Agenda Item No. 9
CITY OF YUCAIPA
AGENDA REPORT
TO: Honorable Mayor and City Council
FROM: Jennifer Crawford, Assistant City Manager
Kimberly Metzler, Deputy City Clerk/Deputy Rent Administrator/Records Technici
FOR: City Council Meeting of August 26, 2024
SUBJECT: Review and Consider Fiscal Year 2024-25 Community Activity Grant Applications RECOMMENDATION:
That the City Council review and consider the Fiscal Year 2024-25 Community Activity Grant (CAG) Applications submitted by Down Right Blessed Foundation and Inland Leaders Charter School and award in-kind/fee waiver support as recommended by the CAG Application Review Ad -Hoc Committee:
FY 2024-25 In-
CAG Ad -Hoc
Kind
Committee
Applicant
Description of Event/Program
Support/Fee
Recommended
Waiver
Award
Re uested
Waive Community Park rental fees to
host the I` Annual Buddy Walk in
October to bring awareness & support to
Down Right Blessed
individuals/families with Down
Foundation
Syndrome.
$1,000
$747.50
Waive Community Center Gym rental
fees for ILCS to host home girls'
Inland Leaders Charter
volleyball games from August 29`' to
School
October 15'.
$1,782
S747.50
Total
$2,782
S 1,495
CAG In-Kind/Fee Waiver Fund Balance
$1,495
$1,495
Remaining Balance
$1,287
$ 0
BACKGROUND/DISCUSSION:
On June 10, 2024, City Council awarded Fiscal Year 2024-25 CAG in-kind/fee waiver awards to organizations providing services/programs/events to the community. Of the $40,000 budgeted for in-kind/fee waiver grant requests, $1,495 remains available.
City staff recently received two in-kind/fee waiver applications from Down Right Blessed Foundation and Inland Leaders Charter School. These applications were presented to the CAG
Application Review Ad -Hoc Committee (Committee) on July 23, 2024, whereby the Committee was asked to consider the following options for recommendation to the Council:
1. Split the funds available equally and grant $747.50 to each organization. Both organizations would need to cover the difference. (Recommended by the Committee)
2. Allocate $1,495 as you deem appropriate.
3. Select one of the organizations to receive the grant funds available.
4. Fund neither organization.
Based on the options presented above, the Committee recommends splitting the remaining CAG In-Kind/Fee Waiver Fund balance of $1,495 between the two applicants. Each applicant would need to fund the difference that the CAG Program does not cover.
FISCAL IMPACT:
In -kind awards allow the applicant(s) the use of city facilities and/or staff time at no cost.
Attachments:
1. Down Right Blessed Foundation Application
2. Inland Leaders Charter School Application
Approved by:
ATTACHMENT 1
I
CITY of
Fiscal Year:
Date Application submitted:
Submit to:
City of Yucaipa
General Services/City Clerk Department
34272 Yucaipa Bled.
Yucaipa, CA 923 9
COMMUNITY ACTIVITY GRANT
2024-2025
6/29/24
FINANCIAL /!N-K1ND /FEE WAIVER
APPLICATION
Received
City of Yuca1PLI
JUL 0 �a ?0z4?_
Attn: Kimberly Metzler Gen r a I Services /
City Clerk's Departi-rent,
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: BeginninJNN-ith 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 sh w proof of program/project cost in your «'rap -up Report (_Accountability Report), detailing the applicants financial match of $500.
Name of Applicant/Organization:
Down Right Blessed Foundation
Applicant/Organi ation Mailing Address: 11130 Chappell Way Applicant/Organi�ation Phone Number:
Contact (1)
Contact (2)
7�14-28�10-3757
Debbie Messick
Name
714-280-3757
Phone Number
[email protected]
E-mail address
Kathleen DePillars
Name
�09-96r-0969
Phone Number
[email protected]
E-mail address
Is your organizatidn located in another community?
No
V
Will the program/event take place in another community? ❑ yj
Are you aware of any other City program providing this service? ❑ ❑ If so, which one?
*If you answered ".Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.
F1
Yes
City of Yucaipa Community Activity Grants Application, Rev. 04/2024 Page 1
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. fl+S k �
Is
Yes
FV-1
No
F�
your organizati n a 501(c)?
If yes, please provide Tax ID# 93-2122 649 and attach all supporting documents.
