all pages are scanned accurately and to check for double feed errors. The scanners are capable of scanning Bi-Tonal Black and White, 255 Gray Scale, Full 24-bit Color. Scanner software can output the image to all major file formats.

Kofax VRS Image Enhancement Software is utilized to provide the optimal quality image - De -speckling, De - Page oF 4
City of Yucaipa Scanning Services
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skewing, image rotation, Background suppression, Adaptive threshold, Edge enhancement, and gray tone filtering. Scanner Technicians live monitor the size, resolution and format of each document scanned using the tags/markers placed by the Document Preparation team. The files are always processed together to ensure the documents remain in the same order. Standard documents will be scanned in PDF, bi-tonal (black and White) at 300 dpi, large format documents at 300 dpi, and for documents that have been reduced, 400 dpi. Documents containing color will! Be scanned in color at 200 dpi or 300dpi, using lossless compression .JPG file formatting. Our process of creating PDF images, other file types, and indexing is as follows.

Document Preparation — Scanning sample boxes are an effective way to find out certain details of the specific job. These samples will determine the most accurate and efficient method to prepare the folder to be scanned. All staff will be trained in the job specific details and are assigned one single box at a time.

Items prepared prior to scanning including removing paperclips/staples, unfolding, utilizing copier technology to maximize scan quality, combine small documents and attached images, and anything we are not 100% clear on, we will place on the side and address with the client to ensure accuracy. If required, we are able to reassemble all data just as we picked it up with the exclusion of staples and paper clips.

Quality Assurance Document Preparation Verification — Our data sheets are updated in real time and if any problem is found, the document is sent back for reprocessing. The tracking report is updated once again, and the corrected data moves on to the next stage.

Scanning High Resolution Digital Imaging — Only the best technology available is used to provide the best outcome of a quality image. Scanning staff will be monitoring each image to ensure image is scanned correctly and no pages are double fed. The utilization of Kofax VRS Software allows for additional cleaning to be done such as de -speckle, de -skew, image rotation, background suppression, edge enhancement, gray tone filtering, blank page removal, and much more if need be.

Quality Assurance Image Quality — One of the most important parts of this process is having a human being review documents for accuracy and not solely rely on software and technology. Image quality is checked at multiple levels to ensure all images are acceptable and do not need to be reprocessed.

Indexing Verification —Staff are trained to manually index one image at a time per box to ensure accuracy every step of the way. Protocols and additional software is in place to make sure indexing errors do not occur such as misspelling or double keying entries.

Quality Assurance Indexing —Taking this process to the next level, we will compare the indexed data with the re -keyed data. If any mismatches are found, they are sent back and reprocessed until it is matched.

Data validation is performed utilizing character mix, date ranges, quantity ranges, including database lookups as well.

Page 3 ends

City of Yucaipa Scanning Services
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File Transfer and Upload — Once documents are ready for transfer/upload, data will be transferred to a file server with your encrypted data. From there instant access is available via VPN to search your data to view images and indexes, along with being able to start internal quality control as well. If encrypted hard drive is preferred, this exists as an alternative as well.

Return and Delivery of Completed Job — Once all files have been reviewed and cleared for approval, data will be repacked, and security labels placed once again. Delivery procedures are followed exactly how our pick-up procedure is, which is listed above with the focus on reliability and security.

HOURLY FEE SCHEDULE/PRICING
All document will be scanned in black and white other than wet signatures will be scanned in color.

File T • e
Price • er unit
Estimated Volume
Total
Permits
Letter Size Documents
$0.12
I
22,000
$2,640.00
Large Format Drawings B&W
$1.10
J
100
$110.00
Large Format Drawings Color
$1.25
100
$125.00
Subtotal
$2,875.00
Box Pickup/Delivery
$150.00
Laserfiche Ingestion
$450.00
Grand Total
$3,475.00
Document Prep (if any): $25/hour will be applied if boxes are handed to us and we need to remove mass amounts of staples, post it notes, paper clips, etc.

Data Entry/Indexing: $25/hour if additional indexing is required above and beyond file name and 2 index fields.

Pick up/delivery: $150 pickup fee with free delivery of documents when returned.

Laserfiche Ingestion: $450 for each upload which we upload all scanned images into the Laserfiche repository.

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ATTACHMENT 3

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
APR 2 9 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.

Be prepared to show proof of program/project cost in your Wrap-up Report (Accountability Report), detailing the applicants financial match of $500.

SECTION 1 — GENERAL INFORMATION
Name of Applicant/Organization:

Applicant/Organization Mailing Address:

Applicant/Organization Phone Number:

Contact (1)
Contact (2)
Rotary Club of Yucaipa
PO Box 661
( )
Henry Markowicz
Name Phone Number
E-mail address
DonnaKaye Ostrander
Name
Phone Number
E-mail address
SECTION 2 - ELIGIBILITY REQUIREMENTS:

City of Yucaipa Community Activity Grants Application, Rev. 04/2024

Page 1 ends

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:

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# 45-5149308
and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? 1956
0 40
53,000
Names and Titles of Officers and Board of Directors: (Please Henry Markowiz (President)
Donnakaye Ostrander (Public Relations)
Dan Hudec (President Elect)
Leslie Wessels (Secretary)
Chris Markarian (Treasurer)
Terry Knight (Club Administrator)
David Avila (Community Svcs)
Yes
attach an organization chart, if available)
Barbara Huffman (Membership)
No
Kent Colby (International Svcs)
Karen Colby (Youth Svcs)
SECTION 4 - PROGRAM DESCRIPTION/SCOPE: (PLEASE USE ADDITIONAL PAGES IF NECESSARY) Name of the program/event:

Date(s) of program/event:

Rotary Weekly Meetings
Every Tuesday (July 2, 2024-June 24, 2025)
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) Weekly Rotary Club Meetings at the Scherer Center Nutrition Facility. Open to the public 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:

The weekly club meetings allow Rotarians to discuss, plan, and implement community events, programs and services that benefit all ages in the community such as: Providing YHS & CHC Scholarships, Military Banner Program, Veterans support, meals to elders during Thanksgiving, Christmas & Easter, Annual Christmas Parade, Senior Center Park adoption, and post flags along Yucaipa Blvd. for the 4th of July, Memorial & Labor Day.

Program/Event Primary Target Population (check all that apply):

Children or Youth
Low Income
Persons with Disabilities
Number of Residents Projected to Serve: +/-5o @ mtgs
Seniors
Victims
Welfare Recipients
Women
Homeless
Entire Community
SECTION 5 — GRANT FUNDING REQUEST
Please identify what your organization is seeking:

Financial Support:

Yes
$200 SEP Fee
Waiver: TIYes
No $
Public
In -kind Support: Police $ Fire $ Works $ CS/Rental $ 9,576.00 OT/Reassigned
Staff $ Other $ Explain
$200 SEP Financial Total Overall
In -Kind Financial Support Fee Waiver Match Request /
Total Amount of Request: $ 9,576.00 $ $ $ = $ 9,576.00 1/ Provide a detailed description of how the financial support will be used:

NA
City of Yucaipa Community Activity Grants Application, Rev. 04/2024 Page 3

SECTION 6 — FINANCIAL CAPABILITIESBUDGET:

What other in-kind/financial contributions has your organization received to fund this event/program (separate from City funding)?
None - funds generated by Rotary
are used to support the services listed
in Section 4.

Total Funds Received To Date:

Total Funds Requested Via Grant Application:
$
$
$
$
$
In -Kind
Amount
$ 9,956
Remaining Balance That Will Be Funded By $
Organization:

Financial
Support Amount
SECTION 6 — FINANCIAL CAPABILITIESBUDGET (CONTINUED):

Provide City funding received by organization in the past three years (required):

Program
2023/2024 Wkly Mtgs
2022/2023 Wkly Mtgs
2021/2022 Wkly Mtgs
In -Kind
Financial $200 SEP
Support Fee Waiver
Date
Received
Total Received
6/26/23 $10,155
6/27/22 $ 9,126
5/24/21 $ 5,454
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 financiaLgrant amount needs to be spent prior to submitting another grant request.

Jigguarurc
Title
Date

TO BE COMPLETED BY CITY
Date Received:

Amount Funded:

Type of Grant:

C? , L�-
"� l
In -Kind
Date City Council received follow up report:

Date Reviewed:

City Council Meeting:
❑ Financial Support
5 [(Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 04/2024

Page 4 ends

Permit

COMMUNITY

SERVICES
Pars
Mk ie
i_tf
Better'.

City of Yucaipa Community PHONE:(909) 790-7460
Services FAX:(909) 790-2589
34272 Yucaipa Blvd EMAIL:communityservicesOyucaipa.org
Yucaipa, CA 92399
Organization Name Rotary Club Of Yucaipa - 336
Customer Type Non -Profit (R)
Organization Address PO Box 661
Yucaipa, CA 92399
Agent Name Donnakaye Ostrander Home Phone Number
System User Julia Base
Yucaipa Rotary Weekly Meetings
Booking Summary
Permit # R6456
Status Tentative
Date Apr 25, 202410:45 AM
Expiration Date Apr 25, 2025
Rental Fee $10,640.00
Discounts -$1,064.00
Subtotal $9,576.00
Deposits $250.00
Deposit Discounts $0.00
Total Permit Fee $9,826.00
Total Payment $0.00
Refunds $0.00
Balance $9,826.00
1 resource(s) 38 booking(s) Subtotal: $9,826.00
SrC Nutrition Center (Indoor Reservations) Center. Yucal • ` - nior Ce

START DATE/TIME
Tue, Jul 9, 2024 6:30 AM

END DATE/TIME
Tue, Jun 17, 2025 830 AM
Occurs every Tuesday effective 07/09/2024 until 06/17/2025 from 6:30 AM to 8:30 AM.

Tue, Jul 9, 2024 6:30 AM Tue, Jul 9, 2024 8:30 AM
Rental - Hourly $140.00 / Hour x 2 $230.00
Resident Discount -'10% -10% x 1-$28.00

ATTENDEE
40 AMT W/O TAX
$9,575.00
$252.00
Tue, Jul 16, 2024 6:30 AM Tue, Jul 16, 2024 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $280.00
Resident Discount -10% -10% x 1-$28.00
Tue, Jul 23, 2024 6:30 AM Tue, Jul 23, 2024 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $280.00
Resident Discount -10% -10% x 1 -$23.00
Tue, Aug 6, 2024 6:30 AM Tue, Aug 6, 2024 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $280.00
Resident Discount -10% -10% x 1 -$28.00
Tue, Aug 13, 2024 6:30 AM Tue, Aug 13, 2024 8:30 AM 40 $252.00 # R6456 Status Tentative Page 1 of 5

Rental - Hourly $140.00 / Hour x 2 $280.00
Resident Discount - 10% -10% x 1-:$28.00
Tue, Aug 20, 2024 6:30 AM Tue, Aug 20, 2024 8:30 AM 40 $252.00 Rental - Hourly $140.00 J Hour x 2 $280.00
Resident Discount - 10% -10% x 1-$28 00
Tue, Sep 3, 2024 6:30 AM Tue, Sep 3, 2024 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $280.00
Resident Discount -10% -10% x 1-$28.00
Tue, Sep 10, 2024 6:30 AM Tue, Sep 10, 2024 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $280.00
Resident Discount - 10% -10% x 1-$28.00
Tue, Sep 17, 2024 6:30 AM Tue, Sep 17, 2024 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $280.00
Resident Discount -10% -10% x 1 -$28.00
Tue, Oct 1, 2024 6:30 AM Tue, Oct 1, 2024 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $280.00
Resident Discount - 10% -10% x 1-$28.00
Tue, Oct 8, 2024 6:30 AM Tue, Oct 8, 2024 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $280.00
Resident Discount - 10% -10% x 1-$28.00
Tue, Oct 15, 2024 6:30 AM Tue, Oct 15, 2024 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $280.00
Resident Discount - 10% -10% x 1-$28.00
Tue, Oct 22, 2024 6:30 AM Tue, Oct 22, 2024 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $280.00
Resident Discount -10% -10% x 1 -$28.00
Tue, Nov 5, 2024 6:30 AM Tue, Nov 5, 2024 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $280.00
Resident Discount - 10% -10% x 1 -$28.00
Tue, Nov 12, 2024 6:30 AM Tue, Nov 12, 2024 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $220.00
Resident Discount - 10% -10% x 1 -$28.00
Tue, Nov 19, 2024 6:30 AM Tue, Nov 19, 2024 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $230.00
Resident Discount - 10% -10% x 1-$28.00
Tue, Dec 3, 2024 6:30 AM Tue, Dec 3, 2024 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $280.00
Resident Discount - 10% -10% x 1 -$28 00
Tue, Dec 10, 2024 6:30 AM Tue, Dec 10, 2024 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $280.00
Resident Discount - 10% -10% x 1-$28.00
Tue, Dec 17, 2024 6:30 AM Tue, Dec 17, 2024 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $280.00
# R6456 Status Tentative

Page 2 of 5 ends

Resident Discount-10%-10%x'I-$23.00
Tue, Jan 7, 2025 6:30 AM Tue, Jan 7, 2025 8:30 AM 40 $252.00 Rental - Hourly $140 00! Hour x 2 $280.00
Resident Discount -10% -10% x 1 -$28.00
Tue, Jan 14, 2025 6:30 AM Tue, Jan 14, 2025 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $280.00
Resident Discount - 10% -10% x 1 -$28.00
Tue, Jan 21, 2025 6:30 AM Tue, Jan 21, 2025 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $280.00
Resident Discount - 10% -10% x 1-$28.00
Tue, Feb 4, 2025 6:30 AM Tue, Feb 4, 2025 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $280.00
Resident Discount -10% -10% x 1 -$28.00
Tue, Feb 11, 2025 6:30 AM Tue, Feb 11, 2025 8:30 AM 40 $252.00 Rental - Hourly $140 00 / Hour x 2 $280.00
Resident Discount - 10% -10% x 1 -$28.00
Tue, Feb 18, 2025 6:30 AM Tue, Feb 18, 2025 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $280.00
Resident Discount - 10% -10% x 1-$28.00
Tue, Mar 4, 2025 6:30 AM Tue, Mar 4, 2025 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $230.00
Resident Discount - 10% -10% x 1 -$28.00
Tue, Mar 11, 2025 6:30 AM Tue, Mar 11, 2025 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $280.00
Resident Discount - 10% -10% x 1-$28.00
Tue, Mar 18, 2025 6:30 AM Tue, Mar 18, 2025 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $230 00
Resident Discount -10% -10% x 1-$22.00
Tue, Apr 1, 2025 6:30 AM Tue, Apr 1, 2025 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $230.00
Resident Discount -10% -10% x 1-$28 00
Tue, Apr 8, 2025 6:30 AM Tue, Apr 8, 2025 8:30 AM 40 $252.00 Rental - Hourly $140.00./ Hour x 2 $280.00
Resident Discount - 10% -10% x 1-$28.00
Tue, Apr 15, 2025 6:30 AM Tue, Apr 15, 2025 8:30 AM 40 $252.00 Rental - Hourly $140.00 i Hour x 2 $280.00
Resident Discount - 10% -10% x 1-$28.00
Tue, Apr 22, 2025 6:30 AM Tue, Apr 22, 2025 8:30 AM 40 $252.00 Rental - Hourly $140 00! Hourx 2 $230.00
Resident Discount - 10% -10% x 1-$28.00
Tue, May 6, 2025 6:30 AM Tue, May 6, 2025 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $230.00
Resident Discount -10% -10% x 1 -$28 00
# R6456
Status Tentative Page 3 of 5

Tue, May 13, 2025 6:30 AM Tue, May 13, 2025 8:30 AM 40 $252.00 Rental - Hourly $140.O0 / Hour x 2 $280.00
Resident Discount-10% -10% x 1 -$23.00
Tue, May 20, 2025 6:30 AM Tue, May 20, 2025 8:30 AM 40 $252.00 Rental - Hourly $140.001 Hour x 2 $280,00
Resident Discount -'10% -10% x 1 -$28.00
Tue, Jun 3, 2025 6:30 AM Tue, Jun 3, 2025 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $280.00
Resident Discount -10% -10% x 1 -$28.00
Tue, Jun 10, 2025 6:30 AM Tue, Jun 10, 2025 8:30 AM 40 $252.00 Rental - Hourly $140.00 / Hour x 2 $280.00
Resident Discount - 10% -10% x 1 -$28 00
Tue, Jun 17, 2025 6:30 AM Tue, Jun 17, 2025 8:30 AM 40 $252.00 Rental - Hourly $140.00 !Hour x 2 $280.00
Resident Discount -10% -10% x 1-$28.00
Resource level fees $250.00
Deposit $250.00 / Each x 1 $250.00
Waivers and Information

INFORMATION DESCRIPTION
Alcohol Sales Lic
Proof of Liability Insurance
Security Guard Contract
Proof of Non Profit Status

WAIVER NAME
Facility Usage Waiver

DUE DATE
Jul 9, 2024
FOR

SIGNING STATUS
Checked
Checked
Checked
Checked

I have read the rules and regulations relating to use of facilities and accept responsibility for meeting the requirements stated herein.

Signature
Deposit

EVENT RESOURCE DEPOSIT FEE CHARGE TAX AMOUNT PAID REFUNDS BALANCE # R6456 Status Tentative Page 4 of 5

Yucaipa SrC Deposit $250.00 $0.00 $0.00 $0.00 $250.00
Rotary Nutrition
Weekly Center
Meetings
Payment Schedules Original Balance: $9,826.00 Current Balance: $9,826.00

DUE DATE AMOUNT DUE AMOUNT PAID WITHDRAWAL ADJUSTMENT BALANCE Jun 25, 2024
$9,826.00 $0.00
$0.00 $9,826.00
# R6456 Status Tentative Page 5 of 5

ATTACHMENT 4

CITY O�
-toe'

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION

COMMUNITY ACTIVITY GRANT APPLICATION INSTRUCTIONS
Fiscal Year:

Date Application submitted:
2024-2025
4/30/2024
Submit to:

City of Yucaipa
General Services/City Clerk Department
34272 Yucaipa Blvd.

Yucaipa, CA 92399
Attn: Kimberly Metzler
Received
City of Yucaipa
MAY 01 2024
Genera! Services/
City Clerk's Department
All sections of the application must be returned complete, anri all 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 fund: 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 $500.

SECTION 1 —GENERAL INFORMATION
Name of Applicant/Organization:

Applicant/Organization Mailing Address:

Applicant/Organization Phone Number:

Contact (1)
Contact (2)
Childhood Cancer Foundation of Southern California
11155 Mountain View Ave, Suite 105, Loma Linda, CA 92354 1 Angelica Tapia
Name Phone Number
[email protected]
E-mail address
Carmina Tejeda
Name
[email protected]
Phone Number
E-mail address
SECTION 2 - ELIGIBILITY REQUIREMENTS:

City of Yucaipa Community Activity Grants Application, Rev. 04/2024

Page 1 ends

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:

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#33-0536599 and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? 43 3
500+
115
Yes
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Peter Brierty, President
Frank Schnetz, Vice President
No
Wayne Williams, Treasurer Terry Lundy, Secretary
Sara Romero, Member
Rebecca Hoggarth, Member
Ryan Stelzner, Member
SECTION 4 - PROGRAM DESCRIPTION/SCOPE: (PLEASE USE .ADDITIONAL PAGES IF NECESSARY) Name of the program/event:

Date(s) of program/event:

Spring EGGstravaganza
April 5, 2025
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) Receiving non-profit status in September of 1981, Childhood Cancer Foundation is now more than 820 families strong committed to serving children with cancer and their families throughout Southern California, emotionally, financially, educationally and with emergency assistance. The Spring EGGstravaganza is an opportunity for families to interact in a relaxed setting and enjoy an activity with other parents and families experiencing childhood cancer. The event has an average attendance of 150 patients, siblings and parents. Through this program we serve as an integral support service for families facing the challenges that a cancer diagnosis can manifest in their lives.

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:

Childhood Cancer Foundation of Southern California serves 115 individuals from the city of Yucaipa.

Our program is geared to offer emotional, social, educational, and emergency assistance for the entire family - not only the patient. When a child is diagnosed with cancer, the entire family is impacted by this life threatening disease. We can measure the impact and success of our individual programs through family and community participation. Widening participation from members of the community and patient families is a strong indicator of a successful program. It is difficult to measure "support" and the impact it might have, but families and members of the community would not continue to participate in our events if they did not realize a benefit in participating.

