Item No. 21 - Review and Consider FY25-26 CAG Applications — Yucaipa City Council, June 9, 2025 (part 1 of 2)

Item No. 21

AGENDA REPORT
DATE: June 9, 2025
TO: Honorable Mayor and City Council
FROM: Ana V. Sauseda, Director of General Services/City Clerk SUBJECT: Review and Consider Fiscal Year 2025-2026 Community Activity Grant Applications RECOMMENDATION:

That the City Council:

1. Review and consider the Fiscal Year 2025-2026 Community Activity Grant awards recommended by the Community Activity Grant Application Review Ad -Hoc Committee as follows:

Applicant
Description of EveutProgram
FY 2025/26
Financial
Support
Requested
FY 2025/26
In-kind/Fee
Waiver
Support
CAG Ad -Hoc Committee
Recommended Awards
Recommended
Financial
Recommended
ln-kind/Fee
Waiver
Childhood Cancer Foundation of Southern California
Spring EGGStravaganza
S1,150.00
S1,150
Family Service Association of Redlands
Housing Assistance and Advocacy Program
S3,000
S3,000
Gardenworks For Kids
Toddler Sensory Garden
S1,500
S1,500
Gracepoint Fellowship/First Baptist Church Yucaipa
Love Yucaipa at the Community Center
S4,000
S200.00
S4,000
S200
Inland Leader's Charter School
Volleyball Games
S945.00
S945
Rotary Club of Yucaipa
70th Annual Christmas Parade
S15,700 00
S15,700
Rotary Club of Yucaipa
Rotary Weekly Meetings
S10,206.00
S10,206
Smiles for Seniors
Low Income Senior Assistance
S3,000
S3,000
The Well Outreach Center
Our Neighbor's Closet
S3,000
S3,000
Yucaipa Calimesa Family Assistance
Facility Repair Maintenance - Asphalt
S1,600
S1,600
Yucaipa Calimesa Veterans Committee
Veterans Day Ceremony
S852.00
S352
Yucaipa Pickleball Inc.

Pickleball in Schools
S1,100
S1,100
Yucaipa Valley Art Association
Wednesday Meetings
S4,739 00
S4,739
Yucaipa Valley Art Association
Tuesday:Thursday Meetings
S5,189.00
S5,189
Yucaipa Valley Lions Club
Youth Peace Poster Contest
S630.00
S630
Yucaipa \Vomans Club
Building Maintenance
S1,500
S1,500

TOTAL REQUESTED

BUDGETED AMOUNT

BALANCE REMAINLNG
S18,700
S39,611.00r
S13,700
S39,611
S20,000
S40,000
S20,000
S40,000
S339.00
S339.00

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.

BACKGROUND/DISCUSSION:

On March 24, 2025, City Council reviewed the Community Activity Grant (CAG) program guidelines and funding levels for Fiscal Year 2025-2026 (FY26) and approved the following:
• FY26 Budget funding levels:
o $20,000 for financial grant requests
o $40,000 for in-kind/fee waiver requests
• Amend the FY26 guidelines to designate the Scherer Community & Nutrition Center as the only City facility made available to accommodate in-kind/fee waiver requests On April 16, 2025, the City issued email notices to past applicants and new contacts, announcing the FY26 CAG program, the firm deadline of May 16, 2025, 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 2, 2025, 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 26 Applications
Attachment 1
Childhood Cancer Foundation of Southern California
Scope
Spring EGGStravaganza
Requested In -Kind Amount
$1,150
Committee Recommended In -Kind Award
$1,150
Attachment 2
Family Service Association of Redlands
Scope
Housing Assistance and Advocacy Program
Requested Financial Amount
$3,000
Committee Recommended Financial Award
$3,000
Attachment 3
Gardenworks For Kids
Scope
Toddler Sensory Garden
Requested Financial Amount
$1,500
Committee Recommended Financial Award
$1,500

Community Activity Grant
FY26 Applications
(Continued)
Attachment 4
Gracepoint Fellowship/First Baptist Church Yucaipa
Scope
Love Yucaipa
Requested Financial Amount
$4,000
Requested In -Kind Amount
$200
Committee Recommended Financial Award
$4,000
Committee Recommended In -Kind Award
**Event to be held at the Community Center
$200
Attachment 5
Inland Leader's Charter School
Scope
Volleyball Games
Requested In -Kind Amount
$945
Committee Recommended In -Kind Award
$945
Attachment 6
Rotary Club of Yucaipa
Scope
70th Annual Christmas Parade
Requested In -Kind Amount
$15,700
Committee Recommended In -Kind Award
$15,700
Attachment 7
Rotary Club of Yucaipa
Scope
Rotary Weekly Meetings
Requested In -Kind Amount
$10,206
Committee Recommended In -Kind Award
$10,206
Attachment 8
Smiles for Seniors
Scope
Low Income Senior Assistance
Requested Financial Amount
$3,000
Committee Recommended Financial Award
$3,000
Attachment 9
The Well Outreach Center
Scope
Our Neighbor's Closet
Requested Financial Amount
$3,000
Committee Recommended Financial Award
$3,000
Attachment 10
Yucaipa Calimesa Family Assistance
Scope
Facility Repair/Maintenance - Asphalt
Requested Financial Amount
$1,600
Committee Recommended Financial Award
$1,600

Community Activity Grant
FY26 Applications
(Continued)
Attachment 11
Yucaipa Calimesa Veterans Committee
Scope
Veteran's Day Ceremony
Requested In -Kind Amount
$852
Committee Recommended In -Kind Award
$852
Attachment 12
Yucaipa Pickleball Inc.

Scope
Pickleball in Schools
Requested Financial Amount
$1,100
Committee Recommended Financial Award
$1,100
Attachment 13
Yucaipa Valley Art Association
Scope
Wednesday Meetings
Requested In -Kind Amount
$4,739
Committee Recommended In -Kind Award
$4,739
Attachment 14
Yucaipa Valley Art Association
Scope
Tuesday/Thursday Meetings
Requested In -Kind Amount
$5,189
Committee Recommended In -Kind Award
$5,189
Attachment 15
Yucaipa Valley Lion's Club
Scope
Youth Peace Poster Contest
Requested In -Kind Amount
$630
Committee Recommended In -Kind Award
$630
Attachment 16
Yucaipa Woman's Club
Scope
Building Maintenance
Requested Financial Amount
$1,500
Committee Recommended Financial Award
$1,500

FISCAL IMPACT:

The draft FY26 Budget includes $60,000 for Community Activity Grant awards. The recommendations do not impact the budget, however any awards granted would utilize available budget.

Attachment(s):

1. Childhood Cancer Foundation of Southern California

2. Family Service Association of Redlands

3. Gardenworks For Kids

4. Gracepoint Fellowship/First Baptist Church Yucaipa

5. Inland Leader's Charter School

6. Rotary Club of Yucaipa

7. Rotary Club of Yucaipa

8. Smiles for Seniors

9. The Well Outreach Center

10. Yucaipa Calimesa Family Assistance

11. Yucaipa Calimesa Veterans Committee

12. Yucaipa Pickleball Inc.

13. Yucaipa Valley Art Association

14. Yucaipa Valley Art Association

15. Yucaipa Valley Lion's Club

16. Yucaipa Woman's Club

17. Prioritization Worksheet

18. Financial Award Grant Tracker fiscal years 2010/11 through 2024/25 Approved by:

ATTACHMENT 1

CITY OF YUCAIPA

COMMUNITY ACTIVITY GRANT APPLICATION

FINANCIAL / IN -KIND / FEE WAIVER

COMMUNITY ACTIVITY GRANT APPLICATION INSTRUCTIONS
FISCAL YEAR:
2025-2026
DATE SUBMITTED: 5/6/2025
SUBMIT TO: CITY OF YUCAIPA

GENERAL SERVICES/CITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

YUCAIPA, CA 92399
Ail 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 25/26 grant cycle, financial grant awarded funds will require 100% financial match by the applicant. For example, if your total program/project cost is 51,000, your financial grant request should be for no more than 3500. 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: Childhood Cancer Foundation of Southern California Applicant/Organization 11155 Mountain View Ave, Suite 105, Loma Linda, CA 92354 Mailing Address
Applicant/Organization Phone Number : (909) 558-3414
CONTACT (1)
CONTACT (2)
Angelica Tapia
NAME
[email protected]
E-mail
Stephanie Avila
NAME
savila d!ccfsocal.org
E-Mail
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?
'If you answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant. (909) 558-3419

PHONE NUMBER
(909) 558-3419
YES

PHONE NUMBER
NO
✓
✓

RECEIVED
MAY 1 3 2025
Yucaipa City Clerk's Offlcti
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 so, please provide Tax ID# and attach all supporting documents.

YES
NO
33-0536599
44 500.H
115
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Peter Brierty, President
Wayne Williams, Board Member
Rebecca Hogarth, Board Member
Synthia Alanis, Board Member
Frank Schnetz, Vice President
Ryan Stelzner, Board Member
Sara Romero, Board Member
Kathleen Flynn, Board Member
2 SECTION 4 - PROGRAM DESCRIPTION/SCOPE (PLEASE USE ADDITIONAL

PAGES AS NECESSARY)
Name of the program/event:

Spring EGGstravaganza
Date(s) of the program/event:

March 21, 2026
Total estimated cost for program/event:

Describe the program/event that the organization is seeking support for:
(Attach any event/program promotional materials associated with the program/event) Receiving non-profit status in September of 1981, Childhood Cancer Foundation is now more than 900 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 200 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.

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

Childhood Cancer Foundation of Southern Califomia 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):

I I Children or Youth I I Entire Community Homeless I I Low Income I I Women Persons with Disabilities ❑ Seniors Victims Welfare Recipients Please answer the following to determine if your program/event requires a Special Event Permit (SEP):

YES NO
Estimated attendance 300-999 persons
Amplified Sound
(excluding Special Event Facilities)

THIS BOX IS FOR STAFF USE ONLY
This event requires City Management/
Administrative Approval:

YES NO
DO
Estimated attendance 1000+ persons
Alcohol Service
(excluding Community Centers & YPAC)
Street Closure - Traffic Management
YES NO
1 THIS BOX IS FOR STAFF USE ONLY
YES NO
This event requires City Council Approval:
3 SECTION S - GRANT FUNDING REQUEST
Please identify what your organization is seeking:

YES NO
Financial Support:

In -Kind Support: $ $ '5O .°2
OT/Reassigned Staff CS/Rental
YES NO
$200 SEP Fee Waiver:
$ $
Scherer Other
Community Center
If other, please explain:

Total Amount $ 9-0
of Request
In -Kind
Financial Suocrort
$ 200
5200 SEP Fee
Waiver
Provide a detailed description of how the financial support will be used:
$ $
Financial Match
1,150
Total Overall
Request
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
In -Kind
Amount
$ 1.500 $
$ $

3.500
$
Total Funds Received to Date: $
Total Funds Requested via Grant Application: $ 1.150
Remaining Balance that will be Funded by Organization: $ $
$
$
$
Financial
Support Amount
4 r

SECTION 6 - FINANCIAL CAPABILITIES/BUDGET(coNriNUEo)
Describe any City Funding received by organization in the past three years (required)? Program
Spring Egg Hunt 2025
Spring Egg Hunt 2024
Spring Egg Hunt 2023
In•Kind
Suppo t
SECTION 7 - CERTIFICATION
Financial
Suppo t
S200 SEP
Fee Waiver
Date Received
6/ 11 /2024
6/28/2023
7/6/2022
Total Received
$ 1.000
$ 1.0110
$310.25
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
Program Director
Title

SUBMIT FORM
5/6/2025
Date
1 TO BE COMPLETED BY THE CITY
Date Received:

Amount Funded:

Type of Grant:

In -Kind Financial
Support Support
Date City Council received follow-up report:

Date Reviewed:

City Council Meeting:

S200 SEP
Fee Waiver
5 CHILDHOOD CANCER FOUNDATION
OF SOUTHERN CALIFORNIA, INC.

NON-PROFIT CORPORATION
May 6, 2025
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 March 21, 2026.

Receiving non-profit status in September of 1981, Childhood Cancer Foundation of Southern California, Inc. (CCFSC) is now more than 900 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 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 200 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
"W eite ZF.eae Ift.em vs [tope."
P.O. BOX 1663 LOMA LINDA, CA 92354 I (909) 558-3419 I www.ccfsocol.org

CHILDHOOD CANCER FOUNDATION
OF SOUTHERN CALIFORNIA, INC.

Board of Directors
2025
Peter Brierty, Board President
Retired San Bernardino County Fire Chief
Highland, CA
September 2006 to December 2027
Wayne Williams, Board Member
Southern California Edison
Redlands, CA
November 2014 to December 2025
Rebecca Hogarth, Board Member
CSU, San Bernardino
Phelan, CA
January 2023 - December 2026
Synthia Alanis, Board Member
Registered Nurse, Loma Linda University
Health
Highland, CA
December 2024 - December 2027
Frank Schnetz, Vice President
F E Schnetz Commercial Real Estate
San Bernardino, CA
January 2014 to December 2025
Ryan Stelzner, Board Member
Southern California Edison
Highland, CA
January 2023 - December 2026
Sara Romero, Board Member
Cerro Coso Community College
California City, CA
January 2023 - December 2026
Kathleen Flynn, Board Member
Retired Counselor for San Bernardino
Valley College & Santa Monica College
Redlands, CA
February 2025 - February 2028
Our volunteer board meets once a month and is very active in participation at our many family activities and fundraising events.

Stephanie Avila, Executive Director

Permit

COMMUNITY

SERVICES
Park
KLkfer (
City of Yucaipa Community
Services
34272 Yucaipa Blvd
Yucaipa, CA 92399
Organization Name
Customer Type
Organization Address
PHONE:(909) 790-7460
FAX:(909) 790-2589
EMAIL:, ,:immunityservices.ayucaipa.org
Childhood Cancer Foundation Of Southern
Calif. - 371
Non -Profit (NR)
11155 Mountain View Ave. Ste. 105
Loma Linda, CA 92354
Agent Name Angelica Tapia
System User Karen Ruiz
Childhood Cancer Foundation of Southem California
Booking Summary
Permit*
Status
Date
Expiratlon Date
Organization Phone 1 (909) 558-3419
Number
Home Phone Number (909) 558-3419
Email Address atapiaaccfsocal•org
Rental Fee
Discounts
Subtotal
Deposits
Deposit Discounts
Total Permit Fee
Total Payment
Refunds
Balance
R7496
Tentative
Apr 17, 2025 6:02 PM
Apr 17, 2026
$950.00
$0.00
$950.00
$100.00
$0.00
$1,050.00
$0.00
$0.00
$1,050.00
2 resource(s) 2 booking(s) Subtotat $1,050.00
Amphitheater (Shelter Fadllties)
Center. Yucaipa Community Center

START DATE/TIME
Sat, Mar 21, 2026 7:00 AM
Resource level fees
Depr?;il
Rental DaHy
$100.00 / Each x 1
S600.00 - Day x 1

END DATE/TIME
Sat, Mar 21, 2026 8:00 PM
$100.00
$600.00

ATTENDEE
1 AMT W/O TAX
$0.00
$700.00
Shelter #2 Large (Shelter Facilities)
Center Yucaipa Community Center

START DATE/TIME
Sat, Mar 21, 2026 7:00 AM
Resource level fees
Rental - Daily
Custom Questions

QUESTION

END DATE/TIME
Sat, Mar 21, 2026 8:00 PM
$350.00 i Day x 1 $350.00
ANSWER

ATTENDEE
1 AMT W/O TAX
$0.00
$350.00
# R7496 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 $20.00 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/Requestor.

Acknowledge
1 acknowledge and understand that all park shelter reservations include an insurance Acknowledged 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 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 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. 51NO VEHICLES ARE ALLOWED IN CITY PARKS, ON TURF, OR ON WALKWAYS.

Acknowledge
Acknowledge
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
# R7496 Status Tentative Page 2 of 3

EVENT RESOURCE DEPOSIT FEE CHARGE TAX AMOUNT PAID REFUNDS BALANCE Childhood Amphitheater Deposit $100.00 $0.00 $0.00 $0.00 $100.00 Cancer
Foundation
of Southern
California
Payment Schedules Original Balance: $1,050.00 Current Balance: $1,050.00

DUE DATE AMOUNT DUE AMOUNT PAID WITHDRAWAL ADJUSTMENT BALANCE Mar 7, 2026 $1,050.00 $0.00 $0.00 $1,050.00
# R7496 Status Tentative Page 3 of 3

EGGSTRAVAGANZ
SATURDAY, MARCH 21, 2026

YUCAIPA COMMUNITY PARK
34900 OAK GLEN RD, YUCAIPA CA 92399
11AM - 2PM

LUNCH - GIVEAWAYS - EGG HUNT
AND MORE!!!!

FREE EVENT FOR FAMILIES OF

CHILDHOOD CANCER FOUNDATION
FAMILIES MUST PRE -REGISTER BY MARCH 4
www.ccfsocal.org/egg

CHILDHOOD CANCER FOUNDATION
OF SOUTHERN CALIFORNIA, INC.

EIRC Department of the Treasury
i0 Internal Revenue Service
002498
OGDEN LIT 84201-0038

CHILDHOOD CANCER FOUNDATION OF

SOUTHERN CALIFORNIA INC
PO BOX 1663
LOMA LINDA CA 92354-1663
In reply refer to: 0441861293
Mar. 12, 200.9 LTR 4168C EC
33-0536599 000000 00 000
00029688
BODC: TE
Employer Identification Number: 33-0536599
Person. to Contact: Erin Johnson
To11 Free Telephone Number: 1-877-829-5500
Bear Taxpayer:

This is in response to your request of Mar. 03, 2009, regarding your tax-exempt status.

Our records indicate that a determination letter was issued in September 1981, that recognized you as exempt from Federal income tax, and discloses that you are currently exempt under section 501(c)(3) of the Internal Revenue Code.

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 section(s) 509(a)(1) and 170(b)(1)(A)(vi).

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.

If you have any questions, please call us at the telephone number shown in the heading of this letter.

Sincerely yours,
Debcrah Bingham
Accounts Management I
Monday April 20 2009.max

Internal Revenue Service
Date: March 31, 2001
Candlelighters Childhood Cancer Foundation Of The
Inland Empire
PO Box 1663
Loma Linda, CA 92354
Dear Sir or Madam:

Department of the Treasury
P. O. Box 2508
Cincinnati, OH 45201
Person to Contact:

Steve Brown 31-07422
Customer Service Representative
Toll Free Telephone Number:
8:00 a.m. to 9:30 p.m. EST
877-829-5500
Fax Number:
513-263-3756
Federal Identification Number:
33-0536599
This is in response to the amendment to your organization's Articles of Incorporation fled with the state on July 25, 2000. We have updated our records to reflect the name change as indicated above.

Our records indicate that a determination letter issued in September 1981 granted your organization exemption from federal income tax under section 501(c)(3) of the Internal Revenue Code. That letter is still in effect.

Based on information subsequently submitted, we classified your organization as one that is not a private foundation within the meaning of section 509(a) of the Code because it is an organization described in sections 509(a)(1) and 170(b)(1)(A)(vi)
This classification was based on the assumption that your organization's operations would continue as stated in the application. If your organization's sources of support, or its character, method of operations, or purposes have changed, please let us know so we can consider the effect of the change on the exempt status and foundation status of your organization.

Your organization is required to file Form 990, Return of Organization Exempt from Income Tax, only if its gross receipts each year are normally more than $25,000. If a return is required, it must be fired_ by the 15th day of the fifth month affer the end of the organization's annual accounting period. The law imposes a penalty of $20 a day, up to a maximum of $10,000, when a return is filed late, unless there is reasonable cause for the delay.

All exempt organizations (unless specifically excluded) are liable for taxes under the Federal Insurance Contributions Act (social security taxes) on remuneration of $100 or more paid to each employee during -a calendar year. Your organization is not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA).

Organizations that are not private foundations are not subject to the excise taxes under Chapter 42 of the Code. However, these organizations are not automatically exempt from other federal excise taxes.

Donors may deduct contributions to your organization as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to your organization or for its 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.

Wednesday September 17 2008.max

-2-
Candlelighters Childhood Cancer Foundation Of The Inland Empire 33-0536599
Your organization is not required to file federal income tax returns unless it is subject to the tax on unrelated business income under section 511 of the Code. If your organization is subject to this tax, it must file an income tax return on the Form 990-T, Exempt Organization Business Income Tax Return. In this letter, we are not determining whether any of your organization's present or proposed activities are unrelated trade or business as defined in section 513 of the Code.

The law requires you to make your organization's annual return available for public inspection without charge for three years after the due date of the return. if your organization had a copy of its application for recognition of exemption on July 15, 1987, it is also required to make available for public inspection a copy of the exemption application, any supporting documents and the exemption letter to any individual who requests such documents in person or in writing. You can charge only a reasonable fee for reproduction and actual postage costs for the copied materials. The law does not require you to provide copies of public inspection documents that are widely available, such as by posting them on the Internet (World Wide Web). You may be liable for a penalty of $20 a day for each day you do not make these documents available for public inspection (up to a maximum of $10,000 in the case of an annual return).

Because this letter could help resolve any questions about your organization's exempt status and foundation status, you should keep it with the organization's permanent records.

If you have any questions, please call us at the telephone number shown in the heading of this letter.

This letter affirms your organization's exempt status.

Sincerely,
John E. Ricketts, Director, TE/GE
Customer Account Services
Wednesday September 17 2008.max

ATTACHMENT 2

CITY OF YUCAIPA

COMMUNITY ACTIVITY GRANT APPLICATION

FINANCIAL / IN -KIND / FEE WAIVER

COMMUNITY ACTIVITY GRANT APPLICATION INSTRUCTIONS
FISCAL YEAR:

DATE SUBMITTED:
2025-2026
SUBMIT TO: CITY OF YUCAIPA

GENERAL SERVICES/CITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

YUCAIPA, CA 92399
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 25/26 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 match of $500.

SECTION 1 - GENERAL INFORMATION
Name of Applicant/Organization: Family Service Association of Redlands Applicant/Organization: 612 Lawton St., Redlands, CA 92374 Mailing Address
Applicant/Organization Phone Number: 909-793-2673
CONTACT (1)
CONTACT (2)
Kyra Stewart
NAME
[email protected]
E-Mail
Andrea Laughlin
NAME
[email protected]
E-Mail
909-793-2673 x130

PHONE NUMBER
909-793-2673 x113

PHONE NUMBER
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? nja
*If you answered "Yes" to any of the questions listeci above, your request is not eligible 'To:- the Lommunity Activity Grant.

NO
n
✓

RECEIVED
MAY 0 6 2025
Yucaipa City Clerk's Office
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 so, please provide Tax ID# 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, due, etc.?
If yes, please describe: n/a
YES
95-1655614
126 years
18 750
250
✓
NO
✓
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) President - Joseph Shaw
Vice President- Strategic Planning, Gary Fagan
Vice President, Resouce - Renee Kern
Vice President Housing & Facilities, Carol Snodgress
Treasurer, Diane Remy
Secretary, Debbie Evans
See Attached for Complete list of Board Members
2 SECTION 4 - PROGRAM DESCRIPTION/SCOPE
(PLEASE USE ADDITIONAL

PAGES AS NECESSARY)
Name of the program/event:

Housing Assistance and Advocacy Program
Date(s) of the program/event: 7/01/2025-6/30/2025
Total estimated cost for program/event:

S773.500
Describe the program/event that the organization is seeking support for:
(Attach any event/program promotional materials associated with the program/event) SEE ATTACHED: The Yucaipa Outreach Project, a Family Service Association of Redlands program, was established to provide critical support to low-income, homeless, and at -risk individuals and families in Yucaipa and the surrounding communities. Designed to overcome geographic and transportation barriers, the project brings essential services directly to those who may otherwise go without them. Through a localized, community -focused approach, it plays a vital role in stabilizing vulnerable households and preventing homelessness.

Family Service has been administering the Housing Assistance and Advocacy Program for decades and brings extensive experience implementing Housing First principles and managing HUD -funded programs such as Emergency Solutions, HHAP, and EFSP. These programs involve complex regulations and performance measures, which Family Service is well-equipped to meet. The heart of the program is its face-to-face case management, which allows staff to build trust, understand the full scope of a household's crisis, and provide wraparound support tailored to each client's unique situation.

TS
Describe how the program/event benefits the residents/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 disabilities. The emergency financial assistance and case management practices work together to stabilize crises and to fight against the imminent dangers of homelessness, i.e, sleeping in cars or unsafe conditions. Also, we have partnered 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 receives wraparound support such as food, clothing, access to holiday programming, and medical services.

SEE ATTACHED
Program/event primary target population (check all that apply):
❑✓ Children or Youth Entire Community 111 Homeless �✓ Low Income n Women nPersons with Disabilities ❑✓ Seniors 111 Victims n✓ Welfare Recipients Please answer the following to determine if your program/event requires a Special Event Permit (SEP):

YES NO
Estimated attendance 300-999 persons n n
Amplified Sound
(excluding Special Event Facilities)
❑ El
THIS BOX 15 FOR STAFF USE ONLY
This event requires City Management/
Administrative Approval:

YES NO
❑
Estimated attendance 1000+ persons
Alcohol Service
(excluding Community Centers & YPAC)
Street Closure - Traffic Management
YES NO
El El
❑ El
THIS BOX 15 FOR STAFF USE ONLY
YES NO
This event requires City Council Approval:
3 SECTION 5 - GRANT FUNDING REQUEST
Please identify what your organization is seeking:

YES
Financial Support:

NO
I 1 $ 3.000
In -Kind Support: $ 0 $ 0
OT/Reassigned Staff CS/Rental
If other, please explain:
n/a
Total Amount 0
of Request $ In -Kind
$200 SEP Fee Waiver:

YES NO
El
$0 $0
Scherer Other
Community Center

3.000 $ 0
Financial Support $200 SEP Fee
Waiver
$ 773,500 $ 3.000
Financial Match Total Overall
Request
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 per night as the ability to provide fmancial assistance to clients who are facing eviction or already homeless.