Does this application include submittal of documentation verifying 501(c) status? a
1 How long has your 501(c) organization been in existence? 6 Months Number of Employees working for organization:
Number of Volun eers working for organization: 12
Is a current City Council Member on your board?
F-1
7 How many Yucai a residents does your organization currently serve? 100+ Does the organization charge admission, membership fees, dues, etc.? F-1
1 -7
If yes, please describe:
Names and Titles f Officers and Board of Directors: (Please attach an organization chart, if available) Kathleen DePillars President
Julie Smith
Debbie Messick
Patrick DePiliars
Felicia Romero
Treasurer
Secretary
Director
Director
Name of the prograt/event: Down Right Blessed Foundation Buddy Walk Date(s) of program/event: 10/19/24 Or 10/20/24
i
Describe the progzam/event that organization is seeking support for:
(Attach any eventfprogratn promotional materials associated with program/event) Our foundation! is looking to have our First Annual Down Right Blessed Buddy Walk on October 19th or 20th, 2024 to bring awareness and support to individuals with Down Syndrome and their families in the community. Tlie Buddy Walk started in 1995 by The National Down Syndrome Society to generate awareness and understanding nationally about Down Syndrome_ We would like to have this event in Yucaipa and use one of the parks in the city to host the event. At the event itself we would have food vendors, a DJ and selling/information booths. We have attached pictures for reference as to what other buddy walks do. We would use the grant money to help fund the cost of the city park rental and anvthinn alca naarlari fnr tha avant p
City of Yucaipa Community Activity Grants Application, Rev. 04/2024 Page 2 3 4
I
i
Describe how the'program/event benefits the residents and/or community of Yucaipa:
The Down Right Blessed Foundation Buddy Walk will bring awareness and support to and from the residents of Yucaipa who have family and/or friends with Down Syndrome.
Program/Event Primary Target Population (check all that apply):
VC' ildren or Youth
F-1 Law Income
aP�rsons with Disabilities
I
Number of Residents .Projected to Serve: 150+
Please identify wh, your organization is seeking:
Financial Support: Eyes WINO
$200 SEP �ee
Waiver: es ON
❑ Seniors
F-1 Victims
F]Welfare Recipients
In -kind Support: Police $ Fire $
OT/Reassigned
Staff $ Other $
Public
Works $
Explain Paris Rental
FlWomen
❑ Homeless
❑ Entire Community
CS/Rental $ 159000 AR)m
$200 SEP Financial Total Overall
In -Kind Financial Support Fee Waiver Match Request
Total Amount of Request: $ 1590100 $ $ 200 $ _ 150 . 0
ioco
Provide a detailed description of how the financial support will be used:
All grant money provided to our foundation would be used to rent the city park for the event. If there was any leftover we would use that to help if electricity and/or bathrooms are needed.
City of Yucaipa Cornaa unity Activity Grants Application, Rev. 04/2024 Page 3
What other in-kind/financial
(separate from City
N/A
i
i
FIRM '11111111 1
contributions has yc
funding)?
Total Funds Received
Total Funds Requested
Remaining Balance
Organization:
To Date:
Via Grant Application:
That Will Be Funded By
ur organization received to fund this event/program
In -Kind
Amount
Provide City funding received by organization in the past three years (required):
Program
i In -Kind
Financial
$200 SEP
Support
Fee Waiver
N/A
❑
❑
❑
❑
❑
❑
❑
❑
❑
Financial
Support Amount
Date Total Received
Received
$
$
I, the undersigned; do hereby attest that the above information is true and correct to the best of my knowledge, and understand thawarded fi at'the nancial grant amount needs to be spent prior to submitting another grant request.
Board of Directors Secretary 6/29/24
Uate Keceivecl:
Amount Funded:
i
Type of Grant:
Date City Council;
I J l
$
In -Kind
received follow up report:
Date Reviewed: t !