Program/Event Primary Target Population (check all that apply):

Children or Youth
Low Income
Persons with Disabilities
Number of Residents Projected to Serve: 50
Seniors Women
Victims l l Homeless
Welfare Recipients Entire Community
SECTION 5 — GRANT FUNDING REQUEST
Please identify what your organization is seeking:

Financial Support: [-Yes
$200 SEP Fee
Waiver:

Yes ON°
In -kind Support: Police $
Public
Fire $ Works $ CS/Rental $ 800
OT/Reassigned
Staff $ Other $ Explain
$200 SEP Financial Total Overall
In -Kind Financial Support Fee Waiver Match Request
Total Amount of Request: $eoo $ $200 $ _ $1,000
Provide a detailed description of how the financial support will be used:

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)?
Jersey Mike's Subs (Projected)
Donations to event
Total Funds Received To Date:

Total Funds Requested Via Grant Application:

Remaining Balance That Will Be Funded By $
Organization:

In -Kind
Amount
1,500
3,500
1,000
Financial
Support Amount
SECTION 6 — FINANCIAL CAPABILITIES/BUDGET (COt TINCED):

Provide City funding received by organization in the past three years (required):

Program
Spring Egg Hunt 2024
Spring Egg Hunt 2023
Spring Egg Hunt 2022
In -Kind
Financial $200 SEP Date
Support Fee Waiver Received
6/28/2023
7/6/2022
5/27/2021
Total Received
$1,000
$ 310.25
$684
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. v
Signature
Program Director 4/30/2024
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
❑ Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 04/2024

Page 4 ends

CHILDHOOD CANCER FOUNDATION
OF SOUTHERN CAUFORNIA, INC.

April 30, 2024
Dear friends at The City of Yucaipa,
I'd like to first offer a generous THANK YOU for your continued support of our program and the many families we serve.

On behalf of Childhood Cancer Foundation of Southern California, I wish to respectfully request your support of the Annual Spring Egg Hunt to be held on April 5, 2025.

Receiving non-profit status in September of 1981, Childhood Cancer Foundation of Southern California, Inc. (CCFSC) is now more than 800 families strong committed to serving children with cancer and their families throughout Southern California emotionally, financially, educationally and with emergency assistance. The Spring Egg Hunt is an excellent opportunity for the families to interact in a relaxed setting and enjoy an activity with other parents and families experiencing childhood cancer. The Egg Hunt has an average attendance of 150 patients, siblings and parents.

Every two minutes a parent hears the devastating news, "Your child has cancer." With these words, normal life stops and a difficult new journey begins; a journey that will test families physically, emotionally, socially, and financially. Families dealing with cancer use every last resource to fight the disease in an effort to keep their child alive.

More children die of cancer than of any other disease, including asthma, diabetes, cystic fibrosis, congenital anomalies and AIDS, COMBINED.

Through this event, Childhood Cancer Foundation of Southern California will serve as an integral support service for children and their families facing the challenges that cancer can manifest in their lives on a daily basis and throughout the year. We greatly appreciate your continued support of our children and their families throughout the years. It is donors like you that help us spread smiles and hope.

We would like to respectfully request your consideration of an In -Kind donation of the use of Community Park Facilities in order to help make this event possible. We recognize that our organization is located outside of the community and also request an exception to that requirement as part of the application.

Thank you for your consideration of our request. Should you have any questions or require additional information, please feel free to contact me at (909) 558-3419.

Childhood Cancer Foundation is a 501c3 Registered Non -Profit Organization, 33-0536599.

Respectfully,
Angelica Tapia
Program Director

pfr,-,i40-4' SHELTER RESERVATION APPLICATION
City of Yucaipa Community Services Department
Step One- Information
Angelica Tapia
Name of Rental Applicant (please print clearly)
11155 Mountain View Ave Loma Linda CA
Phone Number
92354
Address: Street
Childhood Cancer Foundation
City Zip
11155 Mountain View Ave, Loma Linda, CA 92354
Organization Name (if applicable) Address Phone Number
Primary email of Rental Applicant: atapia©ccfsocal.orq
Designated Event Representative (if Applicant will not be present):

Name Phone Number
Step Two- Event
Type of Event: ❑Meeting ❑Birthday ❑Family Gathering 0 Reception/Banquet ❑ Shower- Baby ❑ Bridal/Wedding Names of Event: Other: Egg Hunt
# of Attendees: 150
Date(s) of Use: April 5, 2025
Day: ❑M OTu OW OTh OF VSa OSu
*Hours requested include the time it takes to set up and clean-up the event. Total Number of Hours: 7 hours Step Three- Details
Is the applicant a non-profit? �"
If yes, non-profit #33-0536599 Is the event a fundraiser? ❑Yes sg o Will there be a bounce house?
❑Yes VNo Will you have any of the following: 1DJ ❑ Band Step Four — Facility
Yucaipa Community Park:
'Amphitheater arge Shelter 2 ❑Medium Shelter 3 & 4 ❑Medium Shelter 5 & 6 ❑Small Shelter 1 0Small Shelter 3 0Small Shelter 4 0Small Shelter 5 0Small Shelter 6 0Small Shelter 7 0Small Shelter 8 csci Drop off area/ Loop: 11 am - 12pm Wildwood Park:
0Small Shelter 1
Ave I Park:
0Small Shelter 1 0Small Shelter 2 ❑Medium Shelter 3 0Small Shelter 4 0Small Shelter 5 7th Street Park
0Small Shelter 1 ❑Medium Shelter 2 ❑Medium Shelter 3 ❑Large Shelter 4 Step Five — Review City Policies
Insurance
A. The Applicant shall purchase or provide and maintain general liability insurance and the coverage shall be in the amount of $1 million for bodily injury, personal injury, and property damage. General liability and liquor liability shall be endorsed naming the City of Yucaipa, its officers, agents, employees, and volunteers as additional insured. Each policy required by this clause shall be endorsed to state that coverage shall not be cancelled or changed except after thirty (30) days written notice has been given to the City. Use of the facility will be denied if satisfactory proof of the required insurance is not timely received prior to the event. The insurance company must have an AM Best Rating of VII or better.

Cancellations/Refunds
A. Cancellation of a rental less than thirty-(30) days will result in loss of 100% of the rental fees and deposit (if applicable).

B. Any cancellations prior to thirty days (30) will result in a loss of 50% of the rental fees. All refund requests are subject to a $15.00 processing fee.

C. Refunds will be approved if rain or inclement weather occurs on the day of shelter reservation. A refund request form must be completed and submitted within seven (7) days after reservation for refunds to be honored.

Park Shelters Rules
A. City organized activities shall have priority use over all requests. When possible, neither user shall interfere with the other's use. Sufficient prior notification of canceled requests will be given by the City when possible.

B. Permit Holder/Requestor(s) and event attendees must adhere to the rules and regulations governed by the City (reference City Park Ordinance No. 127). Failure of adherence to such rules and regulations may result in suspension of use or dismissal from the facility.

C. No amplified sound permitted.

D. Due to the unavoidable seasonal and recreational circumstances/activities, there is no guarantee concerning the condition of the shelter and the surrounding area. The City will maintain the shelter to the best of their ability prior to the event.

E. Smoking is prohibited in all City parks and facilities (reference City Park Ordinance No. 256).

F. Alcoholic beverages prohibited unless prior approval as a condition of a Special Event Permit.

G. No wood burning campfires or propane grills permitted, Charcoal only.

H. Motor vehicle use is prohibited on surfaces other than those maintained and specifically designated (reference City Park Ordinance No. 127). NOTE: If motor vehicles are found on prohibited surfaces, $50 will be deducted from the deposit.

Bounce Houses/Jumpers
A. Permit Holder/Requestor must first obtain a Facility Use Agreement for the use of the park and indicate on the Agreement that a bounce house will be used as part of the event (Yucaipa Municipal Code 12.04,281).

Permit Holder/Requestor and bounce house company must execute a written agreement (between the two parties) and agree to indemnify and defend the City from any liability related to the use of a bounce house. A Certificate of Insurance and Endorsement is required for all bouncers in City parks. The Certificate of Insurance and Endorsement must list the City as additionally insured (per Section VIII of this document). The Bounce House Rules and Regulations form and Insurance documents must be received by the Community Services Department fourteen (14) days prior to the event date.

D. The City reserves the right to limit the number and size of bounce houses being used. Only small bounce houses are permitted (18'x18'x18' max). Larger sized bounce houses are permitted only with a Special Event Permit and with Director approval.

E. Bounce houses are to be set up only by the bounce house company in compliance with manufacturer specifications.

F. Bounce house companies will be responsible for providing a generator for the inflation of the bounce house. The City does not provide electricity. The generator must be quiet rated at 60dB or less and not generate noise in excess of City standards. The generator shall be placed a safe distance from the bounce house and electrical cords covered to prevent tripping hazards. Additional gasoline cans MUST NOT be stored next to the generator.

G. The bounce house company must provide a fire extinguisher that is equipped to extinguish any fire that may occur.

H. Bounce houses and generators will be placed at locations designated on the Facility Use Agreement application: Community Park:
(Shelters 2, 3, 4, & 7); Ave I Park: (Shelters 1, 2, 3, 4); 7th Street Park: (Shelters 1, 2, 3); and Wildwood Park: (Shelter 1).

I. Bounce houses must be under supervision by an adult at all times. Permit Holder/Requestor must provide adequate supervision so that the use is in compliance with manufacturer recommendations and reflects safe levels of operation.

J. Bounce houses are not allowed in City parks overnight unless approved as part of a Special Event Permit.

K. Bounce houses must be free standing and weighted. Stakes are prohibited in City parks unless approved as a special condition of a Special Use Permit. Bounce houses must not be tied or tethered to trees, tables, or other park amenities.

L. Permit Holder/Requestor is responsible for all damage caused by their use of the park or bounce house. Damage to City property or turf may result in loss of deposit.

M. NO VEHICLES ARE ALLOWED IN CITY PARKS, ON TURF, OR ON WALKWAYS UNLESS APPROVED AS PART OF A SPECIAL USE PERMIT.

N. The City is not responsible for any damage to the bounce house.

O. Failure by the Permit Holder/Requestor or vendor to adhere to these policies will result in the immediate removal of bounce house from the park and may result in the denial of future use of City parks and facilities. Damages to the park resulting from use of a bounce house are the financial responsibility of the Permit Holder/Requestor.

P. Authorized Jumper Companies:

Jump N Jump Rentals: 909-873-8487 I Jolly Jumps: 877-694-1994 Step Five- Signature, Please Read Carefully Before Signing Facility user hereby agrees to indemnify, defend and hold harmless City of Yucaipa, its officers, officials, employees and volunteers from and against all claims, damages, losses and expenses that may arise during or be caused in any way by such occupancy or use of facilities, but the facility user shall not be liable for any claims, damages, losses and expenses caused by the sole negligence or willful misconduct of the City of Yucaipa.

Applicant Signature: _
Date: 4/30/2024

CITY OF YUCAIPA

SPECIAL EVENT PERMIT

WELCOME TO THE CITY OF YUCAIPA
Thank you for your interest in hosting a Special Event in the City of Yucaipa. The Community Services Department
created this application to help you host a successful and exciting event here in Yucaipa. Please review and complete the following application in accordance with the provided information. A special event in the City of Yucaipa is
defined as a "Carnival", "Community Celebration", or
"Outdoor Festival" which includes the use of amplified
sound and/or estimated attendance equal to or exceeding 300 people on City or private property. Except as otherwise provided by state law, no person or entity shall operate, maintain, conduct, advertise, or provide admission for any temporary special event within the City of Yucaipa without possessing a permit for each such temporary special event (Ord. No. 384).

PROCEDURES
A complete permit application may be filed as early as one (1) year before the event, but it must be received no later than three (3) months before the actual event date. Any organized activity involving the use of, or having impact upon, public property, facilities, public parks, sidewalks or street areas requires a permit. Applicants requesting a waiver of fees or services must submit their application a minimum of six (6) months in advance.

The permit application process begins when you submit a complete Special Event Permit application. Keep in mind that acceptance of your application should in no way be construed as final approval or confirmation of your request. Upon receipt of your application, the Special Events Supervisor will help guide you through the permit process. Copies of the application are forwarded and reviewed by all affected departments and/or agencies. During the review process, you will be notified if your event requires any additional information, permits, licenses or certificates. During our initial application screening process, you will be allowed time to provide us with all pending documents. We must receive these items before issuing a Special Event Permit (i.e., certificates of insurance, secondary permits, etc.). Delays in providing these items often delay our ability to finish our review and approve your application in a timely manner. Special Event Permits can be approved administratively by City management under specific limited criteria. Events that exceed those criteria will require the approval of City Council:

City Management/Administrative Approval
• Estimated attendance 300-999 persons
• Amplified Sound (excluding Special Event Facilities)
City Council Approval
• Estimated attendance 1000+ persons
• Alcohol Service (excluding Community Centers and YPAC) • Street Closure — traffic management
• Fee Waiver/Co-Sponsorship/In-Kind (Community Activity Grant Application required)

APPLICATION
11Page

Il
fio'01-

CITY OF YUCAIPA

SPECIAL EVENT PERMIT

APPLICATION
Organization and Applicant Information 33-0536599
Commercial (For -profit) Ial Noncommercial (Non-profit) Tax I.D. #:

Organization
Name
Childhood Cancer Foundation of Southern California, Inc.

Applicant Name
Angelica Tapia
Address
11155 Mountain View Ave, Suite 105, Loma Linda, CA 92354 Email
[email protected]
Phone Number
On -Site Contact
Angelica Tapia
Phone Number
Event Information
Type of Event:

Circus/Carnival
❑Concert/Performance n Parade/Procession/March ❑Other (specify):

I
Athletic/Recreation 0 Festival/Celebration ❑ Outdoor Market n Event Title
Spring EGGstravaganza
Event Location
Drop off Loop Area / Amphitheather & Shelter 2
Event
Description
Egg Hunt event for families of Childhood Cancer Foundation. Event to include game & activity tables, giveaways, food, and egg hunt.

Free event for all families.

Please complete a daily breakdown of event -related activities. Use multiple lines to distinguish between different daily activities. Please attach additional sheets if necessary.

Date(s)
Daily Activity
Start Time
End Time
4/5/2025
I Set-up I 1 Event Day I I Clean-up
9am
11am
4/5/2025
I 1 Set-up IU1 Event Day ❑ Clean-up
11 am
12pm
4/5/2025
Set-up ■ Event Day I I Clean-up
12:30pm
3pm
4/5/2025
I I Set-up I I Event Day n Clean-up
3pm
4pm
I I Set-up ❑ Event Day I I Clean-up
n Set-up I I Event Day I I Clean-up
Has this event taken place before? ■ Yes
Total anticipated attendance:
150
11 years in Yucaipa
No How many years?
Participants: 150 Spectators:

Wage

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CITY OF YUCAIPA

SPECIAL EVENT PERMIT

APPLICATION
Site Plan
Attach a diagram showing the overall layout and setup locations using the letters below.

Indicate the site for these on your diagram.

A. Alcoholic and nonalcoholic concession and/or beer garden areas B. First -aid facilities and ambulance locations
C. Tables and chairs
D. Fencing, barriers and/or barricades
E. Generator locations and/or source of electricity
F. Canopies or tent locations
G. Booths, exhibits, displays or
enclosures
H. Scaffolding, bleachers,
platforms, stages,
grandstands and related
structures
I. Vehicles and/or trailers
J. Other related event
components not covered
above (describe
separately)
K. Trash containers and
dumpsters
L. Non-food vendor locations
M. Food concession and/or
food preparation areas
N. Potable toilet location(s)
Sample Site Plan:

When planning a moving route, the Yucaipa Police Department is available to assist you in planning your route. Consider the following in your planning:
• Impedance of emergency fire, police or paramedic vehicles. • Conflict with public transportation, such as buses.
• Interference with people trying to reach their own residences, businesses, places of worship and public facilities.

If your event involves street closures, you may be required to obtain traffic safety equipment, and a certified traffic control plan. Depending on the type of event, barricades, traffic cones, signs, etc., may be required. Depending on the type of event and after evaluating roadway conditions, you may be required to properly place this equipment prior to commencing the event. If the closure creates a potential hazard, your organization will be required to contract traffic service from the Yucaipa Police Department and/or Street Division. 3IPage

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CITY OF YUCAIPA

SPECIAL EVENT PERMIT

APPLICATION
List street(s) requiring closure as a result of this event. Include street name(s), day, date, and time of closing and time of reopening:

Partial closure of the drop off loop area as indiacted on diagram.

Indicate how this closing/reopening of streets will be handled:
n City of Yucaipa to handle (cost to be specified) Event to handle per CalTrans standards
List street(s) requiring the posting of "No Parking" signs. Indicate days, dates, and times needed and an explanation of necessity of "No Parking" zone:

Partial closure of the drop off area loop area as indicated on diagram.

Note: "No Parking" signs will be posted forty-eight (48) hours in advance of required days, dates and times. Cost for the posting of No Parking"signs will be specified upon review of the application by City staff Food and Beverage
Please describe how food will be served at the event:

Food to be picked up from local restaurant and served on location Will food be cooked in the event area? I I Yes ill No
Method: Gas [ .I Electric I I Charcoal Other (specify):

Does the event involve the sale or use of alcoholic beverages? Yes n No
If alcohol is to be sold, how will the alcohol sales be regulated? Who will be handling the alcohol sales?
Restrooms
Portable restrooms are required when estimated attendance exceeds what the host facility's restrooms can accommodate. One portable restroom is required for every 50 patrons attending over the minimal site accommodations.

Will Event Organizer provide portable restroom facilities? Yes [■1 No
4IPage

CITY OF YUCAIPA

SPECIAL EVENT PERMIT

APPLICATION
Company
Name
Contact Name
Phone Number
Lighting
If this is an evening event, please state how the event and surrounding areas will be illuminated to ensure the safety of the participants and spectators. (If required, show a separate site map which details streetlights, portable lights, and other illuminating devices.) Waste Removal
Event Organizer is responsible for arranging for the removal of all waste related to the event.

This includes but is not limited to emptying of trash bins and the removal of waste from the event site and other affected areas. If hiring a professional sanitation company, please rovide the following information.

Company
Name
Contact Name
Phone Number
If not hiring a professional sanitation company, please provide the following information for the person(s) responsible for waste removal.

Contact Name
Phone Number
Cal Fire/Medical
In case of an emergency, the on -site contact will call 9-1-1. If event requires an ambulance company to be on -site, please provide the following information:

Company
Name
Contact Name
Phone Number
Wage

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CITY OF YUCAIPA

SPECIAL EVENT PERMIT

APPLICATION
Please describe your medical plan including your communications plan, the number, certification levels (MD, RN, Paramedic, EMT) and types of resources that will be at your event and the manner in which they will be managed and deployed. Your plan should include hours of setup and dismantle of medical aid areas. You may attach the plan to this application if necessary:

Police Services/Security
In the event that a carnival/street fair and/or alcohol service will be included in the event, an
alcohol garden and security plan will need to be submitted as well as a security contract and/or public safety staffing plan for review by the Police Department.

Is there a professional security organization hired for this event? n Yes No
Company
Name
Contact Name
Phone Number
Please describe your security plan including crowd control, internal security or venue safety, or attach the plan to this application:

Entertainment
Will sound amplification be used? [J Yes
Are there any musical entertainment features for this event? I
No Start time: 11 am
Yes
End time: 3pm
f�l
No
Name of Act
Contact Name
Phone
Number
enc
How many stages? 0 Number of bands? 0 Genre of music: °' `dm'"`° ""'°°" Will fireworks, rockets, or other pyrotechnics be used? Yes [■I No
Company
Name
6IPage

c"I 11' nlfaal4

CITY OF YUCAIPA

SPECIAL EVENT PERMIT

APPLICATION
Contact Name
Phone Number
Describe (indicate dates, times and locations for launching and fallout areas):

Has a permit been issued: n Yes I I No
(Note: Additional permits may be required as indicated by staff These include, but are not limited to, Conditional Use 24 Permit, Land Use Permit, and Fire Department permits.) Insurance
Before a Special Event Permit is issued, a certificate of insurance must be submitted.