ERF Grant - City of Redlands
San Manuel Band of Mission Indians
$0
$
0 In -Kind Financial
Amount Support Amount
$ 245,000

30.000
$ $
0 $350,000
$ 0 $ 12,000
$0 $
Total Funds Received to Date: $ 0 $ 637,000
Total Funds Requested via Grant Application: $ 0 $ 3,000 Remaining Balance that will be Funded by Organization: $ 0 $ 150,000 4 SECTION 6 - FINANCIAL CAPABILITIES/BUDGET (CONTINUED) 11101110
1 Describe any City Funding received by organization in the past three years (required)? Program
See Attached
See Attached
Sec attached
In -Kind
Support
Financial
Support
4200 SEP
Fee Waiver
Date Received
2022 $ 56,126
2023 $ 15,506
2024 $
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 grant amount needs to be spent prior to submitting Executive Director
Title

SUBMIT FORM
Date

TO BE COMPLETED BY THE CITY
Date Received:

Amount Funded:

Type of Grant:

Date Reviewed:

City Council Meeting:

In -Kind Financial $200 SEP
Support Support Fee Waiver
Date City Council received follow-up report:

Statement of Need
According to the National Low Income Housing Coalition's most recent report, California has a shortage of 977,040 affordable housing options available for extremely low-income households throughout the state. The average income for a low-income household of four is $35,500 annually, and studies show that 78% of extremely low-income renter households have A 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 26%. 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, the elderly, and those disabled on fixed incomes in the East
and Central Valley of San Bernardino County. Services include case management, food, and clothing. Emergency
rental assistance, transportation assistance, and motel vouchers for households with no other shelter options at the point of intake. We request support from the Community Activity Grant Program to strengthen our work.

Project Description
The Yucaipa Outreach Project, a Family Service Association of Redlands program, was established to provide critical support to low-income, homeless, and at -risk individuals and families in Yucaipa and the surrounding communities. Designed to overcome geographic and transportation barriers, the project brings essential services directly to those who may otherwise go without them. Through a localized, community -focused approach, it plays a vital role in stabilizing vulnerable households and preventing homelessness.

The Yucaipa Outreach Project's housing assistance services include emergency rental assistance, move -in support, motel vouchers, and intensive case management to help clients access and retain safe, stable housing. Clients complete an intake process that includes verification of income, expenses, and crisis documentation using government -approved forms.

Once eligibility is established, clients meet with a case manager to develop a plan that may include housing navigation, job search assistance, and referrals to supportive services that promote long-term stability and wellness.

In addition to housing -related services, the project provides a broad range of complementary supports, including transportation assistance (gas cards and bus passes), clothing donations, hygiene kits, access to showers, and monthly food distributions. Each client receives individualized attention and access to holistic services that address their immediate housing needs and the underlying issues contributing to their crisis. This wraparound model ensures that support is not one -size -fits -all but responsive to each household's needs.

The Yucaipa Outreach Project offers a proven and compassionate approach to preventing and ending homelessness by combining decades of housing program expertise with community - rooted service delivery. It exemplifies how strong local partnerships, personalized care, and integrated support systems can make a lasting impact. Family Service continues to serve as a trusted partner in the region, dedicated to stabilizing households in crisis and empowering them to build a path toward self-sufficiency.

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

The Housing Assistance and Advocacy Program greatly supports residents of Yucaipa and the East and Central Valley regions of San Bernardino County by offering a dependable safety net for low-income households, particularly families with children and elderly individuals with disabilities. By providing targeted emergency financial assistance and personalized case management, the program helps residents navigate and recover from housing crises. It ensures they avoid unsafe living conditions such as sleeping in vehicles, overcrowded spaces, or on the streets. This support stabilizes households in the short term and promotes long-term housing security and self-sufficiency.

One of the program's most impactful aspects is its focus on stabilizing crisis households.

Emergency rental assistance, utility payments, and move -in support work with individualized case management to help families avoid devastating situations like eviction or displacement.

This combination addresses the immediate threat of homelessness and builds a foundation for long-term stability. In many cases, the program prevents people from resorting to unsafe living arrangements such as sleeping in cars, couch surfing, or staying in substandard or overcrowded conditions.

In collaboration with the City of Yucaipa's Homeless Outreach Team, the program also supports individuals already unhoused by providing motel vouchers and emergency shelter placements at the point of intake. This partnership ensures a timely and compassionate response to those experiencing street -level homelessness, reducing exposure to physical danger and trauma while creating a bridge to more permanent housing solutions. Each participant receives wraparound case management, including housing navigation, employment resources, and referrals to services supporting physical and mental health.

Through this holistic, client -centered approach, the program helps individuals and families in crisis and contributes to the overall well-being and resilience of the Yucaipa community.

Reducing homelessness and housing instability strengthens neighborhoods, eases the burden on emergency services, and promotes public health and safety. The program exemplifies how

coordinated, community -based efforts can transform lives while fostering a more stable, inclusive, and compassionate community.

City of Yucaipa Funding Received from 2022
Name of Funding
Source
Amount
Date Received
Comment
CDBG Yucaipa
$47,682
01/2022-/12/2022
Allocated towards
Mortgage Program
staffing and mortgage
payments/COVID at
YOP
City Line Item
$5,000
06/2022
Allocated towards
direct client services
for Yucaipa
Community Activity
Grant
$3,500
07/2022
Allocated for motel
Grant vouchers and
housing
City of Yucaipa Funding Received from 2023
Name of Funding
Source
Amount
Date Received
Comment
CDBG Yucaipa
$8,506
08/31/2023
Allocated towards
Staffing YOP
City Line Item
$5,000
07/2023
Allocated towards
direct client services
for Yucaipa
Community Activity
Grant
$2,000
09/2023
Allocated for motel
Grant vouchers and
housing
City of Yucaipa Funding Received from 2024
Name of Funding
Source
Amount
Date Received
Comment
CDBG Yucaipa
$5,348
07/01/2024 to
06/30/2025
Allocated towards
Staffing YOP
City Line Item
$5,000
07/01/2024 to
06/30/2025
Allocated towards
direct client services
for Yucaipa
Community Activity
Grant
$2,500
07/2024
Allocated for motel
Grant vouchers and
housing

125 Years of
Serving the Community
Family Service Association of Redlands
2025 Board of Directors
612Lactiotl Street, 11cd/and.s. (;7111i nnth 92371
Cl/lice: .909 793-2673 Far: 909793-7321 i 1 i.hsitc: redland l tlnlll venicc.org Alletiate porert); encomage se/l-sulluuvncy and promote the diglitv(did clients

EXECUTIVE COMMITTEE
President
Vice President, Strategic Planning
Vice President, Resource
Vice President, Housing & Facilities
Treasurer
Secretary
Joseph Shaw
Gary Fagan
Renee Kern
Carol Snodgress
Diane Remy
Debbie Evans
Cell
Cell
Cell
Cell
Cell
Cell
909 725-0241
909 771-8423
909 663-7696
909 732-9989
909 556-7760
909 815-2324
BOARD MEMBERS:

Stephanie Banks(Term 1" - 2027)
Provider Liaison Pacific Dermatology
Cell 909 800-0321
Email [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
Deborah Crowley (Term 1' — 2028)
Retired Partner of Eadie & Payne
Cell 909 953-1596
Email [email protected]
1419 E Highland Ave
Redlands, CA 92374-5421
George DeLange (Term 2 - 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 2 - 2027)
Retired Prosecutor
Home 909 389-9166
Cell 909 771-8423
Email [email protected]
1573 Pala Bells Ct
Redlands, CA 92374-2707
Jenn Giacona (Term 1" — 2028)
RCH Marketing Manager
Cell 909 768-0795
Email [email protected]
1380 Groveland St
Beaumont, CA 92223-3256
1 04/28/25

BOARD MEMBERS CONTINUED:

Renee Kern (Term 151— 2026)
Business Owner
Cell 909 663-7696
Home 909 862-7939
Email [email protected]
6580 Applewood St
Highland, CA 92346-5210
Rafael Larios (Term 1 SL — 2027)
Business Owner
Cell 909 908-1246
Email [email protected]
1245 Columbia St
Redlands, CA 92374-3117
Janine Ledoux (Term 2 - 2027)
Professor
Cell 909 838-7813
Email [email protected]
219 Grant St
Redlands, CA 92373-5116
Ipyani Lockert (Term 15L — 2028)
Southern California Faith Organizer
Cell 909 936-0789
Email [email protected]
6988 Caswell Ln
Fontana, CA 92336-1441
Diane Remy (Term 2"d - 2026)
Retired CPA
Cell 909 556-7760
Email [email protected]
515 E Mariposa Dr
Redlands, CA 92373-7351
Joseph Shaw (Term 2"d - 2028)
Business Owner/Realtor
Cell 909-725-0241
Email [email protected]
1107 N Orange St
Redlands, CA 92374-3218
Lori Shelffo (Term 2"d - 2028)
Administrative Assistant
Ce11 909-239-8199
Email [email protected]
338 Sherwood St
Redlands, CA 92373-4964
David Shippee (Term 15L - 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 1 SL 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 2"d - 2028)
Business Owner/Dentist
Cell 951 415-5516
Email [email protected]
PO Box 1125
Redlands, CA 92373-0366
Joyce Volsch (Term 1s' - 2027)
Vice President of Patient Care Services RCH
Home 909 379-5355
Email [email protected]
PO Box 11609
San Bernardino, CA 92423
2 04/28/25

BOARD MEMBERS CONTINUED:

Christopher Walker (Term 2°(1 - 2026)
Professor Emeritus U or R
Home 909 792-7715
Email [email protected]
616 Valley View Dr
Redlands, CA 92373-7358
Tyler Waner (Tern, 2 - 2028)
Financial Advisor
Work 909 798-8888
Cell 909 362-3300
Email [email protected]
300 E State St Ste 530
Redlands, CA 92373-5253
STAFF
Kyra Stewart
Jennifer Watson
Samantha Morgan
Donna Olson Jones
Adela Brown
Andrea Laughlin
Sabrina Song
Corey Romo
Hannah Rodgriguez
Abi Pote
Paula Petty
Jennyfer Melgoza
Rolesha Anderson
Loretta Villarreal
Trevor Hamilton
Stephanie Castellanos
Aundrea De La Cruz
lan McMahon
Ray Watts (Term I'' - 2028)
Associate Vice President Philanthropic Giving
Cal State San Bernardino
Cell 909-289-6811
email [email protected]
912 Knightsbridge 1,n
Redlands, CA 92371-3970
Executive Director
Resource Development Manager
Office Manager
Development Associate
Accounting Clerk
Grant Writer
Marketing Et Volunteer Coordinator
Program Director
Housing Manager
Lead Case Manager
Case Manager
Case Manager/Employment Specialist
Case Manager - Part Time
Program Assistant/Receptionist
Program Assistant/Data Entry
Program Resource Coordinator
Donation Center Lead
Nutrition Program/Donation Center Assist.
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
[email protected]
3 04/28/25

Internal Revenue Service
P.O. Box 2508
Cincinnati, OH 45201
Department of the Treasury
Date: August 22, 2014 Person to Contact
Ms. Wiles
FAMILY SERVICE ASSOCIATION OF REDLANDS Toll Free Telephone Number:
612 LAWTON ST 877-829-5500
REDLANDS, CA 92374 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.
w0:64 0/
Tamera Ripl3erda
Director, Exempt Organizations

C�FAMILY SERVICE ASSOCIATION OF REDLANDS
TO ALLEVIATE POVERTY, ENCOURAGE SELF-SUFFICIENCY, AND PROMOTE THE DIGNITY OF ALL.

Board of Directors
President
Joseph Shaw
Executive Director
Kyra Stewart
.administrative
Administrative
Office Manager
Samantha Morgan
Development
Associate
Donna Jones
Accounting Clerk
Adela Brown
Part Time Grant
Writer
Andrea Laughlin
J
1 Resource
Development
Manager
J
Marketing/
Volunteer
Coordinator
Sabrina Song
J
Committees
Executive Committee
Finance Committee
Strategic Planning Committee
Resource Committee
Housing/Facilities Conunittee
Nominating Conunittee
Friends of the Family
Client Advisory Board
Program
Program Director
Corey Romo
Housing
Manager
Hannah
Rodriguez
J
Case Managers
Abi Pote - Lead
Paula Petty
Rolesha Anderson
Jennyfer Melgoza
Employment Specialist
Shawntries Thompson
Program Resource
Coordinator
Stephanie
Castellanos
Program Assistant
Lori Villarreal
Trevor Hamilton
Data Entry
Donation Center Lead
Aundrea De La Cruz
Nutrition Program
& Donation Center
Assistant
Ian McMahon
Volunteers and Interns

caTHE 4. UCAIPA OUTREACH PROJECT
A PROGRAM OF FAMILY SERVICE ASSOCIATION Of REDLANDS
Please bring the following:
• Official photo ID
• Proof of income
• Current month's expenses
Must be a low-income household
with children or elderly and
disabled on a fixed income and
living in the City of Yucaipa.

Are you behind on rent due to a
temporary financial crisis or
other issue?
Do you need wrap around
support such as holiday
assistance, bus passes, or
employment resources?
Do you live in the city of Yucaipa?
The Yucaipa Outreach Project is here to
help! In partnership with the City of
Yucaipa, County entities and private
sources, we offer the following services:
• Emergency Rental Assistance
• Move -in Deposits
• Motel Vouchers
• Food Assistance
• Gas Cards & Bus Passes
Please visit our website at
redlandsfamilyservice.org or call
909-570-9132 for more information.
11985 4th St, Suite 116, Yucaipa, CA 92399 I yucaipaoutreachproject.org

11985 4th St. Ste 116
Yucaipa, CA 92399
Hours: Mon - Fri
9am-2pm
www.yucaipaoutreachproject.org
6 THE YUCAIPA OUTREACH PROJECT

A PROGRAM OF FAMILY SFRVICE ASSOCIATION OF REDLANDS

DONATIONS
NEEDED
Yucaipa Outreach Project is an
extension of Family Service
Association of Redlands, serving
low income, homeless or at -risk
homeless families.

Our Food Needs:

Canned meat (chicken breast, tuna)
Peanut Butter & Jelly Q
Dry and canned soups ®
Cereals, pancake mix, syrup QQ
Bag/Boxed Pasta CD
Pasta Sauce & Tomato sauce
Bag/Boxed Rice
*Pull tab cans are best
Scan here to view
the many ways to
donate to our food
pantry

n
c...

Family Service Association
�i of Redlands
Our service areas are located in East and Central Valley of San Bernardino County as funding allows. Cities include Redlands, Mentone, Loma Linda, Highland, Bryn Mawr, Yucaipa, City of San Bernardino, Grand Terrace and local mountain communities
About Us
Active in the Redlands community
for over 125 years, Family Service
offers comprehensive services for
low-income households with
children under 18 and the elderly
disabled (55 and up) who are in high
need or facing a housing crisis.

Online Housing Program applications are
accepted on a rolling basis. Applicants will
receive a follow-up phone calla week after
their application is submitted.

To learn more about how to apply for services - please
call the main office or visit our website.

MAIN OFFICE:
612 Lawton St. Redlands, CA 92374
Phone: (909) 793-2673
redlandsfamilyservice.org
YUCAIPA OUTREACH PROJECT:
11985 4th St. Suite 116
Yucaipa, CA 92399
Phone: (909) 570-9132
yucaipaoutreachproject.org
1•►
www.redlandsfamilyservice.org

OUR SERVICES

HOUSING ADVOCACY/ASSISTANCE PROGRAM
Rental Assistance:: Provides emergency assistance for families facing eviction or who are already homeless with the goal of preventing the dangers of homelessness. As funding permits.

Emergency Motel Vouchers: Provides an emergency place to stay in a crisis situation when shelters are inaccessible.

FAMILY SUPPORT PROGRAM
Emergency Food Assistance: 7 days worth of groceries, covering 3 meals a day.

Surplus Food Program: Provided on a daily walk-in basis.

Clothing: Provided to low-income individuals for basic wear and employment.

Hygiene Kits: Includes shampoo/conditioner, soap, lotion, and toothpaste.

Resource and Referrals: Health, dental, and vision referrals.

Holiday Support: Food boxes for Easter, Thanksgiving, and Christmas. Adopt -A -Family Program for Thanksgiving and Christmas.

Holiday Activities: Spring Festival, Mother's Day, Halloween Costume Giveaway, Harvest Festival, Christmas Party, & more!

ADDITIONAL PROGRAMS
Nutritional Support Program: Fresh meals
provided Monday - Friday from 10:00am to
11:00am; open to the entire community.

Virtual Classes & Workshops: For a
complete list of services, scan the QR code.

THE YUCAIPA OUTREACH PROJECT

A PROGRAM OF FAMILY SERVICE ASSOCIATION OF REDLANDS

NDS A PROGRAM OF FAMILY SERVICE ASSOCIATION REDLANDS
The Yucaipa Outreach Project office opened in 2016 to remove the barrier of transportation and distance. The pilot program with an office in Yucaipa was opened to serve low income, homeless or at -risk homeless families.

Partnership with the city of Yucaipa and Redlands Community Hospital was key to making this a reality.

Our Services
/NN Housing Advocacy
uAssistance with motel
Q
` N
vouchers and
rental/mortgage is available
to clients who qualify.

Food Assistance
Our food pantry is available
to clients as a resource to
provide food for their families.

Other Resources
Other services include our
clothing closet, transportation
assistance, hygiene kids,
referrals and employment
resources.

The Yucaipa Outreach Project
11985 4th St., Suite 116
Yucaipa, CA 92399
9:0
Tuesdoy 9:0
Wednesday 9:'
Thursday 4:!
riday
Phone: 909-570-9132
Website: yucaipaoutreachproject.org
Family Service
Association of Redlands

ATTACHMENT 3

CITY OF YUCAIPA

COMMUNITY ACTIVITY GRANT APPLICATION
FINANCIAL /—IN-KIND / FEE WAIVER

COMMUNITY ACTIVITY GRANT APPLICATION INSTRUCTIONS
FISCAL YEAR:
2025-2026
DATE SUBMITTED: 5'16/2025
SUBMIT TO: CITY OF YUCAIPA

GENERAL SERVICES/CITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

YUCAIPA, CA 92399
All sections of the application must be returned complete, and ad supporting documentation must be included as part of the submittal. Incomplete applications received will be returned to the applicant.

Note: Beginningwith the FY 25/26 grant cycle. financial grant awarded funds will require 100% financial match by the applicant. For example, if your total program/project cost is S1,000. your financial vent request should be for no more than $500. Be prrportd to show proof of prngrarnrprolert cost in your Wrap-up Report 'Accountability Report). detailing the appiicants match of S500.

SECTION 1 - GENERAL INFORMATION
Name of Applicant/Organization: Gardenworksfotkids
Applicant/Organization: P.O. Box 207 Yucaipa, CA 92399
Mailing Address
Applicant/Organization Phone Number:

CONTACT (1)
CONTACT (2)
Donna Solomon
NAME
E-Mail
Lisa Adline
NAME
E-Mail

RECEIVED
t
E
MAY 1 6 2025
tt•
Yucaipa City Clerk's Office

PHONE NUMBER
YES
If so, which one?
>r:'Yes•' to any of the questions listed above. your request is npt eligible for the Community Activity Grant. 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 so, please provide Tax ID# and attach all supporting documents.

YES
46-2428869
12/ 12/2013
6 6

2.200
NO
U
Ir IEl
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Donna Solomon
Lisa Adline
Donovan Hinkle II
Peggy Gonzalez
CEO/Owner
Assistant Director
Treasurer
Secretary
2 Name of the program/event: Toddler Sensory Garden
Date(s) of the program/event: September I.2025
Total estimated cost for program/event: S4.000
Describe the program/event that the organization is seeking support for:
(Attach any event/program promotional materials associated with the program/event) We will be putting up fencing and a toddler playground area for our "Busy Bee" students. This will include sensory toys. play area and an interactive learning outdoor area.

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

This program will give children 18 months to 5 years a smaller more intimate play area sized for smaller children.

Program/event primary target population (check all that apply):

J
Children or Youth
Persons with Disabilities
Entire Community ( 1 Homeless n Low Income 7 Women
Seniors
Victims • I Welfare Recipients
Please answer the following to determine if your program/event requires a Special Event Permit (SEP):

YES
Estimated attendance 300-999 persons
Amplified Sound
(excluding Special Event Facilities)
NO
This event requires City Management/
Administrative Approval:

YES NO
n
Estimated attendance 1000+ persons
Alcohol Service
(excluding Community Centers & YPAC)
Street Closure • Traffic Management
YES NO
n
YES
This event requires City Council Approval:

NO
1 J

Please identify what your organization is seeking:

YES NO
NO
Financial Support: � � 5 1.500
In -Kind Support: $ 0 $ 0
OT/Reassigned Staff CS/Rental
If other, please explain:

Total Amount 0
of Request
In -Kind
YES
$200 SEP Fee Waiver:
$0 g0
Scherer Other
Community Center
$1.500 s 0
Financial Support S200 SEP Fee
Waiver
NO
5 0 $ 1.500
Financial Match
Total Overall
Request
Provide a detailed description of how the financial support will be used:

The grant money will be used for fencing materials. labor and securing a sate and nurturing environment for smaller children (toddlers) and give them a sensory garden to explore and play in.

SECTION 6 - FINANCIAL CAPABILITIES/BUDGET
What other in-kind/financial contributions has your organization received to fund this event/program (separate from city funding)?
Donationsifundrai ser
50 S
S
In -Kind
Amount
Financial
Support Amount
$ 1,500
S
$
$ s
S $
Total Funds Received to Date: $ 0 S 0
Total Funds Requested via Grant Application: $ 0 $ 1,500 Remaining Balance that will be Funded by Organization: $ 2,500 $ 0 4 SECTION 6 - FINANCIAL CAPABILITIES/BUDGET CONTINUE DJ Describe any City Funding received by organization in the past three years (required)? Program
Yucaipa City Grant
Yucaipa City Grant
Yucaipa City Grant
In -Kind Financial S200 SEP
Support Support Fee waiver
ElEln
El
n o n
Date Received Total Received
7/2024 $ 1,500
7/2023 $ 1.500
7/2022 S 1.500
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
CEO.Owner-Proerarn Director
Title

SUBMIT FORM,
5/16/2025
Date

TO BE COMPLETED BY THE CITY
Date Received:

Amount Funded:

Type of Grant:

Date Reviewed:

City Council Meeting:

In•Kind Financial S200 SEP
Support Support Fee waiver
Date City Council received follow-up report:
5 INTERNAL REVENUE SERVICE
P. O. BOX 2508
CINCINNATI, OH 45201
Date:

DEC } 2 zo13

GARDENWORKSFORXIDS

C/O DONNA SOLOMON
Dear Applicant:

DEPARTMENT OF THE TREASURY
Employer Identification Number:
46-2428869
DLN:
17053240328033
Contact Person:

SHERRY Q WAN ID# 31052
Contact Telephone Number:
(877) 829-5500
Accounting Period Ending:

December 31
Public Charity Status:
170 (b) (1) (A) (vi)
Form 990 Required:
ves
Effective Date of Exemption:

February 13, 2013
Contribution Deductibility:

Yes
Addendum Applies:

No
We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. organizations exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations. We determined that you are a public charity under the Code section(s) listed in the heading of this letter.

Please see enclosed Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, for some helpful information about your responsibilities as an exempt organization.

RECEIVED
MAY 2 9 2025
Yucaipa City Clerk's Office
Letter 947 (DO/CG)

ATTACHMENT 4

CITY OF YUCAIPA

COMMUNITY ACTIVITY GRANT APPLICATION

FINANCIAL / IN -KIND / FEE WAIVER

COMMUNITY ACTIVITY GRANT APPLICATION INSTRUCTIONS
FISCAL YEAR:

January -December
DATE SUBMITTED: 5-15-2025
SUBMIT TO: CITY OF YUCAIPA

GENERAL SERVICES/CITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

YUCAIPA, CA 92399
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 25/26 grant cycle, financial grant awarded funds will require 100% financial match by the applicant. For example, if your total program/project cost is 51,000, your financial grant request should be for no more than 5500. 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: Grace Point Fellowship/First Baptist Church Yucaipa Applicant/Organization:

Mailing Address
34784 Yucaipa Blvd.

Applicant/Organization Phone Number:

CONTACT (1)
CONTACT (2)
Randy P Balling
NAME
(909) 790-1971
(909)735-6091

PHONE NUMBER
[email protected]
E•Mail
Tammy Meier
NAME
(909) 533-0822

PHONE NUMBER
tmei er @ gpf yucaipa. og
&Mall
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? oa
❑ El
❑a

RECEIVED
MAY 1 4 2025
Yucaipa City Clerk's Office
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. 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 so, please provide Tax ID# and attach all supporting documents.

YES NO
o❑
95-1 8'759'7 )
112 years
100+
❑ El
500+
❑ LI
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Tony Chastain (Presidet)
Jason English (Treasurer)
Dan McHargue (secretary)
John Gonzales (Board member)
Gill Cervatez (Board Member)
Randy Balling (Board member/Sr. Pastor)
2 SECTION 4 - PROGRAM DESCRIPTION/SCOPE (PLEASE USE ADDITIONAL

PACES AS NECESSARY)
Name of the program/event:

Love Yucaipa
Date(s) of the program/event: April 26
Total estimated cost for program/event:
$7,000
Describe the program/event that the organization is seeking support for:
(Attach any eventiprogram promotional materials associated with the program/event) Love Yucaipa is a city-wide day of community service that begins with a high energy kick-off rally. On May 3, 2025, we mobilized 300 volunteers for 14 projects located in Yucaipa and C'alimesa. The projects included three Yucaipa city projects:
painting the perimeter wall of the 7th street pickle ball court, the baseball bleachers and the 13th st. skate park trash clean up.