City Council Meeting: Le
❑ Financial Support [3-Fee Waiver
City of Yucaipa Community Activity Grants Application, Rev. 04/2024 Page 4 i
WELCOME TO THE CITY OF YUCAIPA CITY OF
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 a 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 ofsix (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
Organization and Applicant Information
93-2122649
n Commercial (For-profitl ❑■ Noncommercial (Non-profitl Tax I.D. #:
Organization
Name
Down Right Blessed Foundation
Applicant Name I Debbie Messick
Address Beaumont, CA 92223
Email
[email protected]
Phone Number
714-280-3757
On -Site Contact
Debbie Messick
Phone Number
714-280-3757
Event Information
Type of Event: ❑ Athletic/Recreation ❑ Festival/Celebration ❑ Outdoor Market ❑ Circus/Carnival ❑ Concert/Performance
❑ Parade/Procession/March © Other (specify): Budd/ Wall( Event Title Down Right Brewed Foundation Buddy Walk
Event Location Yucaipa Community Park - Amphitheater Area Event First Annual Down Right Brewed Buddy Walk to bring awareness Description and support for the Down Syndrome Community.
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
10/20/24
❑ Set-up ❑ Event Day ❑ Clean-up
7:30am
9:00am
10/20/24
❑ Set-up ❑ Event Day ❑ Clean-up
9:00am
3:00-4:00pm
10/20/24
❑ Set-up ❑ Event Day 0 Clean-up
4:00pm
5:00pm
❑ Set-up ❑ Event Day ❑ Clean-up
❑ Set-up ❑ Event Day ❑ Clean-up
❑ Set-up ❑ Event Day ❑ Clean-up
Has this event taken place before? ❑ Yes 0 No How many years? n/a Total anticipated attendance: App o% t50 Participants: 150 Spectators:
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 bees- 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. 0 Conflict with public transportation, such as buses.
0 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. 3Pab -e
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:
N/A
Indicate how this closing/reopening of streets will be handled:
❑ City of Yucaipa to handle (cost to be specified) ❑ Event to handle 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:
N/A
Note: "No Parking" signs will be posted forty-eight (48) hours in advance of required days, dates and tunes. cost jor the posting of "No Parking"signs will bespecifred upon reviewof the application by Citystaff.
Food and Beverage
Please describe how food will be served at the event:
Food Trucks/Food Vendor Booths
Vill food be cooked in the event area? ❑■ Yes ❑ No , A I:LL- _ _ _J T_.
Method: ElGas ❑ Electric ❑ Charcoal * Other (specify): vviLi III i [-vvu i i uun Does the event involve the sale or use of alcoholic beverages? ❑ Yes 0 No If alcohol is to be sold, how will the alcohol sales be regulated? N/A
Who will be handling the alcohol sales?
N/A
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 Al No 4] P'a,g e
Company N/A
Name
Contact Name
Phone Number
Lighting
If this is an evening event, please state how the event and surrounding areas will he 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.) N/A
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 r,11;A n fho lFrnllr,,cATinrr infnrm-it-inn
Company
Name
�WE WILL REMOVE OUR OWN TRASH
Contact Name
Phone Number
If not hiring a professional sanitation company, please provide the following information for he person(s) responsible For waste removal.
Contact Name PATRICK DePILLARS/KATHLEEN DePILLARS
Phone Number 909-964-0969
Cal Eire/Medical
In case of an emergency, the on -site contact will call 9-1-1. If event requires an ambulance r .1 r 11 r I- - --
ompany to oe on -site, please provide the following inr01-mau011:
Company N/A
Name
Contact Name
Phone Number
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:
N/A
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.
T.. a.l.,...... .. ........r,,.,... ...,I ,r." , r.rrT-i,�i7ntinn hirafi Fnr I-hic pvpnf? F-1 Ypi F-1 No Company
Name
N/A
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? F Yes ❑ No Start time; 10AM End time; 3PM Are there anv musical entertainment features for this event? ❑ Yes ❑ No Name of Act DJ - TBD
Contact Name
Phone
Number
How many stages? ---- Number of bands? ----- Genre of music; EASY LISTENING Will fireworks. rockets, or other pyrotechnics be used? ❑ Yes Q No Company N/A
Name
Contact Name I N/A
Phone Number
Describe (indicate dates, times and locations for launching and fallout areas).
N/A
Hasa permit been issued: U Yes U No
(Note: Additional permits may be required as indicated by staff.. These include, but are riot 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 ❑ Insurance certificate attached Insurance certificate on file ❑ 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.)
TI-p,a.g:e
Application Checklist
Completed Application
Certificate of liability insurance
Q 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 frd its
officials,
f fi activities
arising employees, and agents, against all claims, liabilities, and losses a g ken pursuant to the Permit. The City is thePermit, liable � Suspension
connected with or underta
loss, property loss, or other damage that may result from the use of or revocation of the Permit.