Insurance certificate must be issued by insurance underwriters "admitted" by the California Insurance Commission and rated 'A' or better by AM Best. Requirements are:
• Minimum $1,000,000 General Liability Limit
• Minimum $1,000,000 General Automobile Liability
• Minimum $1,000,000 Worker's Compensation
• On an additional insured endorsement, the City, its elected officials, officers, and agents are to be named as additional insured
• Minimum limits of coverage may change depending on event [1 Insurance certificate attached n Insurance certificate on file n Insurance certificate not available
Filing Fees
Special Event Permit Application Fee : $200.00
* Other Fees may apply (e.g. street closures, Fire Permit/Inspections, utilities, facility rental, etc.)
7IPage

Application Checklist
■
fl
CI
Completed Application
• Certificate of liability insurance
Site Plan (location of structures, lighting, restrooms, parking, etc.) Copy of Security Contract (if applicable)
Copy of Potable Restroom purchase order (if applicable) n Facility or Shelter Reservation Application (if applicable) Copy of ABC License (if applicable)
Copy of County Health Permit (if applicable)
■
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CITY OF YUCAIPA

SPECIAL EVENT PERMIT

APPLICATION
By signing below, I agree to indemnify, hold harmless, and defend the City and its officials, employees, and agents, against all claims, liabilities, and losses arising from activities connected with or undertaken pursuant to the Permit. The City is not liable for any business loss, property loss, or other damage that may result from the use of the Permit, or suspension or revocation of the Permit.

Angelica Tapia 4/30/2024
Name: Signature U Date:

Wage

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CHILCAN-01
ACORO
`� CERTIFICATE OF LIABILITY INSURANCE

MM/D ( DATE D/YYYY)
MM/D24
THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS

CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.

IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.

If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).

PRODUCER License # 0C36861
San Diego-Alliant Insurance Services, Inc.
701 B St 6th FI
San Diego, CA 92101
CONTACT Diana Barrios
PHONE 1 FAX
(A/C, No, Ext): (A/C, No):
nt iJ $S: [email protected]

INSURER(S) AFFORDING COVERAGE
NAIC b
INSURER A : Nonprofits Insurance Alliance of California 00000

INSURED
Childhood Cancer Foundation of Southern California
PO Box 1663
Loma Linda, CA 92354
INSURERB:State Compensation Insurance Fund of California 35076
INSURER C :

INSURER D :

INSURER E :

INSURER F :
•
REVISION NUMBER:

THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS

CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.

INSR
LTR

TYPE OF INSURANCE
ADDL
INSD
SUBR
WVO

POLICY NUMBER

POLICY EFF
(MM/DDr YYY)

POLICY EXP
fMMIDD/YYYYI
LIMITS
A
X

COMMERCIAL GENERAL LIABILITY
X
2024-10610
3/14/2024
3/14/2025

EACH OCCURRENCE
$ 1,000,000

DAMAGE TO RENTED
PREMISES (Ea occurrence)
500,000
$

CLAIMS -MADE X
OCCUR
MED EXP (Any one person)
$ 20,000

PERSONAL & ADV INJURY
$ 1,000,000

GENERAL AGGREGATE
$ 2,000,000
GEN'L

AGGREGATE
POLICY
OTHER:

LIMIT APPLIES PER:

PRO- I I LOC
JECT

PRODUCTS - COMP/OP AGG
$ 2,000,000
$
A

AUTOMOBILE
X
_

LIABILITY

ANY AUTO
OWNED

AUTOS ONLY
HIRED

AUTOS ONLY
_

SCHEDULED
2024-10610
3/14/2024
3/14/2025

COMBINED SINGLE LIMIT
(Ea accident)
1,000,000
$
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$

PROPERTY DAMAGE
(Per accident)
$
S
_

UMBRELLA LIAB

EXCESS LIAB
O
OCCUR

CLAIMS -MADE

EACH OCCURRENCE
$

AGGREGATE
$
$
DED
RETENTION $
B

WORKERS COMPENSATION

AND EMPLOYERS' LIABILITY
ANY

ANYIPROPRIETOREMBER PARTNER/E ECUTIVE
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
YIN
N / A
164661923
8/18/2023
8/18/2024
y
X
PER

STATUTE
TH-
OER
E.L. EACH ACCIDENT
1,000,000
$
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
1,000,000
S
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Event: Spring EGGstravaganza
Event Date: March 16, 2024
Event Location : Yucaipa Community Park - 34900 Yucaipa Blvd., Yucaipa CA 92399 City of Yucaipa is Additional Insured with respects to General Liability.

CERTIFICATE HOLDER

CANCELLATION
City of Yucaipa
34272 Yucaipa Blvd.

Yucaipa, CA 92399

SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE

THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS.

AUTHORIZED REPRESENTATIVE
�- r
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.

The ACORD name and logo are registered marks of ACORD

POLICY NUMBER: 2022-10610 COMMERCIAL GENERAL LIABILITY
Named Insured: Childhood Cancer Foundation of Southern California CG 20 26 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.

ADDITIONAL INSURED - DESIGNATED

PERSON OR ORGANIZATION
This endorsement modifies insurance provided under the following:

COMMERCIAL GENERAL LIABILITY COVERAGE PART

SCHEDULE
Name Of Additional Insured Person(s) Or Organization(s):

Any person or organization that you are required to add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization.

Information required to complete this Schedule, if not shown above, will be shown in the Declarations.

A. Section II — Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property damage" or "personal and advertising injury'
caused, in whole or in part, by your acts or
omissions or the acts or omissions of those acting
on your behalf:

1. In the performance of your ongoing operations;
or

2. In connection with your premises owned by or
rented to you.

However:

1. The insurance afforded to such additional
insured only applies to the extent permitted by
law; and

2. If coverage provided to the additional insured is
required by a contract or agreement, the
insurance afforded to such additional insured
will not be broader than that which you are
required by the contract or agreement to
provide for such additional insured.

B. With respect to the insurance afforded to these
additional insureds, the following is added to
Section III — Limits Of Insurance:

If coverage provided to the additional insured is
required by a contract or agreement, the most we
will pay on behalf of the additional insured is the
amount of insurance:

1. Required by the contract or agreement; or

2. Available under the applicable Limits of
Insurance shown in the Declarations;
whichever is less.

This endorsement shall not increase the
applicable Limits of Insurance shown in the
Declarations.

CG 20 26 12 19
© Insurance Services Office, Inc., 2012 Page 1 of 1

EGGSTRAVAGANZA
I lAM - i11h�M
Ill- OP
1PM -
SATURDAY, APRIL 5, 2025

YUCAIPA COMMUNITY PARK
34900 OAK GLEN RD, YUCAIPA CA 92399

FREE EVENT FOR FAMILIES OF

CHILDHOOD CANCER FOUNDATION

FAMES MUST PRE -REGISTER BY MARCH II
www.ccfsocal.org/egg

CHILDHOOD CANCER FOUNDATION
OF SOUTHERN CALIFORNIA, INC.

GGSTRAVAGANZA
Yucaipa Community Park
3L900 Oak Glen Road
Yucaipa, CA, 92399
s
CARD TABLE - 5
6 FT TABLE - 12
5 FT TABLE - 1
10'X10' EZUP - 9

SPONSOR WILL BRING
10'X10' EZUP - 5

CCF WILL BRING
10'X20' EZUP - 2
CHAIRS - 12
i1iliiii OM* iimimili, --_ _
ay-. SP //A

HOTOBAC
Saturday, April 5, 20:

Drive-thru: 11a m - 12
In -person: 1pm - 3pr
its lifr4,*41ift *f$ f#1/4-ff't'Ff
141/

Permit

COMMUNITY
pole' SERVICES
City of Yucaipa Community PHONE:(909) 790-7460
Services FAX:(909) 790-2589
34272 Yucaipa Blvd EMAIL:communityseniices@@yucaipa.org Yucaipa, CA 92399
Organization Name
Customer Type
Organization Address
Childhood Cancer Foundation Of Southern
Calif. - 371
Non -Profit (NR)
11155 Mountain View Ave. Ste. 105
Loma Linda, CA 92354
Organization Phone 1
Number
Permit # R6477
Status Tentative
Date May 1, 2024 2:05 PM
Expiration Date May 1, 2025
Agent Name Angelia Tapia Home Phone Number
Email Address [email protected]
System User Julia Basa
Childhood Cancer Foundation Egg Hunt
Booking Summary
Rental Fee $800.00
Discounts $0.00
Subtotal $800.00
Deposits $100.00
Deposit Discounts $0.00
Total Permit Fee $900.00
Total Payment $0.00
Refunds $0.00
Balance $900.00
2 resource(s) 2 booking(s) Subtotal: $900.00
Amphitheater (Shelter Facilities)
Center. Yucaipa Community Center

START DATE/TIME
Sat, Apr 5, 2025 7:00 AM
Resource level fees

END DATE/TIME
Sat, Apr 5, 2025 8:00 PM

ATTENDEE
150

AMT W/O TAX
$0.00
$600.00
Shelter p2 Large (Shelter Fadlitles)
Center. Yucaipa Community Center

START DATE/TIME
Sat, Apr 5, 2025 7:00 AM
Resource level fees
Custom Questions

QUESTION

END DATE/TIME
Sat, Apr 5, 2025 8:00 PM
ANSWER

ATTENDEE

AMT W/O TAX
$0.00
$300.00
# R6477 Status Tentative

Page 1 of 3 ends

A. Any Cancellation of a rental less than 30 days will result in loss of 100% of the rental Acknowledge fees and deposit (If applicable). B. Any cancellations prior to 30 days will result in a loss of 50% of the rental fees and deposit (if applicable). All refund requests are subject to a $15.00 processing fee. C. Refunds will be approved if rain or inclement weather occurs on the day of shelter reservation. Refund request form must be submitted within 7 days after reservation to be honored.

I acknowledge and agree that bounce houses are only permitted at designated shelters. Acknowledge Community Park: Shelters 2, 3, 4, & 7 Ave I Park: Shelters 1, 2, 3, 4 7th Street Park:

Shelters 1, 2, 3 Wildwood Park: Shelter 1
I acknowledge and agree the following Bounce House rules: 1)Bounce houses are to be Acknowledge set up only by the bounce house company. 2)Bounce house companies will be responsible for providing a generator for the inflation of the bounce house. The City does not provide electricity. The generator must be quiet rated at 60dB or less and not generate noise in excess of City standards. 3)Bounce houses are not allowed in City parks overnight.

I acknowledge and agree to the following policies regarding bounce houses: 1) Bounce Acknowledge houses must be free standing and weighted. Stakes are prohibited in City parks. 2) Permit Holder/Requestor is responsible for all damage caused by their use of the park or bounce house. Damage to City property or turf may result in additional fees incurred. 3) The City is not responsible for any damage to the bounce house.

I acknowledge and agree to the following rules and policies regarding Bounce Houses: 1) Acknowledge Bounce Houses/Jumpers must be booked through authorized companies only. Failure to do so will result in Company and/or event to be shut down. 2) The City reserves the right to limit the number and size of bounce houses being used. Only small bounce houses are permitted (18'x18'x18' max). Larger sized bounce houses are permitted only with a Special Event Permit and with Director approval.

I acknowledge and agree to: 1)Permit Holder/Requestor(s) and event attendees must adhere to the rules and regulations governed by the City. 2) Failure by the Permit Holder /Requestor or vendor to adhere to these policies will result in the immediate removal of bounce house from the park and may result in the denial of future use of City parks and facilities. Damages to the park resulting from use of a bounce house are the financial responsibility of the Permit Holder/Requester.

I acknowledge and understand that all park shelter reservations include an insurance fee. Applicant shall purchase or provide and maintain general liability insurance and the coverage shall be in the amount of $1 million for bodily injury, personal injury, and property damage. General liability and liquor liability shall be endorsed naming the City of Yucaipa, its officers, agents, employees, and volunteers as additional insured.

Acknowledge
Acknowledged
I agree and acknowledge that the information provided to this application is correct and Acknowledge City organized activities shall have priority use over all requests. Sufficient prior notification of canceled requests will be given by the City when possible.

I agree and acknowledge to follow the following park shelter rules: 1) No amplified sound Acknowledge permitted. 2) Smoking is prohibited in all City parks and facilities (reference City Park Ordinance No. 256). 3)Alcoholic beverages prohibited unless prior approval as a condition of a Special Event Permit. 4)No wood burning campfires or propane grills permitted, Charcoal only. 5)NO VEHICLES ARE ALLOWED IN CITY PARKS, ON TURF, OR ON WALKWAYS UNLESS APPROVED AS PART OF A SPECIAL USE PERMIT.

What is your type of event? Other (May require approval) Will there be a bounce house? If yes, I acknowledge and agree that bounce houses are No required to be reserved through the City of Yucaipa's authorized bounce house companies only. Not outside companies or personal bouncers permitted. Approved Vendors: Jolly Jumps www.jollyjumps.net or (877)694-1994 Jump N Jump www. jumpnjump.com or (909)873-8487
Deposit
# R6477 Status Tentative Page 2 of 3

EVENT RESOURCE DEPOSIT FEE CHARGE TAX AMOUNT PAID REFUNDS BALANCE Childhood Amphitheater Deposit
Cancer
Foundation
Egg Hunt
$100.00
$0.00 $0.00
$0.00 $100.00
Payment Schedules Original Balance: $900.00 Current Balance: $900.00

DUE DATE AMOUNT DUE AMOUNT PAID WITHDRAWAL ADJUSTMENT BALANCE Mar 22, 2025 $900.00 $0.00 $0.00 $900.00
# R6477 Status Tentative Page 3 of 3

5/2/?P, 8:30 AM
PermitContract
Permit
City of Yucaipa Community PHONE.(909) 790-7460
Services FAX:(909) 790-2589
34272 Yucaipa Blvd ENTAIL:communityservicesayucaipa.org Yucaipa, CA 92399

COMMUNITY
401,; ,• SERVICES
N\a!{e
Bette
Permit # R6478
Status Tentative
Date May 2, 2024 8.29 AM
Expiration Date May 2, 2025
Organization Name
Customer Type
Organization Address
Childhood Cancer Foundation Of Southern
Calif. - 371
Non -Profit (NR)
11155 Mountain View Ave. Ste. 105
Loma Linda, CA 92354
Agent Name Angelia Tapia
System User Tish Christian
Organization Phone 1
Number
Home Phone Number
Email Address [email protected]
Rental Fee $200.00
Discounts $0.00
Subtotal $200.00
Deposits $0.00
Deposit Discounts $0.00
Total Permit Fee $200.00
Total Payment $0.00
Refunds $0.00
Balance $200.00
Childhood Cancer Foundation EGGstravaganza
Booking Summary
Special Event Permits (Special Event Application)

START DATE/TIME

END DATE/TIME
1 resource(s) 1 booking(s) Subtotal: $200.00
Center: Community Services Department

ATTENDEE AMT W/O TAX
Sat, Apr 5, 2025 9:00 AM Sat, Apr 5, 2025 4:00 PM
Special Event Fee (NR-V) $200.00 / Each x 1 $200.00
300
$200.00
Payment Schedules

DUE DATE

AMOUNT DUE
Original Balance: $200.00 Current Balance: $200.00

AMOUNT PAID I WITHDRAWAL ADJUSTMENT I BALANCE
Mar 22, 2025
$200.00 $0.00 $0.00 $200.00
https://anprod.active.com/yucaipa/ui.do?method=showPermitContract&permit_id=COB106870634 1/1

CITY OF YUCAIPA

SPECIAL EVENT PERMIT

WELCOME TO THE CITY OF YUCAIPA
C 17)i I(, 0(,( C'(B,�Cc-�
Thank you for your interest in hosting a Special Event in the City of Yucaipa. The Community Services Department
created this application to help you host a successful and exciting event here in Yucaipa. Please review and complete the following application in accordance with the provided information. A special event in the City of Yucaipa is
defined as a "Carnival", "Community Celebration", or
"Outdoor Festival" which includes the use of amplified
sound and/or estimated attendance equal to or exceeding 300 people on City or private property. Except as otherwise provided by state law, no person or entity shall operate, maintain, conduct, advertise, or provide admission for any temporary special event within the City of Yucaipa without possessing a permit for each such temporary special event (Ord. No. 384).

APPLICATION
11Page

ATTACHMENT 5

CITY of

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION

COMMUNITY ACTIVITY GRANT APPLICATION INSTRUCTIONS
Fiscal Year:

Date Application submitted:
2024-2025
5/10/2024
Submit to:

City of Yucaipa
General Services/City Clerk Department
34272 Yucaipa Blvd.

Yucaipa, CA 92399
Attn: Kimberly Metzler
Received
City of Yucaipa
MAY 0 9 2024
General Services/
City Clerk's Department
All sections of the application must be returned complete, and all supporting documentation must be included as part of the submittal. Incomplete applications received will be returned to the applicant.

Note: Beginning with the FY.2025/26 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 $500.

SECTION 1 — GENERAL INFORMATION
Name of Applicant/Organization:

Applicant/Organization Mailing Address:

Applicant/Organization Phone Number:

Contact (1)
Contact (2)
Strada Corsa dba YUCAIPA BMX
Yucaipa, CA 92399
Tim Hansen
Name Phone Number
[email protected]
E-mail address
Wendy Montgomery
Name
Phone Number
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.

City of Yucaipa Community Activity Grants Application, Rev. 04/2024

Page 1 ends

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:

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)? r °
If yes, please provide Tax IDit45-5 1 80240 and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status'? 12 1
12 1000-2500
Yes
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Tim Hansen (President)
Wendy Montgomery- Treasurer
No
n
SECTION 4 - PROGRAM DESCRIPTION/SCOPE: (PLEASE USE ADDITIONAL PAGES IF NECESSARY) Name of the program/event:

Date(s) of program/event:

Yucaipa BMX
year round
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) City of Yucaipa Community Activity Grants Application. Rev. 0,112024 Page 2

Describe how the prograrn/event benefits the residents and/or community of Yucaipa:

Yucaipa BMX has been a big success in the Inland Empire BMX community (and surrounding counties). Yucaipa BMX has had the highest average rider count in Southern California and there is data showing more participation in BMX compared to Little League in the area.

The track is a welcoming place for riders and families in Yucaipa, as well as neighboring cities.

Our goal was/ and continues to provide a safe and inviting sports venue that would allow kids (of all ages) to stay active and healthy.

Program/Event Primary Target Population (check all that apply):

Children or Youth
11 l Low Income
Persons with Disabilities
Seniors
Victims
Welfare Recipients
Number of Residents Projected to Serve: ,m =
✓
Women
Homeless
Entire Community
SECTION 5 — GRANT FUNDING REQUEST
Please identify what your organization is seeking:

Financial Support:

Yes
No $3500
$200 SEP Fee
Waiver: n1es No
In -kind Support: Police S
Public
Fire S Works S
OT/Reassigned
Staff $ Other $ Explain
CS/Rental. S
$200 SEP Financial Total Overall
In -Kind Financial Support Fee Waiver Match Request
Total Amount of Request: S $ �v) 0c, $ $ = $ .3 j•{7)
1 Provide a detailed description of how the financial support will be used:

We have a fleet of BMX loaner bikes. The bikes allow a rider to come and try BMX without having any of the necessary equipment. The bikes are loaned out at no charge. Totally free.

These bikes have been in service for several years and they need to be replaced. The intent is to also add more bikes that we can offer
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)?
donations
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
500
$ 3500
1000
SECTION 6 — FINANCIAL CAPABILITIES/BUDGET (CO:NMM I ED,:

Provide City funding received by organization in the past three years (required):

Program
In -Kind Financial $200 SEP Date
Support Fee Waiver Received
Total Received
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 trant amount needs to he spent prior to submitting another grant request.

Signature LT
President 5/10/2024
Title
Date

TO BE COMPLETED BY CITY
Date Received:

Amount Funded:

Type of Grant:
$
II
In -Kind
Date City Council received follow up report:

Date Reviewed:

City Council Meeting:

Financial Support
—1 Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev, 04/2024

Page 4 ends

Kim J Metzler, CMC, CPM
From: Yucaipa BMX
Sent: Friday, May 10, 2024 7:40 AM
To: Kim J Metzler, CMC, CPM
Subject: Community Activity Grant application -Yucaipa BMX Attachments: CAG-signed-Yucaipa BMX.pdf
Follow Up Flag: Follow up
Flag Status: Flagged
Hello Kim,
My name is Tim Hansen. I operate Yucaipa BMX. We are the BMX track in between YAPS and the high school. We would like to apply for the Community Activity grant.

I have attached our application. Please let me know if I missed anything, or you need additional information from me.

Thank you for your consideration
Thank you
Tim Hansen
Yucaipa BMX
1 ATTACHMENT 6

CITY OF
yam.