We also had 60 volunteers organizing, assembling product and beautifying YAPS. Other projects included YHS beautification and ILCS gaga ball pit clean up and beautification. In total, we donated the equivalent of $30,000 in volunteer labor.

We also had a high-energy rally that celebrated our city leaders (Mayor, council members, fire chiefs, school board president and school board members). YHS cheerleaders came out to help us cheer for and thank our city leaders.

It was a vibrant collaborative effort between city leaders, churches, non -profits and local businesses. It was a beautiful Describe how the program/event benefits the residents/or community of Yucaipa:

From the love Yucaipa signs and banners around town, to the kick-off rally, to the army of volunteers, Love Yucaipa raises the morale of our citizens while physically improving our city. Further, it affirms our city's leaders by giving us a platform to acknowledge them for their sacrifice and hard work. At the same time, it contributes to credibility for our city leaders as citizens can see them in action, serving their city. Love Yucaipa also gives visibility to non -profits and businesses who sponsor and volunteer and it builds bridges between leaders, organization and citizens. Some of those bridges can help spawn more initiatives in the future. In addition, Love Yucaipa brings pastors together in our community, laying any differences aside to live out our faith as we "love our neighbors." Finally, it fights back against an entitlement mindset by challenging our citizens to, "Ask not, what your city can do for you. Rather, ask what you can do for your city!" For more information, go to loveyucaipaorg We were pleased to hear from our city council, at a council meeting, that they had visited our website and saw that the event and day of service was well organized.

Program/event primary target population (check all that apply):
nChildren or Youth n Entire Community n Homeless n Low Income n Women ❑ Persons with Disabilities n Seniors n Victims n Welfare Recipients Please answer the following to determine if your program/event requires a Special Event Permit (SEP):

YES NO
Estimated attendance 300-999 persons n n
AmplifiedSound (excludingEl Special Event Facilities)
THIS BOX 15 FOR STAFF USE ONLY
This event requires City Management/
Administrative Approval:

YES
NO
Estimated attendance 1000+ persons
Alcohol Service
(excluding Community Centers & YPAC)
Street Closure - Traffic Management
YES NO
1111
❑a
THIS BOX 15 FOR STAFF USE ONLY
This event requires City Council Approval:

YES NO
El El
3 SECTION 5 - GRANT FUNDING REQUEST
Please identify what your organization is seeking.

Financial Support:

YES o NO
$4000
In -Kind Support: $ $
OT/Reassigned Staff CS/Rental
YES NO
$200 SEP Fee Waiver: I✓
$
Scherer
Community Center
$ YPAC (if approved)
Other
If other, please explain:

Our last event was held successfully at the YPAC on the morning of the Music and Arts Festival.

If this location is not available next year, we would like to hold Love Yucaipa at the Yucaipa Community Park with the kick off event being held at the outdoor amphitheater. ,
Total Amount �p
$ $4,000 200 $ 4,000 $ .$8 2tI Li 2 O c)
of Request In -Kind Financial Support ee Financial Match Total Overall Waiver Request
Provide a detailed description of how the financial support will be used:

Signs, banners, advertising: $4,000
Website membership with Love our Cities: $1,400
Supplies (paint, brushes, rollers, gloves, etc.) : $1,000 Project leaders training, food, supplies and support: $500 Love Yucaipa T-shirts for project leaders: $500
Sound equipment rental, tech needs, $600
Note: These are approximate. Actual costs will be clearly determined as we gather project needs and facility rental costs.

SECTION 6 - FINANCIAL CAPABILITIES/BUDGET
What other in-kind/financial contributions has your organization received to fund this event/program (separate from city funding)?
Financial
Support Amount
$0
Churches
Businesses
City of Yucaipa May 3, 2025
City of Yucaipa May 3, 2025
$0
In -Kind
Amount
Use of YPAC
$ $200 sign foe waived
Total Funds Received to Date: $
Total Funds Requested via Grant Application: $
Remaining Balance that will be Funded by Organization: $ None since ow last event
$o
$ none since last event
$ 4,000
$ 4,000
4 SECTION 6 - FINANCIAL CAPABILITIES/BUDGETIcoNrinrueol Describe any City Funding received by organization in the past three years (required)? Program
Fits uce of do YJ C on day of music and assfcstis-al
In•Klnd financial S200 SEP
Support Support Fee Waiver Date Received Total Received CI El El
yiay 3, 2025
$Nr\
5 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 Signa
Lead Pastor of Grace Point Church, Yucaipa 05/14/2025
Title

SUBMIT FORM
Date

TO BE COMPLETED BY THE CITY
Date Received:

Amount Funded:

Type of Grant:

In•Klnd
Support
Financial
Support
Date City Council received follow-up report:

Date Reviewed:

City Council Meeting:

S200 SEP
Fee Waiver
5 ,`j
.r.

IRSDepartment of the Treasury
Internal Revenue Service
CINCINNATI OH 45999-0038

FIRST BAPTIST CHURCH OF YUCAIPA
34784 YUCAIPA BLVD
YUCAIPA CA 92399-4253
In reply refer to: 0242905122
Jan. 25, 2023 LTR 4384C 0
95-1875979 202203 01 0
00012192
BODC: TE
Taxpayer Identification Number: 95-1875979
Tax Period(s): Mar. 31, 2022
Form(s): 941
Dear Taxpayer:

We received your amended/corrected Form 941 for the tax period ending Mar. 31, 2022. To correct the information you previously reported, you should file the enclosed Form 941-X. If you are correcting more than one tax period, please file a separate form for each tax period.

If you have any questions, please call us toll free at
1-800-829-0115.

If you prefer, you may write to us at the address shown at the top of the first page of this letter.

A copy of this letter and any referenced enclosures have been forwarded to your authorized representative(s).

Sincerely yours,
Warren R. Burton, Operations Mgr
Accounts Management Operations 1
Enclosure(s):

Copy of this letter
Form 941X

2:13 .11 A -
Grace Point Fellowship Church's post
Grace Point Fellowship Church
Posted by Matt Dunn
5d•0
Thank You to Our Love Yucaipa & Calimesa
Volunteers
To everyone who showed up, rolled up their
sleeves, and gave their time and energy for Love
Yucaipa & Calimesa—thank you.

This day of community service was more than
just a collection of projects. It was a powerful
expression of love for our cities and the people
who call them home. From YAPS and Yucaipa
High School to 7th Street Park and many other
sites, your hard work made a visible impact and
an even greater difference in hearts.

We are incredibly blessed by the spirit of service
you brought to each location. Thank you for being
the hands and feet of love in our community.

Let's keep this momentum going. Together, we
are stronger —and together, we are building
something beautiful.

OQr 7
05 Like
Q Comment O Send
1 share
Share
"Each of you should use whatever
gift you have received to serve
others, pc fnif'h f.sl ctoviards of

LVE
Yucaipa & Calimesa
MAY 3,2025
Love Yucaipa & Calimesa is a movement to
create greater collaboration in our cities.

During our community -wide service day on May 3,
residents, businesses, city government, faith groups,
service groups, schools, and sports organizations
will unite to make Yucaipa & Calimesa a better place.

The day will start with a kick-off event at the YPAC at 8 AM. There are many ways to participate! Volunteer
for a project, or lead your very own. Encourage
others to participate with you by registering to
volunteer, lead, donate, or become a sponsor. Find
out more and sign up at loveyucaipa.com.

LVE
Yucaipa & Calimesa
MAY 3, 2025
Love Yucaipa & Calimesa is a movement to
create greater collaboration in our cities.

Order Of Love Yucaipa & Calimesa Pep-Rally/Kick-off Event 7:00 Table set up
• Information table with project addresses, waivers, volunteers for Q&A
• One table for every two projects
o Tape project sign to table
o Signs on sticks to held high by project leader or assistant o A stack of Waivers with pens at each table
o QR code at each table for web registration
• Vendor tables set up
o American Road Trip
o White Rabbit
o Jose's
o Other...?
0 7:30 am Pre -Kick-off
• Food services begins (Pancakes, Coffee, other)
• Music begins playing
• Project leaders check in between 7:30-8:00 am
8:00 am Rally Begins
• Welcome from Randy. Invite to join us at the stage
• High energy music from 8:05-8:10 high energy music played 8:10-8:15 Grace Point Twirlers perform
8:15:-8:20 First Cheer from YHS Cheer Team followed by
"human tunnel"
8:20-8:25 Randy and Olin introduce and thank
• Sponsoring pastors
• Non -profits
• Sponsoring businesses
8:25-8:30 Olin introduces and thanks all Calimesa city leaders 8:30-8:35 Randy Introduces and thanks all Yucaipa City Leaders 8:35-8:40 Closing
• Throw any freebies into the crowd

• Pray
• Final Cheer from Yucaipa Cheer Team
8:45 Charge to everyone to go to their table with team leader and then to project
8:45-9am Clean up, tear down

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 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
Wage

„Aproot

CITY OF YUCAIP

SPECIAL EVENT PERMI
Organization and Applicant Information-1875979
❑ Commercial (For -profit) ❑Q Noncommercial (Non-profit) Tax I.D. #:

Address
784 Yucaipa blvd. Yucaipa,CA 92399
Phone Number
Event Information
Type of Event ❑ Athletic/Recreation ❑ Festival/Celebration ❑ Outdoor Market ❑ Circus/Carnival
❑Concert/Performance ❑ Parade/Procession/March ❑Other (specify):

Event Location
NC or Yucaipa Community Park (second option)
Description
city in various projects throughout the city
Please complete a daily breakdown of event -related activities. Use multiple lines to distinguish between different daily activities. Please attach additional sheets if necess:

April 2E
❑ Set-up ❑ Event Day ❑ Clean-up
8:30 am
9:30 am
Has this event taken place before? 0 Yes ❑ No How many years? May 3, 2025 Total anticipated attendance: Participants: Spectators:

.411wiwv
faa19'a

CITY OF YUCAIP

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

Indicate the site for these on your diagram.

1. 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)
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.

Ifyour 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.

CITY OF YUCAIP

SPECIAL EVENT PERMI
List street(s) requiring closure as a result of this event. Include street name(s), day, d and time of closing and time of reopening:

Same as the Music and Arts Festival assuming we are allowed to use it again Our plan B is Yucaipa Community Park
Indicate how this closing/reopening of streets will be handled:
❑ City of Yucaipa to handle (cost to be specified) E Event to handle per CalTrans standards
needed and an explanation of necessity of "No Parking" zone:

Same as the music and arts festival
Note: No Parking' signs will be posted forty-eight (48) hours in advance of required days, dates and time Cost for the posting of No Parking" signs will be specified upon review oftheapplicationbyCitystaff Food and Beverage
Please describe how food will be served at the event:

Food would be donated by local restaurants (American Road Trip, White Rabbit, Joses, others TBD) No County license required since the food will be donated.

Will food be cooked in the event area? ❑ Yes ❑ No
Method: ❑Gas Electric at this time, warmers/chaffing dishes ❑ ❑ Charcoal ❑ Other (specify):

Does the event involve the sale or use of alcoholic beverages? ❑ Yes ❑ No LI
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? l Yes ❑ No

fam°
Appel

CITY OF YUCAIP

SPECIAL EVENT PERMI
Company
Name
Ice Point Fellowship Church
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.) As before - no lighting needed
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 provide the following information.

Phone Number
Iff hiring a professional sanitation company, please provide the following information for the person(s) responsible for waste removal.

Contact Name
lobinson
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:

Contact Name
thief Grant Malinowski
5IPage

�
7 CITY OF YUCAIP
SPECIAL EVENT PERM!
Please describe your medical plan including your communications plan, the numl certification levels (MD, RN, Paramedic, EMT) and types of resources that will be at y event and the manner in which they will be managed and deployed. Your plan she include hours of setup and dismantle of medical aid areas. You may attach the plan to application if necessary:

Chief Malinowski would oversee all emergency needs as well as several volunteers including doctors and nurses
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? ❑ Yes ❑ No Contact Name
Please describe your security plan including crowd control, internal security or ve safety, a attach the plan to this application:

As a collaborative effort with city leadership, we would look to city support for crowc control, as at our last event. Please advise if we need a different plan.

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

Are there any musical entertainment features for this event? ❑ Yes ❑ No PhonE
NumbE
(Dan)
(Dre
How many stages? Number of bands? Genre of music:

Will fireworks, rockets, or other pyrotechnics be used? ❑ Yes ❑ No

CITY OF YUCAIP

SPECIAL EVENT PERMI
Phone Number
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 ❑ 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.)

Aliper
Pem°6fr.

Application Checklist

CITY OF YUCAIP

SPECIAL EVENT PERMI
❑ 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, 1 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.

Name:
ndy P. Bal
Signature: Date:
05-14202E

Re: SEP for Community Grant Application
From: Kelsey Vega ([email protected])
To:

Cc: [email protected]
Date: Wednesday, May 14, 2025 at 04:00 PM PDT
Hi Randy,
I have snipped an Image of the YPAC building for you to mark up and indicate your plan for next year. I don't think a site plan map was submitted on your previous SEP application.

Hope this helps.
ucaipaBlv,.

Yucaipa Performing
Arts Center
Recemly vlrvvrd
ucaipa Blvd
Google.

Kelsey Vega
Administrative Assistant
City of Yucaipa
YPAC • 12062 California Si • Yucaipa, CA 92399
Office: 909-797-2489 Ext. 558
« u.n1:14

From: Kelsey Vega
Sent: Wednesda Ma 14 20253:01 PM
To: randy balling
Cc: Megan Wolfe : Tara Davis
Subject: SEP for Community Grant Application
Hi Randy,
It was a pleasure speaking with you in the office, per our conversation, please fill out the attached SEP application (typed out applications only accepted). Please send me a copy of the SEP and print out a copy to submit in with your CAG application tomorrow for Tara to review.

Please feel free to let me know if you have any other questions.

Thank you

NextDayFlyers
Fast Printing, Done Right
Invoice for Order # 13947535
Order Date: 04/25/2025
P.O.*:

Product Details
ITEM #22047130
Product Banners
Size (inches) : 72 x 48
Front Side : Full color
Back Side : No Printing
Material : 13 oz. Scrim Vinyl
Treatments : Hem with Grommets
Ready to Ship In : 3 Business Days
Grommets : Add 10 Grommets per banner (24"
gaps)
Payment Information
Credit Card: MASTERCARD Ending in
Payment Date: 04/25/2025

RECEIVED
JUN 0 2 2025 RR
Yucaipa City Clerk's Ofr
Delivery & Destination
8000 Haskell Ave., Van Nuys, CA 91406
Toll Free: 855-898-9870
Mon-Fri(24 Hours a Day), Sat-Sun(6am-5pm PT)
ill to: Grace Point Fellowship Church
Jamie Endres
34784 YUCAIPA BLVD, YUCAIPA, CA, ID 4089492
Email: [email protected] I Phone: (909) 790-1971 Delivery
1 Day Tra is.;
Shipping Address
Grace Point Fellowship Church
34784 YUCAIPA BLVD
YUCAIPA, CA 92399
Phone: (909) 790-1971
Shipping & Handling: 521.6
Quantity
Subtotal
Shipping & Handling
Sales Tax
Order Total
Paid
Balance Due
Price
$ 104.95
$104.95
$21.6
$11.07
$137.62
5137.62
$0
All orders are subject to the Terms & Conditions on NextDayFlyers.com. For details, please visit h;tps:// www.nextdayflyers.com/secure/terms-conditions

NextDayFlyers
Fast Printing, Done Right
Invoice for Order # 13
Order Date: 02/11/2025
P.O,#:

Product Details
ITEM #21519455
8000 Haskell Ave., Van Nuys, CA 91406
Toll Free: 855-898-9870
Mon-Fri(24 Hours a Day), Sat-Sun(6am-5pm PT)
328 Bill to: Grace Point Fellowship Church
Jamie Endres
34784 YUCAIPA BLVD, YUCAIPA, CA, ID 4089492
Email: [email protected] Phone: (909) 790-1971
Product: Custom Banners
Reorder : From Job 13357484 / Item 21073033
Front Side : Full color
Size : 95" x 47"
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Material : 13 oz. Scrim Vinyl
Ready to Ship In : 3 Business Days
Treatments : Hem with Grommets
Grommets : Add 8 Grommets per banner (24"
gaps)
ITEM #21519456
Product: Banners
Size (inches) : 60 x 36
Front Side : Full color
Back Side : No Printing
Material : 13 oz. Scrim Vinyl
Treatments : Hem with Grommets
Ready to Ship In : 3 Business Days
Grommets : Add 6 Grommets per banner (24"
gaps)
Payment Information
Credit Card: MASTERCARD Ending in 6833
Payment Date: 02/11/2025
Delivery & Destination
Delivery
1 Day Transit
Shipping Address
Grace Point Fellowship Church
34784 YUCAIPA BLVD
YUCAIPA, CA 92399
Phone: (909) 790-1971
Shipping & Handling: $21.26
Delivery
1 Day Transit
Shipping Address
Grace Point Fellowship Church
34784 YUCAIPA BLVD
YUCAIPA, CA 92399
Phone: (909) 790-1971
Shipping & Handling: $65.55
Quantity Price
1 $ 98.86
7 $ 261.95
Subtotal
Shipping & Handling
Sales Tax
Order Total
Paid
Balance Due
$360.81
$86.81
$34.69
$482.31
$482.31
$0
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Invoice for Order # 13773595
Order Date: 03/17/2025
P.O,#:

Product Details
ITEM #21753898
Product: Banners
Size (inches) : 120 x 60
Front Side : Full color
Back Side : No Printing
Material : 13 oz. Scrim Vinyl
Treatments : Hem with Grommets
Ready to Ship In : 3 Business Days
Grommets : Add 14 Grommets per banner (24"
gaps)
ITEM #21753899
Product: Banners
Size (inches) : 120 x 60
Front Side : Full color
Back Side : No Printing
Material : 13 oz. Scrim Vinyl
Treatments : Hem with Grommets
Ready to Ship In : 3 Business Days
Grommets : Add 14 Grommets per banner (24"
gaps)
Payment Information
Credit Card: MASTERCARD Ending in 6833
Payment Date: 03/17/2025
Delivery & Destination
Delivery
1 Day Transit
8000 Haskell Ave., Van Nuys, CA 91406
Toll Free: 855-898-9870
Mon-Fri(24 Hours a Day), Sat-Sun(6am-5pm PT)
Bill to: Grace Point Fellowship Church
Jamie Endres
34784 YUCAIPA BLVD, YUCAIPA, CA, ID 4089492
Email: reception@gpfyucaipa,org 1 Phone: (909) 790-1971 Quantity Price
Shipping Address
Jamie Endres
9826 ONYX ST 1 $ 143.95
YUCAIPA, CA 92399
Phone: (909) 790-1971
Shipping & Handling: $20.49
Delivery
1 Day Transit
Shipping Address
Jamie Endres
9826 ONYX ST 1 $ 143.95
YUCAIPA, CA 92399
Phone: (909) 790-1971
Shipping & Handling: $20.49
Subtotal $287.9
Shipping & Handling $40.98
Sales Tax $25.49
Order Total $354.37
Paid $354.37
Balance Due $0
All orders are subject to the Terms & Conditions on NextDayFlyers.com. For details, please visit https://www.nextdayflyers.com/secure/terms-conditions •

Order# 600600449
https://www.buildasign.com
Date: Tuesday, January 28, 2025
Billing Information Shipping Information
Name: Jamie D Endres
Phone: 9097901971
Address: United States, California, YUCAIPA, 34784
YUCAIPA BLVD, 923994253
Payment method: Credit Card
Name: GRACE POINT FELLOWSHIP
Phone: 9097901971
Address: United States, California, YUCAIPA, 34784
YUCAIPA BLVD, 923994253
Shipping method: Rush
Get it by: 2/5/2025
Name Price Qty Total
18"x 24"
Corrugated Plastic
I do not need a protective coating
Single Sided
24'h x 10"w Wire Stakee./strong>
$5.02
150 $753.00
Sub -total: $753.00
Shipping: $6.99
Tax: $58.90
Order total $818.89
-1-

Order# 600620664
https://www.buildasign.com
Date: Monday, March 10, 2025
Billing Information
Name: Jamie D Endres
Phone: 9097901971
Address: United States, California, YUCAIPA, 34784
YUCAIPA BLVD, 92399
Payment method: Credit Card
Shipping Information
Name: GRACE POINT FELLOWSHIP
Phone: 9097901971
Address: United States, California, YUCAIPA, 34784
YUCAIPA BLVD, 923994253
Shipping method: Standard
Get it by: 3/19/2025
Price Qty
Total
18"x 24"
Corrugated Plastic
! do not need a protective coating
Single Sided
$14.54
1i) $145.40
Sub -total: $145.40
Shipping: $0.00
Tax:$I1.27
Order total $156.67
-1-

ATTACHMENT 5

CITY OF YUCAIPA

COMMUNITY ACTIVITY GRANT APPLICATION

FINANCIAL / IN -KIND / FEE WAIVER

COMMUNITY ACTIVITY GRANT APPLICATION INSTRUCTIONS
FISCAL YEAR:
2025/2026
DATE SUBMITTED: 5-142025
SUBMIT TO: CITY OF YUCAIPA

GENERAL SERVICES/CITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

Note: BogInning with the FY 25/26 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 match of $500.

SECTION 1 - GENERAL INFORMATION
Name of Applicant/Organization: ;inland Leaders Charter School • Applicant/Organization:

Mailing Address
237.5 California St.'Yucaipa, CA 92399
Applicant/Organization Phone Number:

CONTACT (1)
CONTACT (2)
Jeremy Hoch
NAME
[email protected]
E•MaII
Mike Gordon
NAME
[email protected]
E-Mail

PHONE NUMBER

PHONE NUMBER
• t.
•
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? -- Yucaipa City Clerk's (office
*RECEIVED
MAY 1 4 2025
If so, which one? i
*If you answered "Yes" to any of the questions listed above, your request Is p9eligible for the Community Activity Grant. 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)?
If so, please provide Tax ID# and attach all supporting 20-8343378 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, due, etc.?
If yes, please describe:
17 years
120
100
NO
nn
✓
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, If available) Dr, Jay Jimenez
Michael Casavan
Jacob Rosario
Bonnie Mitchell
%Eli Gillespi
;Mike Gordon
President
Treasurer
Member
•Secretary
Member
Director.
2 SECTION 4 - PROGRAM DESCRIPTION/SCOPE (PLEASE USE ADDITIONAL

PAGES AS NECESSARY)
Name of the program/event: Volleyball Games
Date(s) of the program/event: Aug. 29. Sept. 7, 14, I8, 26, Oct 6, 10 Total estimated cost for program/event:

Describe the program/event that the organization is seeking support for:
(Attach any event/program promotional materials associated with the program/event) Our sports program is in need of a gym to host our volleyball home games. We have 6 or 7 home volleyball games. I do not have our league schedule to provide exact dates.

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

We believe that athletic are an important part of the educational experience at ILCS. Our students benefit from learning how to handle succes and disappointment. Athletics help build good leadership qualities. in students that will help them. be leaders in our community.

Program/event primary target population (check all that apply):

Children or Youth
Persons with Disabilities
Entire Community
Seniors
Homeless
Victims
Low Income
Welfare Recipients
Women
Please answer the following to determine if your program/event requires a Special Event Permit (SEP):

Estimated attendance 300.999 persons
Amplified Sound
(excluding Special Event Facilities)
YES NO
✓
✓

THIS BOX IS FOR STAFF USE ONLY
This event requires City Management/
Administrative Approval:

YES NO
Estimated attendance 1000+ persons
Alcohol Service
(excluding Community Centers & YPAC)
Street Closure - Traffic Management
YES NO
IV
✓

THIS BOX IS FOR STAFF USE ONLY
YES
This event requires City Council Approval:

NO
3 SECTION 5 - GRANT FUNDING REQUEST
Please identify what your organization is seeking:

YES NO
Financial Support:111 El $ $200 SEP Fee Waiver: D z
01,a-,va
In -Kind Support: $ $`1200-Fiti0-- $ $
OT/Reassigned Staff CS/Rental Scherer Other
Community Center
Total Amount
of Request
YES NO
If other, please explain:

In -Kind Financial Support $200 SEP Fee
Waiver
Financial Match
Total Overall
Request
Provide a detailed description of how the financial support will be used:

Our sports program is in need of a gym to host our volleyball home games. We have 6 or 7 home volleyball games. I do not have our league schedule to provide exact dates.

SECTION 6 - FINANCIAL CAPABILITIES/BUDGET
What other in-kind/financial contributions has your organization received to fund this event/program (separate from city funding)?
'NA
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
4 111111111111111111

SECTION 6 - FINANCIAL CAPABILITIES/BUDGET (CONTINUED)
Describe any City Funding received by organization in the past three years (required)? P rogra m
CC Gym
CC Gym
CC Gym
In -Kind
Support
Financial
Support
S20D SEP
Fae Waiver
Date Received Total Received
Spring 2022 $ 1500
Spring 2023 $ 1500
Spring 2024 $ 1800
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 •1 • I - • I - . _;.f•i
Athletic Director
Title
SUBMIT .FORM
5 14 2025
Date

TO BE COMPLETED BY THE CITY
Date Received: Date Reviewed:

Amount Funded: City Council Meeting:

Type of Grant: In -Kind Financial S200 SEP
Support Support Foo Waiver
Date City Council received follow-up report:
5 Permit

COMMUNITY

SERVICES
Mai
Better.