Name: DEBBIE MESSICK Signature:
81Page
7/15/24
Date:
Permit
City of Yucaipa Community PHONE:(909) 790-7460
Services FAX:(909) 790-2589
34272 Yucaipa Blvd EMAIL:communityservices9yucaipa.org
Yucaipa, CA 92399
Organization Name Down Right Blessed Foundation - 458
Customer Type Non -Profit (NR)
Organization Address
Beaumont, CA 92223
Agent Name Debbie Messick
System User Julia Basa
Down Right Blessed Foundation
COMMUNI I Y
SERVICES M�f e
eetfer!
Permit # R6660
Status Tentative
Date Jul 16, 2024 5:56 PM
Expiration Date Jul 16, 2025
Home Phone Number (714) 280-3757
Email Address deb bievdownrightbless ed.org
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 $Z00.00
1 resource(s) 1 booking(s) Subtotal: $200.00
Booking Summary
DepartmentSpecial Event Permits (Special Event ApplIcation) Center Community Services
START DATE/TIME END DATEITIME ATTENDEE AMT W/O TAX
Sun, Oct 20, 2024 9:00 AM Sun. Oct 20, 2024 5:00 PM 150 $200.00 Spec,al Event Fee (NR-V) _y?GO 00 ; Eech < 1 1S200 00
Payment Schedules Original Balance: $200.00 Current Balance: $200.00
DUE DATE AMOUNT DUE AMOUNT PAID WITHDRAWAL ADJUSTMENT BALANCE Oct 6, 2024 $200.00 $0.00 $0.00 $200.00
7/16/24, 5:53 PM
Permit
City of Yucaipa Community
Services
34272 Yucaipa Blvd
Yucaipa, CA 92399
PHONE:(909) 790-7460
FAX:(909) 790-2589
EMAIL:co mm u nityservices�ayucai p a. org
Organization Name Down Right Blessed Foundation - 458
Customer Type Non -Profit (NR)
Organization Address
Beaumont, CA 92223
Agent Name Debbie Messick
System User Julia Basa
PermitContract
t� COMMUNITY M2kk
SERVICES Life
Permit # R6659
Status Tentative
Date Jul 16, 2024 5:53 PM
Expiration Date Jul16, 2025
Home Phone Number (714) 280-3757
Email Address debbie;g�downrightblessed.org
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
Down Right Blessed Buddy Walk
2 resource(s) 2 booking(s)
Subtotal: $900.00
Booking Summary
Center:
YucaipaAmphitheater
Community Center
(Shelter Facilities)
START DATE/TIME I
END DATE/TIME
I ATTENDEE
I AMT WIO TAX
Sun, Oct 20, 2024 7:00 AM
Sun, Oct 20, 2024 8:00 PM
150
$0.00
Resource level fees
$600.00
Deposit $100.00 / Each x 1
$100.00
Rental - Daily $500.00 / Day x 1
$500.00
..
Community Center
LargeShelter #2 (Shelter Facilities)
START DATE/TIME
END DATE/TIME
ATTENDEE
I AMT W/O TAX
Sun, Oct 20, 2024 7:00 AM
Sun, Oct 20, 2024 8:00 PM
1 $0.00
Resource level fees
$300.00
Rental - Daily $300.00 / Day x 1
$300.00
https://anprod.active.com/yucaipa/ui.do?method=showPermitContract&permit_id=F7BBOE8EOF37AA 1/3
7/16/24, 5:53 PM
Custom Questions
PermitContract
I QUESTION I ANSWER
A. Any Cancellation of a rents l less than 30 days will result in loss of 100% of the Acknowledge rental 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 Acknowledge shelters. 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 Acknowledge be 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 Clty standards. 3)Bounce houses are not allowed in City parks overnight.
I acknowledge and agree to the following policies regarding bounce houses: 1) Acknowledge Bounce 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 Acknowledge Houses: 1) 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 Acknowledge 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/Requestor.
I acknowledge and understand that all park shelter reservations include an Acknowledged 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.
I agree and acknowledge that the information provided to this application Is correct Acknowledge and 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 food trucks Acknowledge permitted in parks or parking lot. 1) No amplified sound permitted. 2) Smoking is prohibited in all City parks and facilities (reference City Park Ordinance No. 256). 3)Alcoholic beverages prohibited. 4)No wood burning campfires or propane grills permitted, Charcoal only. 5)NO VEHICLES ARE ALLOWED IN CITY PARKS, ON TURF, OR ON WALKWAYS.