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 15 2024
General Services/
City Clerk's Department:

All sections of the application must be returned complete, and all 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 $500.

SECTION I — GENERAL INFORMATION
Name of Applicant/Organization:

Applicant/Organization Mailing Address:

Applicant/Organization Phone Number:

Contact (1)
Contact (2)
Yucaipa Woman's Club aka Woman's Club of Yucaipa
P.O.Box 153, Yucaipa, CA 92399
Virginia Cosby
Name Phone Number
[email protected]
E-mail address
Sharon Ring
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 nfvnraina Cnmmnnity Artivitvflrantc Annliratinn Rev 04/2(17.4 Pace 1

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#95-1640492 and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? 1912
How long has your 501(c) organization been in existence? Number of Employees working for organization:

Number of Volunteers working for organization:

Date(s) of program/event:

Building maintenance
tba
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) The Yucaipa Woman's Club owns a clubhouse that is 102 years old. The members work to maintain it in a usable and beautiful condition. It is a California Historic Point of Interest. We are asking for funds to continue upkeep on the building the cost of which is above what fundraising and donations bring to the treasury.

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:

The Yucaipa Woman's Club clubhouse is available for not only our members but all residents of the community. It is used for weddings, receptions, workshops, classes, dances, and meetings of other organizations. Some club fundraisers are earmarked for donation to civic projects.

Program/Event Primary Target Population (check all that apply):

Children or Youth
Low Income
Persons with Disabilities
Number of Residents Projected to Serve: ail
Seniors I I Women
Victims Homeless
Welfare Recipients I - I Entire Community
SECTION 5 — GRANT FUNDING REQUEST
Please identify what your organization is seeking:

Financial Support:
$200 SEP Fee
Waiver:

Yes
Yes
In -kind Support: Police $
No $9e 3 Pod _
�10
Public
Fire $ Works $ CS/Rental $
OT/Reassigned
Staff $ Other $ Explain
$200 SEP Financial Total Overall
In -Kind Financial Support Fee Waiver Match Request
Total Amount of Request: $ •$`4tjee- $ $ = $4
Provide a detailed description of how the financial support will be used:

We are asking financial assistance for these areas:
* Gutters. last year our roofer removed existing gutters and did not replace them. We are unable to reach settlement with them but we need the gutters now. Any money received from a future settlement will be used for the clubhouse. Quotes were all just over $2000, we have not chosen a contractor yet.
*tea room floor - the room is tiled and some tiles are coming lose due to water leakage. It is becoming a safety hazard. Estimated cost $3500.
*Painting of some walls. One stage wall and one main hall wall need to be painted for sure. This is quoted (verbal) at $600. It would be best to repaint the entire inside of the stage and main hall as it has not been done in at least 20 years. Estimated cost $2200.

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)?
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 CAPABILITIES/BUDGET (CO!VTI\C ED):

Provide City funding received by organization in the past three years (required):

Program
2023-2024
In -Kind Financial $200 SEP Date
Support Fee Waiver Received
Total Received
May 2023 $2050
$
$
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
Trustee
Title
5/14/2024
Date

TO BE COMPLETED BY CITY
Date Received:

Amount Funded:

Type of Grant:
5 - 2 L
❑ In -Kind
Date City Council received follow up report:

Date Reviewed:

City Council Meeting:
❑ Financial Support
n Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 04/2024

Page 4 ends

American Sheet Metal Specialties, Inc.
2025 Mentone Blvd, Unit 0
Mentone, CA 92359
(909)794-7010
Lic# 859704 / DIR Lic# 1000790068
Email: ame{ ioasisheet:mnetaisK©oniaii.com
Proposal
Project: Womens Club
35215 Ave A Yucaipa CA
4/26/24
Furnish & Install Per Plans & Specifications
New seamless gutters @ all areas with existing downspout locations.

Re -use 3 downspout locations for new gutters
Replace 4 downspouts w/ new 4 locations to match all others Color to be determined by owners rep
Color of choice from color standard chart

Exclusions:Rigid Insulation,Gang pipe enclosure, clad metal roofing scuppers, roof vents/caps ,solatubes, duct vents/caps,duct flashings, Sump/Lead Drain Flashing, Mechanical Vents/caps.Prefinished Storefront Aluminum cladding break metal.

Metal Awnings or Canopies . Roof Screen Frame/Structure & Panels ,Trellis Structures . Any parapet or roof substrate. EIFS metal flashing, membranes, or plaster metal drips,screed, millcore, etc. Trash Enclosure Structure and deck & flashing. All paint,high temp butyl flashing membrane, cold fluid applied waterproofing, or self adhered flashings by others unless noted specifically. ANY AND ALL METAL NOT DESCRIBED IN ABOVE PROPOSED DESCRIPTION.

Thank you for the opportunity.

Robert Adame
to me
11:32AM
(13
minutes
ago)
Please accept our proposal for the above referenced project. Feel free to reach out with any questions or concerns. We can meet up to choose the color when you are ready and walk the job for a clear understanding of everything that will be provided. Thank you in advance for your consideration.

Robert Adame President
American Sheet Metal Specialties
2025 Mentone Blvd, Ste "O" Mentone, CA 92359
P: 909.794.7010 F: 909.794.6084 Direct: (909) 435-6258
a mericansheetmetalsp_cpgmaiil.com__
AGREED AND ACCEPTED:

NAME

TITLE DATE

ATTACHMENT 7

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION

COMMUNITY ACTIVITY GRANT APPLICATION INSTRUCTIONS
Fiscal Year:

Date Application submitted:
2024-2025
05/15/2024
Submit to:

City of Yucaipa
General Services/City Clerk Department
34272 Yucaipa Blvd.

Yucaipa, CA 92399
Attn: Kimberly Metzler
Hecelved
City of Yucaipa
MAY 2 0 202.4
General Services/
City Clerk's Department
All sections of the application must he returned complete, and all 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 (00% 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 S500.

Be prepared to show proof of program/project cost in your Wrap-up Report (Accountability Report), detailing the applicants financial match of $500.

SECTION l — GENERAL INFORMATION
Name of Applicant/Organization:

Applicant/Organization Mailing Address:

Applicant/Organization Phone Number:

Contact (1)
Contact (2)
Smiles for Seniors
P.O. Box 1113 Yucaipa Ca 92399
Catherine Serianni
Name Phone Number
smiles4seniors©yahoo.com
E-mail address
Name
( )
Phone Number
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.

City olYucaipa Community Activity Grants Application, Rev. 04/2024 Page I

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.

Yes
Is your organization a 501(c)?
If yes, please provide Tax ID#26-0373602
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:
2007
2 35
100
No
✓
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Don Bagwell- President Ret. Navy, Retired USPS, Community Volunteer Sabrina Ferras- Technical Support, Web Designer Kathy Dexter- Vice PresidenLVeterans Administration Community Service Specialist Stephanie Robertson- TreasurerBusiness Owner/ Community Volunteer Gloriselda Garcia- Secretary, Senior Housing Manager and Community Liaison N,aclau Cm,ssmao. AIcntn,Sc,„ , Sarvvcas CUQanVala,I Aaa,nM,alut al AssislcJ Lmi,p and Man,ory Cara Brandy Gomez- MemberRet. Navy/ Financial Advisor and Fiduciary Peggy Murphy- MemberSatellite Radio Dee Jay/ Senior Housing Manager Del Laurerback-Member, Community Volunteer
SECTION 4 - PROGRAM DESCRIPTION/SCOPE: (PLEASE USE ADDITIONAL PAGES IF NECESSARY) Name of the program/event:

Date(s) of program/event:

Low Income Senior Assistance Fund
06/01 /2024-06/01 /2025
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) Enclosed in proposal
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:

Enclosed in proposal
Program/Event Primary Target Population (check all that apply):
✓
Children or Youth
Low Income
Persons with Disabilities
Number of Residents Projected to Serve: 40+
✓
Seniors
Victims
Welfare Recipients
✓
✓
Women
Homeless
Entire Community
SECTION 5 — GRANT FUNDING REQUEST
Please identify what your organization is seeking:

Financial Support:

Yes
$200 SEP Fee
Waiver: nYes
No $3,000
✓❑No
Public
In -kind Support: Police $ Fire $ Works $ CS/Rental $
OT/Reassigned
Staff $ Other $ Explain
S200 SEP Financial Total Overall
In -Kind Financial Support Fee Waiver Match Request
Total Amount of Request: $ $3,000 $ $ = $
Provide a detailed description of how the financial support will be used:

If granted funding, we will use it to provide low income seniors much needed basic needs such as food, housing, utility assistance, life saving medications and medical equipment just to name a few.

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)?
ARPA
Various contributions, Corporations, Foundations,Individuals, Fundraisers
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
$ 21,450.00
$ 16,000
$ 10,000
$
$
SECTION 6— FINANCIAL CAPABILITIES/BUDGET (CONTINUED):

Provide City funding received by organization in the past three years (required):

Program
Low Income Seniors Assistance
Low income Seniors Assistance
Low Income Seniors Assistance
In -Kind
Financial $200 SEP Date
Support Fee Waiver Received
Total Received
7/27/2023 $3,000
07/20/2022 $2,800
08/19/2021 $3,587.00
SECTION 7 — CERTIFICATION
1, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand 011 he p. arded financial grant amount needs to be spent prior to submitting another grant request.

Signature
Executive Director
Title
05/20/2024
Date
Date Received:

Amount Funded:

Type of Grant:
ri In -Kind
Date City Council received follow up report:

Date Reviewed:

City Council Meeting:

Financial Support
E Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 04/2024

Page 4 ends

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ATTACHMENT 8

CITY OF

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION

COMMUNITY ACTIVITY GRANT APPLICATION 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 0 nil
General Services/
City Clerks 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.

Be prepared to show proof of program/project cost in your Wrap-up Report (Accountability Report), detailing the applicants financial match of $500.

SECTION 1— GENERAL INFORMATION
Name of Applicant/Organization:

Applicant/Organization Mailing Address:

Applicant/Organization Phone Number:

Contact (1)
Contact (2)
Yucaipa Pickleball, Inc.

Patty Ingram
Name Phone Number
[email protected]
E-mail address
Richard Rios
Name
Phone Number
E-mail address
SECTION 2 - ELIGIBILITY REQUIREMENTS:

City of Yucaipa Community Activity Grants Application, Rev. 04/2024

Page 1 ends

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:

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# 87- 1 919072 and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? 07/17/2021
0 30 varies
+/- 3000
$40 / year for play during organized time and events , $3 drop in fee Yes
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Patricia Ingram, President Debra Hitter - Secretary
No
Richard Rios, Vice President Melinda Daniel - Youth Coordinator Char Broersma, Treasurer Dennis Banaag - Adult Coordinator John Manly, Facility Coordinator
SECTION 4 - PROGRAM DESCRIPTION/SCOPE: (PLEASE USE ADDITIONAL PAGES IF NECESSARY) Name of the program/event:

Date(s) of program/event:

Pickleball in the Schools and Community Pickleball Day and Clinics 24/25 School year, & date TBD for Community Pickleball Day & Clinics Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) We want to continue our school program, where with last year's grant we served over 2500 students and gave over 750 volunteer hours. We went to 6 elementary schools, all 3 middle schools and the high school to teach pickleball to the kids.

We would like to hold a Community Pickleball Day to introduce the community to Pickleball.

We host low cost clinics and tournaments for the community for all ages from youth to seniors.

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:

1. Our Youth program has generated interest not only from the kids, but extends to theft families. With the new courts we will be able to offer programs during evenings and weekends.

2. Pickleball is one of the few athletic activites that seniors can particpate in due to it's low impact and low cost. It can imporve cardiovascular health, enhance mobility and coordination and reduce the risks of chroic diseases such as diabetes, heart disease and obesity.

3. Pickleball engages people of all ages. Our group supplies equipment to newcomers to introduce them to the sport.

Program/Event Primary Target Population (check all that apply):

Children or Youth
Low Income
Persons with Disabilities
Number of Residents Projected to Serve: 2000
Seniors
Victims
Welfare Recipients
Women
Homeless
Entire Community
SECTION 5 — GRANT FUNDING REQUEST
Please identify what your organization is seeking:

Financial Support:

Yes
$200 SEP Fee
Waiver: []Yes
In -kind Support: Police $
No $
OT/Reassigned
Staff $
Fire $
Other $
Public
Works $
CS/Rental $
Explain
$200 SEP Financial Total Overall
In -Kind Financial Support Fee Waiver Match Request
Total Amount of Request: $ $9,000 $ $4,500 = $4,500
Provide a detailed description of how the financial support will be used:

Purchase of Equipment:
20 Portable Nets = $3,000
200 Paddles = $4,000
500 Balls = $1,500
Supplies for Clinics/Pickleball Day = $500
Total: $9,000
City of Yucaipa Community Activity Grants Application, Rev. 04/2024 Page 3

SECTION 6 — FINANCIAL CAPABILITIESBUDGET:

What other in-kind/financial contributions has your organization received to fund this event/program (separate from City funding)?
Membership Dues
Clinics
Tournaments
Donations
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
$ 7000
$ 2000
$ 6000
$ 1000
$
$ 16,000
$ 4,500
$ 4,500
SECTION 6 — FINANCIAL CAPABILITIESBUDGET (CONTINUED):

Provide City funding received by organization in the past three years (required):

Program
CAG for Pickleball
In -Kind
Financial $200 SEP Date
Support Fee Waiver Received
Total Received
6/28/23 $2,450
$
$
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.

Patricia Ingram
Digitally signed by Pmnoa Ingram
DN: cis=Palroa Ingram, o=YUnipa Pickleball. Inc., ou=Yucapa Pickleball Youth Program. omail=yvnlpapickleb0P@gmail nm. c=US Data: 2024.05.16 14:32:27
Signature
President 5/18/24
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:
n Financial Support
❑ Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 04/2024

Page 4 ends

YUCAIPA PICKLEBALL invites YOUTH to
our

JUNIOR DIVISION TOURNAMENT
Rotating Partner Round Robin
(No partner needed)
GRADES 5-12 welcome
(Younger with prior approval)
Divisions will be created by skill & age
If entries allow.

WHEN: SATURDAY, May 11, 2024
Check in at 9:00 am
Games start at 9:30 am
WHERE: 7T" STREET PARK SHADE STRUCTURE
33994 Ave. E, corner of 7t" St., Yucaipa, CA
COST: $10
Registration open until full,
No refunds after May 1, 2024
Receipt of registration/entry fee holds slot
This is a covered facility so we should be a go rain or shine! Registration opens March 1, 2024
Click on TOURNAMENTS tab at www,yucaipapicklebalLcom
Pay with ZELLE to [email protected]
Or VENMO @yucaipa-pickleball-1
Or Pay on the registration website with credit card ($1 fee applies) Text Patty Ingram at 909-709-1770 for additional info.

SPONSORED BY:

SELl<IT21‹

YUCAIPA

PICKLEBALL

PICKLEBALL IN THE SCHOOLS
/ r
FY 2023-2024

YUCAIPA

PICKLEBALL
Supported by Yucaipa Pickleball, Inc. through a
Grant by the City of Yucaipa

WHAT's HAPPENING11
City Awarded Yucaipa Pickleball a $2450 grant to promote pickleball $350 Grant from USAP Youth Program Grant for each school Selkirk sports partnership
YPI will be donating one net, eight paddles and eight balls to each school.

Sys pools put in a request for courts to be painted at their sites YPI did a training with all of the elementary PE teachers rades 5-8 are part of our training program
2 PARTICIPATING SCHOoLS
Valley Elementary
O Dunlap Elementary
Chapman Heights Elementary
• Wildwood Elementary
• Ridgeview Elementary
® Calimesa Elementary
o Parkview Middle School
• Mesa View Middle School
Competitive Edge Charter Academy
Adult School ESL
O Wildwood Calvary Christian School
• STARS Program Schools
• Yucaipa High School Athletic Program
3 WI�Dl10DD

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9 ELEMENTAR?

TEACHER
�ii COLLABORATION
DAY
10 OUTLOOK:

After School Programs - over 50 students currently enrolled Anticipating 200 after school students
Elementary PE classes - over 500 students
Middle School PE classes - over 1900 students
VHS Athletic Conditioning Program - over 250 students
12 GROWTH POSSIBILITIES:

City is building 4 new permanent courts at 7th St. park Est. 3000 students will be taught before the end of the school year YPI offering youth leagues and tournaments
Families will be playing
0 Doubling our club size
Need for the completion of Phase 1 and Phase 2

THANK VOU
•l.
dii Ord Ali &di wi Ji AG& 4. zs. wl /ir. Alp pia Jrr arr Gi wAA pi Aida!

YUCAIPA

ILPICKLEBALL

ROTATING PARTNER

ROUND ROBIN

TOURNAMENT
WHEN: Saturday
April 27, 2024
COST: per event
$20 Yucaipa Club Members
$30 Non -Club Members
Minimum of 4 games guaranteed.

Medals for top 3 and random
prize drawings for players.

Full refund less $5 handling fee
prior to April 12, 2024.

Space is limited. Payment & Reg.
holds spot. No weather refunds.

WHERE: 7111 St Park
33994 Ave E, Yucaipa, CA
No partner needed.

Skill levels will be used where
possible. Random partner draw for
each game. Space is limited.

Men's Division: 9 am
Women's Division: 11 am
A l l ages
Senior Men's: 1pm
Senior Women's - 3pm
All players must be over 60.

For more info contact Patty
Ingram at
[email protected]
or text 909-709-1770
Bring snacks
and water.

YUCAIPA PICKLEBALL

BEGINNER CLINIC
Beginner and Low Intermediate players may register.

We will have groups based on skill level.

Yucaipa Pickleball is hosting a clinic focusing on Beginner Skills including scoring, serving, ground strokes, dinking and court positioning. Space is limited.

WHEN: Saturdays: Feb. 24 and March 2 (2 sessions)
1:00 pm — 3:00 pm
WHERE: 7th Street Park Courts
33994 Avenue E, Yucaipa, CA 92399
COST: $20 — for Yucaipa Pickleball Club Members
$30 — for Non -Members
(minors ages 10-15 must be accompanied by an enrolled adult) Receipt of registration/entry fee holds slot
No refunds after Feb 16, 2024
This is a covered facility so we should be a go rain or shine! Register on yucaipapicklehall.com
Pay via VENMO @yucaipa-pickleball-1
Or ZELLE— [email protected]
Or Pay on the registration website with credit card ($1 fee applies) Text Patty Ingram at 909-709-1770 or email: [email protected] for additional info.

YUCAIPA

PICKLEBALL

YUCAIPA PICKLEBALL CLINIC
Level up your game
Geared towards the Intermediate Player (3.0-3.5)
Things to be covered... Court Positioning, 3rd shot drops, 3rd shot drives, lobs and more!
WHEN: SATURDAY March 23, 2024
Check in at 12:30am
Clinic: 1:00pm - 3:00pm
Courts will be open at 8:30am for Open Play
WHERE: 7TH STREET PARK SHADE STRUCTURE
33994 Ave E, Yucaipa, CA
COST: $15 FOR YUCAIPA PICKLEBALL, INC. CLUB MEMBERS
$25 FOR NON - MEMBERS
Space is limited.

Minors, ages 10-15, must be accompanied by an adult.

Receipt of registration/entry fee holds slot
No refunds after March 15, 2024
This is a covered facility so we should be a go rain or shine! Register on 'ucaipapiciclehall.com
Pay via VENMO @yucaipa-pickleball-1
Or ZELLE— [email protected]
Or Pay on the registration website with credit card ($1 fee applies) Text Patty Ingram at 909-709-1770 or
email [email protected] for additional info.

Hosted by Yucaipa Pickleball, Inc.

YUCAIPA

PIGKLEBALL

Kim J Metzler, CMC, CPM
From: Yucaipa Pickleball
Sent: Saturday, May 18, 2024 2:56 PM
To: Kim J Metzler, CMC, CPM
Subject: Community Activity Grant Application
Attachments: 24-25 signed city grant application.pdf; youth flyer.pdf; fy 23-24 school program summary PP.pdf; 24.04 Rotating partner flyer.pdf; 24.02 beg clinic.pdf; 24.03 int clinic jpg
Kim,
Attached is our grant application for your review and consideration. I didn't see in the application a list of supporting documentation that was required. However, I did attach some information about events and programs we've offered in the past to support our continued desire to build pickleball in the community, youth through seniors.

Thank you for your consideration. Please let me know if you have any questions and that the application is complete.