City of Yucaipa Community
Services
34272 Yucaipa Blvd
Yucaipa. CA 92399
Organization Name
Customer Type
Organization Address
PHONE:(909) 790-7460
FAX:(909) 790-2589
EMAIL:communi tyservices©yucaipa.org
Inland Leaders Charter School - 170
Non -Profit (R)
12375 California St
Yucaipa, CA 92399
Agent Name Jeremy Hoch
System User Nick Johnson
ILCS Volleyball
Booking Summary
Permit #
Status
Date
Expiration Date
R7565
Tentative
May 21. 2025 1:16 PM
May 21, 2026
Home Phone Number
Email Address ;noc'i(«,:nlandleaders.com
Rental Fee
Discounts
Subtotal
Deposits
Deposit Discounts
Total Permit Fee
Total Payment
Refunds
Balance
$1,050.00
-$105.00
$945.00
$100.00
$0.00
S1,045.00
$0.00
S0.00
$1,045.00
2 resource(s) 7 booking(s) Subtotal: S1,045.00
Gymnasium, North (Indoor Reservations)
Center: Yucaipa Community Center

START DATE/TIME
Thu, Aug 28, 2025 2:30 PM
Rental - Hourly
Resident Discount - 10%
Tue, Sep 9, 2025 2:30 PM
Rental - Hourly
Resident Discount - 10%
Tue, Sep 16, 2025 2:30 PM
Rental - Hourly
Resident Discount - 10%
Thu, Sep 25, 2025 2:30 PM
Rental - Hourly
Resident Discount - 10%
Resource level fees

END DATE/TIME
Thu, Aug 28, 2025 5:00 PM
S60.00 / Hour x 2.5 $150.00
-10% x 1-$15.00
Tue, Sep 9. 2025 5:00 PM
$60.00 / Hour x 2.5 S150.00
-10%x1-S15.00
Tue. Sep 16, 2025 5:00 PM
$60.00 / Hour x 2.5 $150.00
-10% x 1-S15.00
Thu, Sep 25, 2025 5:00 PM
$60.00 / Hour x 2.5 $150.00
-10%x 1-$15.00
S 100.00 / Each x 1
$100.00

ATTENDEE
40 40
40 40

AMT W/O TAX
$135.00
$135.00
$135.00
$135.00
$100.00
Gymnasium. South (Indoor Reservations) Center: Yucaipa Community Center # R7565 Status Tentative

Page 1 of 2 ends

START DATE/TIME END DATE/TIME ATTENDEE AMT W/O TAX
Thu, Sep 18, 2025 2:30 PM Thu, Sep 18, 2025 5:00 PM 40 $135.00 Rental - Hourly $60.00 / Hour x 2.5
Resident Discount - 10% -10% x 1 _ ).',
Thu, Oct 2, 2025 2:30 PM Thu, Oct 2, 2025 5:00 PM 40 $135.00 Rental - Hourly $60.00 / Hour x 2.5 S150.00
Resident Discount - 10% -10% x 1-$15.00
Thu, Oct 9, 2025 2:30 PM Thu, Oct 9, 2025 5:00 PM 40 $135.00 Rental - Hourly $60.00 1 Hour x 2.5 $150.00
Resident Discount - 10% -10% x 1 -$15.00
Resource level fees $0.00
$0.00 / Each x 1 $0.00
Deposit

EVENT RESOURCE DEPOSIT FEE CHARGE TAX AMOUNT PAID REFUNDS BALANCE ILCS Gymnasium, Deposit $100.00 $0.00 $0.00 $0.00 $100.00 Volleyball North
ILCS Gymnasium, Deposit $0.00 $0.00 $0.00 $0.00 $0.00
Volleyball South
Payment Schedules Original Balance: $1,045.00 Current Balance: $1,045.00

DUE DATE AMOUNT DUE
Aug 14, 2025

AMOUNT PAID WITHDRAWAL ADJUSTMENT BALANCE
$1,045.00 $0.00
$0.00 $1,045.00
# R7565 Status Tentative Page 2 of 2

Permit
City of Yucaipa Community
Services
34272 Yucaipa Blvd
Yucaipa, CA 92399
Organization Name
Customer Type
Organization Address
PHONE:(909) 790-7460
FAX:(909) 790-2589
EMAIL:[email protected]
Inland Leaders Charter School -170
Non -Profit (R)
12375 California St
Yucaipa, CA 92399
Agent Name Jeremy Hoch
System User Nick Johnson
ILCS Volleyball
Booking Summary

COMMUNITY
port,

SERVICES

RECEIVED
MAY 3 0 2025
Yucaipa City Clerk's Office
Permit #
Status
Date
Expiration Date
£a fkpa
Better!
R7565
Tentative
May 21, 20251:16 PM
May 21, 2026
Home Phone Number
Email Address [email protected]
Rental Fee
Discounts
Subtotal
Deposits
Deposit Discounts
Total Permit Fee
Total Payment
Refunds
Balance
$900.00
$0.00
$900.00
$100.00
$0.00
$1,000.00
$0.00
$0.00
$1,000.00
2 resource(s) 6 booking(s) Subtotal: $1,000.00
Gymnasium, North (Indoor Reservations)
Center. Yucaipa Community Center

START DATE/TIME
Thu, Aug 28, 2025 2:45 PM
Rental - Hourly
Thu, Sep 25, 2025 2:45 PM
Rental - Hourly
Resource level fees
Deposit
S60.00 / Hour x 2.5
S60.00 / Hour x 2.5
$100.00 / Each x 1 $100.00

END DATE/TIME
Thu, Aug 28, 2025 5:15 PM
$150.00
Thu. Sep 25. 2025 5:15 PM
$150.00

ATTENDEE
40 40

AMT W/O TAX
$150.00
$150.00
$100.00
Gymnasium, South (Indoor Reservations)
Center: Yucaipa Community Center

START DATE/TIME
Mon, Sep 15, 2025 2:45 PM
Occurs on selected dates effective 09/15/2025 until 09/18/2025.

Mon, Sep 15, 2025 2:45 PM
Rental - Hourly $60.00 / Hour x 2.5 $150.00

END DATE/TIME
Thu, Sep 18, 2025 5:15 PM
Mon, Sep 15, 2025 5:15 PM

ATTENDEE
40 AMT W/O TAX
$300.00
$150.00

Thu, Sep 18, 2025 2:45 PM Thu, Sep 18, 2025 5:15 PM 40 $150.00 Rental - Hourly $60.00 / Hour x 2.5 $150.00
Mon, Oct 6, 2025 2:45 PM Mon, Oct 6, 2025 5:15 PM 40 $150.00 Rental - Hourly $60.00 / Hour x 2.5 $150.00
Thu, Oct 9, 2025 2:45 PM Thu, Oct 9, 2025 5:15 PM 40 $150.00 Rental - Hourly $60.00 / Hour x 2.5 $150.00
Deposit

EVENT RESOURCE DEPOSIT FEE CHARGE TAX AMOUNT PAID REFUNDS BALANCE ILCS Volleyball Gymnasium, Deposit $100.00 $0.00 $0.00 $0.00 $100.00 North
Payment Schedules Original Balance: $1,000.00 Current Balance: $1,000.00

DUE DATE AMOUNT DUE AMOUNT PAID WITHDRAWAL ADJUSTMENT BALANCE Aug 14, 2025 $1,000.00 $0.00 $0.00 $1,000.00

ATTACHMENT 6

CITY OF YUCAIPA

COMMUNITY ACTIVITY GRANT APPLICATION

FINANCIAL / IN -KIND / FEE WAIVER

COMMUNITY ACTIVITY GRANT APPLICATION INSTRUCTIONS
FISCAL YEAR:

DATE SUBMITTED:

FY 25/26
SUBMIT TO: CITY OF YUCAIPA

GENERAL SERVICES/CITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

Note: Beginning with the FY 25/26 grant cycle, financial grant awarded funds will require 100% financial match by the applicant. For example, if your total program/project cost is S1,000, 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 match of S500.

Received
SECTION 1 - GENERAL INFORMATION
Name of Applicant/Organizatiort Rotary Club of Yucaipa
Applicant/Organizatiort PO Box 661
Mailing Address
Applicant/Organization Phone Number
CONTACT (1)
CONTACT (2)
DonnaKaye Ostrander
NAME
MAY 15 2025
General Services/
City Clerk's Department

PHONE NUMBER
E-Mail
Jennifer Crawford
NAME

PHONE NUMBER
E-Mail
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? NO
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. 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 so, please provide Tax ID# and attach all supporting documents.

YES
NO
45-5149308
1956
0 40

55.000
Dues $180
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Dan Hudec (President)
Karen Swedlove (Secretary)
Jack Knight (Treasurer)
Terry Knight ((Club Administrator)
David Avila (Community Services)
Henry Markowicz (Foundation Coordinator)
Chris Markarian (Membership)
Kent & Karen Colby (Youth Servic/Protection)
Leslie Wessels (Public Relations)

SECTION 4 - PROGRAM DESCRIPTION/SCOPE (PLEASE USE ADDITIONAL

PAGES AS NECESSARY)
Name of the program/event:
70th Annual Christmas Parade
Date(s) of the program/event:

Saturday December 13, 2025
Total estimated cost for program/event:
$15,700 CAG In -Kind Grant Request additional costs covered by Rotary Describe the program/event that the organization is seeking support for:
(Attach any event/program promotional materials associated with the program/event) The 70th Annual Christmas Parade will be held on Saturday, December 13, 2025. This year will mark the 6th 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.

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

The 70th 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):

YES NO
Estimated attendance 300-999 persons
Amplified Sound
(excluding Special Event Facilities)

THIS BOX IS FOR STAFF USE ONLY
This event requires City Management/
Administrative Approval:

YES
NO
YES NO
Estimated attendance 1000+ persons
Alcohol Service
(excluding Community Centers & YPAC)
Street Closure - Traffic Management
THIS BOX 15 FOR STAFF USE ONLY
YES
This event requires City Council Approval:

NO
3 SECTION 5 - GRANT FUNDING REQUEST
Please identify what your organization is seeking:

YES NO
Financial Support: S
In -Kind Support: $ 15,500 $
OT/Reassigned Staff CS/Rental
If other, please explain:

YES
I I I 1
$200 SEP Fee Waiver:
$ $
Scherer Other
Community Center
Total Amount $ 15,500
of Request
In -Kind
Financial Support
$ 200
$200 SEP Fee
Waiver
Provide a detailed description of how the financial support will be used:

S S
Financial Match
15,700
Total Overall
Request
The In -Kind Support received from the CAG will cover the costs of police (S9,500) and Public Works support (6,000) 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.

SECTION 6 - FINANCIAL CAPABILITIES/BUDGET
What other in-kind/financial contributions has your organization received to fund this event/program (separate from city funding)?
Rotary Club contributes
Rotary Volunteers (approx 25)
In -Kind
Amount
S
S S
Priceless
Total Funds Received to Date: $ $
Total Funds Requested via Grant Application: S
Remaining Balance that will be Funded by Organization: $ $ Financial
Support Amount
S6000
$
$6,000
4 SECTION 6 - FINANCIAL CAPABILITIES/BUDGET(CONTINUEO)
Describe any City Funding received by organization in the past three years (required)? Program
2024 Event
2023 Event
2022 Event
In -Kind
Support
Financial
Support
S200 SEP
Fee Waiver
Date Received Total Received

6.26.23 $ 16,200
$ 12,334

10.10.22 $8,713
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.

Title

0. V\ti\0-__. 5)1,1Zs
Date

SUBMIT FORM

TO BE COMPLETED BY THE CITY
Date Received:

Amount Funded:

Type of Grant:

In -Kind
Support
Date Reviewed:

City Council Meeting:

Financial S200 SEP
Support Fee Waiver
Date City Council received follow-up report:
5 Docusign Envelope ID: 05ACE1CC-778E-497D-9149-4E174B5D7FE3 • , � I A D A

SPECIAL EVENT PERMIT

APPLICATION
11Page

Docusign Envelope ID: 05ACE1CC-778E-497D-9149-4E174B5D7FE3 facaeg7-
Organization and Applicant Information

CITY OF YUCAIPA

SPECIAL EVENT PERMIT

APPLICATION
45-5149308
❑ Commercial (For -profit) 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: ❑ Athletic/Recreation ❑ Festival/Celebration ❑ Outdoor Market ❑ Circus/Carnival
❑Concert/Performance ❑t Parade/Procession/March ❑Other (specify):

Event Title
70th Annual Christmas Parade
Event Location
Yucaipa Blvd (California St / Yucaipa Blvd. / 6th St.)
Event
Description
The 70th Annual Christmas Parade will be held on Saturday, December 13. 2025.

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

End Time
Date(s)
Daily Activity
Start Time
12/13/25
❑■ Set-up ❑ Event Day ❑ Clean-up
8:00 am
12:0o pm
12/13/25
❑ Set-up ■❑ Event Day ❑ Clean-up
12:00 pm
3:00 pm
12/13/25
❑ Set-up ❑ Event Day ❑■ Clean-up
3:00 pm
4:00 pm
❑ Set-up ❑ Event Day ❑ Clean-up
❑ Set-up ❑ Event Day ❑ Clean-up
❑ Set-up ❑ Event Day ❑ Clean-up
Has this event taken place before? DYes ❑ No
+/-10,000
Total anticipated attendance:

How many years? 69 yrs
000 9,000
Participants: 1,Spectators:

Docusign Envelope ID
05ACE1 CC-778E-497D-9149-4E 174B5D7FE3

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:

Macaw y&uw
80'x40'
..,, CANOPY ,aaa,1
ua.as us.

NMUS aLa1
L.ap...aw <.r.
e.n..

L.,. <.Mo..(aaa.)
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

Docusign Envelope ID: 05ACE1CC-778E-497D-9149-4E174B5D7FE3 CHYOF
facedfia7.

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, 12/13/25 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 lst 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 lst St to Adams St; Yucaipa Blvd: California St to 6th St6th St:

Yucaipa Blvd to OVEC Campus
Soft closure at 6th and Avenue E
Indicate how this closing/reopening of streets will be handled:
n City of Yucaipa to handle (cost to be specified) n 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:

California Street: Yucaipa Blvd to just north of post office. Avenue A: 1st St to Adams St.

Avenue B: 1st St to Adams St, Avenue C: 1st St to Adams St. Avenue D: 1st St to Adams St, Yucaipa Blvd: California St to 6th St. 6th 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? ❑ Yes [1 No
Method: ❑ Gas Electric ['Charcoal E Other (specify):

Does the event involve the sale or use of alcoholic beverages? 11 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? Q■ Yes [-[ No 4IPage

p
Docusign Envelope ID: 05ACE1CC-778E-497D-9149-4E174B5D7FE3

CITY OF YUCAIPA

SPECIAL EVENT PERMIT

APPLICATION
Company
Name
Diamond Environmental
Contact Name
Victor Jackson
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
Rotary representative will coordinate with Burrtec thru Ana Sauseda 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
Yucaipa Rotary Club - DonnaKaye / Jennifer Crawford
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

Docusign Envelope ID: 05ACE1CC-778E-497D-9149-4E174B5D7FE3

OF YUCAIPA

PECIAL EVENT PERMIT

APPLICATION
am
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:

S
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 n 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? EI Yes ❑ No Start time: End time:

Are there any musical entertainment features for this event? n Yes n No Name of Act
Various bands in the parade & sound from various floats Contact Name
Phone
Number
How many stages? 1 Number of bands? 3-4 Genre of music: various Will fireworks, rockets, or other pyrotechnics be used? ❑ Yes n[ No Company
Name
Wage
1 Docusign Envelope ID: 05ACE1CC-778E-497D-9149-4E174B5D7FE3 p4oav

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: (1 Yes n 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 ■0 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.)
71Page

Docusign Envelope ID: 05ACE1CC-778E-497D-9149-4E174B5D7FE3 Application Checklist

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.

Name:

J. Crawford Signature:

Docusign Envelope ID: 05ACE1CC-778E-497D-9149-4E174B5D7FE3 • • VI A ' A

SPECIAL EVENT PERMIT

DEPARTMENT APPROVAL PAGE

YUCAIPA FIRE DEPARTMENT APPROVAL
❑ APPROVED ❑ DENIED
a/661e(
,tto

FIRE DEPT
COMMENTS:

Maintain Emergency Access at all times.

FEES:

None
NAME: Grant Mal i nowski
SIGNATURE:

DocuSignad by:
/41
4A4A72915GAM93..

DATE: 5/15/2025

Docusign Envelope ID 05ACE1CC-778E-497D-9149-4E174B5D7FE3 A
T

SPECIAL EVENT PERMIT

DEPARTMENT APPROVAL PAGE

COMMUNITY SERVICES DEPARTMENT APPROVAL

APPROVED
DENIED
COMMENTS:

There will be 3 planning meetings prior to the event.

FEES:

None
NAME:

Megan Wolfe
SIGNATURE:

DocuSigned by:
()6ocft'
0094720EEC984CA
DATE:
5/15/2025

Docusign Envelope ID: 05ACE1CC-778E-497D-9149-4E174B5D7FE3 ••• 1 A

SPECIAL EVENT PERMIT

DEPARTMENT APPROVAL PAGE

DEVELOPMENT SERVICES APPROVAL
(Planning, Public Works, Building and Safety, Engineering)

APPROVED
DENIED
COMMENTS:

Items to include staff time (set-up/take-down of road
closures
FEES:
$6,000
Planning
NAME:

SIGNATURE:

Public Works
Scott washburn
NAME:

DATE:
r DocuSigned by:

SIGNATURE: Scbff OiaS o lit, DATE:
'-C6886998ECE444
Building/Safety and Engineering
NAME:
5/15/2025
SIGNATURE: DATE:

Docusign Envelope ID. 05ACE1CC-778E-497D-9149-4E174B5D7FE3 A
IT
•FY

SPECIAL EVENT PERMIT

DEPARTMENT APPROVAL PAGE

SHERIFF'S DEPARTMENT APPROVAL

APPROVED
DENIED
COMMENTS:

POLICE
Staffing remains same as previous year
FEES:

Cost for event is anticipated at $9,500
NAME:

Ryan Ford
DocuSigned by:

SIGNATURE: '64
DATE:
5/15/2025

ATTACHMENT 7

CITY OF YUCAIPA

COMMUNITY ACTIVITY GRANT APPLICATION

FINANCIAL / IN -KIND / FEE WAIVER

COMMUNITY ACTIVITY GRANT APPLICATION INSTRUCTIONS
FISCAL YEAR:

FY 25/26
DATE SUBMITTED: 5/8/25
SUBMIT TO: CITY OF YUCAIPA

GENERAL SERVICES/CITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

Note: Beginning with the FY 25/26 grant cycle, financial grant awarded funds will require 100% financial match by the applicant. For example, if your total program/project cost is S1,000, 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 6500.

SECTION 1 - GENERAL INFORMATION
Name of Applicant/Organization: Rotary Club of Yucaipa
Applicant/Organization: PO Box 661
Mailing Address
Applicant/Organization Phone Number:

CONTACT (1)
CONTACT (2)
Dan Iludcc
NAME
E-Mail
Jennifer Crawford
NAME
E-Mail
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?
'If you answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.

PHONE NUMBER

PHONE NUMBER
NO
YES
n
✓
✓

RECEIVED
MAY 0 8 2025
Yucaipa City Clerk's Office
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 so, please provide Tax ID# and attach all supporting documents.

YES
NO
45-5149308
1956
0 40
5_000
Dues S 180/per member
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Dan Hudec (President)
Karen Swedlove (Secretary)
Jack Knight (Treasurer)
Terry Knight ((Club Administrator)
David Avila (Community Services)
Henry Markowicz (Foundation Coordinator)
Chris Markarian (Membership)
Kent & Karen Colby (Youth Servic/Protection)
Leslie Wessels (Public Relations)
7 SECTION 4 - PROGRAM DESCRIPTION/SCOPE (PLEASE USE ADDITIONAL

PAGES AS NECESSARY)
Name of the program/event: Rotary Weekly Meetings
Date(s) of the program/event: Every Tuesday (July 1, 2025 - June 30, 2025) Total estimated cost for program/event:

S 10,456
Describe the program/event that the organization is seeking support for:
(Attach any event/program promotional materials associated with the program/event) Weekly Rotary Club Meetings at the Scherer Center Nutrition Facility. Meetings are open to the public.

Describe how the program/event benefits the residents/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.

In addition, Rotary Club has adopted and maintains the landscaping in front of the Senior Center.

Program/event primary target population (check all that apply):
❑ Children or Youth
nPersons with Disabilities
Entire Community
Seniors
Homeless El Low Income El Women
Victims
Welfare Recipients
Please answer the following to determine if your program/event requires a Special Event Permit (SEP):

YES NO
Estimated attendance 300-999 persons n n
Amplified Sound
(excluding Special Event Facilities)

THIS BOX IS FOR STAFF USE ONLY
This event requires City Management/
Administrative Approval:

YES NO
❑ ❑
Estimated attendance 1000+ persons
Alcohol Service
(excluding Community Centers & YPAC)
Street Closure - Traffic Management
YES NO
n
I� I
❑

THIS BOX IS FOR STAFF USE ONLY
This event requires City Council Approval:

YES NO
❑
3 SECTION 5 - GRANT FUNDING REQUEST
Please identify what your organization is seeking:

YES NO
Financial Support:

In -Kind Support: $ $
OT/Reassigned Staff CS/Rental
If other, please explain:

YES NO
$200 SEP Fee Waiver:
$ 10,456' 10 2 O W $
Scherer Other
Community Center
Total Amount $ 10,456 10 Zp $ $
of Request 1
In -Kind Financial Support $200 SEP Fee
Waiver
Provide a detailed description of how the financial support will be used:

Financial Match Total Overall
Request
$ 10,456 I\ 2.
0 NA
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 - funds generated by Rotary are used to support the services listed in Section 4
In -Kind
Amount
Financial
Support Amount
Total Funds Received to Date: $ $
Total Funds Requested via Grant Application: $J )0/ 201P$ Remaining Balance that will be Funded by Organization: $ $ 4 SECTION 6 - FINANCIAL CAPABILITIES/BUDGET (CONTFNUED) Describe any City Funding received by organization in the past three years (required)? Program
2024:25
2023/24
2022/23
In•Kind
Support
Financial
Support
S200 SEP
Fee Waiver
Date Received Total Received

6.10.24 $ 9.956

6.26.23 $ 10,155

6.27.22 $ 9,126
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.

Z�
Da e

S(BMIT FORM

TO BE COMPLETED BY THE CITY
Date Received:

Amount Funded:

Type of Grant:
in -Kind
Support
Date Reviewed:

City Council Meeting:

Financial S200 SEP
Support Fee Waiver
Date City Council received follow-up report:
5 Permit
ygyeefr COMMUNITY

SERVICES
Pa1 ee
Better!
City of Yucaipa Community PHONE:(909) 790-7460
Services FAX:(909) 790-2589
34272 Yucaipa Blvd EMAIL:[email protected]
Yucaipa, CA 92399
Organization Name
Customer Type
Organization Address
Rotary Club Of Yucaipa - 336
Non -Profit (R)
PO Box 661
Yucaipa. CA 92399
Agent Name Daniel Hudec Home Phone Number
Email Address
System User Karen Ruiz
Yucaipa Rotary Club Weekly Meetings
Booking Summary
Permit # R7541
Status Tentative
Date May 7. 2025 5:51 PM
Expiration Date May 7, 2026
Rental Fee $11,340.00
Discounts -$1,134.00
Subtotal $10,206.00
Deposits $250.00
Deposit Discounts $0.00
Total Permit Fee $10,456.00
Total Payment $0.00
Refunds $0.00
Balance $10,456.00
1 resource(s) 36 booking(s) Subtotal: $10,456.00
SrC Nutrition Center (Indoor Reservations) Center: Yucaipa Senior Center

START DATE/TIME
Tue, Jul 8, 2025 6:00 AM

END DATE/TIME
Tue, Jun 16, 2026 8:15 AM
Occurs every Tuesday effective 07/08/2025 until 06/16 2026 from 6:00 AM 10 815AM Tue, Jul 8, 2025 6:00 AM
Rental - Noun/ $140.00 / Hour x 2.25 $315.00
Resident Discount - 10% -10% x 1 -531 50
Tue. Jul 8, 2025 8:15 AM

ATTENDEE

AMT W/O TAX
510,206.00
40 $283.50
Tue, Jul 15, 2025 6:00 AM Tue. Jul 15, 2025 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 $315.Oi1
Resident Discount - 10% -10% x 1-531.90
Tue, Jul 22, 2025 6:00 AM Tue, Jul 22, 2025 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 5315 is
Resident Discount - 10% -10% x 1 -531 5C
Tue, Aug 5, 2025 6:00 AM Tue, Aug 5, 2025 8:15 AM 40 $283.50 Rental - Hourly 5140.00 / Hour x 2.25 :.,1=,
Resident Discount - 10%-10`;. x 1 -331 50
Tue, Aug 12, 2025 6:00 AM Tue, Aug 12, 2025 8:15 AM 40 $283.50 # R7541 Status Tentative