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 No are required to be reserved through the City of Yucaipa's authorized bounce house https://anprod.active.com/yucaipa/ul.do?method=showPermitContract&permit_id=F7BBOE8EOF37AA 2/3
7/16/24, 5:53 PM PermitContract
cornpanies 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
EVENT RESOURCE I DEPOSIT FEE i CHARGE I TAXI AMOUNT PAID Down Right Amphitheate Deposit $100.00 $0.00 $0.00
Blessed Buddy r
Walk
REFUNDS BALANCE
$0.00 $100.00
Payment Schedules Original Balance: $900.00 Current Balance: $900.00
DUE DATE I AMOUNT DUE I AMOUNT PAID WITHDRAWAL ADJUSTMENT I BALANCE Oct 6, 2024 $900.00 $0.00 $0.00 $900.00
https://anprod.active.com/yucaipa/ui.do?method=showPermitContract&permit_Id=F7BBOE8EOF37AA 313
•1T1'UF ',^�
SHELTER RESERVATION APPLICATION
City of Yucaipa Community Services Department
Step One- Information
Name of Rental AvOicai
(please print
city
iJ
Organization Nanie�(if applicable) Address 1.>34.
Primary email of Rental Applicant:
Designated Event' Representative (if Applicant will not be present): _ CAS
3ne Number
l c.3 r
}Phone Number
Name Phone Number
Step Two- Event li
Type of Event: OMeeting ❑Birthday) ❑Family Gathering ❑ Recep tion/Banquet ❑ Shower Bfaby ❑ BridallWedding
Names of Event : 1+i�i� ( -its �1 l` `�( f� �.�i�lC� A( =`�pther:� _ r#of Attendees: `l11 Dates) of Use: Cl , I Day: ❑M ❑Tu O ❑Th ❑F ❑Sau *Hours requested, include the time it takes to set up and clean-up the event. Total Number of Hours: r( 1 Step Three- Details'
Is the applicant a non-profit? 1�
If yes, non-profit # 2v_Aa r Is the event a fundraiser? C�Yes ❑No i i
ill you have any of the following: p DJ ❑Band
Will there be a bounce house? ❑Yes $No W
Step Four — Facility!
rnphitheater' � arge Shelter 2 ❑Medirttn Shelter 3 & 4 El Medium Shelter S & 6 ❑Small Shelter 1 ❑Small Shelter 3 ❑Small Shelter 4 ❑Small Shelter S OSmallShelter 6 ❑Small Shelter 7 ❑Small Shelter 8
Wildwood Park:
❑Small Shelter 1
Ave I Park:
❑Small Shelter I ❑Small Shelter 2 ❑Medium Shelter 3 ❑Small Shelter 4 ❑Small Shelter 5 701 Street Park
❑Small 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 Till 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 V11 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. Cityor
prior nq
B. Permit
C. No amll
D. Due to I
and the
E. Smokin
F. Alcohol
G. No woe
H. Motor t
127). 1
Bounce Houses/Jun
A. Permit
house v
Permit
and de',
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F. Bonn,
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Event P
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N. The Cit
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sized activities shall have priority use over all requests. When possible, neither user shall interfere with the other's use. Sufficient 1 tication of canceled requests will be given by the City when possible. alder/Requestor(s) and event attendees must adhere to the rules and regulations governed by the City (reference City Park e No. 127). Failure of adherence to such rules and regulations may result in suspension of use or dismissal from the facility.
Ged sound permitted.
e unavoidable seasonal and recreational circumstancestactivities, there is no guarantee contenting the condition of the shelter irrounding area. The City will maintain the shelter to the best of their ability prior to the event. is prohibited in all City parks and facilities (reference City Park Ordinance No. 256). beverages prohibited unless prior approval as a condition of a Special Event Permit. burning campfires or propane grills permitted, Charcoal only.
Iticle use is prohibited on surfaces other than those maintained and specifically designated (reference City Park Ordinance No.