Patty Ingram
Yucaipa Pickleball, Inc.
www.YucaipaPickleball.com
i

ATTACHMENT 9

CITY OF

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION

COMMUNITY ACTIVITY GRANT APPLICATION 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
5/17/24
Received
City of Yucaipa
MAY 20 20Q
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.

Be prepared to show proof of program/project cost in your Wrap-up Report (Accountability Report), detailing the applicants financial match of $500.

SECTION 1 — GENERAL INFORMATION
Name of Applicant/Organization:

Applicant/Organization Mailing Address:

Applicant/Organization Phone Number:

Yucaipa Valley Art Association
P.O. Box 404, Yucaipa CA 92399
( )
Contact (1) Zully Martinez
Contact (2)
Name Phone Number
[email protected]
E-mail address
Alan Remele
Name
Phone Number
E-mail address
SECTION 2 - ELIGIBILITY REQUIREMENTS:

City of Yucaipa Community Activity Grants Application, Rev. 04/2024

Page 1 ends

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# 95-3701090
and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? 43 years
0 How long has your 501(c) organization been in existence? Number of Employees working for organization:

Number of Volunteers working for organization:

If yes, please describe:
15 70+
Yes
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Zully Martinez, President and Board Member Karen Hoak, Ways & Means Alan Remele, Vice President and Board member
Bea Gardner, Secretary
Carol Maidlow, Treasurer
Enrique Lima, Public Exhibits
Bob Norris, publicity
Judy Remele, student scholarships
No
SECTION 4 - PROGRAM DESCRIPTION/SCOPE: (PLEASE USE ADDITIONAL PAGES IF NECESSARY) Name of the program/event:

Date(s) of program/event:

YVAA Art Meetings, weekly on Wednesdays
Sept 2024 through May 2025, Permit R6523
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) The Yucaipa Valley Art Association's will hold weekly art meetings to encourage any adult artists to participate in a group collaborative painting session with fellow artists. Participants bring their own supplies. This event is free and open to the public and the City can include this activity as part of community programs. YVAA will hold weekly painting sessions from 1:00 pm to 3:00 pm on Wednesdays at the Scherer Community Center located at 12202 1st Street, Yucaipa. Meeting schedule is outlined in Permit R6523.

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:

The Yucaipa Valley Art Association's small group painting sessions give artists in the community the opportunity to meet up in person to paint in a collaborative and peer group environment. The meetings help to promote art in our community and supports the creativity and talent of our local community members. Our community contributions and activities significantly increase awareness and appreciation for the artistic talent of our members and local community members.

Program/Event Primary Target Population (check all that apply):

Children or Youth
Low Income
Persons with Disabilities
Number of Residents Projected to Serve: 5-15 weekly
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: nVes
Public
In -kind Support: Police $ Fire $ Works $ CS/Rental $ 4,212.00 'v OT/Reassigned
Staff $ Other $ Explain
$200 SEP Financial Total Overall
In -Kind Financial Support Fee Waiver Match Request
Total Amount of Request: $ 4212.00 $ $ $ = $ 4,212.00
Provide a detailed description of how the financial support will be used:

The in -kind CAGrant support will be used to cover the cost to reserve a room for two (2) hours on a weekly basis on Wednesdays for meetings at the Scherer Center in room B from July 2023 to June 2024. This CAGrant covers rental costs for the weekly meetings year round. Activities will include art painting in any medium chosen by participant. This event is open to any adult, including our members and the general public who may wish to participate in a group painting session.

We cut 3 months (June, July, August) of our program last year due to CAG funding cuts in 2023-2024. This year we have a reduced schedule again, offering classes from Sept. 2024 thru May 2025.

City of Yucaipa Community Activity Grants Application, Rev. 04/2024 Page 3

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:

In -Kind
Amount
$0
Remaining Balance That Will Be Funded By $
Organization:

Financial
Support Amount
SECTION 6 — FINANCIAL CAPABILITIESBUDGET (CONTINUED):

Provide City funding received by organization in the past three years (required):

Program
YVAA Tues & Thur Mtgs.

Wednesday Art Mtgs.

Spring Art Show
In -Kind
Financial $200 SEP Date
Support Fee Waiver Received
Total Received
6/2023 $ 2957.67
6/2023 $ 4462.00
6/2022
$1689.00
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.

Zully Martinez
Digitally signed by Zully Martinez President
Date: 2024.05.17 14:20: 34-07'00'
Signature
Title
5/17/24
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
J U —
❑ Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 04/2024

Page 4 ends

Permit

COMMUNITY
?Or' SERVICES

1. EPARTMhi 1
Bett
City of Yucaipa Community PHONE:(909) 790-7460
Services FAX:(909) 790-2589
34272 Yucaipa Blvd EMAIL:communityservices*yucaipe.org
Yucaipa, CA 92399
Organization Name
Customer Type
Organization Address
Yucaipa Valley Art Association - 49
Non -Profit (R)
PO Box 404
Yucaipa, CA 92399
Agent Name Zully Martinez Home Phone Number
System User Julia Basa
Wednesday's Paint Sessions - YVAA
Booking Summary
Permit # R6523
Status Tentative
Date May 16, 2024 4:01 PM
Expiration Date May 16, 2025
Rental Fee $4,680.00
Discounts-$468.00
Subtotal $4,212.00
Deposits $250.00
Deposit Discounts $0.00
Total Permit Fee $4,462.00
Total Payment $0.00
Refunds $0.00
Balance $4,462.00
1 resource(s) 36 booking(s) Subtotal: $4,462.00
SrC Banquet Room B (Indoor Reservations) Center. Yucaipa Senior Center

START DATE/TIME
Wed, Sep 4, 2024 1:00 PM Wed, May 28, 2025 3:00 PM
Occurs on selected dates effective 09/04/2024 until 05/28/2025.

Wed, Sep 4, 20241:00 PM Wed, Sep 4, 2024 3:00 PM
Rental • Hourly S65 00 / Houi i< 2 5130 00
Resident Discount - 10% -10 x 1 -$13 00

END DATE/TIME

ATTENDEE
10 AMT W/O TAX
$4,212.00
$117.00
Wed, Sep 11, 20241:00 PM Wed, Sep 11, 2024 3:00 PM 10 $117.00 Rental - Hourly $65.00 / How x 2 $130 00
Resident Discount - 10% • 10% x i -$13 00
Wed, Sep 18, 2024 1:00 PM Wed, Sep 18, 2024 3:00 PM 10 $117.00 Rental - Hourly $65 00 / Houi x 2 $130.00
Resident Discount - 10''6 -10`: x t-$13.00
Wed, Sep 25, 2024 1:00 PM Wed, Sep 25, 2024 3:00 PM 10 $117.00 Rental - Hourly 565 00 / Hour x 2 $130 00
Resident Discount - 10% -10% x 1 -S i3.0C
Wed, Oct 2, 2024 1:00 PM Wed, Oct 2, 2024 3:00 PM 10 $117.00 # R6523 Status Tentative

Page 1 of 4 ends

- Hourly
Resident Discount -10%
Wed, Oct 9, 2024 1:00 PM
Rental - Ho Ir!y
Resident Discount - 10'n
Wed, Oct 16, 2024 1:00 PM
Rental - Hourly
Resident Discount - 10':,
Wed, Oct 23, 20241:00 PM
Rental - Hourly
Resident Discount - 10%
Wed, Oct 30, 20241:00 PM
Rental - Hourly
Resident Discount - 10%
Wed, Nov 6, 20241:00 PM
Rental - Hourly
Resident Discount - 10%
Wed, Nov 13, 2024 1:00 PM
Rental - Hourly
Resident Discount • 10^;,
Wed, Nov 20, 20241:00 PM
Rental Hourly
Resident Discount - 10"3
Wed, Dec 4, 2024 1:00 PM
Rental - Hourly
Resident Discount - 10%
Wed, Dec 11, 2024 1:00 PM
Rental Hourly
Resident Discount - 10%
Wed, Dec 18, 2024 1:00 PM
Rental - Hourly
Resident Discount - 10i,
Wed, Jan 8, 2025 1:00 PM
Rental - Hourly
Resident Discount - 103
Wed, Jan 15, 2025 1:00 PM
Rental - Houi ly
Resident Discount - 10:5
Wed, Jan 22, 2025 1:00 PM
Rental - Hourly
Resident Discount -'10"%
Wed, Jan 29, 2025 1:00 PM
Rental - Hourly
353 00 Hour x 2 5130.00
-10% x '1-313.00
Wed, Oct 9, 2024 3:00 PM 10 $117.00
S66.00 r' Ho'si x 2 $130 00
-10% x '1-S13.00
Wed, Oct 16, 2024 3:00 PM 10 $117.00
565.00 % Hour x 2 S130 00
x 1 -S13 00
Wed, Oct 23, 2024 3:00 PM 10 $117.00
565 00 / Hour x 2 S130.00
-10';41 -$13.00
Wed, Oct 30, 2024 3:00 PM 10 $117.00
56500!Hourx2 S13000
-10`o x I -S13 00
Wed, Nov 6, 2024 3:00 PM 10 $117.00
$65.00 / Hour x 2 $130 00
x 1-$13.00
Wed, Nov 13, 2024 3:00 PM 10 $117.00
S65.00 / Hour x 2 $130 00
0"sx 1 -51300
Wed, Nov 20, 2024 3:00 PM 10 $117.00
S65.001 Hours 2 5130 00
-10'%x I -S1300
Wed, Dec 4, 2024 3:00 PM 10 $117.00
565 00 ,' Hour x 2 5130.00
-10%x1 -$1300
Wed, Dec 11, 2024 3:00 PM 10 $117.00
565.00/Hourx.2 513000
-10% x 1-513.00
Wed, Dec 18, 2024 3:00 PM 10 $117.00
565 G0 r Hour x 2 5130 00
-10% s I -$13 00
Wed, Jan 8, 2025 3:00 PM 10 $117.00
$65.00 / Hour x 2 5130 00
.103x1-513.00
Wed, Jan 15, 2025 3:00 PM 10 $117.00
S65 00 ' Hour 2 $130 00
-10% x I-513.00
Wed, Jan 22, 2025 3:00 PM 10 $117.00
56500 Horn:<2 5130.00
IObx1-513.00
Wed, Jan 29, 2025 3:00 PM 10 5117.00
565 00 ! Hour x 2 $130 00
# R6523 Status Tentative

Page 2 of 4 ends

Resident Discount - 100-10°:i'< 1 -313 00
Wed, Feb 5, 2025 1:00 PM Wed, Feb 5, 2025 3:00 PM 10 $117.00 Rental - Houi ly 565.00 / Hour x 2 3130 CO
Resident Discount -10% -10% x 1 -$13 00
Wed, Feb 12, 2025 1:00 PM Wed, Feb 12, 2025 3:00 PM 10 $117.00 Rental - Hourly 565 00 / Hour x 2 $130 00
Resident Discount - 10",-10''.: x 1 -$13.00
Wed, Feb 19, 2025 1:00 PM Wed, Feb 19, 2025 3:00 PM 10 $117.00 Rental - Hourly 565.00 / Hour x 2 S130.00
Resident Discounr. - 10 -100 x 1-513.00
Wed, Feb 26, 2025 1:00 PM Wed, Feb 26, 2025 3:00 PM 10 $117.00 Rental - Hourly S65.00 / Hour x 2 $130 00
Resident Discount-10%-10%:<I -51300
Wed, Mar 5, 2025 1:00 PM Wed, Mar 5, 2025 3:00 PM 10 $117.00 Rental - Hourly $65.00 / Hour x. 2 S130 00
Resident Discount -10% -10°, x 1-513.00
Wed, Mar 12, 20251:00 PM Wed, Mar 12, 2025 3:00 PM 10 $117.00 Rental - Hourly $65 00 !Hour x 2 $130.00
Resident Discount - 10% -10% x 1 -S13 00
Wed, Mar 19, 2025 1:00 PM Wed, Mar 19, 2025 3:00 PM 10 5117.00 Rental - Hourly S65 00 / Hour x 2 5130.00
Resident Discount - 100, -10% x'I -$13.00
Wed, Mar 26, 2025 1:00 PM Wed, Mar 26, 2025 3:00 PM 10 $117.00 Rental - Hourly S65.00 / Hour x 2 $130 00
Resident Discount -10% -10% x 1 -513 00
Wed, Apr 2, 20251:00 PM Wed, Apr 2, 2025 3:00 PM 10 $117.00 Rental - Hourly S65.00 Hour e 2 $130 CO
Resident Discount -10% 100, x 1 -$13.00
Wed, Apr 9, 20251:00 PM Wed, Apr 9, 2025 3:00 PM 10 $117.00 Rental - Hourly 565 00 / Hour x 2 S 130.00
Resident Discount - 10` -10°0, x 1-513.00
Wed, Apr 16, 2025 1:00 PM Wed, Apr 16, 2025 3:00 PM 10 S117.00 Rental - Hourly $65 00 ; Hour x 2 S 130 00
Resident Discount - 101;; -10% x 1 -$13.00
Wed, Apr 23, 2025 1:00 PM Wed, Apr 23, 2025 3:00 PM 10 $117.00 Rental - Hourly 565.00 / Hour x 2 $130 00
Resident Discount -10% -10`,, x 1 -513 00
Wed, Apr 30, 2025 1:00 PM Wed, Apr 30, 2025 3:00 PM 10 $117.00 Rental - Hourly 565 00 - Hour, 2 $130 00
Resident Discount -10% -10°. x 1 -51300
Wed, May 7, 2025 1:00 PM Wed, May 7, 2025 3:00 PM 10 $117.00 Rental - Hourly S65 00 ' Hour x 2 $130.00
Resident Discount - 10%b -10' x 1-S13.00
# R6523 Status Tentative Page 3 of 4

Wed, May 14, 20251:00 PM Wed, May 14, 2025 3:00 PM 10 $117.00 P,enta: - Hourly S65.00 , Hour x 2 $130..00
Resident Dacount-10''- -10%xI-$13,00
Wed, May 21, 2025 1:00 PM Wed, May 21, 2025 3:00 PM 10 $117.00 Rental - Hourly 565 00 / Hour x 2 $130 00
Resident Discount -10% -105 x 1 -$13 00
Wed, May 28, 2025 1:00 PM Wed, May 28, 2025 3:00 PM 10 $117.00 Rental - Hourly S55.00 / Hour a 2 S130.00
Resident Discount - 10% -10% < I -513.00
Resource level fees $250.00
Deposit S250.00 i Each x. I S250 00
Waivers and Information

INFORMATION DESCRIPTION
Alcohol Sales Lic
Proof of Liability Insurance
Security Guard Contract
Proof of Non Profit Status

WAIVER NAME
Facility Usage Waiver

DUE DATE
Sep 4, 2024
FOR

SIGNING STATUS
Checked
Checked
Checked
Checked

Permittee shall have received any and all permission or Ilcense(s) as may be required to perform or use any protected materials in its use of the Premises. Permittee agrees to protect and save harmless the City, its elected officials, employees and agents from and against any and all claims, penalties, and/or damages which may accrue as a result of Permittee's failure to comply with this requirement.

I have read the rules and regulations relating to use of facilities and accept responsibility for meeting the requirements stated herein.

Signature
Deposit

EVENT RESOURCE DEPOSIT FEE CHARGE TAX AMOUNT PAID REFUNDS BALANCE Wednesday' SrC Deposit $250.00 $0.00 $0.00 $0.00 $250.00 s Paint Banquet
Sessions - Room B
YVAA
Payment Schedules Original Balance: $4,462.00 Current Balance: $4,462.00

DUE DATE AMOUNT DUE

AMOUNT PAID WITHDRAWAL ADJUSTMENT BALANCE
Aug 21, 2024 $4,462.00 $0.00 $0.00 $4,462.00
# R6523 Status Tentative Page 4 of 4

ATTACHMENT 10

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION

COMMUNITY ACTIVITY GRANT APPLICATION 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
5/17/24
Received
City of Yucaipa
MAY , 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.

Be prepared to show proof of program/project cost in your Wrap-up Report (Accountability Report), detailing the applicants financial match of $500.

SECTION 1 — GENERAL INFORMATION
Name of Applicant/Organization:

Applicant/Organization Mailing Address:

Applicant/Organization Phone Number:

Contact (1)
Contact (2)
Yucaipa Valley Art Association
P.O. Box 404, Yucaipa CA 92399
( )
Zully Martinez
Name Phone Number
[email protected]
E-mail address
Alan Remele
Name
Phone Number
E-mail address
SECTION 2 - ELIGIBILITY REQUIREMENTS:

City of Yucaipa Community Activity Grants Application, Rev. 04/2024

Page 1 ends

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:

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# 95-3701090
and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? 43 years
0 15
70+
Yes
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Zully Martinez, President and Board Member Karen Hoak, Ways & Means Alan Remele, Vice President and Board member
Bea Gardner, Secretary
Carol Maidlow, Treasurer
Enrique Lima, Public Exhibits
Bob Norris, publicity
Judy Remele, student scholarships
No
SECTION 4 - PROGRAM DESCRIPTION/SCOPE: (PLEASE USE ADDITIONAL PAGES IF NECESSARY) Name of the program/event:

Date(s) of program/event:

YVAA Art Meetings, twice a month on Tuesday & Thurs
Sept 2024 through May 2025, permit R6506
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) The Yucaipa Valley Association's monthly art meetings encourage members to exhibit artwork and photography for peer enjoyment. At the meeting, artists are voted on and awarded a ribbon for their artwork. Members and guests also benefit from demonstrations on art techniques and methods. The public is able to attend meetings as guests and encouraged to become members of our organization.

YVAA will hold monthly Tuesday planning meetings from 10:00 am to 12:00 pm and the Thursday art show from 6:00 pm to 9:15 pm at the Scherer Community Center located at 12202 1st Street, Yucaipa.

Meeting dates as detailed in Permit R6506
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:

The Yucaipa Valley Art Association meetings give our members and guests an opportunity to to visually appreciate local artistic talent. The meetings also help us in planning and our fundraising activities to promote art in our community. Throughout the year, we coordinate with local businesses and other organizations such as Vision Quest and the City of Yucaipa on art related events and displays. Futhermore, YVAA cooperates with YHS art dept. in helping promote art, lending art displays or awarding two student scholarships in our community. Our community contributions and activities significantly increase awareness and appreciation for the artistic talent of our members and local ---
Progratn/Event Primary Target Population (check all that apply):

Children or Youth
Low Income
Persons with Disabilities
Number of Residents Projected to Serve: 80
Seniors
Victims
Welfare Recipients
Women
Homeless
Entire Community
SECTION 5 — GRANT FUNDING REQUEST
Please identify what your organization is seeking:

Financial Support:

Yes
$200 SEP Fee
Waiver: Tikes
In -kind Support: Police $
No $
No
Fire $
OT/Reassigned
Staff $ Other $
In -Kind
Total Amount of Request: $
78 Public
Works $
Explain
CS/Rental $ N2 r 3/1-3
$200 SEP Financial Total Overall
Financial Support Fee Waiver Match ' quest
$ $ $ _ $ 2892." , '3 5/13
Provide a detailed description of how the financial support will be used:

The in -kind CAGrant support will be used to cover the cost to reserve rooms monthly at the Scherer Center twice a month Tuesday morning planning meeting (2 hr) in SrC Activity/storage room and a Thursday night art show/meeting (3.25 hrs) in room A & B and from September 2024 through May 2025. This CAGrant covers rental costs for two monthly meetings. Activities include planning, artwork take -in, setup of displays, peer review of artwork for ribbon award, fundraising, demonstration of art techniques. This event is open to our members and general guests or visitors. Anyone can join the organization.

City of Yucaipa Community Activity Grants Application, Rev. 04/2024 Page 3

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
$0
SECTION 6 — FINANCIAL CAPABILITIESBUDGET (CONTINUED):

Provide City funding received by organization in the past three years (required):

Program
YVAA Tues & Thur Mtgs.

Wednesday Art Mtgs.

Spring Art Show
In -Kind
Financial $200 SEP
Support Fee Waiver
Da to
Received
6/2023
Total Received
$ 2957.67
6/2023 $ 4462.00
6/2022 $1689.00
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.