Page 1 of 4 ends

Rental - Hourly $140.00 / Hour x 2.25 $315.00
Resident Discount - 10% -10% x 1-$31.50
Tue, Aug 19, 2025 6:00 AM Tue, Aug 19, 2025 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 $315.00
Resident Discount - 10°%, -10°/° x 1-$31.50
Tue, Sep 2, 2025 6:00 AM Tue, Sep 2, 2025 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 $315.00
Resident Discount - 10% -10% x 1-$31.50
Tue, Sep 9, 2025 6:00 AM Tue, Sep 9, 2025 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 S315.00
Resident Discount - 10% -10% x 1-$31.50
Tue, Sep 16, 2025 6:00 AM Tue, Sep 16, 2025 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 S315.00
Resident Discount - 10% -10% x 1-$31.50
Tue, Oct 7, 2025 6:00 AM Tue, Oct 7, 2025 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 $315.00
Resident Discount - 10% -10% x 1-$31.50
Tue, Oct 14, 2025 6:00 AM Tue, Oct 14, 2025 8:15 AM 40 $283.50 Rental - Hourly $140.00 1 Hour x 2.25 $315.00
Resident Discount - 10% -10% x 1-$31.50
Tue, Oct 21, 2025 6:00 AM Tue, Oct 21, 2025 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 $315.00
Resident Discount - 10% -10% x 1-$31.50
Tue, Nov 4, 2025 6:00 AM Tue, Nov 4, 2025 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 $315.00
Resident Discount - 10% -10% x 1 -$31.50
Tue, Nov 11, 2025 6:00 AM Tue, Nov 11, 2025 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 $315.00
Resident Discount - 100-:, -10% x 1 -$31 50
Tue, Nov 18, 2025 6:00 AM Tue, Nov 18, 2025 8:15 AM 40 $283.50 Rental - Houry $140.00 / Hour x 2.25 $315.0U
Resident Discount - 10% -10% x 1 -$31 50
Tue, Dec 2, 2025 6:00 AM Tue, Dec 2, 2025 8:15 AM 40 $283.50 Rental . Hourly $140.00 1 Hour x 2.25 $315.00
Resident Discount - 10% -10% x 1-$31.50
Tue, Dec 9, 2025 6:00 AM Tue, Dec 9, 2025 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 $315.00
Resident Discount - 10% -10% x 1-$31.50
Tue, Dec 16, 2025 6:00 AM Tue, Dec 16, 2025 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 $315.00
Resident Discount - 10% -10% x 1 -$31.50
Tue, Jan 6, 2026 6:00 AM Tue, Jan 6, 2026 8:15 AM 40 $283.50 Rental - Hourly $140.00 ! Hour x 2.25 $315.0
# R7541 Status Tentative Page 2 of 4

Resident Discount - 10% -10% x 1-$31.50
Tue, Jan 13, 2026 6:00 AM Tue, Jan 13, 2026 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 $315.00
Resident Discount - 10°,, -10%, x 1 -$31.50
Tue, Jan 20, 2026 6:00 AM Tue, Jan 20, 2026 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.2.-
Resident Discount - 10% -10% x 1
Tue, Feb 3, 2026 6:00 AM Tue, Feb 3, 2026 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 $315.00
Resident Discount - 10% -10% x 1-$31.50
Tue, Feb 10, 2026 6:00 AM Tue, Feb 10, 2026 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 $315.00
Resident Discount - 10'.a -10% x 1-$31.50
Tue, Feb 17, 2026 6:00 AM Tue, Feb 17, 2026 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 $315.00
Resident Discount - 10% -10% x 1-$31.50
Tue, Mar 3, 2026 6:00 AM Tue, Mar 3, 2026 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 $315,00
Resident Discount - 10% -10% x 1-$31.50
Tue, Mar 10, 2026 6:00 AM Tue, Mar 10, 2026 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 $315.00
Resident Discount - 10% -10% x 1 -$31.50
Tue, Mar 17, 2026 6:00 AM Tue, Mar 17, 2026 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 $315.00
Resident Discount - 10% -10% x 1 -$31.50
Tue, Apr 7, 2026 6:00 AM Tue, Apr 7, 2026 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 $315.00
Resident Discount - 10% -10% x 1-$31.50
Tue, Apr 14, 2026 6:00 AM Tue, Apr 14, 2026 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 $315 0
Resident Discount - 10% -10% x 1 -$31 50
Tue, Apr 21, 2026 6:00 AM Tue, Apr 21, 2026 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 $315.00
Resident Discount - 10% -10% x 1 -$31.50
Tue, May 5, 2026 6:00 AM Tue, May 5, 2026 8:15 AM 40 $283.50 Rentai - Hourly $140,00 / Hour x 2.25 $315-00
Resident Discount - 10°%° -10% x 1-$31.50
Tue, May 12, 2026 6:00 AM Tue, May 12, 2026 8:15 AM 40 $283.50 Rental - Hourly $140.001 Hour x 2.25 $315.00
Resident Discount - 10% -10% x 1-$31.50
Tue, May 19, 2026 6:00 AM Tue, May 19, 2026 8:15 AM 40 $283.50 Rental - Hourly $140.00 ! Hour x 2.25 $315.00
Resident Discount - 10% -10% x 1 -$31.50
# R7541 Status Tentative Page 3 of 4

Tue, Jun 2, 2026 6:00 AM Tue, Jun 2, 2026 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 $315.00
Resident Discount - 13'% -10% x 1 -$31 50
Tue, Jun 9, 2026 6:00 AM Tue, Jun 9, 2026 8:15 AM 40 $283.50 Rama, - Hcuriy $140.00 i Hour x 2.25 $315.C: i
Resident Di ; -c.trlt - 10'11, -10% x 1 -$31 50
Tue, Jun 16, 2026 6:00 AM Tue, Jun 16, 2026 8:15 AM 40 $283.50 Rental - Hourly $140.00 / Hour x 2.25 $315.00
Resident Discount - 10% -10% x 1-$31.50
Resource level fees $250.00
Deposit $250.00 / Each x 1 $250.00
Waivers and Information

INFORMATION DESCRIPTION
Proof of Liability Insurance
Proof of Non Profit Status

WAIVER NAME
Facility Usage Waiver

DUE DATE
Jul 8, 2025
FOR

SIGNING STATUS
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 Yucaipa SrC Deposit $250.00 $0.00 $0.00 $0.00 $250.00
Rotary Club Nutrition
Weekly Center
Meetings
Payment Schedules Original Balance: $10,456.00 Current Balance: $10,456.00

DUE DATE AMOUNT DUE AMOUNT PAID WITHDRAWAL ADJUSTMENT BALANCE Jun 24, 2025 $10,456.00 $0.00 $0.00 $10,456.00
# R7541
Status Tentative Page 4 of 4

ATTACHMENT 8

CITY OF YUCAIPA

CPIVIMU ITY ACTIVITY GRANT APPLICATION

FINANCIAL / IN -KIND / FEE WAIVER
TYACTIVITY GRANT 'APPL.!CATION
FISCAL YEAR:
2025126ZG
DATE SUBMITTED: 05/12/2025
SUBMIT TO: CITY OF YUCAIPA

GENERAL SERVICES/CITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

YUCAIPA, CA 92399
All sections of the application must be returned complete. and all supporting documentation must be included as part of the submittal incompiere anidications received will be returned to rile applicant.

Nutt- i3eginnink i,ith the Fr 25/2b grant cycle. financial grant awarded funds will require 1UO 'i financial match by the applicant. For example. if yo,:: ,otal program/project cost is 51,000 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.

Name of Applicant/Organization: Sides for Seniors 1-oundatiun Applicant/Organization: p,0. Box l 1 13 Yucaipa C'ai 92399 Mailing Address
Applicant/Organization Phone Number : 909-790-6671
CONTACT (1)
CONTACT (2)
Catherine Serianni
NAME
E-Mail
YO9-790-6671
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?
-it y[iu answeie.d "Yes" to any of the questions listed above. your request is nateltgible for the Community Activity Gr lilt

PHONE NUMBER
YES
M;1e34sen vrS a •6.4)111

PHONE NUMBER
NO

RECEIVED
✓
}
a MAY 1 3 2025
Yucaipa City Clerk's Office
1 SECTION 3 - ORGANtZAT(ON 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 so, please provide Tax ID# and attach all supporting 2() documents.

YES
NO
Since June 2007 18 y
35 Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Don Bagwell
Kathy Dexter
Stephanie Robertson
Glory Garcia
Sabrina Ferras
Betty Cocchini
Gayle Fiethner
Letty Flores
Peggy Murphy
President
Vice President
Treasurer
Secretary
Internet Technology Specialist
Board Member
Board Member
Board Member
Board Member
2 SECTION
- PROGRAM DESCRIPTION/SCOPE
Name of the program/event: Low Income Senior Assistance Date(s) of the program/event: Assistance for Basic Needs t'ur strugglin;i seniors Total estimated cost for program/event: 185000
(PLEASE USE ADDITIONAL
PACES. AS NECESSARY)
Describe the program/event that the organization is seeking support for: , (Attach any event/program promotional materials associated with the program/event) Purpose of Program
Smiles 4 Seniors is a non-profit organization committed to enhancing the lives of low-income seniors by offering assistance for essential needs crucial to their survival. Our organization aims to alleviate the burdens taced by \ ulnerable seniors, ensuring they can maintain a decent quality of life Chen on limited fixed incomes. For the past IS years Smiles for Seniors proudly operates a comprehensive program that addresses the pressing needs of low-income seniors. including financial assistance for basic necessities needed to survive such as food, housing, utility assistance, minor home and auto repairs, lifesaving medications and medical equipment along with providing valuable resource and referrals for our vulnerable low income seniors in need, Each year, our program extends emergency assistance and safety net services to hundreds of struggling seniors who have nowhere else to turn when basic necessities and everyday emergency situations arise and do not align within their fixed income budget. We also work closely with various government and non-govemrent agencies. law enforcement, social workers, senior centers and others in collaboration for the good of our seniors.

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

Program for which funds are being requested
Smiles for Seniors is a Non Profit 501 c (3) organization proudly serving our low income seniors in the inland Empire and surrounding areas since 2007. We have quickly become one of the leading senior assistance agencies known for providing emergency assistance for food, housing, utility payments Stich as water, gas, electricity, minor home and auto repair and help pay firr life saving prescriptions and medical equipment just 10 name a few. In fact Riverside and San I3ernardino Counties 211 program, refer over 400 love income seniors per month to our agency. To be eligible tiri the program senior clients must he age 65 and be very love income. Please note that most of our clients only receive an average Social Security 01950.00 per month Our Programs and Services
HEALTH. We provide emergency funding for Co -pays, not covered by Medi-Ca1/Medi-Care or private insurance. Our program has assisted low income seniors with lifesaving medications and medical supplies, Cochlear implants, hearing aids, glasses and eve exams. dental procedures. prosthetic limbs. cancer treatments. nutritional supplements, diabetes supplies.

Program/event primary target population (check all that apply):

Iv
Children or Youth
Persons with Disabilities
L
‘/I
Entire Community
Seniors
Homeless
Victims
Low Income
Welfare Recipients
Women
Please answer the following to determine if your program/event requires a Special Event Permit (SEP):

YES NO/
Estimated attendance 300-999 persons f , l" J
Amplified Sound
(excluding Special Event Facilities)
LJ Lvi
This event requires City Management/
Administrative Approval:

YES
NO
Estimated attendance 1000+ persons
Alcohol Service
(excluding Community Centers & YPAC)
Street Closure - Traffic Management
YES
1 This event requires City Council Approval:

YES
NO

Please identify what your organization is seeking:

YES NO
Financial Support:
$
In -Kind Support: $ $
OT/Reassigned Staff CS/Rental
If other, please explain:

YES
$200 SEP Fee Waiver:
$ $
Scherer Other
Community Center
Total Amount 3,000
of Request $$ $ $ 3,000
In -Kind Financial Support $200 SEP Fee Financial Match Total Overall Waiver
Request
Provide a detailed description of how the financial support will be used:

Providing emergency assistance lur loud. housiup'., u'lux payments such as water. gas, elcetrictty, minor home and auto repair and help pay for life saving prescriptions and medical equiptnent just to name a few. In fact Rn.erside and San Bentardinu Counties 211 program, refer over 400 low income seniors per rnonth to our agency. To be eligible for the program senior clients must be age 65 and be very low income. Please note that most of our clients only receive an average Social Security of 950.00 per month
SECTION 6 - FINANCIAL CAPABILITIES/BUDGET
What other in-kind/financial contributions has your organization received to fund this event/program (separate from city funding)?
Various grants and sponsorships
5 Total Funds Received to Date: $
Total Funds Requested via Grant Application: $
Remaining Balance that will be Funded by Organization: $ In -Kind Financial
Amount Support Amount
$ 37045.10
$
$ 37045.10
$ 3000
$ I449)54.9U
4 SECTION 6 - FINANCIAL CAPABILITIES/BUDGET (CONTINUED) a..

Describe any City Funding received by organization in the past three years (required)? Program
Low -Income Senior Assistance
Low -Income Senior Assistance
Low -Income Senior Assistance
In•K,n 1 F.nanc al 5200 SEP
Support Support Fe Wawer
EI
L✓d
CJ [
I-1
Li
Date Received Total Received
tr • ',1 2024 g 3000
'l)-'i g3iuO
ON 1 U 022 g 2800
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
Executive Director
Title

SUBMIT FORM'

TO BE COMPLETED BY THE CITY
05 I212025
Date
Date Received:

Amount Funded:

Type of Grant:

Date Reviewed:

City Council Meeting:
lo•Kmo Finapt ,al 5200 SEP
Support Support Fee Waive!
Date City Council received follow-up report:
5 Smiles for Seniors Foundation A Non Profit 501 C3 Organization Tax ID # 26-0373602 P.O. Box 1113 Yucaipa Ca. 92399 "' Ph. 909-790-6671 ^' www.smiles4seniors.org [email protected]

INTERNAL REVENUE SERVICE
F. 0. BOX 2508
CINCINNATI, OH 45201
Date: OCT 2 3 2007
SMILES FOP. SENIOPS FOUNDATION
Dear Applicant:

DEPARTMENT OF THE TREASURY
Employer Identification Number:
— 26-0373602
DLN:
1'853261361037
Contact Person:

DEL TRIMBLE ID8 31309
Contact Telephone Number:
(877) 829-5500
Accounting Period Ending:

December 31
Public Charity Status):
170db) (1) (A) (vi)
Form 990 Required:

Yes
Effective Date of Exemption:

June 8, 2007
Contribution Deductibility:

Yea
Advance Ruling Ending Date:

December 31, 2011
Addendum Applies:

Organizations exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations. During your advance ruling period, you will be treated as a public charity. Your advance ruling period begins with the effective date of your exemption and ends with advance ruling ending date shown in the heading of the letter.

Shortly before the end of your advance ruling period, we will send you Form 8734, Support Schedule for Advance Ruling Period. You will have 90 days after the end of your advance ruling period to return the completed form. We will then notify you, in writing, about your public charity status.

Please sec enclosed Publication 4221-PC, Compliance Guide for 501(c)(3) Public charities, for some helpful information about your responsibilities as an exempt organization.

If you distribute funds to other organizations, your records must show whether they are exempt under section 501(c)(3). In cases where the recipient Letter 1045 (DO/CG)
i

ATTACHMENT 9

CITY OF YUCAIPA

COMMUNITY ACTIVITY GRANT APPLICATION

FINANCIAL / IN -KIND / FEE WAIVER

COMMUNITY ACTIVITY GRANT APPLICATION INSTRUCTIONS
FISCAL YEAR:
2025-2026
DATE SUBMITTED: May 15, 2025
SUBMIT TO: CITY OF YUCAIPA

GENERAL SERVICES/CITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

YUCAIPA, CA92399
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 25/26 grant cycle, financial grant awarded funds will require 100% financial match by the applicant. For example, if your total program/project cost is S1,000, 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 5500.

SECTION 1 - GENERAL INFORMATION
Name of Applicant/Organization: The Well Outreach Center Applicant/Organization: 12717 14th Street Yucaipa, CA 92399 Mailing Address
Applicant/Organization Phone Number:

CONTACT (1)
CONTACT (2)
Vicki Wood
NAME
[email protected]
E-Mail
Ken Jones
NAME
[email protected]
E-Mail
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?
"If you answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.

PHONE NUMBER
YES

PHONE NUMBER
NO
✓

RECEIVED
i MAY 1 5 2025
cYucaipa
City Clerk's Office
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 so, please provide Tax ID# and attach all supporting documents.

YES
NO
83-1042899
2019
3 14
364
Our professional counselors charge for services at discount rate Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Ken Jones
Terry Knight
Geg Franklin
Natalie Brasher
Jose Banda
Sue Moreland
Melissa Williamson
Board President and Board Member
Board Secretary and Board Member
Board Treasurer and Board Member
Board Member
Board Member
Board Member
Board Member
2 SECTION 4 - PROGRAM DESCRIPTION/SCOPE (PLEASE USE ADDITIONAL

PAGES AS NECESSARY)
Name of the program/event: Our Neighbrs Clothing Closet Date(s) of the program/event:
on -going
Total estimated cost for program/event:

Describe the program/event that the organization is seeking support for:
(Attach any event/program promotional materials associated with the program/event) Our Neighbors Clothing Closet in Yucaipa is a community outreach program dedicated to supporting at -risk middle and high school students in the Yucaipa-Calimesa area. By providing students with clothing, we remove barriers to education, allowing them to attend school with confidence and dignity. Our mission is to ensure every student has access to essential clothing, empowering them to focus on their education and future. The program also offers vocational training opportunities for special education high school students enrolled in the Yucaipa-Calimesa Joint Unified School District.

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

Our Neighbors Clothing Closet is more than just a clothing resource —it's a citywide outreach that fosters support, dignity, and wellness for the entire Yucaipa community. By providing essential clothing to at -risk middle and high school students, the program removes barriers to education, ensuring that students can attend school with confidence. This initiative strengthens the community by uplifting its youth, promoting educational success, and fostering a culture of care and inclusion.

Beyond clothing assistance, the program is part of a broader outreach effort that supports the physical, emotional, and psychological well-being of Yucaipa residents. It operates under The Well Outreach Center, which provides additional services aimed at holistic wellness. Through vocational training opportunities for special education students, Our Neighbors Clothing Closet also empowers young individuals with skills that prepare them for the future, contributing to the overall economic and social health of the city.

By addressing fundamental needs and creating opportunities for growth, this program embodies the spirit of community support, ensuring that every resident —regardless of their circumstances —has access to resources that enhance their well-being Program/event primary target population (check all that apply):
nChildren or Youth Entire Community ❑� Homeless n Low Income nPersons with Disabilities n Seniors I r l Victims
Welfare Recipients
Women
Please answer the following to determine if your program/event requires a Special Event Permit (SEP):

YES NO
Estimated attendance 300-999 persons n n
Amplified Sound
(excluding Special Event Facilities)
❑ ❑

THIS BOX IS FOR STAFF USE ONLY
This event requires City Management/
Administrative Approval:

YES NO
❑
Estimated attendance 1000+ persons
Alcohol Service
(excluding Community Centers & YPAC)
Street Closure - Traffic Management
YES NO
❑
n
❑

THIS BOX IS FOR STAFF USE ONLY
This event requires City Council Approval:

YES NO
n
3 SECTION 5 - GRANT FUNDING REQUEST
Please identify what your organization is seeking:

Financial Support:

In -Kind Support: $
YES
NO
3000
OT/Reassigned Staff CS/Rental
If other, please explain:
$200 SEP Fee Waiver:

YES NO
nn
$ $
Scherer Other
Community Center
Total Amount
of Request $
In -Kind
3000 $ $ $
Financial Support $200 SEP Fee Financial Match
Waiver
3000
Total Overall
Request
Provide a detailed description of how the financial support will be used:

Financial support for Our Neighbors Clothing Closet is used to directly impact at -risk middle and high school students in the Yucaipa-Calimesa community. Donations and funding go toward purchasing essential clothing items, including shoes, jackets, and everyday wear, ensuring that students have access to appropriate attire for school and daily life. By removing barriers related to clothing insecurity, the program helps students attend school with confidence and dignity.

Additionally, financial contributions support vocational training opportunities for special education high school students enrolled in the Yucaipa-Calimesa Joint Unified School District. These funds help provide hands-on learning experiences, equipping students with valuable skills that prepare them for future employment.

Beyond clothing, the program operates as part of The Well Outreach Center, which offers broader services aimed at supporting the physical, emotional, and psychological well-being of Yucaipa residents. Donations help sustain outreach efforts that strengthen the community and provide resources to those in need.

SECTION 6 - FINANCIAL CAPABILITIES/BUDGET
What other in-kind/financial contributions has your organization received to fund this event/program (separate from city funding)?
Donated Clothing
YCJUSD Classroom
Walmart Grant
Professional Bookkeeping
Private Donations
$
$
$
Total Funds Received to Date: $
Total Funds Requested via Grant Application: $
Remaining Balance that will be Funded by Organization: $ In -Kind
Amount
7100
6000
1680
14780
$
$
$
Financial
Support Amount
1,500
9000
10500
3000
4 SECTION 6 - FINANCIAL CAPABILITIES/BUDGET(coNT!NUED)
Describe any City Funding received by organization in the past three years (required)? Program
In -Kind
Support
Financial
Support
S200 SEP
Fee Waiver
Date Received Total Received
2022 g 1000
2024 $ 2000
$
SECTION 7 - CERTIFICATION
I, the undersigned, do hereby attest that the above information is true and correct to the best of my knowledge, and understand that the awarded financial grant amount needs to be spent prior to submitting another grant request.

Peggy St. Martin
Signature
Grant Writer
Title

SUBMIT FORM
May 15, 2025
Date

TO BE COMPLETED BY THE CITY
Date Received:

Amount Funded:

Type of Grant:

Date Reviewed:

City Council Meeting:

In -Kind Financial S200 SEP
Support Support Fee Waiver
Date City Council received follow-up report:
5 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

OUTREACH CENTER
Providing services that support
spiritual, physical, emotional, and
psychological wholeness

�` 1SGtLG pt•
Cenfe .�n• C,�
«
Narrative Focused
Trauma Care Groups
Providing a safe place for healing through
writing & sharing our stones 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 ChristJesus so we can do the good things He
planned for us long ago. EPH. 2:70
909-274-9117
[email protected]
www.mosaictwoc.com
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 ChristJesus so we can do the good things He
planned for us long ago. EPH. 2:10
909-274-9117
[email protected]
www.mosaictwoc.com
•
°tafe SK.3
pQcrne
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.

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
u do not have to fight
your battles alone.
—Call or em it 4s today!
gammosP)
(909) 353-3920
[email protected]
www.counselingtwcc.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
Y
d of have to fight
ou -battles alone.
'fall or em
utoday!
(909) 353-3920
[email protected]
www.counselingtwcc.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
u do not have to fight
vo = battles alone.

Call or em it cis today!
(909) 353-3920
[email protected]
www.counselingtwcc.com

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? JAMES 2:15-16 (NLT)
Visit our website:
www.neighborscc.com

OUR NEIGHBORS
2 /
\)(

CLOTHING
CLOSET
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
INFO(NEIGHBORSCC.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:
www.neighborscc.com
k

OUR NEIGHBORS
f
/:„..)

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?
JAMES 2:15-16 (11LT)
Visit our website:
www.neighborscc.com

.. •
ThQ• 'y' �� ;r:'��
Ceder:-.
r_
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 ChristJesus 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
of have to fight
attles alone.

I )its today!
(909) 353-3920
[email protected]
www.counselingtwcc.com
r it t

OUR NEIGHBORS
v\c
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
INFO@N E I G H BO RSCC.CO 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?
JAMES 2:15-16 (NIT)
Visit our website:
www.neighborscc.com

INTERNAL REVENUE SERVICE
P. O. BOX 2508
— CINCINNATI, OH 45201
Date. JAN 2 1 ZOZO

THE WELL OUTREACH CENTER INC
12717 14TH ST
YUCAIPA, CA 92399
Dear Applicant:

DEPARTMENT OF THE TREASURY
Employer Identification Number:
83-1042899
DLN:
29053262315009
Contact Person:

ERIC KAYE ID# 31612
Contact Telephone Number:
(877) 829-5500
Accounting Period Ending:

December 31
Public Charity Status:
509(a)(2)
Form 990/990-EZ/990-N Required:

Yes
Effective Date of Exemption:

December 3, 2018
Contribution Deductibility:

Yes
Addendum Applies:

No
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 determined you're a public charity under the IRC Section listed at the top of this letter.

If we indicated at the top of this letter that you're required to file Form 990/990-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard). 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-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements.

Letter 947

THE WELL OUTREACH CENTER INC
-2-
Sincerely,
Director, Exempt Organizations
Rulings and Agreements
Letter 947

The Well Outreach Center
2025 Annual Budget

RECEIVED
MAY 3 0 2025
Yucaipa City Clerk's Office
Description
The Well Our Neighbors Mosaic The Well
Counseling Center Clothing Closet Center Outreach Center Total

REVENUES
Grants $ 22,158 $ 3,693 $ 3,693 $
Monthly Donations 5,500 3,734
1 X Donations 1,417 2,000 1,500
Donations (Program related) 1,700
Fundraising (T-shirts) 400
Fundraising (In -Person) 1,000 1,000 -
Fundraising (Digital) 2,000 -
SW Conference Donations - 250
Other Full Day Conference Donations - 750
In -Kind Volunteer Contriutions
Fees for Services (Direct and Insurance) 54,975
44,316 $ 73,860
4,800
28,342
4,200
100,000
9,717
1,700
400
30,342
6,200
250
750
100,000
54,975
TOTAL REVENUES $ 87,050 $ 10,427 $ 8,293 $

EXPENSES
181,658 $ 278,194
Payroll 30% 5% 60% 100%
Executive Director $ 8,673 $ 1,445 $ 1,445 $ 17,345 $ 28,909 Administrative Assistant 10,296 1,716 1,716 20,592 34,320 Counselors 30,000 - - 30,000
Payroll Taxes 4,236 273 273 3,282 8,064
Workers' Compensation Insurance 350 25 25 100 500
Payroll Fees 938 67 67 267 1,339
Total Payroll Expenses $ 54,492.49 $ 3,526.92 $ 3,526.92 $ 41,585.99 $ 103,132.31 Operational Expenses
Liability Insurance $ 2,000 $ 500 $ 500 $ 2,000 $ 5,000 Story Groups (2 rounds w/ 10 part's) - 700 700
Professional Development - 500 500
Professional Services (Grant Writer) 5,400 900 900 10,800 18,000 Hiring Platform 1,000 - 1,000
Conferences 400 - 400
Scholarships - -
Training 6,000 - 946 - 6,946
Supplies 6,000 250 250 6,500
Inventory - 4,210 - 4,210
Total Operational Expenses $ 20,400 $ 5,860 $ 3,696 $ 13,300 $ 43,256 Administrative Expanses
Website/Domain $ 100 $ 100 $ 100 $ 100 400
Internet/Wi-Fi 60 120 - 120 300
Simpte Practice 1,500 - - 1,500
Google Voice 120 120 120 60 420
Billing 3,000 - 3,000
Miscellaneous Software - - 372 372
Hospitality 300 300 500 1,100
Marketing 1,000 150 150 632 1,932
Office Supplies 1,340 100 250 1,000 2,690
AB 506 (D01) 1,200 - - 1,000 2,200
Miscellaneous Administrative 150 150 150 150 600
Contingency 3,688 - - 22,838 17,292
Total Administrative Expenses $ 12,158 $ 1,040 $ 1,070 $ 26,772 $ 31,806

TOTAL EXPENSES
$ 87,050 $ 10,427 $ 8,293 $
81,658 $ 178,194
TOTAL REVENUES OVER EXPENSES $ (0) $ 0 $ 0 $ 100,000 $ 100,000 6/2/2025

Tara Davis
From: [email protected]
Sent: Friday, May 30, 2025 8:02 AM
To: Tara Davis
Subject: RE: Yucaipa Community Activity Grant
Attachments: Budget 2025 Revised.xlsx
Good morning Tara,
Thank you for reaching out. The only document I have is the 2025 budget, now updated with volunteer contributions included.