JTE: If motor vehicles are found on prohibited surfaces, 950 will be deducted from the deposit. )ers
older/Requestor must first obtain a Facility Use Agreement for the use of the park and indicate on the Agreement that a bounce I be used as part of the event (Yucaipa Municipal Code 12.04.281). older/Requestor and bounce house company must execute a written agreement (between the two parties) and agree to indemnify ,id the City from any liability related to the use of a bounce house. A Certificate of Insurance and Endorsement is required for i :ers in City parks. The Certificate of Insurance and Endorsement must list the City as additionally insured (per Section VIII of ment). The Bounce House Rules and Regulations form and Insurance documents must be received by the Community Services ent fourteen (14) days prior to the event date. '
reserves the right to limit the number and size of bounce houses being used. Only small bounce houses are permitted (18'xl8'xl8' urger sized bounce houses are permitted only with a Special Event Permit and with Director approval.
Louses are to be set up only by the bounce house company in compliance with manufacturer specifications. cause companies will be responsible for providing a generator for the inflation of the bounce house. The City does not provide ;y. The generator must be quiet rated at 60dB or less and not generate noise in excess of City standards. The generator shall be I safe distance from the bounce house and electrical cords covered to prevent tripping hazards. Additional gasoline cans MUST stored next to the generator.
nce house company must provide a fire extinguisher that is equipped to extinguish any fire that may occur. houses and generators will be placed at locations designated on the Facility Use Agreement application: Community Park: I 2, 3, 4, & 7); Ave I Park: (Shelters 1, 2, 3, 4); Ts Street Park (Shelters 1, 2, 3); and Wildwood Park: (Shelter t). houses must be under supervision by an adult at all times. Permit Holder/Requestor must provide adequate supervision so that s in compliance with manufacturer recommendations and reflects safe levels of operation. houses are not allowed in City parks overnight unless approved as part of a Special mnit.
houses mustbe free standing and weighted. Stakes are prohibited in City parks unless approved as a special condition of a Special nit. Bounce houses must not be tied or tethered to trees, tables, or other park amenities. -[older/Requester is responsible for all damage caused by their use of the park or bounce house. Damage to City property or turf Lilt in loss of deposit.
3ICLES ARE ALLOWED IN CITY PARKS, ON TURF, OR ON WALKWAYS UNLESS APPROVED AS PART OF A SPECIAL is not responsible for any damage to the bounce house.
y the Permit Holder/Requestor or vendor to adhere to these policies will result in the immediate removal of bounce house from 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 nancial responsibility of the Permit Holder/Requestor.
ized Jumper Companies:
Jump Rentals: 909-873-8487 1 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 liabl� for any claims, damages, losses and expenses caused by the sole negligence or willful misconduct of the City of Yucaipa.
Permittee shall have deceived 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 a rees 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 and agree to abide by all of the City of Yucaipa Comnjunity Center policies stated above and in the Community Center Rental policies.
Date: `
Applicant Signature
of the Treasury
Date:
raDepartment
Internal Revenue Service
12/11/2023
Tax Exempt and Government Entities
IDQ
NS-7 P.O. Box 2508
Employer ID number:
93-2122649
Cincinnati, OH 45201
Person to contact:
Name: Customer Service
ID number: 31954
Telephone: 877-829-5500
DOWN RIGHT BLESSED FOUNDATION
Accounting period ending:
34590 COUNTY LINE ROAD SUITE 3
December 31
YUCAIPA, CA 92399
Form 990-PF required:
Yes
Effective date of exemption:
May 31, 2023
Addendum applies:
No
DLN:
26053733004963
Dear Applicant:
We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records.
Organizations exempt under IRC Section 501(c)(3) are further classified as either public charities or private foundations. We detennined you're a private foundation within the meaning of Section 509(a).
You're required to file Form 990-PF, Return of Private Foundation or Section 4947(a)(1) Trust Treated as Private Foundation, annually, whether or not you have income or activity during the year. If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked.
If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter.
For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities .
Enter "4221-PF" in the search bar to view Publication 4221-PF, Compliance Guide for 501(c)(3) Private Foundations, which describes your recordkeeping, reporting, and disclosure requirements.