Zully Martinez
Digitally signed by Zully Martinez President
Date: 2024.05.17 14:01:20-07'00'
Signature
Title
5/17/24
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

Page 4 ends

Permit
�r= ` COMMUNITY

SERVICES
D S
Make
Better,
City of Yucaipa Community PHONE:(909) 790-7460
Services FAX:(909) 790-2589
34272 Yucaipa Blvd EMAIL:communityservicesayucaipa.org
Yucaipa, CA 92399
Organization Name
Customer Type
Organization Address
Yucaipa Valley Art Association - 49
Non -Profit (R)
PO Box 404
Yucaipa, CA 92399
Agent Name Zully Martinez Home Phone Number
System User Julia Basa
YVAA Tues/Thur Monthly Meetings
Booking Summary
Permit # R6506
Status Tentative
Date May 15, 202410:05 AM
Expiration Date May 15, 2025
Rental Fee $3,863.60
Discounts -$321.47
Subtotal $3,542.13
Deposits $300.00
Deposit Discounts $0.00
Total Permit Fee $3,842.13
Total Payment $0.00
Refunds $0.00
Balance $3,842.13
2 resource(s) 19 booking(s) Subtotal: $3,842.13
SIC Activity Room (Indoor Resetvatlons) Center: Yucaipa Senior Cente

START DATE/TIME
Tue, Sep 17, 202410:00 AM Tue, May 13, 202512:00 PM
Occurs on selected dates effective 09/17/2024 until 05/13/2025.

Tue, Sep 17, 202410:00 AM Tue, Sep 17, 202412:00 PM
Rental - Hourly S40,00 i Houi 2 580 00
R sicient Discount - 10", -10%x 1 -$3.00
Tue, Oct 15, 202410:00 AM Tue, Oct 15, 202412:00 PM
Rental - Hourly 536 00 / Hour x 2 $72.00
Tue, Nov 19, 202410:00 AM Tue, Nov 19, 202412:00 PM
- $36 00.1 Hour x 2 572 20
Tue, Dec 10, 202410:00 AM Tue, Dec 10, 202412:00 PM
Rental - Houi ly S36.00 ; Hour x 2 S72 00
Tue, Jan 14, 2025 10:00 AM Tue, Jan 14, 202512:00 PM
Rental - Hourly 536 00 ' Hour x 2 572.00
Tue, Feb 18, 2025 10:00 AM Tue, Feb 18, 2025 12:00 PM
Rental - Hourly 536 00 i Hoot: x 2 $72.00

END DATE/TIME

ATTENDEE

AMT W/O TAX
$720.00
15 $72.00
15 S72.00
15 $72.00
15 $72.00
15 $72.00
15 $72.00
# R6506 Status Tentative

Page 1 of 4 ends

Tue, Mar 18, 2025 10:00 AM
Rental - Ho.,':

Tue, Apr 15, 2025 10:00 AM
Rental - Hourly
Tue, Apr 29, 2025 10:00 AM
Rental - Hourly
Tue, May 13, 2025 10:00 AM
Rental - Hourly
Resource level fees
Deposit
Tue, Mar 18, 2025 12:00 PM
5>6.00 i Hour :< 2 572 00
Tue, Apr 15, 2025 12:00 PM
$36 00 Hour x 2 572.00
Tue, Apr 29, 2025 12:00 PM
53600/Hourx2 $72.00
Tue, May 13, 2025 12:00 PM
536 00 ; Hour x 2 $72.00
550.00! Each x 1
550 00
15 $72.00
15 $72.00
15 $72.00
15 $72.00
$50.00

AMT W/O TAX
$2,822.13
SrC Banquet Room AB (Indoor Reservations) Center. Yucaipa Senior Center

START DATE/TIME
Thu, Sep 19, 2024 6:00 PM Thu, May 15, 2025 9:15 PM
Occurs on selected dates effective 09/19/2024 until 05/15/2025.

Thu, Sep 19, 2024 6:00 PM
Rental - Hourly S35.00 / Houi x 3 25 $276 25
Rental - Weekday Event Assistant (4P-12A) S22 20 / Hour x 3.25 $72.15 Resident Discount - ID'S -10% x 1 -$34 83

END DATE/TIME
Thu, Sep 19, 2024 9:15 PM

ATTENDEE
30 $313.57
Thu, Oct 17, 2024 6:00 PM Thu, Oct 17, 2024 9:15 PM 30 $313.57 Rental - Hourly S85.00 !Hour x 3 25 $276 25
Rental - Weekday Event Assistant (4P-12A) $22.20 / Hour x 3.25 S72 15 Resident Discount -10% -10% x 1 -534 83
Thu, Nov 21, 2024 6:00 PM Thu, Nov 21, 2024 9:15 PM 30 $313.57 Rental - Hourly S85.00 / Hour x 3.25 527625
Rental - Weekday Event Assistant (4P-12A) $22 20 - Flou x 3 25 $7 2 15 Resident Discount - 10":. -105 x 1 -$34 S3
Thu, Dec 12, 2024 6:00 PM Thu, Dec 12, 2024 9:15 PM 30 $313.57 Rental - Hourly $85 00 / Hour x 3.25 5276.25
Rental - Weekday Event Assistant (4P-I2A) $22.20 Hour x 3.25 $72 15 Resident Discount -10% -10% x 1 -$34.33
Thu, Jan 16, 2025 6:00 PM Thu, Jan 16, 2025 9:15 PM 30 $313.57 Rental - Hourly $35 00 !Hour x 3.25 S276 25
Rental - Weekday Event Assistant (4P-12.A) 32220 Hour x 3.25 372 15 Resident Discount - 10?5 -10% x 1 534 83
Thu, Feb 20, 2025 6:00 PM Thu, Feb 20, 2025 9:15 PM 30 $313.57 Rental - Hour!v S85 00 . Hour x 3 25 S276 25
Rental - Weekday Event Assistant (4P-12A) 522 20 Hour x 3 25 $72.15 Resident Discount - 105 -10% x 1 -534 33
Thu, Mar 20, 2025 6:00 PM Thu, Mar 20, 2025 9:15 PM 30 $313.57 Rental - Hourly 585.00 % Hour x 3 25 $276 25
Rental - Weekday Event Assistant (4P-12A) 322 20 i Hour s 3.25 572.15 Resident D:scount - 10% -10% x 1 -534 33
Thu, Apr 17, 2025 6:00 PM Thu, Apr 17, 2025 9:15 PM 30 $313.57 # R6506 Status Tentative Page 2 of 4

Rental - Hourly
535 00 Hour 4 3. 2 5 327523
Rental - Weekday .Event Assistant (4P-12A) 522 20 i Hour x 3 23 572.15 Resident Discount - 10%-10,,.;‹ 1 -534.33
Thu, May 15, 2025 6:00 PM Thu, May 15, 2025 9:15 PM 30 $313.57 Rental - Hourly $85.00 !Hour x 3 25 5276.25
Rental - Weekday Event Assistant (4P-12A) $22.20 / Hour x 3 25 $72 15 Resident Discount - 10% -10%, x 1 -534.83
Resource level fees $250.00
Deposit 5250.00 I Each '4 1 $2.50..0.0
Waivers and Information

INFORMATION DESCRIPTION
Alcohol Sales Lic
Proof of Liability Insurance
Security Guard Contract
Proof of Non Profit Status

WAIVER NAME
Facility Usage Waiver

DUE DATE
Sep 17, 2024
FOR

SIGNING STATUS
Checked
Checked
Checked
Checked

I have read the rules and regulations relating to use of facilities and accept responsibility for meeting the requirements stated herein.

Deposit
EVENT
Signature

RESOURCE DEPOSIT FEE CHARGE TAX AMOUNT PAID REFUNDS BALANCE YVAA Tues SrC Activity Deposit
/Thur Room
Monthly
Meetings
$50.00 $0.00 $0.00 $0.00 $50.00
YVAA Tues SrC Deposit $250.00 $0.00 $0.00 $0.00 $250.00 /Thur Banquet
Monthly Room A/B
Meetings
Payment Schedules

DUE DATE
May 15, 2024

AMOUNT DUE
Original Balance: $3,842.13 Current Balance: $3,842.13

AMOUNT PAID WITHDRAWAL ADJUSTMENT BALANCE
$457.57 $0.00
$0.00 $457.57
# R6506 Status Tentative Page 3 of 4

Sep 3, 2024 $3,384.56 $0.00 $0.00 $3,384.56
# R6506 Status Tentative Page 4 of 4

rt As roclation
Yucaipa Valley Art Association's
Come join us Wednesday from
1: 0 0 pm to 3 : 0 0 pm at the Scherer Center
Located at 12202 1st Street, Yucaipa, CA
See YVAA's September through May meeting schedule.

Bring your art supplies, artwork in progress or start
a new art project and get creative with us!
No pre -registration required, just show up.

Paint with fellow artists in a friendly group environment.

Contact YVAA at [email protected] gmail.com for more info. tAlbSIZ

Kim J Metzler, CMC, CPM
From: YVAA Yucaipa
Sent: Friday, May 17, 2024 3:09 PM
To: Kim J Metzler, CMC, CPM
Subject: YVAA 2024-2025 CAG Application Submission
Attachments: YVAA IRS 501 c 3 form.pdf; FY2425 CAG YVAA T & TH Meetings Scherer Signed.pdf; FY2425 CAG YVAA Wed Meetings Scherer Signed.pdf; Permit#R6523 - Wednesday's Paint Sessions YVAA.pdf; Permit#R6506 - Tues & Thur Monthly Meetings YVAA.pdf; YVAA Group Art Sessions.pdf
Hello Kim,
Attached is the Yucaipa Valley Art Association's submission of CAG applications for 2024-2025 in -kind grants. Included are the following PDF attachments:
• FY2425 CAG YVAA Wed. Meetings application
• Group Art Sessions Flyer (Supporting document to Wed meetings.) • FY2425 CAG YVAA T&TH Meetings application*
• Permit #R6523
• Permit #R6506
• YVAA IRS 501C 3 form
*Weblink provided for supporting documentation on YVAA's programs and activities can be viewed via our May 2024 Newsletter by clicking here: MAY 2024 NEWSLETTER. The newsletter is a supporting document to the CAG applications for all our meetings.

Due to the success of our partnership with the City of Yucaipa/YPAC to include our art show as part of the 2024 Yucaipa Music and Art Festival, we will not be submitting an in -kind funding application for this additional event for the second year in a row.

If you have any questions, please contact me at this email or phone (909) 797-7741.

Best Regards,
Zully Martinez
President and Board Member
Yucaipa Valley Art Association
P.O. Box 404
Yucaipa, CA 92399
[email protected]
i

a Valley
It Association
Find out more about our organization by visiting our Facebook page:
https://www.facebook.com/YUCAIPAVALLEYARTASSOCIATION/
YVAA is a non-profit organization supporting the artistic endeavors of the community. If you do not wish to receive any further YVAA marketing emails, reply to this email with UNSUBSCRIBE. 2 ATTACHMENT 11.

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 62:r_ Z024
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.

Be prepared to show proof of program/project cost in your Wrap-up Report (Accountability Report), detailing the applicants financial match of $500.

SECTION 1— GENERAL INFORMATION
Name of Applicant/Organization:

Applicant/Organization Mailing Address:

Applicant/Organization Phone Number:

City of Yucaipa Community Activity Grants Application, Rev. 04/2024

Page 1 ends

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:

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#45-5149308
and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? 1956
0 40
53,000
Yes
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Henry Markowiz (President) Barbara Huffman (Membership) No
Donnakaye Ostrander (Public Relations) Kent Colby (International Svcs) Dan Hudec (President Elect) Karen Colby (Youth Svcs)
Leslie Wessels (Secretary)
Chris Markarian (Treasurer)
Terry Knight (Club Administrator)
David Avila (Community Svcs)
SECTION 4 - PROGRAM DESCRIPTION/SCOPE: (PLEASE USE ADDITIONAL PAGES IF NECESSARY) Name of the program/event:

Date(s) of program/event:
69th Annual Christmas Parade
Saturday, December 14, 2024
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) The 69th Annual Christmas Parade will be held on Saturday, December 14, 2024. This year will mark the fifth year that the parade will be organized by the Rotary Club of Yucaipa.

The Parade will start at the corner of Avenue D and California Street. The route will proceed north on California Street until Yucaipa Boulevard, travel west on Yucaipa Boulevard until 6th Street, travel south on 6th Street and end at the Oak Valley Education Center campus.

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:

The 69th Annual Christmas Parade rings in the holiday season for Yucaipa residents. The parade provides an opportunity for local & regional groups, clubs, organizations and businesses to their services/activities. The annual parade draws approximately 10,000 spectators that gather in the Uptown and along Yucaipa Boulevard. Businesses along the parade route also benefit from the event.

Program/Event Primary Target Population (check all that apply):

Children or Youth
Low Income
Persons with Disabilities
Number of Residents Projected to Serve: +i-1o,000
Seniors
Victims
Welfare Recipients
Women
Homeless
Entire Community
SECTION 5 — GRANT FUNDING REQUEST
Please identify what your organization is seeking:

Financial Support:

Yes
No S
$200 SEP Fee
Waiver: nYes ❑r o
In -kind Support: Police $ s,soo
OT/Reassigned
Staff $
In -Kind
Total Amount of Request: $ 1s,000
Fire $ o
Other $
Financial Support
$ another funding source
Public
Works $ 6,500
Explain
CS/Rental $
$200 SEP Financial Total Overall
Fee Waiver Match Request
$ 200 $ = $ 16,200
Provide a detailed description of how the financial support will be used:

The In -Kind Support received from the CAG will cover the costs of police and fire personnel an provide Public Works support for street closures (personnel and equipment).

Rotary is granted $1,000 in financial support through the Non -Department Not -for -Profit Budget, which is separate from the CAG.

City of Yucaipa Community Activity Grants Application, Rev. 04/2024 Page 3

SECTION 6 — FINANCIAL CAPABILITIESBUDGET:

What other in-kind/financial contributions has your organization received to fund this event/program (separate from City funding)?
In -Kind
Amount
Rotary Club contributes $
Rotary Volunteers +/-25 Rotarians $ Priceless
$
$
$
$
Remaining Balance That Will Be Funded By $
Organization:

Total Funds Received To Date:

Total Funds Requested Via Grant Application:
16,200
Financial
Support Amount
$ 6,000
$ 6,000
SECTION 6 — FINANCIAL CAPABILITIESBUDGET (CONTINUED):

Provide City funding received by organization in the past three years (required):

Program
2023/2024 Event
2022/2023
2021/2022
In -Kind
�✓
Financial $200 SEP Date
Support Fee Waiver Received
Total Received

6.26.23 $$12,334

10.10.22 $$8,713

5.24.21 $ $5,125
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 awardedfiupncjatrant amount needs to be spent prior to submitting another grant request.

Signafute4 —
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
❑ Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 04/2024

Page 4 ends

DocuSign Envelope ID: 372F897B-6270-4658-8662-B795EDC93BA2 Yucaipa Police Request Form (Exhibit A)
Attachment to the Community Activity Grant Application/SEP Process cm' of
I re"
/40
Fiscal Year: 2024-2025
Date Application submitted:

SECTION 1— GENERAL INFORMATION
Name of Applicant / Organization
Mailing Address:

Phone Number:

Contact:

Applicant Signature:

Rotary Club of Yucaipa
PO Box 661 Yucaipa CA 92399
Jennifer Crawford
Name
Phone Number
E-mail address
Title:

SECTION 2 — EVENT INFORMATION
Event Name:

Event Location:

Event Date:
69th Annual Christmas Parade
Yucaipa Blvd. (California St. / Yucaipa Blvd. / 6th St) 12/14/24
Estimated Event Attendance Number: +/- 1 0, 000
Event Time:

Parade starts @12 Noon & ends @ 3 pm
SECTION 3 — YUCAIPA POLICE SERVICES REQUESTED
Number of Officers Requested:

Dates Officers/COPS Requested:

Equipment Requested
Additional Information:

Sworn Officers:
12/14/24
11 sworn/9 non Citizen Patrol (COPS): 16
Patrol Car: ❑
Times Officers/COPS Requested:
10:30am-3pm
Motorcycle: ❑ Other:

TO BE COMPLETED BY YUCAIPA POLICE
Reviewed DocuSigned by:

Signature: nn1F1RrAARPAIA
Title: sergeant
Total Cost for In -Kind Request: $9 500.00
Date
5/16/2024
City of Yucaipa Community Activity Grants Application, Rev. 02/2024

Page 1 ends

DocuSign Envelope ID: B42ECBCD-FB28-4EC8-8E4A-B6ED39D82E2B Public Works Department Request Form (Exhibit C)
Attachment to the Community Activity Grant Application/SEP Process Fiscal Year:

Date Application submitted:
2024-2025
SECTION 1— GENERAL INFORMATION
Name of Applicant / Organization
Mailing Address:

Phone Number:

Contact:

Applicant Signature:

Rotary Club of Yucaipa
PO Box 661 Yucaipa CA 92399
Jennifer Crawford
Name
Phone Number
E-mail address
Title:

SECTION 2 — EVENT INFORMATION
Event Name:

Event Location:

Event Date:

Estimated Event Attendance Number:
69th Annual Christmas Parade
Yucaipa Blvd. (California St / Yucaipa Blvd. / 6th Street) 12/14/24 Event Time: Parade starts @12 Noon & ends © 3 pm +/- 10,000
SECTION 3 — PUBLIC WORKS SERVICES REQUESTED
Number of Public Works Staff Requested:

Equipment Rentals and Quantity Requested:
1 Cones
Dates Requested:

Z Delineators 0 Street Closures
12/14/24
Projected Staff Time Expense: $
Tines Requested:

Z Signage
8:30am - 3:30pm
Equipment Expense: $
Additional Information: Items to include staff time (set-up/take-down of road closures, assisting with clean up of trash boxes, use of electronic message boards, & misc. traffic control equipment).

TO BE COMPLETED BY PUBLIC WORKS DEPARTMENT
Reviewed b,y;-oocuslgned by:

Stott OJMUOVAL
L c688c acrc6414...

Signature:

Deputy Director of Public works 5/20/2024
Title: Date
Total Cost for In -Kind Request:
$6,500.00
City of Yucaipa Community Activity Grants Application, Rev. 02/2024

Page 1 ends

DocuSign Envelope ID: 075E1534-1B89-4551-A8B7-DA9B53AFD905

FIRE DEPT
Yucaipa Fire Request Form (Exhibit B)
Attachment to the Community Activity Grant Application/SEP Process Fiscal Year: 2024-2025
Date Application submitted:

SECTION 1 — GENERAL INFORMATION
Name of Applicant / Organization
Mailing Address:

Phone Number:

Contact:

Applicant Signature:

Rotary Club of Yucaipa
PO Box 661, Yucaipa CA 92399
Jennifer Crawford
Name
Phone Number
E-mail address
Title:

SECTION 2 — EVENT INFORMATION
Event Name:

Event Location:

Event Date:
69th Annual Christmas Parade
Yucaipa Blvd (California Street/Yuca Blvd./6th Street)
December 14, 2024 Event Time:

Estimated Event Attendance Number: +/- 1 0,000
Parade starts @12 Noon & ends @ 3 pm
SECTION 3 — YUCAIPA FIRE SERVICES REQUESTED
Number of Fire/EMS Requested: TBD
Dates Requested:

Additional Information:
12/14/24
Times Requested:
11 am -3 pm

TO BE COMPLETED BY YUCAIPA FIRE
Reviewed by: oo��slg�edd by:/
4 Signature:
4A4A723DCA7r433...

Title: Fi re chief
Total Cost for In -Kind Request: 0.00
Date 5/20/2024
City of Yucaipa Community Activity Grants Application, Rev. 02/2024 Page I

CITY OF YUCAIPA

SPECIAL EVENT PERMIT

City Management/Administrative Approval
• Estimated attendance 300-999 persons
• Amplified Sound (excluding Special Event Facilities)
City Council Approval
• Estimated attendance 1000+ persons
• Alcohol Service (excluding Community Centers and YPAC) • Street Closure - traffic management
• Fee Waiver/Co-Sponsorship/In-Kind (Community Activity Grant Application required)

APPLICATION
11Page

II
fam°a7-

CITY OF YUCAIPA
Organization and Applicant Information 45-5149308
Commercial (For -profit) I•I Noncommercial (Non-profit) Tax I.D. #:

Organization
Name
Rotary Club of Yucaipa
Applicant Name
DonnaKaye Ostrander
Address
PO Box 661
Email
Phone Number
On -Site Contact
Donnakaye Ostrander / Jennifer Crawford
Phone Number
Event Information
Type of Event: n Athletic/Recreation n Festival/Celebration I Outdoor Market P1 Circus/Carnival
nConcert/Performance n Parade/Procession/March nOther (specify):

Event Title
69th Annual Christmas Parade
Event Location
Yucaipa Blvd (California St / Yucaipa Blvd. / 6th St.