Volunteer hours play a crucial role in demonstrating community engagement, financial efficiency, and organizational sustainabitity. By leveraging volunteer support, we maximize resources and enhance the impact of our programs, ensuring that grant funding is used effectively to serve our mission.

Please let me know if this aligns with your review process or if any additional information is needed. I appreciate your time and consideration.

Best regards, Peggy
On 29/05/2025 12:27 EDT Tara Davis wrote:

Good morning Peggy,
We are preparing the applications for ad -hoc review. If you have any invoices/quotes/estimates to justify the cost of the FY25/26 grant cycle please send those to me asap as these will go for review Monday morning.

Thank you,
1 ATTACHMENT 10

CITY OF YUCAIPA

COMMUNITY ACTIVITY GRANT APPLICATION

FINANCIAL / IN -KIND / FEE WAIVER

COMMUNITY ACTIVITY GRANT APPLICATION INSTRUCTIONS
FISCAL YEAR:

DATE SUBMITTED:
2025/2026
5/1/25
SUBMIT TO: CITY OF YUCAIPA

GENERAL SERVICES/CITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

Note: Beginning with the FY 25/26 grant cycle, financial grant awarded funds will require 100% financial match by the applicant. For example, if your total program/project cost is S1,000, 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 Address
Yucaipa Calimesa Family Assistance
PO Box 130, Yucaipa CA 92399
Applicant/Organization Phone Number:

CONTACT (1)
CONTACT (2)
Paul Kielhold
NAME
E-Mail
Holly Warner
NAME

PHONE NUMBER

PHONE NUMBER
[email protected]
E-Mail
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? NO
✓

RECEIVED
MAY 0 5 2025
Yucaipa City Clerk's Office
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. 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 so, please provide Tax ID# and attach all supporting documents.

YES
✓
NO
95-6102982
76 years
1/2 fte
+/- 30
2, 200
N/A
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Richard Rios, President
Paul Kielhold, Vice President
Debbie Wilson, Secretary
Jackie Klof, Treasurer
Yvonne Wood. Board Member
Holly Warner, Operations Coordinator
2 SECTION 4 - PROGRAM DESCRIPTION/SCOPE (PLEASE USE ADDITIONAL

PAGES AS NECESSARY)
Name of the program/event:

Facility Repair / Maintenance - Asphalt
Date(s) of the program/event:

Perpetual
Total estimated cost for program/event:
$3,200
Describe the program/event that the organization is seeking support for:
(Attach any event/program promotional materials associated with the program/event) YCFA needs to repair and resurface the asphalt in order to maintain safe access to the facility by food distributors, volunteers, and the general public.

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

The grant would enable repair and resurfacing of the asphalt in order to maintain safe access to the facility by food suppliers and the general public, many of whom have ambulatory limitations.

Program/event primary target population (check all that apply):

Children or Youth
Persons with Disabilities
Entire Community I7 I Homeless
Seniors
Victims
Low Income
Welfare Recipients
Women
Please answer the following to determine if your program/event requires a Special Event Permit (SEP):

YES NO
Estimated attendance 300-999 persons
Amplified Sound
(excluding Special Event Facilities)
THIS BOX !S FOR STAFF USE ONLY
YES
This event requires City Management/
Administrative Approval:

NO
Estimated attendance 1000+ persons
Alcohol Service
(excluding Community Centers & YPAC)
Street Closure - Traffic Management
YES NO
✓
n
✓
THIS BOX IS FOR STAFF USE ONLt
YES
This event requires City Council Approval:

NO
n
3 SECTION 5 - GRANT FUNDING REQUEST
Please identify what your organization is seeking:

Financial Support:

In -Kind Support: $
Total Amount
of Request $
YES
NO
$
$
OT/Reassigned Staff CS/Rental
If other, please explain:

In -Kind
1,600 ) $
Financial Support $200 SEP Fee
Waiver
$200 SEP Fee Waiver:

YES NO
El El
$ $
Scherer Other
Community Center
Provide a detailed description of how the financial support will be used:
$ 1,600
Financial Match
047Ki4,06
Total Overall
Request
The support will be used to match an equal amount that will be used to hire an asphalt contractor per the attached bid.

SECTION 6 - FINANCIAL CAPABILITIES/BUDGET
What other in-kind/financial contributions has your organization received to fund this event/program (separate from city funding)?
YCFA is funded by thrift store donations and sales. These sources will be used to match the grant.
$
In -Kind
Amount
$
Total Funds Received to Date: $
Total Funds Requested via Grant Application: $
Remaining Balance that will be Funded by Organization: $ $
Financial
Support Amount
$
$
4 SECTION 6 - FINANCIAL CAPABILITIES/BUDGET(coNTINUED)
Describe any City Funding received by organization in the past three years (required)? Program
Computer hardware and support
Security cameras
Repair counter and sink
In -Kind
Support
Financial
Support
5200 SEP
Fee Waiver
Date Received
Total Received
$ 1,699.37
$ 2,000
$2,500
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 gnature
ice President of the Board of Directors
Title

SUBMIT FORM
Date

TO BE COMPLETED BY THE CITY
Date Received:

Amount Funded:

Type of Grant:

In -Kind
Support
Date Reviewed:

City Council Meeting:

Financial 5200 SEP
Support Fee Waiver
Date City Council received follow-up report:

Internal Revenue SService
District Director
Date: M,AY f 6 in
Yucaipa Valley Wt fare, Inc.
wr t
-P-1705*T-4ar
Dep'rtment of- the Treasul
Employer Identification Number.

Accounting Period Ending:
-r 3 L't': 7.: � 1
Form 5=^ Required: Q Yes 0 N
Person to Contact:

I. Hill
Contact Telephone Number.
(213) 668-4889
Dear Applicant:

Based on information supplied, and assuming your operations will be as state in your application for recognition of exemption, we have determined you are exem from Federal income tax under section 501(c)(3) of the Internal Revenue Code.

We have further determined that you are not a private foundation within the meaning of section 509(a) of the Code, because you are an organization described in section 170(b)(1)(A)(vi) and 509(a)(1).

If your sources of support, or your purposes, character, or method of operat change, please let us know so we can consider the effect of the change on your exempt status and foundation status. Also, you should inform us of all changes it your name or address.
.Generally, you are not liable for social security (FICA) taxes unless you fi a waiver of exemption certificate as provided in the Federal Insurance Contribute Act. If you have paid FICA taxes without filing the waiver, you should contact uE You are not liable for the tax imposed under the Federal Unemployment Tax Act (FU" Since you are not a private foundation, you are not subject to the excise ti
under napter 42 of the Code. However, you are not automatically exempt from o .:iu Federal excise taxes. If you have any questions about excise, employment, or ot!:( Federal taxes, please let us know.

Donors may deduct contributions to you as provided in section. 170 of the Co, .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, 2)06, and 2522 of the Code.

The box checkedin the heading of this letter shows whether you must file.

Form 990, Return of Organization Exempt from Income tax: If Yes is-checkad,=you are required to file Form 990 only if your gross receipts each year are normally more than S10,000 If a return is required, it must be filed by the 15th day of of the fifth month after the end of your annual accounting period. The law impos a penalty of S10 a day, up to a maximum of S5,000, when a return is filed late, unless there is reasonable cause for the delay.

P.Q. Box 2350. Los Angeles, Calif. 90053
Corer)
Letter947(DO)

Invoice

BILL TO
Yucai a / Calimesa Family Assistance
United States
%9�5PH/�1L
Invoice No.: 007
Issue date: Apr 29, 2025
Due date: Apr 29, 2025
Payment method: Transfer
Invoice No
007
Issue date
Apr 29, 2025
Due date
Apr 29, 2025
Description
Quantity
iota' n.i?

3.200.00
Unit price ($) Amount ($)
work on parking lot
# 1 clean Asphalt with power blower
# 2 apply Hot Asphalt to four areas
# 3 compact Asphalt with vibratory compacter plate
# 4 Apply slurry seal to Asphalt
1 3,200.00 3,200.00
Subtotal
Total (USD):
$3,200.00
$3,200.00
Adam Estevanovich t. (951) 544-9461
[email protected]

ATTACHMENT 11

REC
MA`' Q 5 2025
Yucaipa City Clerk's Office

CITY OF YUCAIPA

COMMUNITY ACTIVITY GRANT APPLICATION

FINANCIAL / IN -KIND / FEE WAIVER

COMMUNITY ACTIVITY GRANT APPLICATION INSTRUCTIONS
FISCAL YEAR:
2025/26
DATE SUBMITTED: 5-5-25
SUBMIT TO: CITY OF YUCAIPA

GENERAL SERVICES/CITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

YUCAIPA, CA 92399
Alt sections of the appiication 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 25/26 grant cycle, financial grant awarded funds will require 100% financial match by the applicant. For xample, if your total program/project cost is S1,000, 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. liSECTION 1 - GENERAL INFORMATION
Name of Applicant/Organization: YUCAIPA CALIMESA VETERANS COMMITTEE Applicant/organization: P.O. BOX 124, YUCAIPA 92399
Mailing Address
Applicant/Organization Phone Number:

CONTACT (1)
CONTACT (2)

GEORGE SARDESON
NAME
E-Mail

RACHAEL GUSTUSON
NAME
E-Mail

PHONE NUMBER

PHONE NUMBER
SECTION 2 - ELIGIBILITY REQUIREMENTS
Is your organization located in another community?
Will the program/event take place in another community? Are you aware of any other City program providing this service? YES
u
NO
✓
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. 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 so, please provide Tax ID# and attach all supporting documents.

YES NO
99-1674306
3-1-24
0 7
Approx. 300
El El
Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available)

RACHAEL GUSTUSON - PRESIDENT

GEORGE SARDESON - TREASURER

JUDGE ROBERI' FAWKE - BOARD MEMBER

CATHERINE SERIANNI - BOARD MEMBER

CAECELIA JOHNS - BOARD MEMBER

DEE ANDERSON - VICE PRESIDENT

STEPHANIE ROBERTSON - SECRETARY
2 SE
USE
PROGRAM DESCRIPTION/SCOPI^ PAGES AS NEC SSITIO)AL
Name of the program/event:

VETERANS DAY CEREMONY
Date(s) of the program/event:
1I-11-2i
Total estimated cost for program/event:
$1,000 (NOT INCLUDING IN -KIND FOR AMPHITHEATER & SHELTER #2 Describe the program/event that the organization is seeking support for:
(Attach any event/program promotional materials associated with the program/event) 2025 VETERANS DAY CEREMONY, PROGRAM NOT AVAILABLE UNTIL ONE MONTH PRIOR TO EVENT JCZII IIUC IIUVV Lilt piUg'r dill/el/CIIL UellelIL Lile ICSIUCIILS/Ur LUIUJIlUlllly Ui TULdIpd:

THIS PROGRAM CELEBRATES, AND RECOGNIZES THE SACRIFICE OF SERVICE OF VETERANS, OF ALL BRANCHES OF THE UNITED STATES MILITARY.

Program/event primary target population (check all that apply):
nChildren or Youth n Entire Community n Homeless n Low Income ri Women ❑ Persons with Disabilities n Seniors n Victims n Welfare Recipients Please answer the following to determine if your program/event requires a Special Event Permit (SEP):

YES NO
Estimated attendance 300-999 persons n n
Amplified Sound
(excluding Special Event Facilities)
n❑

THIS BOX IS FOR STAFF USE ONLY
This event requires City Management/
Administrative Approval:
nn
YES NO
YES
Estimated attendance 1000+ persons
Alcohol Service
(excluding Community Centers & YPAC)
Street Closure - Traffic Management

THIS BOX IS FOR STAFF USE ONLY
This event requires City Council Approval:

YES
NO
3 SECTION 5 - GRANT FUNDING REQUEST..

Please identify what your organization is seeking:

YES NO
Financial Support: I I IJ $
In -Kind Support: $
Total Amount
of Request
$
OT/Reassigned Staff CS/Rental
If other, please explain:
$200 SEP Fee Waiver:
$
Scherer
Community Center
YES NO
$ 1,000
Other
USE OF THE COMMUNITY PARK AMPHTI'HEATER AND SHELTER It2 In -Kind Financial Support
$200 SEP Fee
Waiver
$
Financial Match
Total Overall
Request
Provide a detailed description of how the financial support will be used:

COSTS FOR CHAIR RENTAL. SOUND SYSTEM, COLOR GUARD PRESENTATION, BAGPIPER,ADVEKI'ISING

MATERIALS
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 Financial
Amount Support Amount
$ 4269

DONATIONS, FUNDRAISING
Total Funds Received to Date:

Total Funds Requested via Grant Application:

Remaining Balance that will be Funded by Organization: $ $
$
$
$
$ 4269
$ 2000
$ 2269
4 SECTION 6 - FINANCIAL CAPABILITIES/BUDGETrcoNTINueo)
Describe any City Funding received by organization in the past three years (required)? Program
1 1 -1 I - 24
I I - 1 1-23
II-11-22
In•Kind
Support
✓
Financial S200 SEP
Support Fee Waiver Date Received Total Received
u
u
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 that the awarded financial grant amount needs to be spent prior to submitting another grant request.

Title

SUBMIT FORM

TO BE COMPLETED BY THE CITY
Date
Date Received:

Amount Funded:

Type of Grant:

Date Reviewed:

City Council Meeting:

In•Kind Financial S200 SEP
Support Support Fee Waiver
Date City Council received follow-up report:
5 Permit
ti COMMUNITY

SERVICES
iff9a
Bet t!
City of Yucaipa Community PHONE:(909) 790-7460
Services FAX:(909) 790-2589
34272 Yucaipa Blvd EMAIL:[email protected]
Yucaipa, CA 92399
Customer Name George Sardeson - 46909 Home Phone Number Customer Type General Public Email Address
Mailing Address
System User Gilbert Guardado
2025 Veterans Day Ceremony
Booking Summary
Permit # R7542
Status Tentative
Date May 8, 2025 10:30 AM
Expiration Date May 8, 2026
Rental Fee $937.00
Discounts -$85.00
Subtotal $852.00
Deposits S100.00
Deposit Discounts $0.00
Total Permit Fee S952.00
Total Payment $0.00
Refunds $0.00
Balance 5952.00
2 resource(s) 2 booking(s) Subtotal: $952.00
Amphitheater (Shelter Facilities)
Center: Yucaipa Community Center

START DATE/TIME
Tue, Nov 11. 2025 7:00 AM
Resource level fees
Deposit
Rental - Daily
Rental - Daily
$100.00 / Each x 1
$500.00 / Day x 1
-10% x 1

END DATE/TIME
Tue, Nov 11, 2025 8:00 PM
$100.00
$500.00
-S50.00

ATTENDEE
1 AMT W/O TAX
$0.00
$550.00
Shelter #2 Large (Shelter Facilities)
Center: Yucaipa Community Center

START DATE/TIME
Tue, Nov 11, 2025 7:00 AM
Resource level fees

END DATE/TIME
Tue, Nov 11, 2025 8:00 PM
Liability Insurance 587.00 / Each x 1 S87.00
Rental - Daily S350.00 / Day x 1 S350.00
Rental - Daily -10% x 1 -$35.00
Custom Questions

QUESTION
ANSWER

ATTENDEE
1 AMT W/O TAX
$0.00
$402.00
# R7542 Status Tentative

Page 1 of 3 ends

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:

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: Acknowledge 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)(18'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 insurance Acknowledged 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 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 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? Gathering
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
# R7542 Status Tentative Page 2 of 3

EVENT RESOURCE DEPOSIT FEE CHARGE TAX AMOUNT PAID REFUNDS BALANCE 2025 Amphitheater Deposit $100.00 $0.00 $0.00 $0.00 $100.00 Veterans
Day
Ceremony
Payment Schedules

DUE DATE
Oct 28, 2025

AMOUNT DUE
Original Balance: $952.00 Current Balance: $952.00

AMOUNT PAID WITHDRAWAL ADJUSTMENT BALANCE
$952.00 $0.00
$0.00 $952.00
# R7542 Status Tentative Page 3 of 3

Step,One- Information

SHELTER RESERVATION APPLICATION
City of Yucaipa Community Services Department
/12 0 C,v',('
hone Number
Address: Street
tiLA ( L/ti-rt;sia �rcTc�,ik;"-) (OWW1 / r mm
Organization Name (if applicable) a Number
Primary email of Rental Applicant:

Designated Event Representative (if Applicant will not be present):

Name Phone Number
City Zip
Step Two- Event
Type of Event: ❑Meeting
Bridal/Wedding
Names of Event: (0-,2/7
# of Attendees: :2-'00
❑Birthday ❑Family Gathering 0 Reception/Banquet 0 Shower- Baby 0 �2c uti`;
U'�%-2c?tiS 1)/9 i ❑Other:

Date(s) of Use: /
Day: ❑M f2Tu ❑W ❑Th OF ❑Sa ❑Su
*Hours requested include the time it takes to set up and clean-up the event. Total Number of Hours:

Step Three- Details
Will there be food? ❑Yes 1184o
Is the event a fundraiser?
* if yes, no food trucks/carts/tents permitted unless approved by Special Event Permit. ❑Yes 1 10
Will there be a bounce house? DYes 111Qo Will you have any of the following: 0 DJ 0 Band * if yes, must book Bounce House through Authorized Jumper companies only.

Step Four - Facility
Yucaipa Community Park:
lafmphitheater aLlrge Shelter 2 DMedium Shelter 3 & 4 ❑Medium Shelter 5 816 ❑Small Shelter 1 ❑Small Shelter 3 ❑Small Shelter 4 ❑Small Shelter 5 ❑Small Shelter 6 ❑Small Shelter 7 ❑Small Shelter 8
Wildwood Park:
❑Small Shelter 1
Ave I Park:
❑Small Shelter 1 ❑Small Shelter 2 ❑Medium Shelter 3 ❑Small Shelter 4 ❑Small Shelter 5 7th Street Park
❑Small Shelter 1 ❑Medium Shelter 2 ❑Medium Shelter 3 ❑Large Shelter 4 Crafton Hills Park:

DSmall Shelter 1
Step Five - Review City Policies
Insurance
A. The Applicant shall purchase special event general liability insurance through the City of Yucaipa and cannot be provided. Insurance fees are included in shelter pricing, and Insurance premiums are subject to change annually.

General liability coverage is in the amount of $1 million for bodily injury, personal injury, and property damage. Use of the facility will be denied if required insurance is not purchased prior to the event.

Cancellations/Refunds
A. Any 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 Toss of 50% of the rental fees and deposit (if applicable). All refund requests are subject to a $20.00 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. No food trucks. carts. or food carts arc permitted unless approved by Special Event Permit.

C. 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.

O. No amplified sound permitted.

E. 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.

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

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

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

1. No motor vehicles are permitted in the parks, on turf, walkways, and on surfaces unless approved by a special event permit. (reference City Park Ordinance No. 127). NOTE: If motor vehicles are found on prohibited surfaces, additional fees cart be incurred.

Bounce Houses/Jumpers
A. Permit Holder/Requester 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).

B. 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 VI II 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). No obstacles or water jumpers permitted. 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 1 Park: (Shelters 1, 2, 3, 4); 71h Street Park: (Shelters 1, 2, 3); and Wildwood Park: (Shelter 1).

1. 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 permitted overnight unless approved by 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 additional fees incurred.

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

N. Failure by the Permit I lolder/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.

O. Authorized Jumper Companies:

Jum. N Jum. Rentals: 909-873-8487 loll Jum•s: 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. 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. 1 have read and agree to abide by all of the City of Yucaipa Community Center policies stated above and in the Community Center Rental Policies.

Applicant Signature:

Date: c` 6

gitem%
City of Yucaipa
City of Calimesa
Yucaipa Citizen on Patrol
Yucaipa/Calimesa News Mirror
US Naval Sea Cadets Corps/March Air Reserve Base
VFW Post 7347 & American Legion Post 426
Mike Gross — Sound System
Dunlap Elementary School
Girl Scout Troops 1549,795,1795
Dick Riddell
Judge Robert & Mary Fawke
Exclusive Car & Truck, Yucaipa
Hickory Ranch, Yucaipa
Bob & Lenore Will, Donors, Hand Flags (Made in the USA) Sullivan Party Rentals
Smiles for Seniors
Flowers, Etc., Beaumont (wreath donation)
YHS Madrigals Director Kirk Young
YHS Symphonic Band Director Robert Presler
KQLH Radio 92.5 FM
Yucaipa Calimesa Veterans Committee
Sen. Rosilice Ochoa Bogh
Program Designed & Printed By
Desert Lawn Funeral Home & Memorial Park FD1819
November 11, 2024 - 11:00 AM
Yucaipa Community Park
34900 Oak Glen Road
Yucaipa, CA 92399

Tim O'Connell enlisted in the United States Marine Corps in 1984, serving in the 1st Marine Division and 3rd Marine Aircraft Wing. Near the end of his enlistment in 1989, after deploying to the Persian Gulf, Tim sought a career as a firefighter with the California Department of
Forestry/Riverside County Fire Department.

Tim was a San Bernardino County Deputy Sheriff for 24
years and served in numerous assignments with the balance of his career being assigned to the now Specialized
Enforcement Division. Tim rose to the Rank of Lieutenant and took an early retirement service.

In July of 2018, Tim accepted a permanent position with the Calimesa Fire Department as a Fire Captain and was
promoted to Battalion Chief in 2019.

ORDER OF SERVICE
Prelude Music VHS Symphonic Band
Master of Ceremony George Sardeson, Navy Veteran
Invocation Deacon Peter Bond
Posting of Colors .... ITS Naval Sca Cadets Corps, March Air Reserve Base Pledge of Allegiance -Judge. Robert Fawke, %ocy Smith
Dunlap Elementary
Fly over presented by WWII Vintage aircraft
National Antlicm Rebecca Gossart
Recognition Special Honor WWII Veteran
Dick Riddell
Recognition Rachael M. Gustuson, VCVC
Recognition Sen. Rosilicic ( )choa Bogh
Recognition Sup. Dawn Rowe, Scott Wand
Placing of Wreath Bi Sandi Gomez and Lynn Tanner
"In Flanders Fields" Performed by VHS Madrigals
"Amazing Grace" Bagpiper Tim Riley
Keynote Speaker Tim ()'Connell
""I'iie Battle Hymn of the Republic" VHS Symphonic Band Military Medley Bill Daley
"God Bless tlic i T.S.A." Mr. Dave Ambrose
Benediction Deacon Pctcr Bond
Closing George Sardcson
Parade of Flags with students from
Dunlap Elementary School quid Local Girl Sellouts

RECEIVED
rg)Department of the Treasury
Internal Revenue Service
Tax Exempt and Government Entities Yucaipa City Clerk's IRS P.O. Box 2508
Cincinnati. OH 45201
MAY 0 5 2025

YUCAIPA CALIMES VETERANS COMMITTEE

C/O RAC USON
Date:
03/20/2024
Employer ID number:

Office 99-1674306
Person to contact:

Name: Customer Service
ID number: 31954
Telephone: 877-829-5500
Accounting period ending:

December 31
Public charity status:
170(b)(1)(A)(vi)
Form 9901990-EZ 1 990-N required:

Yes
Effective date of exemption:

March 1, 2024
Contribution deductibility:

Yes
Addendum applies:

No
DLN:
26053473005324
Dear Applicant:

We're pleased to tell you we determined you're exempt from federal i ccome tax x ur er Internal
Revenue
v nueu Coe
(lRC) Section 501(c)(3). Donors can deduct contributions they make l"'
n
qualified to receive tax deductible bequests, devises, transfers or gs underovouroc2 55 2106. or 2522. This letter could help resolve questions on your exempt status. Please keep it 3 s.
are further classified as either public charities or private Organizations exempt under 1RC Section 501(c)( )
foundations. We determined you're a public charity under the lRC Section listed at the top of this letter.

If we indicated at the top of this letter that you're required to file Form 9 9 90/990--EZ) Z/990Ct . our recic of ds show
rm
you're required to file an annual information return (Form 990 or m
990-N. the e-Postcard). 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 j rea li ation,nce Guide 1olto5tl l (cww.irs.goPubcharities. c
Enter "4221-PC' in the search bar to view Publication 4221-PC. C 1 Charities, which describes your recordkeeping, reporting. and disclosure requirements.

Sincerely.
,y,AL'�, a- . "ylrx'k,
Stephen A. Martin
Director. Exempt Organizations
Rulings and Agreements
Letter 947 (Rev. 2-2020)
Catalog Number 35152P

1 (II11I1I IIII III IIIIIII III 1II1
1 IIIIIII IIIII IIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII

STATE OF CALIFORNIA
Office of the Secretary of State

STATEMENT OF INFORMATION

CA NONPROFIT CORPORATION
California Secretary of State
1500 litn Street
Sacramento. California 95814
(916) 657-5448
Entity Details
Corporation Name
Entity No.