Sincerely,
Stephen A. Martin
Director, Exempt Organizations
Rulings and Agreements
Letter 1076 (Rev. 2-2020)
Catalog Number 35161A
ATTACHMENT 2
CITY OF
Fiscal Year:
Date Application submitted
Submit to:
COMMUNITY ACTIVITY GRANT
FINANCIAL / IN -KIND /FEE WAIVER
APPLICATION
2024-2025
City of Yucaipa
General Services/City Clerk Department
34272 Yucaipa Blvd.
Yucaipa, CA 92399
Attn: Kimberly Metzler
6-28-2024
Received
City of Yucai;_)'--A
JUL0 20V
General Services/
City Clerk's Departn-ient
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.
Name of Applicant/Organization: Inland Leaders Charter School Applicant/Organization Mailing Address: 12375 California St. Yucaipa, CA Applicant/Organization Phone Number: ( 909 ) 446-1100
Contact (1) Jeremy Hoch (909 ) 705-9507
Name Phone NLunber
[email protected]
E-mail address
Contact (2) Mike Gordon ( 90 9 ) 446-1100
Name Phone Number
[email protected]
E-mail address
SECTION 2 - ELIGIBILITY REQUIREMENTS:
Yes
No
Is your organization located in another community'?
❑
Will the program/event take place in another community'? ❑
FV]
Are you aware of any other City program providing this service? El
❑
If so, which one?
*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 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 No
Is your organization a 501(c)? 20-8343378 ❑
Tf yes, please provide Tax TD# and attach all supporting documents.
Does this application include submittal of documentation verifying 501(c) status? F-1 Fv1 How long has your 501(c) organization been in existence? 1 7years Number of Employees working for organization: 120
Number of Volunteers working for organization: 100
Ts a current City Council Mernber on your board? ❑
How many Yucaipa residents does your organization currently serve? 700 Does the organization charge admission, membership fees, dues, etc.? F-1 Fv], If yes, please describe:
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Dr. Jay Jimenez President
Bonnie Mitchel
Michael Casavan
Eli Gillespie
Jake Rosario
Secretary
Member
Member
Member
SECTION 4 - PROGRAM DESCRIPTION/SCOPE: (PLEASE USE ADDITIONAL PAGES IF NECESSARY) Name of ffie program/event: ILCS Girls Volleyball Games Date(s) of program/event:
September to October
Describe the program/event that organization is seeking support for:
(Attach any event/program promotional materials associated with program/event) Our Lions Volleyball teams need a inside gym to host our home games this season. I hae our schedule and it has been sent to Julia Basa for scheduling at the Community Center.
City of Yucaipa Community Activity Grants Application, Rev. 04/2024 Page 2
Describe how the prograin/event benefits the residents and/or community of Yucaipa:
We believe that athletics are an important part of the educational experiance at Inland Leaders Charter School. Our students benifit from learning how to handle success and dissappointment. Athletics build good leadership qualities in studenets that will help them be leaders in our community.
Prograin/Event Primary Target Population (check all that apply):
P/1 Children or Youth
1-1 Low Income
F-1 Persons with Disabilities
Number- of Residents Projected to Serve: 20
Please identify what your organization is seeking:
Financial Support: FlYes F'/]N'o
$200 SEP Fee
Waiver: [Jes aTo
Seniors
Victims
Welfare Recipients
Public
In -kind Support: Police $ Fire $ Works $
OT/Reassigned
Staff $ Other $ Explain
$200 SEP
In -Kin Financial Support Fee Waiver
Total Amount of Request: $ 7r- $ $
Provide a detailed description of how the financial support will be used:
Women
Homeless
Entire Community
CS/Rental $ 1782
Financial Total Overall
Match Request
$ _ $ 1 782
Our Volleyball team is in need of gym to play our home games in. We have 12 home games this year.
City of Yucaipa Community Activity Grants Application, Rev. 04/2024 Page 3
SECTION 1CAPABILITIES/BUDGET:
What other in-kind/financial contributions has your organization received to fund this event/program (separate from City funding)?
In -Kind Financial
Amount Support Amount
Total Funds Received To Date:
Total Funds Requested Via Grant Application: $
Remaining Balance That Will Be Funded By $
Organization:
Provide City funding received by organization in the past three years (required):
Program
2022
2023
In -Kind Financial
Support
$200 SEP
Fee Waiver
❑✓ ❑
❑
❑✓ ❑
❑
SECTION 7 —CERTIFICATION
Date Total Received
Received
$1500
s 1700
$
T, the undersigned, do hereby attesV4tatthe above information is true and correct to the best of my knowledge, and understand that the award &1inancial,> t mount needs to be spent prior to submitting ai her grant request.