Event
Description
The 69th Annual Christmas Parade will be held on Saturday, December 14, 2024.

Please complete a daily breakdown of event -related activities. Use multiple lines to distinguish between different daily activities. Please attach additional sheets if necessary.

Dates)
Daily Activity
Start Time
End Time
12/14/24
I Set-up Event Day Clean-up
8:00 am
12:00 pm
12/14/24
Set-up ICI Event Day ❑ Clean-up
12:00 pm
3:00 pm
12/14/24
I 1 Set-up I I Event Day I•l Clean-up
3:00 pm
4:00 pm
Set-up I I Event Day Clean-up
r I Set-up Event Day Clean-up
I I Set-up 1 I Event Day Clean-up
Has this event taken place before?
■
+t-io,000
Total anticipated attendance: Participants: ' Spectators: ' Yes! I No How many years? 68 yrs
1 000 9 000

[ITY (lF3049'6'7'

CITY OF YUCAIPA

SPECIAL EVENT PERMIT

APPLICATION
Site Plan
Attach a diagram showing the overall layout and setup locations using the letters below.

Indicate the site for these on your diagram.

A. Alcoholic and nonalcoholic concession and/or beer garden areas B. First -aid facilities and ambulance locations
C. Tables and chairs
D. Fencing, barriers and/or barricades
E. Generator locations and/or source of electricity
F. Canopies or tent locations
G. Booths, exhibits, displays or
enclosures
H. Scaffolding, bleachers,
platforms, stages,
grandstands and related
structures
I. Vehicles and/or trailers
J. Other related event
components not covered
above (describe
separately)
K. Trash containers and
dumpsters
L. Non-food vendor locations
M.Food concession and/or
food preparation areas
N. Potable toilet location(s)
Sample Site Plan:

DDDVANDON
80'x40'
VAT

ANOT CLINIC

WAXY CANOPY (CODA)
cArs
00'x20
Cho.per table (..c.P, M C.. TMa,
a.._... CHOCK IN A INFO
LIC•NSINO

0.,d •
80'x40"

LAST CANOPY (DOGS)
When planning a moving route, the Yucaipa Police Department is available to assist you in planning your route. Consider the following in your planning:
• Impedance of emergency fire, police or paramedic vehicles. • Conflict with public transportation, such as buses.
• Interference with people trying to reach their own residences, businesses, places of worship and public facilities.

<:I Il' OF
faaa9s6fr'

CITY OF YUCAIPA

SPECIAL EVENT PERMIT

APPLICATION
List street(s) requiring closure as a result of this event. Include street name(s), day, date, and time of closing and time of reopening:

All streets listed below require closures on Saturday, 12/9/23 from 8:00 a.m.-4:00 p.m. California Street: Acacia Ave. to USPS; Acacia Ave: Entrance of YPAC Parking Lot to California; Avenue A:
2nd St to Bryant St - Maybe scaled back to 1st St to Adams St; Avenue B: 2nd St to Bryant St - Maybe scaled back to 1st St to Adams St; Avenue C: 2nd St to Bryant St - Maybe scaled back to 1st St to Adams St; Avenue D: 2ns St to Bryant St - Maybe scaled back to 1st St to Adams St; Yucaipa Blvd: California St to 6th St6th St: Yucaipa Blvd to OVEC Campus Indicate how this closing/reopening of streets will be handled:

City of Yucaipa to handle (cost to be specified) n Event to handle per CalTrans standards
11 List street(s) requiring the posting of "No Parking" signs. Indicate days, dates, and times needed and an explanation of necessity of "No Parking" zone:

California Street: Acacia Ave. to USPSAcacia Ave: Entrance of YPAC Parking Lot to CaliforniaAvenue A: 2nd St to Bryant St - Maybe scaled back to 1st St to Adams StAvenue B:
2nd St to Bryant St - Maybe scaled back to 1st St to Adams StAvenue C: 2nd St to Bryant St - Maybe scaled back to 1st St to Adams StAvenue D: 2ns St to Bryant St - Maybe scaled back to 1st St to Adams StYucaipa Blvd: California St to 6th St6th St: Yucaipa Blvd to OVEC Note: "No Parking" signs will be posted forty-eight (48) hours in advance of required days, dates and times. Cost for the posting of No Parking"signs will be specified upon review of the application by City staff Food and Beverage
Please describe how food will be served at the event:

None
Will food be cooked in the event area?
Method: Gas I I Electric I I Charcoal
Yes
1N1
No
Other (specify):

Does the event involve the sale or use of alcoholic beverages? Yes
No
If alcohol is to be sold, how will the alcohol sales be regulated? NA
Who will be handling the alcohol sales?
NA
Restrooms
Portable restrooms are required when estimated attendance exceeds what the host facility's restrooms can accommodate. One portable restroom is required for every 50 patrons attending over the minimal site accommodations.

Will Event Organizer provide portable restroom facilities? n Yes n No 4IPage

CITY OF YUCAIPA

SPECIAL EVENT PERMIT

APPLICATION
Company
Name
Diamond Environmental
Contact Name
Phone Number
Lighting
If this is an evening event, please state how the event and surrounding areas will be illuminated to ensure the safety of the participants and spectators. (If required, show a separate site map which details streetlights, portable lights, and other illuminating devices.) None
Waste Removal
Event Organizer is responsible for arranging for the removal of all waste related to the event.

Company
Name
Will coordinate with Burrtec
Contact Name
Phone Number
If not hiring a professional sanitation company, please provide the following information for the Dersonfsl responsible for waste removal.

Contact Name
Yucaipa Rotary Club - DonnaKaye / Jennifer Crawford
Phone Number
626-274-8403 / 909-255-4655
Cal Fire/Medical
In case of an emergency, the on -site contact will call 9-1-1. If event requires an ambulance company to be on -site, please provide the following information:

Company
Name
Cal Fire
Contact Name
Phone Number

crn• oF
facael.

CITY OF YUCAIPA

SPECIAL EVENT PERMIT

Is there a professional security organization hired for this event? [ I Yes ■
No
Company
Name
SBCSD
Contact Name
Phone Number
Please describe your security plan including crowd control, internal security or venue safety, or attach the plan to this application:

Entertainment
Will sound amplification be used? ■ Yes No Start time:

Are there any musical entertainment features for this event? ■
End time:

Yes No
Name of Act
Various bands in the parade & sound from various floats Contact Name
Phone
Number
How many stages? 1 Number of bands? 4-6 Genre of music: various Will fireworks, rockets, or other pyrotechnics be used? n Yes No Company
Name

crrr oG;�l��fam°'

CITY OF YUCAIPA

SPECIAL EVENT PERMIT

APPLICATION
Contact Name
Phone Number
Describe (indicate dates, times and locations for launching and fallout areas):

Has a permit been issued: Yes No
(Note: Additional permits may be required as indicated by staff These include, but are not limited to, Conditional Use 24 Permit, Land Use Permit, and Fire Department permits.) Insurance
Before a Special Event Permit is issued, a certificate of insurance must be submitted.

Insurance certificate must be issued by insurance underwriters "admitted" by the California Insurance Commission and rated 'A' or better by AM Best. Requirements are:
• Minimum $1,000,000 General Liability Limit
• Minimum $1,000,000 General Automobile Liability
• Minimum $1,000,000 Worker's Compensation
• On an additional insured endorsement, the City, its elected officials, officers, and agents are to be named as additional insured
• Minimum limits of coverage may change depending on event n Insurance certificate attached
available
■
Insurance certificate on file n Insurance certificate not Filing Fees
Special Event Permit Application Fee : $200.00
* Other Fees may apply (e.g. street closures, Fire Permit/Inspections, utilities, facility rental, etc.)
7IPage

Application Checklist
I■1
II
■

CITY OF YUCAIPA

SPECIAL EVENT PERMIT

APPLICATION
Completed Application
Certificate of liability insurance
Site Plan (location of structures, lighting, restrooms, parking, etc.) Copy of Security Contract (if applicable)
Copy of Potable Restroom purchase order (if applicable) Facility or Shelter Reservation Application (if applicable) Copy of ABC License (if applicable)
Copy of County Health Permit (if applicable)
By signing below, I agree to indemnify, hold harmless, and defend the City and its officials, employees, and agents, against all claims, liabilities, and losses arising from activities connected with or undertaken pursuant to the Permit. The City is not liable for any business loss, property loss, or other damage that may result from the use of the Permit, or suspension or revocation of the Permit.

J . Crawford 4.29.24
Name: Signature: Date:

Wage

ATTACHMENT 12

COMMUNITY A C TI VI T Y GRA N T
FINANCIAL 1. ;IN / FEE WAI k/FR

APPL'CAT

COMMUNITY ACTIVITY GRANT APPLICATION INSTRUCTIONS
Fiscal Year:

Date Application submitted:

Submit to:

City of Yucaipa
Cieneral Services/City Clerk Department
34272 Yucaipa Blvd.

Yucaipa, CA 92399
Attn: Kimberly Metzler
2024-2025
May 21, 2024
Received
City of Yucaipa
MAY 21. 2024
General Services/
nit y Clerk's Reparthenf
All section' of tl., ;,pplic ;Jim 1,1•:wt !t, rctvrn: ; c:r!rp: tt , a ! l ; I st;pporliw: 'nenr,ttnt IlLr„ . ! snfa:;tittat, incomplete r1ppii_:!tio:i, rrr,i s:d •,.ill be ref ,rued to the alrplic;,rtf.

Note_ ise;ionirr,.,vith the VY2025726 ,.!.rant c.;cle, rl;; a1I1 require 100% fin,toci:;l ;:,::Ich by the licatai. For ce:ua!Jalc, iI four tot.!! 1,ro :r:atlprojcct cc,t i, 51,001, yu!tr lii;., ici_;! ;(ru!!t retlt„^;t should be for no ;:;ore than S500.

Se prep tred to short proof of pr',gr: n pr•,,ject co,t it; your AVr!p-up Report (tkecotmtability Report), detailing the applicants financial match of S500.

SECTION 1 — GENERAL 1NFOR%IATION
Name of Applicant/Organization:

Applicant/Organization Mailing Address:

Applicant/Organization Phone Number:

Contact (1)
Contact (2)
The Well Outreach Center
12717 14th Street Yucaipa, CA 92399
1 Vicki Wood
Name Phone Number
[email protected]
E-mail address
Ken Jones
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? Arc you aware of any other City program providing this service? If so. which one?
No
V
lv
"II 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 Page I

Flow 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?
Flow many Yucaipa residents dots your organization currently serve? Does the organization charge admission, membership fees, dues, etc.? Our professional counselors charge for services
If yes, please describe:

SECTION 3 — ORGANIZATION INFORMIATION/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 50'1(c)?1
if yes, please provide Tax IDIi.8-1 U42899__ and attach all supporting documents.

Does this application include submittal ofdocumcntation verifying 501(c) status? 2019
3 14
322
Yes
✓
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Ken Jones
Terry Knight
Greg Franklin
Natalie Brasher
Jose Banda
Sue Moreland
Melissa Williamson
No
Board President and Board Member
Board Secretary and Board Member
Board Treasurer and Board Member
Board Member
Board Member
Board Member
Board Member
SECTION 4 - PROGRAi1 DESCRIPTION/SCOPE: 1PLEASE USE ADDITIONAL PAGES IF NECESSARY) Name of the program/event:

Date(s) of program/event:

Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) ONCC is dedicated to fulfilling the essential clothing requirements of vulnerable students in Yucaipa.

Our goal is to equip middle and high school students with appropriate attire, thereby facilitating an environment conducive to their educational advancement. We focus our efforts on students who face economic challenges, ensuring they have access to necessary clothing that supports their academic pursuits and personal growth. By providing students with clothing, we remove barriers to education, allowing them to attend school with confidence and dignity. In collaboration with Yucaipa High School's Transition Program, ONCC offers vocational training to special education students, preparing them for future employment and community integration.

Our Neighbors Clothing Closet
on -going
City of Yucaipa Community Activity Grants Application, Rev. Q41/202't t' igcT2

Describe how the program/event benefits the residents and/or community of Yucaipa:

ONCC provides immediate relief to students and families in need, offering them access to quality clothing without cost. It fosters a sense of community and sharing, as residents come together to donate and help those less fortunate within their own community. By providing access to clothing, ONCC helps level the playing field for those who may not afford new clothes, aiding in job interviews or school attendance. ONCC helps raise awareness about the needs within a community and the importance of giving back. ONCC also offers vocational training opportunities for special education students enrolled in the Yucaipa High School Transition Program.

Program/Event Primary Target Population (check all that apply):
✓
Children or Youth
Low Income
Persons with Disabilities
Number of Residents Projected to Serve: 35°
✓,
Seniors
Victims
Welfare Recipients
✓
Women
Homeless
Entire Community
SECTION 5 — GRANT FUNDING REQUEST
Please identify what your organization is seeking:

Financial Support: ✓ Yes No
$20(1 SEP Fee
Waiver:

In -kind Support: Police $
OT/Reassigned
Staff $
$3000
Public
Fire $ Works $
Other $ Explain
CS/Rental $
$200 SEP Financial Total Overall
In -Kind Financial Support Fee Waiver Match Request
Total Amount of Request: $ S 3,000 $ $ = S 3.000
Provide a detailed description of how the financial support will be used:

We are reaching out for financial support crucial to the success of our initiative aimed at assisting at -risk secondary students within our community. The requested funds will be specifically allocated for the purchase of new undergarments, footwear, belts, and other specialized apparel that our students urgently require. While we gratefully accept and repurpose gently used clothing donations, we firmly believe in providing our students with brand new essential items. This not only ensures hygiene and comfort but also upholds the dignity of each student. To achieve this objective, we are seeking an investment of $3 000T1 i10.�is fun ing is pivotal in co I wing our efforts to meet the basic clothing needs of these students. )'' `3 j 00 D , O ?� The provision of new, quality clothing goes beyond mere physica necessity; it instills a sense of hope, boosts morale, and nurtures confidence among students. This empowerment enables them to attend school proudly and participate actively in their educational journey.

City of Yucaipa Community Activity Grants Application, Rev. 04/2024 Page

SECTION 6— FIN %NCIAL CAPABILITIES/BUDGET:

What other in-kind/financial contribulious has your organization received to fund this event/program (separate from City funding)?
Donated Clothing
YCJUSD Classroom
Private Donations
Morongo Band of Mission Indians
Professional Bookkeeping
Total Funds Received To Date:

Total Funds Requested Via Grant Application:

In -Kind
Amount
$ 7,100
$ 6,000
$
$
S
Remaining Balance That Will Be Funded By $
Organization:
1,680
14,780
s
Financial
Support Amount
$ 9,000
1,000
$
$ 10,000
s 3,000
SECTION 6 — FINANCIAL CAPABILITIES/BUDGET (CONTINUED):

Provide City funding received by organization in the past three years (required):

Program
In -Kind
Financial S200 SEP Date
Support Fee Waiver Received
Total Received
2022 $1,000
$
s
SECTION 7 —CERTIFICATION
I, the undersigned, do hereby attest that the above information is true and correct to the hest of my knowledge, and understand that the awarded financial grant amount needs to be spent prior to submitting another grant request.

Signature
!ice-ta
Titletiw�•+�'"
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

Page 4 ends

Our Neighbors Clothing Closet (ONCC)
Community Activity Grant
Statement of Need and Measurement
We invite you to support Our Neighbors Clothing Closet (ONCC) and join in the significant, positive change we are driving for the students of YCJUSD. Your involvement can make a real difference.

For over two decades, my role as a Special Education Teacher and Program Specialist within the Yucaipa-Calimesa Joint Unified School District (YCJUSD) has granted me firsthand insight into the profound adversities our students endure. Our Neighbors Clothing Closet (ONCC) emerged from a heartfelt commitment to these young individuals, many of whom view basic clothing necessities as unattainable luxuries.

The genesis of ONCC was a deliberate response to a pervasive issue: the plight of homeless students and those from financially struggling families who lack access to proper attire. This initiative, established in August 2020, was born out of 24 years of close encounters with the daily struggles of our students.

ONCC's mission is clear and unwavering: to eliminate educational obstacles for YCJUSD students caused by the absence of appropriate clothing. We stand as a pillar of hope, offering essential clothing items to students impeded by socioeconomic barriers.

We firmly believe in the power of support to transform lives. ONCC is dedicated to providing more than mere clothing; we bestow dignity and instill confidence in our students, empowering them to overcome their challenges.

As ONCC expands its reach, the necessity for financial backing intensifies. Your generous contribution will have a direct and meaningful impact, enabling us to broaden our services and sustain our efforts seamlessly.

We pledge full transparency and accountability, ensuring that donors are kept informed about ONCC's progress and the positive changes we are fostering in the lives of our students.

Outcome measurement for ONCC involves evaluating the effectiveness of our services, particularly in terms of our mission to provide essential clothing and hygiene items to students in need and to offer vocational training opportunities for special education students enrolled in the Yucaipa High School Transition Program. The process typically includes collecting data on various metrics to assess the impact of ONCC's services on the community and the individuals they serve.

These metrics help ONCC understand the effectiveness of our program and identify areas for improvement.

This detailed approach to outcome measurement ensures that ONCC can continue to refine its services and maximize its positive impact on the Yucaipa community and individuals in need of support.

In our preliminary research, we discovered a need exists for supporting the basic needs of students living in our community.

According to Education Data Partnership, YCJUSD 2019-20 enrollment included:

Total Student Enrollment 10,394
95 of those enrolled were foster youth.
5,074 of those enrolled qualified for free and reduced lunch.

According to Education Data Partnership, YCJUSD 2021 — 2022 enrollment included:

Total enrollment was not available
82 of those enrolled were foster youth
5,364 of those enrolled qualified for free and reduced lunch.

According to Education Data Partnership, YCJUSD 2022-20-23 enrollment included:

Total enrollment is 10,000
75 of those enrolled were foster youth
5,580 of those enrolled qualified for free and reduced lunch.

The following chart represents the number of students receiving services each month during the 2023 calendar year. This data further supports the continued need for this service in your community. 2023 Calendar Year - Total Students who Visited ONCC was 257 Jan
Feb
March
April
May
June
July
Aug
Sept
Oct
Nov
Dec
29 15
23 16
12 10
8 25
24 28
32 35
2022 Calendar Year - Total Students who Visited ONCC was 255 The compelling data we have gathered not only reinforces our determination to meet the fundamental needs of at -risk students in our community but also aligns with the foundational principles of Maslow's hierarchy of needs. According to Maslow, the most basic physiological needs serve as the primary motivators for human behavior. It is upon this bedrock of understanding that we seek your support.

Our initiative is driven by the knowledge that fulfilling these essential needs is the first step towards empowering our students to reach their full potential. We are committed to ensuring that every student has the opportunity to thrive, starting with the satisfaction of their most basic necessities. • Air
• Water
• Food
• Shelter
• Sleep
• Clothing

This concept provides insights into the diverse necessities of individuals and the influence of these needs on their drive and ambition. Specifically, it suggests that meeting fundamental physiological requirements is essential for students to be sufficiently motivated to reach their optimal academic capabilities.

Moreover, the demand for this service has notably escalated due to the multifaceted impact of the COVID-I9 pandemic, which has affected our community spiritually, physically, emotionally, psychologically, and financially for over two years. In response, the TWOC Board of Directors and staff are actively engaging in community partnerships and seeking collaboration with major department stores for the contribution of necessary items. We are also reaching out to service clubs for financial support and planning a community fundraising event this summer, with a portion of the proceeds dedicated to this initiative.

To assess the program's impact and identify any required modifications, we are compiling data and monitoring the frequency of student visits to the closet, as well as the volume of clothing distributed. This information will be shown through a bar graph and shared with our department store partners, offering a tangible overview of the number of students assisted and the quantity of clothing items provided. This granular data will underscore our dedication and effectiveness in fulfilling the essential clothing needs of students within the Yucaipa Community.

Our Neighbors Clothing Closet
Community Activity Grant
Experience In Program Area
My name is Vicki Wood. I am the Executive Director of The Well Outreach Center (TWOC).

Our agency was established four years ago as a 501(C)(3) non-profit corporation. Our employment identification number is 83-1042899. We focus on providing service that support spiritual, physical, emotional, and psychological wholeness to individuals living within the Yucaipa Calimesa community. TWOC seeks to meet the needs of people living in our community through the development of three different entities doing business as (OBA) The Well Counseling Center, The Mosaic Center, and Our Neighbors Clothing Closet.