Formed In
Street Address of California Principal Office of Corporation Street Address of California Office
Mailing Address of Corporation
Mailing Address
Attention
Officers
Officer Name
5 Rachael M Gustuson
© George Sardeson
© Stephanie K Robertson
Additional Officers
Officer Name
Agent for Service of Process
Agent Name
Agent Address
Email Noul,eations
Opt -in Email Notificatons
For Office Use Only
-FILED-
File No.: BA20240727458
Date Filed: 4/8/2024
Yucaipa Calimesa veterans Committee
6138412

CALIFORNIA
P.O. BOX 1113
YUCAIPA, CA 92399
Committee
Officer Address
P.O. BOX 1113
YUCAIPA, CA 92399
P.O. BOX 1113
YUCAIPA, CA 92399
None Entered
Rachael Gustuson
Position(s)
Chief Executive Officer
Chief Financial Officer
Secretary
No, I do NOT want to receive entity notifications via email. I prefer notifications by USPS mail.

Electronic Signature
® By signing. I affirm that the information herein is true and correct and that I am authorized by California law to sign.

Rachael Gustuson
Signature
04/08,12024
Date
P»e

ATTACHMENT 12

CITY OF YUCAIPA

COMMUNITY ACTIVITY GRANT APPLICATION

FINANCIAL / IN -KIND / FEE WAIVER

COMMUNITY ACTIVITY GRANT APPLICATION INSTRUCTIONS
FISCAL YEAR:
2025-2026
DATE SUBMITTED: 5/06 25
SUBMIT TO: CITY OF YUCAIPA

GENERAL SERVICES/CITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

YUCAIPA. CA 92399
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 25/26grant cycle, financial grant awarded funds will require 100% financial match by the applicant. For example. if your total program/project cost is 51,000, 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 tAccountability Report), detailing the applicants match of $500.

SECTION 1 - GENERAL INFORMATION
Name of Applicant/Organization: Yucaipa Pickit:ball. Inc.

Applicant/Organizatiort
Mailing Address
Applicant/Organization Phone Number
CONTACT (1)
CONTACT (2)
Patricia htgtant
NAME
yucaipapickltbal I{2i:gnmil.cum
E-Mal I
Melinda Daniel
NAME
E•Mail
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?
•If you answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.

PHONE NUMBER

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

Is your organization a 501 (c)?
If so, please provide Tax ID# and attach all supporting documents.

07. 17/2021
0 25
400
El El
o n
O D
If yes, please describe: We charge S40/year membership. but anyone can come play for free at our open play days.

Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Patricia Ingram President
R ichard Rios Vice President / treasurer
Debra Hitter Secretary
!Melinda Daniel Director - Youth Activity Coordinator
Diane Kuehl Director - Webntaster!Membership•communication Rito Chisholm Director - Facility and Volunteer Coordinator 2 SECTION 4 - PROGRAM DESCRIPTION/SCOPE !PLEASE Val' ADDITIor1AL

PAGES AS NECESSAPYI
Name of the program/event: Pickieball in the Schools
Date(s) of the program/event; 25-26 School Year
Total estimated cost for program/event: S2.200
Describe the program/event that the organization is seeking support for:
(Attach any event/program promotional materials associated with the program/event) We want to continue our YCJUSD school program. In the first year we served over 3000 students and gave over 750 volunteer hours. We went to 6 elemntary schools, 3 middle schools and the high school to introduce Pickieball.

After that first year introduction, our second year we were able to concentrate on 3 schools with additional equipment and instruction in more detail. This year we would like to do the same.

We purchase paddles, nets and halls for the Yucaipa Calimesa Joint Unified School District Schools. Our volunteers go to the schools to do teacher and student training.

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

Our Youth Program has generated interest from not only the kids, but extends to the family. This past weekend we hosted a Youth' tournament with 25 students participating.

Pickieball is one of the few activities where the entire family can participate. There are no age restrictions. It is a low impact, km cost sport. It can improve cardiovascular health, heart disease and over all mental well being. The Superintendent of YC JUSD, Cali Rinks. told inc last week that she witnessed pickleball being played at Mesa View Middle School after our instruction there and there was not one student sitting on the sidelines! They all want of be involved.

Program/event primary target population (check all that apply):

Li
Children or Youth
Persons with Disabilities
❑ Entire Community
Seniors
Homeless ❑ Low Income
Victims ri Welfare Recipients
riWomen
Please answer the following to determine if your program/event requires a Special Event Permit (SEP):

YES NO
Estimated attendance 300-999 persons n [✓
Amplified Sound
(excluding Special Event Facilities? ❑ ❑✓
THIS AO% IS FOR 5TAFF WS* ONI Y
This event requires City Management/
Administrative Approval:

YES NO
n❑
Estimated attendance 1000+ persons
Alcohol Service
(excluding Community Centers & VPAC)
Street Closure - Traffic Management
THIS PDX 15 FOR STAFF USE ONLY
YES NO
This event requires City Council Approval:
3 SECTION 5 - GRANT FUNDING REQUEST
Please identify what your organization is seeking:

YES NO
Financial Support: I6 I I I s 1,100.00
In -Kind Support: $ $
OT/Reassigned Staff CS/Rental
If other, please explain:

Total Amount s 0
of Request
In -Kind
$200 SEP Fee Waiver:

YES NO
nn
s s
Scherer Other
Community Center
1,100.00 S 0
Financial Support $200 SEP Fee
Waiver
50 Financial Match
$ 1,100.00
Total Overall
Request
Provide a detailed description of how the financial support will be used:

We intend to purchase 150 pickleball paddles, 6 nets and 100 balls for the schools. Estimated cost of these items is S2.200.00.

SECTION 6 - FINANCIAL CAPABILITIES/BUDGET
What other in-kind/financial contributions has your organization received to fund this event/program (separate from city funding)?
Membership Dues - portion
Ilostinp Tournaments - Portion
' hosting Clinics - Ponion
In -Kind Financial
Amount Support Amount
s $ 7500.00
$
s
$
5000.00
S
1000.00
S $
s $
Total Funds Received to Date: $ $ 13,000.00
Total Funds Requested via Grant Application: $ S 1100.00 Remaining Balance that will be Funded by Organization: $ s 1100.00 4 ,SECTION 6 - FINANCIAL CAPABILITIES/BUDGET ic6NrfNvED/ Describe any City Funding received by organization in the past three years (required)? Program
C,\G 23-24
C 1G 24-25
In-Kintl rman(ial $200 SEP
Support Support Fee waiver Date Received Total Received Ill CI El6/28/23 $2,450.00
❑ I, I ❑ 6/12/24 $2,820.00
❑ U ❑
$
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 President
Title

SUBMIT FORM
.`TO B.E COMPLETED BY THE CITY

5.0(•25
Date
Date Received:

Amount Funded:

Type of Grant:

Date Reviewed:

City Council Meeting:

Ih•Kind Finanoal S200 SEP
Support Support Fee Waiver
Date City Council received follow-up report:
11111111111111111

aDepartment cf the Treasury
Internal Revenue Service
Tax Exempt and Government Entities
IIZS P.O. Box 2508
!'incinnati, OH 45201
YUCAIPA PICKLEBALI. INC

C/O DIANE SMITH
uate:
11/01/2021
Employer ID number:
87-1919072
Person to contact:

Name: Customer Service
ID number: 31954
Telephone: (877) 829-5500
Accounting period ending:

June 30
Public charity status:
509(a X2 )
Form 990 / 990-EZ / 990-N required:

Yes
Effective date of exemption:

July 17. 2021
Contribution deductibility:

Yes
Addendum applies:

No
DLN:
26053630002901
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.

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-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements.

Sincerely,
,..,424crce a, - NL2%
Stephen A. Martin
Director, Exempt Organizations
Rulings and Agreements
Letter 947 (Rev. 2-2020)
Catalog Number 35152P

1 Secretary of State
Articles of Incorporation of a
Nonprofit Public Benefit Corporation
IMPORTANT — Read Instructions before completing this form.

Filing Fee — $30.00
Copy Fees — First part St oil, each attachment page 50.50, Certification Fee - 35.00
Note: A separate California Franchise Tax Board application is required to obtain tax exempt status. For more information, go to tub _ra.uov FILED
Secretary of State
State of California
4766963
!tiling Number
07/17/2021
Filing Date
This Space For Office Use Only

1. Corporate Name (Go to wee.sott..cayovlbr,smesSibrename-resenr;r, ei fro general trnporatename runts and restrxxmTna The name of the corporation is Yucaipa Picicleball, Inc.

2. Business Addresses (Enter tlw complete business addresses. item 2a cannot be a P.O.Boxor'mum or an m3•rdual or entity.) t
-DonotenteraP.O.BBax
! ). frgt:tl Ma ng Address -ess or Corporation. it different than earn Ta

ARTS-PB-
501(c)(3)
City (n0 abbrev'awn)
Yucaipa
City trra 4Arcrata-cs)
State Yip Code
CA 92399
Stale
Zip Code

3. Service of Process (Must pronde either Individual OR Corporation.

INDIVIDUAL — Complete Items 3a and 3b only. Must include agent s ru+t rare and Cal -dolma street eakress.

Cak!onua Agenrs Fast Name (d agent is not a copxa'ront
Diane
tide Name
Alane
Las! tarts
Smith
City (no ebbreveases)
Yucaipa
h. S.ry t Address z ent is not a aorporaton) - Do not enter a P.O. Box CORPORATION — Complete Item 3c. Only indude the name of Ile regis ered agent Corpo:atron State
CA
Z-D Code
92399
c. Caldomia Regotered Corporate Agent's Name (if agent is a corpora.iorq — Do comnJe:e hell 32 o 3b Item 4a: One or both boxes must be checked.

4. Purpose Statement item 4b: If 'pubic purposes is cneckca m Item 4a or it you trend to apply for tax-exempt status rn Caldorrt;a you must enter the specs4c purpose in Item 4b.)
a. This corporation is a nonprofit public benefit corporation and is not organized for the private gain of any person. It is organized unae the Nonprofit Public Benefit Corporation Law for 0 public purposes ['charitable purposes b The specific purpose of tins corporation is to promote exerciser good sportsmanship, and teach pitkdeball skills

5. Additional Statements (See Instructions and Filing Tips. a. This corporation is organized and operated exclusively for the purposes set forth in Article 4 hereof vrithtn the cleaning of Internal Revenue Code section 501(c)(3).
b. No substantial part of the actMhes of this wrporation strati consist of carrying on propaganda. or otherwise attempt ny to enih:entx legislation. and this corporation shall not participate or intervene m any potitrcat campaign (including the publishing or distnbubon of statements) on behalf of any candidate for public office_ c The property of this corporation is irrevocably dedicated to the purposes in Article 4 hereof and rio pad of the net income or c s;*ts of ttus corporation shall ever inure to the benefit of any director. officer or member thereof or to the benefit of any private person. d- Upon the dissolution or winding tip of this corporation. its assets remaining after payment or provision for payment. of pa debts and liabilities of this corporation shalt be distributed to a nonprofit fund. foundation or corporation which is organized and operated exclusively for charitable, educational andlor religious purposes and which has estabbshed tug tax-exempt status uncle: Internal Revenue Code section 501(cX3).

8. Read and Sign Below (This form must be signed by each !morn:calor See instructions. Da not include a tide ) bIAtfE AtAtIE SMITH
Signature Type or Pnnt Name
rS*s•:Aiicift•ia.Vd 12.2r..0) e'IitG'�:ie Orrc;,,c•;:;:. ° i

5/7/2025

YUCAIPA

ICKLEBALL
Supported by Yucaipa Pickleball, Inc. through a
Grant by the City of Yucaipa
1 WHAT'S HAPPENING??
• 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.
• Schools put in a request for courts to be painted at their sites • YPI did a training with all of the elementary PE teachers • Grades S-8 are part of our training program
2 2
1 5/7/2025
PAR1IfIPAiING S(OLS
• Valley Elementary,
Dunlap Elementary
• Chapman Heights Elementary
• Wildwood Elementary
• Ridgeview Elementary
• Calimesa Elementary
• Parkview Middle School
• Mesa View Middle School
• Competitive Edge Charter Academy
• Adult School ESL
• Wildwood Calvary Christian School
• STARS Program Schools
3 4
2 5/7/2025
5 6
3 5/7/2025
7 8
4 5/7/2025
9 ELEMENTARY

TEACHER

COLLABORATION
DAY

5/7/2025
11 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
12 12
6 5/7/2025
�ROWTN POSSIBILITIES
City is building 4 new permanent courts at 7th St. park • 2500 students will be taught before the end of the school year • YPi offering youth leagues and tournaments
' Families will be playing
• Doubling our club size
• Need for the completion of Phase 1 and Phase 2
13 13

TUANKYOU
r 1
14 14
7 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 3, 2025
Check in at noon
Games start at 12:30 pm
WHERE: 7' STREET PARK SHADE STRUCTURE
33994 Ave. E, corner of 7th St., Yucaipa, CA
Location may be moved due to possible court resurfacing.

COST: $10
Registration open until full,
No refunds after April 25, 2025
Receipt of registration/entry fee holds slot
Registration opens March 1, 2025
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:

SELI<1T11‹

YUCAIPA
PICKLEBALL®
wvn. Y.ji:p.*kktk.?i;an

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• OFFICIAL SIZE: This regulation size pickleball net is 22' feet long to cover the length of the court with 12' inches on either side and stands 3' feet high to adhere to official USA Pickleball (USAPA) net standards for competitive and toumament play
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• Best Entry Level Pickleball Paddles TYD03: This Is the best entry- level pickleball paddles set of 4 for beginners! The textured surface allows you to perform amazing spin shots like professional athletes. The 16mm fibreglass pickleball paddles provide you with more power, while the 7.8-8.0 oz weight helps reduce stress on your elbow and shoulder. With a 5.5" elongated foam moulding grip, this pickle ball rackets 4 pack offers a blend of reach and control.
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Tara Davis
From: Yucaipa Pickleball
Sent: Thursday, May 29, 2025 7:47 PM
To: Tara Davis
Subject: Re: Accepting Applications - Community Activity Grant - Fiscal Year 2024/25 - PLEASE

READ IN ENTIRETY
Attachments: AMAZON-3.PDF; Amazon.com _ Franklin Sports Pickleball Net - Official Size with Wheels -Superior Portability, White_Black _ Sports & Outdoors.pdf; AMAZON-1.PDF Tara, I missed your call and am on vacation. But I happen to have my computer with me, so I'm attaching the Amazon pages we used to calculate our costs.

Our numbers were rounded for the application
Paddles - 40 packages of 4 paddles each at $30 per Package = $1200 Nets - 6 nets @ $130 ea = $780
Balls - 100 in a package = $200
Total $2180 - used $2,200 in application
We may need additional equipment depending on the final school numbers.

Let me know if you have any questions or need additional information.

Thank you
Patty Ingram
Yucaipa Pickleball, Inc.
www.YucaipaPickleball.com
On Thu, May 29, 2025 at 9:20 AM Tara Davis wrote:

Good morning, We are preparing the applications for ad -hoc review. We need the following from you as soon as possible.

Supporting documentation of estimated cost - quotes/invoices/etc.

Thank you,
From: Yucaipa Pickleball
Sent: Tuesday, May 6, 2025 11:55 AM
To: Tara Davis
Cc: Richard Rios Melinda Daniel
Rito Chisholm Diane Kuehl
Subject: Re: Accepting Applications - Community Activity Grant - Fiscal Year 2024/25 - PLEASE READ IN ENTIRETY Debi Hitter
1 Tara,
Thank you for the opportunity to apply for a CAG this year. I have attached our application and supporting documents. Included are our IRS non-profit approval letter, Articles of Incorporation, a flier regarding our recent youth tournament and our Pickleball in the Schools PowerPoint presented to the city council and YCJUSD.

We look forward to your confirmation of receipt of these documents. Please, do not hesitate to contact us if you have any questions or need additional information.

Patty Ingram
Yucaipa Pickleball, Inc.
www.YucaipaPickleball.com
On Wed, Apr 16, 2025 at 5:12 PM Tara Davis wrote:

Good Afternoon,
On March 24, 2025, City Council approved the Community Activity Grant (CAG) Program and approved funding levels in the amounts of $20,000 for financial requests and $40,000 for in -kind requests. In order to be eligible for the FY 2025/26 Community Activity Grant Program, all Wrap-up Reports (from prior grant cycles) must be completed and turned in for Council review prior to applying. Wrap-up Reports are due within 30 days of your scheduled event/program — if you are unable to meet the deadline, please reach out to us to make alternative arrangements, as needed.

ACCEPTING APPLICATIONS BEGINNING APRIL 16, 2025!
COMMUNITY ACTIVITY GRANT - FISCAL YEAR 2025/26
The Community Activity Grant (CAG) Program supports the efforts of local non-profit 501(c) agencies/organizations that provide valuable services, programs, and/or events to Yucaipa residents. Local non -profits who are proposing 2 to continue on -going programs/services, new programs and/or services for small/large scale special events that meet the grant guidelines are eligible for the CAG Program. The City of Yucaipa will begin accepting CAG applications for the Fiscal Year (FY) 2025/26 on April 16, 2025. The application and guidelines may be accessed on the "Residents" tab of the City's website (click on Community Activity Grants under Non -Profits) at www.vucaipa.gov .

Organizations seeking financial assistance will be required to submit a completed FY 2025/26 CAG application with all required documentation and attachments by the established deadline of May 16, 2025, at 5:00 PM. Financial applications received after the deadline will not be considered. Applications for In-kind/fee waiver assistance will not have an established deadline; however, requests will be reviewed and considered as received until funds are depleted.

Please follow the application process below to the ensure timely processing of your request.

REQUEST FOR FINANCIAL SUPPORT
Financial support may be requested to assist with the funding of a local program/event that meets the established guidelines for the program.

STEP 1
Complete the Community Activity Grant Application — Sections 1 through 7 with supporting documentation, as required.

STEP 2
Attach event/program promotional materials.

STEP 3
Submit your signed, original application with attachments to:

City of Yucaipa
General Services/City Clerk Department
3 Attn: Tara Davis
34272 Yucaipa Blvd.

Yucaipa, CA 92399

REQUEST FOR IN-KIND/FEE WAIVER SUPPORT
In-kind/fee waiver support may be requested to offset facility rental fees (excluding the YPAC), permit fees, and/or special events
STEP 1
Prior to submitting a CAG application, contact Kelsey Vega, Administrative Assistant, at 909-500-7714 ext. 558.

STEP 2
Submit your signed, original CAG application with attachments (facility permit, Special Event Application and event/program promotional materials, etc.) to:

City of Yucaipa — General Services/City Clerk Department Attn: Tara Davis
34272 Yucaipa Blvd.

Yucaipa, CA 92399
All applications received and deemed complete will be reviewed for consideration by the Yucaipa City Council. Questions regarding the CAG Program may be directed to Tara Davis at 909-797-2489, ext. 282 or via email at tdavisyucaipa.qov. Once a City Council Meeting date has been established for the consideration of applications, applicants will be notified and invited to the meeting in order to provide the opportunity to speak on behalf of their grant request.

Note: The FY 2025/26 City approved CAG Guidelines include a provision that requires a 100% financial match for ALL applicants receiving CAG financial awards. 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 4 program/project cost in your Wrap-up Report (Accountability Report). This notification is meant to give applicants adequate notice to plan accordingly.

Tara Davis
Administrative Assistant
City of Yucaipa
City Hall • 34272 Yucaipa Blvd • Yucaipa, CA 92399
Office: 909-797-2489 Ext. 282
wwwyucaipa.gov
5 ATTACHMENT 13

CITY OF YUCAIPA

COMMUNITY ACTIVITY GRANT APPLICATION

FINANCIAL / IN -KIND / FEE WAIVER

COMMUNITY ACTIVITY GRANT APPLICATION INSTRUCTIONS
FISCAL YEAR:
2025-2026
DATE SUBMITTED: 5/16/25, Amended 5/21/25
SUBMIT TO: CITY OF YUCAIPA

GENERAL SERVICES/CITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

Note: Beginning with the FY 25/26 grant cycle, financial grant awarded funds will require 100% financial match by the applicant. For example, if your total program/project cost is S1,000, 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 S500.

SECTION 1 - GENERAL INFORMATION
Name of Applicant/Organization: Yucaipa Valley Art Association Applicant/Organization: P.O. Box 404, Yucaipa, CA 92399 Mailing Address
Applicant/Organization Phone Number:

CONTACT (1)
CONTACT (2)
Zully Martinez
NAME
[email protected]
E-Mail
Enrique Lima
NAME
E-Mail
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? PH • NE NUMBER

PHONE NUMBER
YES
n
NO

RECEIVED
MAY 2 1 2025
Yucaipa City Clerk's Office
"u I
VCR T� — "d I �i
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. 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 so, please provide Tax ID# and attach all supporting documents.

Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Zully Martinez, President, Board member
Alan Remele, Vice President, Board Member
Carol Maidlow, Treasurer, Board Member
Bea Gardner, Secretary & Shows, Board Member
Enrique Lima, Exhibitions, Board Member
Kathryn Ravenwood, Membership, Board Memb
Judy Remele, Scholarships, Board Member
Bob Norris, Publicity, Board Member
Robin Staton, Hospitality, Board Member
Karen Hoak, Ways & Means, Board Member
2 SECTION 4 - PROGRAM DESCRIPTION/SCOPE (PLEASE USE ADDITIONAL

PAGES AS NECESSARY)
Name of the program/event:

YVAA Art Meetings, weekly on Wednesdays at the Scherer Center, Permit #R7557 Date(s) of the program/event: 7/2/25 to 6/24/26
Total estimated cost for program/event:
5,833.00
Describe the program/event that the organization is seeking support for:
(Attach any event/program promotional materials associated with the program/event) The Yucaipa Valley Art Association's holds weekly art meetings at the Scherer Center 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 does include this activity as part of the City of Yucaipa's community services booklet. It is listed on pg. 10 of the 2025 Yucaipa Community Services Guide as "Paint and Art Club". 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 #R7557.

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 Sept. to May. This CAGrant covers rental costs for the weekly meetings for 12 months. 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. The amended CAG application adds back 3 months (June, July, August) of our program which were previously cut due to CAG Describe how the program/event benefits the residents/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. This activity is free to all attendees at the Scherer Community Center and is listed as an activity in the City of Yucaipa's community services programs booklet.

Program/event primary target population (check all that apply):
nChildren or Youth
Persons with Disabilities
Entire Community
Seniors
Homeless
Victims
Low Income ❑ Women
Welfare Recipients
Please answer the following to determine if your program/event requires a Special Event Permit (SEP):

Estimated attendance 300-999 persons
Amplified Sound
(excluding Special Event Facilities)
YES NO
1 ▪ LI

THIS BOX IS FOR STAFF USE ONLY
This event requires City Management/
Administrative Approval:

YES NO
❑ ❑
Estimated attendance 1000+ persons
Alcohol Service
(excluding Community Centers & YPAC)
Street Closure - Traffic Management
YES
❑
❑ u
❑
NO
THIS BOX 15 FOR STAFF USE ONLY
This event requires City Council Approval:

YES NO
❑
3 SECTION S - GRANT FUNDING REQUEST
Please identify what your organization is seeking:

Financial Support:

In -Kind Support: $
Total Amount
of Request
YES NO
$
OT/Reassigned Staff CS/Rental
If other, please explain:
$
In -Kind
$200 SEP Fee Waiver:

Gi ? U- • 4'S -co
$ y?;4700
Scherer
Community Center
Financial Support $200 SEP Fee
Waiver
Provide a detailed description of how the financial support will be used:
$
YES
Other
Financial Match
NO
Total Overall
Request
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
$0
$
$
Financial
Support Amount
Total Funds Received to Date: $ 0 $ (J
Total Funds Requested via Grant Application: $ t) $
Remaining Balance that will be Funded by Organization: $ 0 4

SECTION 6 - FINANCIAL CAPABILITIES/BUDGET (CONTINUED)
Describe any City Funding received by organization in the past three years (required)? Program
Y'VAA Tues & Thur Mtgs.

Wednesday Art Mtgs.
2023 Spring Art Show
In -Kind
5uppo t
Financial
Support
S200 SEP
Fee Waiver
111
El
Date Received Total Received
6/2024
6/2024
6/2022
$ 2,892.7s
$ 4,212.00
$ 1,999.51
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
President
Title

SUBMIT FORM
521'_5
Date

TO BE COMPLETED BY THE CITY
Date Received:

Amount Funded:

Type of Grant:

Date Reviewed:

City Council Meeting:

In -Kind Financial S200 SEP
Support Support Fee Waiver
Date City Council received follow-up report:

FACILITY RESERVATION APPLICATION
City of Yucaipa Community Services Department
Step One - Information
Zully Martinez
Applicant Name (please print clearly)
P.O. Box 404
Yucaipa
Phone Number
92399
Street Address City Zi
Yucaipa Valley Art Association P.O. Box 404, Yucaipa
Organization Name (if applicable) Address Phone Number
Is applicant a City of Yucaipa resident? (Proof of residency required) Applicant email: [email protected]
Alternate contact person: Enrique Lima, Treasurer
❑■ Yes ❑ No
Name Phone Number
Step Two - Event
Event Name: Revised art painting session meetings on Wednesdays from July 2025 to June 2026, see attached.

Type of Event: 0 Meeting 0 Birthday 0 Family Gathering 0 Reception/Banquet 0 Shower -baby or Bridal ❑Wedding - ❑Other:
# of Attendees: 5-10 Date(s) of Use: 7/2/26 to 6/24/2€Day: ❑M ❑Tu iW ❑Th OF ❑Sa ❑Su Set-up Time: 1:00 prto 3:00 pr Guest Arrival: 1:00 Clean-up Time: 2:45 pm to 3:00 pm *Hours requested include the time it takes to set up and clean up the day of event. Total Number of Hours: 2 hrs. (No set-up day(s) prior to event).