Simatw-e / Title Date
COMPLETEDJO BE BYCITY
Date Received: _ Date Reviewed: —(
Amount Funded: $ City Council Meeting:
Type of Grant: [s m-Kind ❑ Financial Support ❑,,Vee Waiver Date City Council received follow up report:
City of Yucaipa Community Activity Grants Application, Rev. 04/2024 Page 4
CONIN41LINITY
Permit SERVICES
City of Yucaipa Community PHONE:(909) 790-7460 Permit # R6599 Services FAX:(909) 790-2589
Status Tentative
34272 Yucaipa Blvd EMAIL:
Date Jun 18, 2024 2:24 PM
Yucaipa, CA 92399
Expiration Date Jun 18, 2025
Organization Name Inland Leaders Charter School -170
Customer Type Non -Profit (R)
Organization Address 12375 California St
Yucaipa, CA 92399
Agent Name Jeremy Hoch Home Phone Number (909) 705-9507 Emall Address
System User Julia Basa
Rental Fee $1,980.00
Discounts-$198.00
Subtotal $1,782,00
Deposits $100.00
Deposit Discounts $0.00
As
Total Permit Fee $1,882.00
Total Payment $0.00
Refunds $0.00
Balance $1,882.00
ILCS Volleyball Games 1 resource(s) 12 booking(s) Subtotal: $1,882.00
START DATE/TIME
END DATEfTIME
ATTENDEE
AMT W/O TAX
Thu, Aug 29, 2024 2:30 PM
Tue, Oct 15, 2024 5:15 PM
—
$1,782.00
Occurs on selected dues effective 08.,-Z9/2024 until 1045/2024.
Thu, Aug 29, 2024 2:30 PM
-Thu, Aug 29, 2024 5:15 PM
20 $148.50
Thu, Sep 5, 2024 2:30 PM
Thu, Sep 5, 2024 5:15 PM
20 $148.50
Tue. Sep 10, 2024 2:30 PM
Tue, Sep 10, 2024 5:15 PM
20 $148.50
Thu, Sep 12, 2024 2:30 PM
Thu, Sep 12, 2024 5:15 PM
20 $148.50
Thu, Sep 19, 2024 2:30 PM
Thu, Sep 19, 2024 5:15 PM
20 $148.50
# R6599 Status Tentative
Tue, Sep 24, 2024 2:30 PM
Tue, Sep 24.2024 5:15 PM
20 $148.50
Mon, Sep 30, 2024 2:30 PM
Mon, Sep 30, 2024 5:15 PM
20 $148.50
Tue, Oct 1, 2024 2:30 PM
Tue, Oct 1, 2024 5:15 PM
20 $148.50
Thu, Oct 3, 2024 2:30 PM
Thu, Oct 3, 2024 5:15 PM
20 $148.50
Tue, Oct 8, 2024 2:30 PM
Tue, Oct 8, 2024 5:15 PM
20 $148.50
Thu, Oct 10, 2024 2:30 PM
Thu. Oct 10, 2024 5:15 PM
20 $148.50
Tue, Oct 15, 2024 2:30 PM
Tue, Oct 15, 2024 5:15 PM
20 $148.50
Resource level fees
$100.00
INFORMATION DESCRIPTION SIGNING STATUS
Alcohol Sales Lic Checked
Proof of Liability Insurance Checked
Security Guard Contract Checked
Proof of Non Profit Status Checked
WAIVER NAME DUE DATE FOR SIGNING STATUS
Facility Usage Waiver Aug 29, 2024 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. # R6599 Status Tentative Page 2 of 3
EVENT
RESOURCE
DEPOSIT FEE CHARGE
ILCS
Gymnasium,
Deposit $0.00
Volleyball
South
Games
ILCS
Gymnasium,
Facility $100.00
Volleyball
South
Deposit
Games
DUE DATE AMOUNT DUE
Aug 15, 2024 $1,882.00
Signature
TAX AMOUNT PAID REFUNDS BALANCE
$0.00 $0.00 $0.00 $0.00
$0.00 $0.00 $0.00 $100.00
Original Balance: $1,882.00 Current Balance: $1,882.00
AMOUNT PAID WITHDRAWAL ADJUSTMENT BALANCE
$0.00 $0.00 $1.882.00
# R6599Status Tentative Page 3 of 3