We seek funding specifically for Our Neighbors Clothing Closet (ONCC). The dream for ONCC originated from my 24 years of working for the Yucaipa-Calimesa Joint Unified School District (YCJUSD) as a Special Education Teacher and Program Specialist and witnessing firsthand the heart -breaking reality of students whose families do not have the means to provide for their family's basic clothing needs. Coming face to face with this reality for 24 years, prompted the development and opening of ONCC in August of the 2020 school year.

Our volunteer Director of ONCC was also a former YCWSD employee who worked directly with Special Education Students for 27 years and is passionate about serving students in need of clothing. Debby modeled our Clothing Closet after a clothing closet that has been running successfully for over 15 years and housed at Moore Middle School in Redlands. Debby has worked closely with the director of this closet to ensure this project is a successful one for our community.

jThe Well Outreach Center
Our Neighbors Clothing Closet
2024 Projected Budget
Revenue:
\Valmart Grant $5,000
Morongo Grant $5,000
City of Yucaipa Grant $2,306
Monthly Donations $1,200
Fundraising $5,000
In -Kind Bookkeeper $1 „680
Total Revenue:

S20,186
Expenditures
Clothing Inventory $7,100
Hygiene Inventory $7,100
Payroll Ex Director $2,891
Administrative Cost $1,415
In -Kind Bookkeeper $1,580
Total Expenditures:
$20,186
Administrative Cost (Above) Includes
• Web site/Do main: $100
• Bookkeeping: $360
• Googte Voice: $230
• KO; $125
• Operating Expenses: $200
o Closet Related
o Office Related
• Housekeeping Essentials: $200
• Hospitality: $200
Calculating Executive Director Wages and Other Shared Expenses • TWOC - of Annual Wages
• TWCC - 45' Of .Annual Wages
• Mosaic -10% of Annual Wages
• ONCC - 10C.ki of Annual Wages

gOY.

CTNC7NNATI, (11. .E.N)1
Date, JAN 2 1 2Cizo
T:(E
14Tli L:,%•
UCIIA. CA
Dear App..i7-:tnf,:

DEPAF.TENT OF TWL li.P.EASUR1
Numbr..r:

Contant
KA%/E EDF! 3L4712
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1:429-500
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to reTelve tax tranr:fr:!rr or 7iitc under
• cCiorl ".L0(,, Of let.:_er could res.D1re question:, Cr; exea.pt 7IeaJc iL fiJ• r,71cordi:.

Or;nitiobf, ey.t7rT:,. St!clion -,01(c)(.3) ara tuchtr cl peblio cTiaritik,5; or 1:riv:ite to-init. Wo determined, you're a public epi'-? r ttie LC top ot Coif.; 1J2:Cter.
wf.2: Pjle tr.-o of rhi. t oe're rac..0c,.j to
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orm1e3,7,n (Fof-J,. ::L,j or f:ora, notico (7orm 990-N, :t yo1:4 7Y.le Cear-:) retrtl or Tiorce for Chcee
Ye.;11Di, Lt ai.ttmitLcally revoked.
.:1-AiCat,z!d te top01 hi.- let,ter that a:, -iddendum appile, th=- rir.cloz;ed diideno31-; 1- An intaQr1
FOr Abut yoJr rec,onsibilltits as ' tax-exempt
Or te to www.irs.9ovicharitien . alter ”41-= in the :.;:arc bar to - Y-ro 42fl-P2, C.C,mPliadce Glide f0::" 501(7)(3) P,Abiic deL.;3 record;ieepine, repoct.ine, and discisura

TirZ Wi.:LL OUTRFACIT
.17.c..-.npt: Ur.Arit........:
-:'..3",=-7 q71,7_'.

THE WELL

COUNSELING CENTER
r
INTAKE.

COORDINATOR
AMFT
ACSYJ
LMFT
41 LCSW

THE WELL CHURCH
r.
1 TWOC

BOARD OF DIRECTORS

EXECUTIVE DIRECTOR
WWW.TWOCYVC:AIP4.COM
INFO .TWOCYUCA►PA,COM

OUR NEIGHBORS

LCLOTHING CLOSET

VOLUNTEERS

The Well Counseling Center
Supporting our community and surrounding
areas by providing hope during trying times.

We offer low-cost professional therapy for
children, teens, single adults, couples, and
families.

Individual and Group
Sessions are Available
lou do. not have to fight
your battles alone.
--Call or email cis today!
(909) 353-3920
[email protected]
WWVV. COUnsel►ngtwcc.com
The Well Counseling Center
Supporting our community and surrounding
areas by providing hope during trying times.

We offer low-cost professional therapy for
children, teens, single adults, couples, and
families.

Individual and Group
Sessions are Available
Yau do not have to fight
tyour battles alone.
fall or email u today!
y
tf
(909) 353-3920
[email protected]
wnwvvw.cocrnselingtvvcc.com
The Well Counseling Center
Supporting our community and surrounding
areas by providing hope during trying times.

We offer low-cost professional therapy for
children, teens, single adults, couples, and
families.

Individual and Group
Sessions are Available
1159u do not have to fight
your battles alone.
--Call or email as today!
(909) 353-3920
[email protected]
www.counselingtWcc.com

OUR NEIGHBORS
ci
Providing for the basic needs of at -risk
students living within the Yucaipa-Calimesa
community. We target middle school and
high school students in need of clothing in
order to support them through a successful
learning journey.

Our clothing outreach also provides
vocational training opportunities to special
education high school students who are
enrolled in the Yucaipa High School
Transition Program.
909-353-3264
[email protected] M
Suppose you see a brother or
sister who has no food or clothing,
and you say, "Good-bye and have
a good day; stay warm and eat
well,"but then you don't give that
person any food or clothing. What
good does that do? LAMES 2:15 i6 (NLT)
Visit our website:
www.neighborscc.com

OUR NEIGHBORS
3 S
Providing for the basic needs of at -risk
students living within the Yucaipa-Calimesa
community. We target middle school and
high school students in need of clothing in
order to support them through a successful
learning journey.

Our clothing outreach also provides
vocational training opportunities to special
education high school students who are
enrolled in the Yucaipa High School
Transition Program.
909-353-3264
[email protected]
Suppose you see a brother or
sister who has no food or clothing,
and you say, "Good-bye and have
a good day; stay warm and eat
well,"but then you don't give that
person any food or clothing. What
good does that do?
LAMES 2:15.16 (HLT)
Visit our website:
www.neighborscc.com
ti
1 l 1

OUR NEIGHBORS
Providing for the basic needs of at -risk
students living within the Yucaipa-Calimesa
community. We target middle school and
high school students in need of clothing in
order to support them through a successful
learning journey.

Our clothing outreach also provides
vocational training opportunities to special
education high school students who are
enrolled in the Yucaipa High School
Transition Program.
909-353-3264
[email protected]
Suppose you see a brother or
sister who has no food or clothing,
and you say, "Good-bye and have
a good day; stay warm and eat
well," but then you don't give that
person any food or clothing. What
good does that do?
LAMES 2:15-16 (NtT)
Visit our website:
www.neighborsce.com

E cr
rE Y

06. M'2
Narrative Focused
Trauma Care Groups
Providing a safe place for healing through
writing & sharing our stories from
brokenness to masterpiece, leading to
freedom in relationships with
God, self, and others.

SUPPORT OFFERED BY TRAINED

FACILITATORS WHO HAVE
SIMILAR EXPERIENCES.

We Also Offer Low Cost
Truama informed Conferences
For we are God's masterpiece. He has created us
anew in Christ Jesus so we can do the good things He
planned for us long ago. EPH. 2:10
909-274-9117
[email protected]
www.mosaictwoc.com
The Well Counseling Center
Supporting our community and surrounding
areas by providing hope during trying times.

We offer professional therapy for children,
teens, single adults, couples, and families.

Individual and Group
Sessions are Available
Yc4u do not have to fight
our battles alone.

Call or em
kis today!
(909) 353-3920
[email protected]
www.counselingwcc.com
4 .1 , t .:

OUR NEIGHBORS
u I
Providing for the basic needs of at -risk
students living within the Yucaipa-Calimesa
community. We target middle school and
high school students in need of clothing in
order to support them through a successful
learning journey.

Our clothing outreach also provides
vocational training opportunities to special
education high school students who are
enrolled in the Yucaipa High School
Transition Program.
909-353-3264
i INFO@NEi G1130RSCC.COM
Suppose you see a brother or
sister who has no food or clothing
and you say, "Good-bye and have
a good day,' stay warm and eat
well," but then you don't give that
person any food or clothing. What
good does that do?
LAMES 2:15.16 (NLT)
Visit our website:
ww.neighborscc.com

THE WELL OUTREACH CENTER

BOARD MEMBERS
Ken Jones President
Terry Knight Secretary
Jose Banda Board Member
Natalie Brasher Board Member
Coleen Hinkle Board Member
Sue Moreland Board Member
Melissa Williamson Board Member
Executive Director
Vicki Wood
Contact us at
[email protected]
Visit our Website
twocyucaipa.com
the Well

OUTREACH CENTER
12717 14th Street
Yucaipa, CA 92399
the Well
O U i k: A C H C E N T E k
Providing services that support
spiritual, physical, emotional, and
psychological wholeness

ATTACHMENT 13

CITY OF

COMMUNI TY ACTIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION
COMts1UNITY :ACTI\'ITn' GRANT APPLICATION INSTRUCTIONS
Fiscal Year:

Date Application submitted:
2024-2025
22 March 2024
Submit to:

City of Yucaipa
General Services/City Clerk Department
34272 Yucaipa Blvd.

Yucaipa, CA 92399
Attn: Kimberly Metzler
City of Yucaipa
MAY 22 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% 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 tite applicants financial match of $500.

SECTION 1 — GENERAL INFORMATION
Name of Applicant/Organization:

Applicant/Organization Mailing Address:

Applicant/Organization Phone Number:

Contact (l )
Contact (2)
BPOE #2389
12165 2nd St., Yucaipa, CA 9239990
Name
E-n'di1 address
Name
Phone Number
( )
Phone Number
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
n
*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, Rcv. 04/2024 Pagc 1

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.

Yes
Is your organization a 501(c)? AN.

If yes, please provide Tax ID#95-2777976 and attach all supporting documents.

Does this application include submittal of documentation verifying 501(c) status? 50+ years
How long has your 501(c) organization been in existence? Number of Employees working for organization:

Number of Volunteers working for organization:

Date(s) of program/event:

Hoop Shoot
December 2024
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) The Hoop Shoot is an annual event sponsored by Grand Lodge of the Elks. All school children are eligible to compete in the organized event. Local level winner go to District, winners there continue on and eventually there are national winners.

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:

Program/Event Primary Target Population (check all that apply):

Children or Youth
Low Income
Persons with Disabilities
Number of Residents Projected to Serve:

Seniors L __I Women
Victims I I Homeless
Welfare Recipients Entire Community
SECTION 5—GRANT FUNDING REQUEST
Please identify what your organization is seeking:

Financial Support: nYes No $ l000
$200 SEP Fee
Waiver:

Ves Do
In -kind Support: Police $
OT/Rcassigned
Staff$
Fire $
Other $ 500
Public
Works $
CS/Rental $ l `` L'
Explain Use of community center basket ball court
4 C $200 SEP Financial Total Overall
n-Kind Financial Support Fee Waiver Match equest fl
Total Amount of Request: $ e $ i000 $ $ = eat 1 I
Provide a detailed description of how the financial support will be used:

In -kind for use of a basketball court for the competition.

Financial support would cover cost of basketballs, t-shirts, trophies and any miscellaneous items needed for the competition.

The city awarded a grant for the Elks hoop shoot each year but circumstances precluded our holdding the event twice.

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)?
none
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 CAPABILITIES/BUDGET (CONTINUED):

Provide City funding received by organization in the past three Program
2022
2023
In -Kind Financial
Support
✓
years (required):
$200 SEP
Fee Waiver
Date
Received
Total Received
$1000 returned
returned
$1000
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 gran t amount needs to be spent prior to submitting another grant request. )v CYhaVT,. ,L_, 1c / 2 2
Title
Signature
U
Date

TO BE COMPLETED BY CITY'
Date Received:

Amount Funded:

Type of Grant:
el
❑ In -Kind
Date City Council received follow up report:

Date Reviewed:

City Council Meeting:
❑ Financial Support ❑ Fee Waiver
n
City of Yucaipa Community Activity Grants Application, Rev. 04/2024 Pagc 4

Permit

COMMUNITY
SERVICES Mace
L1EPAR N : i Sotler.

City of Yucaipa Community PHONE:(909) 790-7460
Services FAX:(909) 790-2589
34272 Yucaipa Blvd EMAIL:[email protected]
Yucaipa, CA 92399
Organization Name Yucaipa Elks Lodge #2389 - 341
Customer Type Non -Profit (R)
Organization Address P. O. Box 578
Yucaipa, CA 92399
Agent Name Kandy Joyce
System User Julia Basa
Elks Lodge Hoop Shoot
Booking Summary
Organization Phone 1
Number
Home Phone Number
Email Address
Permit # R6539
Status Tentative
Date May 22, 2024 4:30 PM
Expiration Date May 22, 2025
Rental Fee $600.00
Discounts $0.00
Subtotal $600.00
Deposits $100.00
Deposit Discounts $0.00
Total Permit Fee $700.00
Total Payment $0.00
Refunds $0.00
Balance $700.00
1 resource(s) 1 booking(s) Subtotal: $700.00
Gymnasium (Indoor Reservations) Center. Yucaipa Community Center.

START DATE/TIME
Sat, Nov 9, 2024 9:30 AM
Rental - Hourly
Resource level fees
S200 00 / Hour v.3

END DATE/TIME
Sat, Nov 9, 2024 12:30 PM
S600.00
Deposit $100 00 / Each x I $100 00
Waivers and Information

INFORMATION DESCRIPTION
Alcohol Sales Lic
Proof of Liability Insurance
Security Guard Contract
Proof of Non Profit Status

WAIVER NAME
Facility Usage Waiver

DUE DATE
Nov 9, 2024
FOR

ATTENDEE
30 AMT W/O TAX
$600.00
$100.00

SIGNING STATUS
Checked
Checked
Checked
Checked

SIGNING STATUS
Waiver Signed
# R6539 Status Tentative

Page 1 of 2 ends

Facility user hereby agrees to indemnify, defend and hold harmless City of Yucaipa, its officers, officials, employees and volunteers from and against all claims, damages, losses and expenses that may arise during or be caused in any way by such occupancy or use of facilities, but the facility user shall not be liable for any claims, damages, losses and expenses caused by the sole negligence or willful misconduct of the City of Yucaipa.

I have read the rules and regulations relating to use of facilities and accept responsibility for meeting the requirements stated herein.

Signature
Deposit

EVENT RESOURCE DEPOSIT FEE CHARGE TAX AMOUNT PAID REFUNDS BALANCE Elks Lodge Gymnasium Deposit $100.00 $0.00 $0.00 $0.00 $100.00 Hoop Shoot
Payment Schedules Original Balance: $700.00 Current Balance: $700.00

DUE DATE AMOUNT DUE
Oct 26, 2024

AMOUNT PAID WITHDRAWAL ADJUSTMENT BALANCE
$700.00 $0.00
$0.00 $700.00
# R6539 Status Tentative Page 2 of 2

ATTACHMENT 14

CITY OF
17677

COMMUNITY ACTIVITY GRANT

FINANCIAL / IN -KIND / FEE WAIVER

APPLICATION
COMMUNITY -ACTIVITY GRANT APPLICA'TION1NSTRUCTIONS
Fiscal Year:
2024-2025
Date Application submitted: 5/2.2 / 2 o /1A
Submit to:

City of Yucaipa
General Services/City Clerk Department
34272 Yucaipa Blvd.

Yucaipa, CA 92399
Attn: Kimberly Metzler
City, o Yucaipa
MAY 2 f7-7' 20?"-i.

General Services/
City Clerk's Departrneni:

All sections of the application must be returned complete, and all supporting documentation must be included as part of the submittal. incomplete applications received will be returned to tiic applicant.

Note: Beginning, with the FY2025/26 grant cycle_ financial grant awarded lands \vill require 100°fin 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 $500.

SECTION 1 --GENERAL INFORMATION
Name of Applicant/Organization:

Applicant/Organization Mailing Address:

Applicant/Organization Phone Number:

Contact (1)
Contact (2)
GarAenwoc-'5.cor `'S' ,s
l C Q 22 r`1 r-eth
n o. c o1anic
Name Phone Number
E-mail address
Name
111011%, 1`4 U111UV1
Co 9ckircenwof-AA scar • or
E-mail address
SECTION 2-ELIGIBILITY REQUIREMENTS:

Is your organization located in another conununity?
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
v
n
x
*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

Page 1 ends

Describe how the program/event benefits the residents and/or community of Yucaipa:
-che_ innn-- efdCct C,h r La re ln,'S qarde/r, C Gar-d,en wcy-iiJ%' 1'evvas o\teX'
o O C r 1 a.renu a ityl,o 1-41rci u2 h a s�
c ;1 e\ e \4S) %J Sri C 'f e ctr4'es c -v open .� """T clays, Yt race O'- 9cir`de n wri.4 a
(��►�\ c ren ter tim�or �1
na
-\-ur -e 0.rn ck- ' Nyn r ce (.7 c SUS Oral l l i l Conti hea\-E1 ,
Program/Event Primary Target Population (check all that apply):

X
x1
Children or Youth
Low Income
Persons with Disabilities
Number of Residents Projected to Serve:

Seniors
Victims
Welfare Recipients
OV,er 20) 000 per year
X
Women
Homeless
Entire Community
SECTION 5 - GRANT FUNDING REQUEST__
Please identify what your organization is seeking:

Financial Support:
es
0 No $ l 500
$200 SEP Fee
Waiver: I Ves ONo
In -kind Support: Police $ O Fire $ -e--
Public
Works $ -�-
CS/Rental $
OT/Reassigned
Staff $ Other $ -G- Explain
$200 SEP Financial Total Overall
In -Kind Financial Support ee Waiver Match Request
Total Amount of Request: $ ->3— $ 1) 55 OC) $ =
Provide a detailed description of how the financial support will be used:
e_ Wou1 c \Ace ko Fur ck cerrre * wa\kway -Fo
Our b?ecr,a1 needs S'enSOry area
for- wli.ee I Chair
o,CC-eSS. The r une wt1\ qo ;or-Cerrrteri a lA
m
a-E-er °As • y
City of Yucaipa Community Activity Grants Application, Rev. 04/2024

Page 3 ends

-SEC-T-ION 3 --ORGANIZATION-INFORMATION/APPLICANT--BACKGROUND Your organization must be an established 501(c) to be considered for Community Activity Grant funding.

PIease submit documentation verifying organization 501(c) status along with this application.

Is your organization a 501(c)?
If yes, please provide Tax ID# q 6 `214 2. WO W9 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:

Yes

1.j►2)20r3
2O,00c pPr year
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) "Don n c.� S v` own o n t'oc� rcvm 10% rec -l--or) G t d Rr \ \J err'-u - q
Pre Scillca Class O rec -or
No
x
-SECTION 4 PROGRAM-DESCRIPTION/SCOPE: (PLEASE USE ADDIT-TONAL PAGES IF NECESSARY-) -- Name of the program/event:

Date(s) of program/event:

ON.

N1
Describe the program/event that organization is seeking support for:
(Attach any evenUprogram promotional materials associated with program/event) City of Yucaipa Community Activity Grants Application, Rev. 04/2024 Page 2

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
jikal COS Irc -- �onc -►onS $
$
$
$
$
Total Funds Received To Date: $
Total Funds Requested Via Grant Application: $
Remaining Balance That Will Be Funded By $
Organization:

Financial
Support Amount
$ l5D0
$
$
$
$
$ 1, 50o o0
$ I, 5o0 Ga
_6-
SECTION 6 -- FINANCIAL-CAPABILITIES/BUDGET (CONTINUED):

Provide City funding received by organization in the past three years (required):

Program
In -Kind
(;ornmur,f\eA-ion Gran
�� 11
I
Financial $200 SEP Date
Support Fee Waiver Received
Total Received
6)24)3 S l,00C
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. ? rcwn cec o c 3/24 20 a �
Title Date
Sigma

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:

D Financial Support
n Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 04/2024

Page 4 ends

Yucaipa City CouncilJune 10, 2024

Yucaipa City Council
June 10, 2024