Step Three - Details
Is applicant a non-profit?
If yes, non-profit # 95-3701090
0Yes ❑No
Is the event a fundraiser? 0Yes O No
Is the event open to the public? 0Yes 0 No
Is there an admission fee for the event? 0Yes 0No
Will any items be sold? ❑Yes I] No
Will alcoholic beverages be sold? 0Yes 0No
Ifx & ABC license will be required. License must be
received by staff no later than 1 week prior to event date.

Will alcoholic beverages be served? plies 0No
If yes, additional fees will be charged.

Will food be served? ❑Yes ❑Q No
Will you have any of the following?
❑DJ ❑Band ❑Caterer:

Insurance (Required - please check one):

Insurance fee is dependent on the size and nature of the event.

No Alcohol: ❑
With Alcohol: 0
*Events with alcohol are required to purchase designated insurance and mandatory liquor liability.

Step Four - Facility
Community Center -34900 Oak Glen Rd:
❑Banquet Room EiMeeting Room ❑Kitchen ❑Dance Room ❑Activity Room ❑Gymnasium Scherer Center - 12202 1st St:
❑Banquet Room: ❑Room A []Room B ❑Room C ❑Kitchen ❑Arts & Crafts Room ElNutrition Center Yucaipa Performing Arts Center —12062 California St:
❑ Mountain View Room: ❑Room A ❑ Room B
❑Theater Rental: ❑Banquet Setup ❑Theater Setup
❑ Kitchen O Front Lobby ❑ Blackbox
❑Dressing Rooms: ❑I ❑II ❑Ilt ❑IV ❑Green Room
❑Outdoor Stage ❑Outdoor Stage with Park
Will you require the use of City -owned equipment? ❑Yes ❑No *If yes, an additional cost and is sold as a bundle. Please check items:
❑Microphone ❑ Projector ❑Sound System ❑Stage (YPAC only) Step Five - Signature, Please Read Carefully Before Signing Applicant(s) 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(s) 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. Applicant(s) agrees to protect and hold 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 Applicant's failure to comply with this requirement. I have read and agree to abide by all of the City of Yucaipa policies stated above and in the Facility Rental Policies.

Applicant Signature :

Print Applicant Name: ZUIIy Martinez
uat�. 5/20/25

Initial
Application Process
A reservation is not confirmed until a Facility Reservation Application has been completed, signed, and all deposits have been paid. Quotes and telephone/email inquiries are not binding and do not constitute a reservation. Applications and availability based on a first come, first serve basis. gi,
cri
Initial
Fees, Cancellations & Refunds
Full payment is due thirty (30) days prior to the event date. Cancellation of a rental more than thirty (30) days prior to the event date will result in a loss of the deposit(s).

Cancellation requests between twenty-nine (29) and sixteen (16) days prior to the event will result in a loss of 50% of rental fees paid and loss of the deposit(s).

Cancellation of a rental fifteen (15) days prior to the event will result in loss of 100% of rental fees and deposit(s).

Deposit Refund Process
A security deposit will be required for all reservations. The security deposit is in addition to the reservation fees. The deposit is refundable provided the facility is returned in the same condition in which it was found.

If the facility is found in satisfactory condition (clean, no damage, or loss of equipment), the refund deposit will be returned via credit card if the reservation was paid with a credit card. If the refund deposit was paid by cash or check, it will be returned via check and mailed to the address on the Facility Reservation Application approximately four (4) to six (6) weeks after the event date. If damage or loss does occur, the deposit will be held until estimates can be obtained. All replacement and/or repair fees will be deducted from the deposit.

Initial
I'
Alcohol
For alcohol to be permitted, applicant must pay an alcohol permit fee and purchase liquor liability prior to their event. Types of alcohol are restricted to beer, wine, and champagne only, unless permitted by the Director of Community Services. If the Applicant is approved by the City to have alcoholic beverages at the event, it must be served over a bar by a person at least 21 years of age designated by the Applicant. All alcohol must be served in individual, non -breakable containers, and not set out to be self -served. Bottles of any kind may not be placed on the tables or be used as centerpieces. Alcohol must remain in the designated rented facility. Alcohol is not allowed in the facility lobby or outside of the facility.

Injuries caused to any person as a result of alcoholic beverages being served and/or consumed by a minor on City premises shall be the sole responsibility of the Applicant, user, group, organization, its sponsors, or the adult representative.

Selling Alcohol: If alcohol is sold at an event (i.e. cash bar, tickets, and drinks for a fee), the Applicant will be nitial
required to provide a license from the State Alcoholic Beverage Control Department. The Applicant must provide a copy of the permit from the Alcoholic Beverage Control office to the City seven (7) days prior to the event. Injuries caused to any person as a result of alcoholic beverages being served and/or consumed by a minor on City premises shall be the sole responsibility of the Applicant, user, group, organization, its sponsors, or the adult representative.
** Events found serving or containing any alcohol beverage without approval, will result in the event being immediately canceled and 100% of fees will be forfeited**

Initial
Decorations
Signs or decorations all must be freestanding and cannot be nailed or permanently affixed to the facility's walls. ceilings, windows, or drapes. All decorations and signs are permitted in the privately rented facility only. Decorations must be fireproof. Glitter, rice, birdseed, open flame candles, smoke, fog, bubble machines or other similar items are not permitted in or around the facility. All decorations must be completely removed and disposed of at the end of the event. No alteration of existing facilities is permitted.

Any events found with decorations that do not comply with the policies may result in loss of deposit and any additional incurred fees for damages and/or additional cleaning required. ; ,,
//4
Initial
Hours and Permitted Time
The applicant, guests, vendors, etc., will not be permitted into the facility prior to the rented space at the time indicated on the permit. The applicant must account for their set-up time, decorating, and clean-up time when submitting the original request. Set-up day(s) prior to the event is not permitted, all set-up times must be on the event date. Storage or pre -staging of event items prior to the contracted start time is not allowed. This includes both personal as well as professionally delivered items. The rental ending time means the facility must be empty of all guests and event staff. The clean-up time means all decorations, food, etc. must be removed and the facility cleaned according to the checklist provided to the renter. The event time for facilities may not go past 11:00 p.m., with clean up time not exceeding 12:00 a.m.

If an applicant or event stays after permitted time, overtime charges will incur fees at the rate of time and half (1.5) for the room and staff. No refunds for any unused rental time. Rentals that do not comply with the contracted time may result in a minimum loss of deposit and additional fees incurred.

Initial
Insurance
The Applicant shall purchase special event general liability insurance through the City of Yucaipa and cannot be provided. Insurance premiums are dependent on the size and nature of the event and are subject to change annually. General liability coverage is in the amount of $1 million for bodily injury, personal injury, and property damage. If alcoholic beverages are served, then liquor liability in the amount of $1 million, for bodily injury and property damage, will be required to be purchased.

Use of the facility will be denied if required insurance is not purchased prior to the event. ❑
Initial
Cleaning Fee
A cleaning fee is required for any event and rental exceeding seventy-five (751 guests. Events with less than 75 guests, a cleaning fee is optional. If opted out, general cleanup is the Applicant's responsibility.

If a cleaning fee is paid for:

1. Clean-up time is still required in the reservation request. Clean-up time means event time has concluded and means time requested for all personal belongings to be removed.

2. The Applicant shall make sure all decorations, food, gifts, personal belongings, and any equipment is removed and cleaned from the facility at the end of the event.

3. The rented facility, parking lot, grounds, and/or equipment shall be left in the same condition as prior to the event.

4. After your event, staff will conduct a post -event inspection walk-through with the Applicant. This inspection will determine if any damage or vandalism to City property has occurred.

Deposit will be forfeited if cleaning policies and requirements are not met. ❑

SE-
Initial
Cleaning - Renter Responsibility
If cleaning fee is opted out, general clean-up is renters' responsibility and includes:

1. Applicant shall make sure all decorations, food, gifts, and rental equipment is removed from the facility at the end of the event.

2. All trash must be bagged and removed and placed into the dumpster located in the Community Center Parking Lot.

3. The Applicant must sweep floors of the facility.

4. The rented facility, parking lot, grounds, and/or equipment shall be left in the same condition as they were prior to the event.

5. Staff are there to help you with your event and will advise what needs to be done for your deposit to be refunded.

6. After your event, staff will conduct a post -event inspection walk-through with the Applicant. This inspection will determine if any damage or vandalism to City property has occurred, or if any additional cleaning needs to be done. The amount of the refunded deposit will be based on the outcome of the inspection.

Deposit will be forfeited if cleaning policies and requirements are not met. `'
Initial
Equipment
FE
Access to AV equipment, including a sound system, microphones, and projector, is available for an additional fee and must be requested and paid prior to the event. Equipment is rented as a complete package and bundle. Events opting out of equipment or requesting use the day of the event will be denied access. Any damage or loss of equipment will be deducted from the deposit(s).

Smoking and vaping are prohibited in all City parks and facilities (reference City Park Ordinance #256). • Tables and chairs are provided and will be set up and taken down by staff. Set up diagrams must be submitted at least two (2) weeks prior to the event. If a diagram is not submitted, sample set-up will be utilized, or tables and chairs will not be set up until the start of the reservation. • The maximum number of participants for the facility cannot be exceeded. • Staff are responsible for, and have authority over, the facility, equipment, and activities. Staff shall have the authority to request changes in activities or termination of activities for public safety and well-being.

M•
1, the undersigned applicant, agree to abide by and enforce the rules, regulations, and policies governing this facility as set forth by the City of Yucaipa. I understand that by signing this document 1 accept responsibility for any damages to premises, furniture, equipment, or grounds resulting from the use of the facility. I further agree that any violation of the Facility Use Policies and Agreements can result in immediate cancellation of the reservation and forfeiture of all fees and deposits.

Applicant Signature: Date:

MIE
Print Applicant Name:

La(ap° VoU ,
Acwclatlon
P.O. Box 404, Yucaipa, CA, 92399. Email: [email protected] YVAA Monthly Meeting Schedule 2025-2026
at the Scherer Center
Revised to include summer months, July 2025, August 2025, June 2026.

Wednesday Paint Sessions 2025-2026
Wednesday Paint Session
Times
July: 7/2/25, 7/9/25, 7/16/25, 7/23/25, 7/30/25
1:00 pm to 3:00 pm
August: 8/6/25, 8/13/25, 8/20/25, 8/27/25
1:00 pm to 3:00 pm
September: 9/3/25, 9/10/25, 9/17/25, 9/24/25
1:00 pm to 3:00 pm
October: 10/1/25, 10/8/25, 10/15/25, 10/22/25,
10/29/25
1:00 pm to 3:00 pm
November: 11/5/25, 11/12/25, 11/19/25
1:00 pm to 3:00 pm
December: 12/3/25, 12/10/25, 12/17/25
1:00 pm to 3:00 pm
January: 1/7/26, 1/14/26, 1/21/26, 1/28/26
1:00 pm to 3:00 pm
February: 2/4/26, 2/11/26, 2/18/26, 2/25/26
1:00 pm to 3:00 pm
March: 3/4/26, 3/11/26, 3/18/26, 3/25/26
1:00 pm to 3:00 pm
April: 4/1/26, 4/8/26, 4/15/26, 4/22/26, 4/29/26
1:00 pm to 3:00 pm
May: 5/6/26, 5/13/26, 5/20/26, 5/27/26
1:00 pm to 3:00 pm
June: 6/3/26, 6/10/26, 6/17/26, 6/24/26
1:00 pm to 3:00 pm
For the Wednesday art painting sessions, meetings will be held at the Scherer Center in room B to have a free group paint session for two (2) hours, open to the public. This schedule may be subject to change by the Scherer Center staff with prior notice.

Reference 2024-2025 Permit No. R6523 for new permit.
5/20/25, v2

rt A•wcM.tlm
ram ... REP.

P.O. Box 404, Yucaipa, CA, 92399. Email: [email protected] 5/20/25, v2
II'

INTERNAL REVENUE SERVICE
P. O. BOX 2508
CINCINNATI, OH 45201
Date:

JUN232012

YUCAIPA VALLEY ART ASSOCIATION
PO BOX 404
YUCAIPA, CA 92399
Dear Applicant:

DEPARTMENT OF THE TREASURY
Employer Identification Number:
95-3701090
DLN:
17053096355012
Contact Person:

PAUL F CAPPEL II ID# 31665
Contact Telephone Number:
(877) 829-5500
Accounting Period Ending:

December 31
Public Charity Status:
170(b) (1) (A) (vi)
Form 990 Required:

Yes
Effective Date of Exemption:

May 15, 2010
Contribution Deductibility:

Yes
Addendum Applies:

Yes
We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records.

Organizations exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations. We determined that you are a public charity under the Code section(s) listed in the heading of this letter.

Please see enclosed Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, for some helpful information about your responsibilities as an exempt organization.

Enclosure: Publication 4221-PC
Sincerely,
Lois G. Lerner
Director, Exempt Organizations
Letter 947 (DO/CG)

Permit

COMMUNITY
pieev SERVICES
Pa r,k5
t
Be r!
City of Yucaipa Community PHONE:(909) 790-7460
Services FAX:(909) 790-2589
34272 Yucaipa Blvd EMAIL:[email protected]
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 Karen Ruiz
YVAA Wednesday Monthly Meetings
Booking Summary
Permit # R7557
Status Tentative
Date May 15, 2025 8:35 AM
Expiration Date May 15, 2026
Rental Fee S5.265.00
Discounts -$526.32
Subtotal $4,738.68
Deposits $100.00
Deposit Discounts $0.00
Total Permit Fee $4,838.68
Total Payment $0.00
Refunds $0.00
Balance 54.838.68
1 resource(s) 36 booking(s) Subtotal: $4,838.68
SrC Banquet Room B (Indoor Reservations) Center: Yucaipa Senior Center

START DATE/TIME
Wed, Sep 3, 2025 1:00 PM Wed, May 27, 2026 3:15 PM
Occurs on selected dales effective 09/03/2025 unit/ 05i27/2026.

Wed, Sep 3, 2025 1:00 PM
Rental - Hourly $65.00 / Hour x 2.25 S 146.25
Resident assount - 10% -10°4, x 1 -$1.1 f57

END DATE/TIME
Wed, Sep 3, 2025 3:15 PM

ATTENDEE
5 AMT W/O TAX
$4,738.68
$131.63
Wed, Sep 10, 2025 1:00 PM Wed, Sep 10, 2025 3:15 PM 5 $131.63 Rental - Hourly S65.00 / Hour x 2.25 $146 7
Resident Discount - 10% -10% x 1 -$ I 62
Wed, Sep 17, 2025 1:00 PM Wed, Sep 17. 2025 3:15 PM 5 $131.63 Rental • Hourly 565.00 / Hour x 2.25 $146.2 ;
Resident Discount - 10% -10% x 1 5 t 4 ',2
Wed, Sep 24, 2025 1:00 PM Wed, Sep 24, 2025 3:15 PM 5 5131.63 Rental - Hourly 565.00 / Hour x 2.25 $14d.2°,
Resident Discount - 10°6, -10% x 1-$14.62
Wed, Oct 1. 2025 1:00 PM Wed, Oct 1, 2025 3:15 PM 5 5131.63 # R7557 Status Tentative

Page 1 of 4 ends

Rental - Hourly $65.00 1 Hour x 2.25 S146.25
Resident Discount - 10% -10% x 1 S14 62
Wed, Oct 8, 2025 1:00 PM Wed, Oct 8, 2025 3:15 PM 5 $131.63 Rental - Hourly $65.00 / Hour x 2.25 5
Resident Discount - 10'• -10% x 1 f; i-! e._'
Wed, Oct 15, 2025 1:00 PM Wed, Oct 15, 2025 3:15 PM 5 $131.63 Rental - Hourly $65.00 !Hour x 2.25 S146.25
Resident Discount - 10% -10% x 1-$14.62
Wed, Oct 22, 2025 1:00 PM Wed, Oct 22, 2025 3:15 PM 5 S131.63 Rental - Hourly $65.00! Hour x 2.25 S146.25
Resident Discount - 10% -10% x 1-514.62
Wed, Oct 29, 2025 1:00 PM Wed, Oct 29, 2025 3:15 PM 5 $131.63 Rental - Hourly $65.00 / Hour x 2.25 S146.25
Resident Discount - 10°% -10% x 1-S14.62
Wed, Nov 5, 2025 1:00 PM Wed, Nov 5, 2025 3:15 PM 5 S131.63 Rental - Hourly S65.00 1 Hour x 2.25 5146.25
Resident Discount - 10% -10% x 1-$14.62
Wed, Nov 12, 2025 1:00 PM Wed, Nov 12, 2025 3:15 PM 5 $131.63 Rental - Hourly 565.00 / Hour x 2.25 $146.25
Resident Discount - 10% -10% x 1-$14.62
Wed, Nov 19, 2025 1:00 PM Wed, Nov 19, 2025 3:15 PM 5 $131.63 Rental - Hourly $65.00 / Hour x 2.25 $146.25
Resident Discount - 10"4., -10% x 1 -$14.62
Wed, Dec 3, 2025 1:00 PM Wed, Dec 3, 2025 3:15 PM 5 $131.63 Rental - Hourly $65.00 / Hour x 2.25 $146.25
Resident Discount - 10% -10% x 1-$14.62
Wed, Dec 10, 2025 1:00 PM Wed, Dec 10, 2025 3:15 PM 5 $131.63 Rental - Hourly $65.00 1 Hour x 2.25 5146.25
Resident Discount - 10% -10% x 1 -S 14 62
Wed, Dec 17, 2025 1:00 PM Wed, Dec 17, 2025 3:15 PM 5 $131.63 Rental - Hourly 565.00 / Hour x 2.25 $14625
Resident Discount - 10% -10% x 1-S14.62
Wed, Jan 7, 2026 1:00 PM Wed, Jan 7, 2026 3:15 PM 5 $131.63 Rental - Hourly $65.00 / Hour x 2.25 S146 25
Resident Discount - 10% -10% x 1-$14.62
Wed, Jan 14, 2026 1:00 PM Wed, Jan 14, 2026 3:15 PM 5 S131.63 Rental - Hourly S65.00 / Hour x 2.25 S146.25
Resident Discount - 10% -10% x 1-$14.62
Wed, Jan 21, 2026 1:00 PM Wed, Jan 21, 2026 3:15 PM 5 $131.63 Rental - Hourly S65.00 !Hour x 2.25 $146.25
Resident Discount - 10% -10% x 1-$14.62
Wed, Jan 28, 2026 1:00 PM Wed, Jan 28, 2026 3:15 PM 5 $131.63 Rental - Hourly $65.00 / Hour x 2.25 $146.25
# R7557 Status Tentative Page 2 of 4

Resident Discount - 10% -10% x 1-S14.62
Wed, Feb 4, 2026 1:00 PM Wed, Feb 4, 2026 3:15 PM 5 $131.63 Rental - Hourly S65.00 / Hour x 2.25 $146.25
Resident Discount - 10%, -10% x 1 -$14 62
Wed, Feb 11, 2026 1:00 PM Wed, Feb 11, 2026 3:15 PM 5 S131.63 Rental - Hourly S65.00 / Hour x 2.25 $146.25
Resident Discount - 10% -10% x 1 S 14 62
Wed, Feb 18, 2026 1:00 PM Wed, Feb 18, 2026 3:15 PM 5 $131.63 Rental - Hourly $65,00 / Hour x 2.25 S146.25
Resident Discount - 10' 10% x 1-$14.62
Wed, Feb 25, 2026 1:00 PM Wed, Feb 25, 2026 3:15 PM 5 $131.63 Rental - Hourly $65.00 / Hour x 2.25 S146.25
Resident Discount - 10% -10% x 1-$14.62
Wed, Mar 4, 2026 1:00 PM Wed, Mar 4, 2026 3:15 PM 5 $131.63 Rental - Hourly $65.00 / Hour x 2.25 S146.25
Resident Discount - 10% -10% x 1-S14.62
Wed, Mar 11, 2026 1:00 PM Wed, Mar 11, 2026 3:15 PM 5 $131.63 Rental - Hourly $65.00 / Hour x 2.25 $146.25
Resident Discount - 10% -10°/0 x 1-S14.62
Wed, Mar 18, 2026 1:00 PM Wed, Mar 18, 2026 3:15 PM 5 $131.63 Rental - Hourly $65.00 / Hour x 2.25 $146.25
Resident Discount - 10% -10% x 1 -$14 62
Wed, Mar 25, 2026 1:00 PM Wed, Mar 25, 2026 3:15 PM 5 $131.63 Rental - Hourly $65.00 / Hour x 2.25 S146.25
Resident Discount - 10% -10% x 1-$14.62
Wed, Apr 1, 2026 1:00 PM Wed, Apr 1, 2026 3:15 PM 5 $131.63 Rental - Hourly $65.00 / Hour x 2.25 $146.25
Resident Discount - 10% -10% x 1-S14.62
Wed, Apr 8, 2026 1:00 PM Wed, Apr 8, 2026 3:15 PM 5 $131.63 Rental - Hourly $65.00 / Hour x 2.25 $146.25
Resident Discount - 10% -10% x 1-S14.62
Wed, Apr 15, 2026 1:00 PM Wed, Apr 15, 2026 3:15 PM 5 $131.63 Rental - Hourly $65.00 / Hour x 2.25 5146.25
Resident Discount - 10q• -10% x 1-$14.62
Wed, Apr 22, 2026 1:00 PM Wed, Apr 22, 2026 3:15 PM 5 $131.63 Rental - Hourly $65.00 / Hour x 2.25 S146.25
Resident Discount- 10% -10% x 1-$14.62
Wed, Apr 29, 2026 1:00 PM Wed, Apr 29, 2026 3:15 PM 5 $131.63 Rental - Hourly $65.00 / Hour x 2.25 S146.25
Resident Discount - 10% -10% x 1-S14.62
Wed, May 6, 2026 1:00 PM Wed, May 6, 2026 3:15 PM 5 $131.63 Rental - Hourly $65.00 / Hour x 2.25 S146.25
Resident Discount - 10% -10% x 1 -$14.62
# R7557 Status Tentative Page 3 of 4

Wed, May 13, 2026 1:00 PM Wed, May 13, 2026 3:15 PM 5 $131.63 Rental - Hourly $65.00 / Hour x 2.25 $146.25
Resident Discount - 10% -10% x 1-$14.62
Wed, May 20, 2026 1:00 PM Wed, May 20, 2026 3:15 PM 5 $131.63 Rental - Hourly $65.00 / Hour x 2.25 $146.25
Resident Discount - 10%% -10% x 1-S14.62
Wed, May 27, 2026 1:00 PM Wed, May 27, 2026 3:15 PM 5 $131.63 Rental - Hourly $65.00 / Hour x 2.25 $146.25
Resident Discount - 10% -10% x 1-$14.62
Resource level fees $100.00
Deposit $100.00 / Each x 1 $100.00
Waivers and Information

INFORMATION DESCRIPTION
Proof of Liability Insurance

WAIVER NAME
Facility Usage Waiver

DUE DATE
Sep 3, 2025
FOR

SIGNING STATUS
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 YVAA SrC Deposit $100.00 $0.00 $0.00 $0.00 $100.00
Wednesday Banquet
Monthly Room B
Meetings
Payment Schedules

DUE DATE
Aug 20, 2025

AMOUNT DUE
Original Balance: $4,838.68 Current Balance: $4,838.68

AMOUNT PAID WITHDRAWAL ADJUSTMENT BALANCE
$4,838.68 $0.00
$0.00 $4,838.68
# R7557 Status Tentative Page 4 of 4

ATTACHMENT 14

CITY OF YUCAIPA

COMMUNITY ACTIVITY GRANT APPLICATION

FINANCIAL / IN -KIND / FEE WAIVER

COMMUNITY ACTIVITY GRANT APPLICATION INSTRUCTIONS
FISCAL YEAR:
2025-2026
DATE SUBMITTED: 5/16/25
SUBMIT TO: CITY OF YUCAIPA

GENERAL SERVICES/CITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

Note: Beginning with the FY 25/26 grant cycle, financial grant awarded funds will require 1009'0 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 S500.

SECTION 1 - GENERAL INFORMATION
Name of Applicant/Organization: Yucaipa Valley Art Association Applicant/Organization P.O. Box 404, Yucaipa, CA 92399
Mailing Address
Applicant/Organization Phone Number:

CONTACT (1)
CONTACT (2)
7u11y Martinez
NAME
[email protected]
E-Mail
Enrique Lima
NAME
E-Mall

PHONE NUMBER

RECEIVED
MAY 1 6 2025
Yucaipa City Clerk's Office
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?
*If you answered "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.

NO
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 so, please provide Tax ID# and attach all supporting documents.

YES NO
95-3701090
❑
44 years
0 10
75 Names and Titles of Officers and Board of Directors: (Please attach an organization chart, if available) Zully Martinez, President, Board member
Alan Remele, Vice President, Board Member
Carol Maidlow, Treasurer, Board Member
Bea Gardner, Secretary & Shows, Board Member
Enrique Lima, Exhibitions, Board Member
Kathryn Ravenwood, Membership, Board Memb
Judy Remele, Scholarships, Board Member
Bob Norris, Publicity, Board Member
Robin Staton, Hospitality, Board Member
Karen Hoak, Ways & Means, Board Member
2 SECTION 4 - PROGRAM DESCRIPTION/SCOPE !PLEASE USE ADDITIONAL

PAGES AS NECESSARY)
Name of the program/event: YVAA Art Meetings, twice a month on Tuesday & Thursdays. Permit R7556 Date(s) of the program/event:
9/16/25 to 5/21/26
Total estimated cost for program/event:
$3,770.13
Describe the program/event that the organization is seeking support for:
(Attach any event/program promotional materials associated with the 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 Permits R7556.

The In -kind CAGrant support will be used to cover the cost to reserve rooms monthly at the Scherer Center twice a month Tuesday 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 2025 through May 2026. 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.

Describe how the program/event benefits the residents/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 community clubs, YPAC 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 students.

Program/event primary target population (check all that apply):

Children or Youth n Entire Community Homeless n Low Income Women Persons with Disabilities El Seniors Victims Welfare Recipients Please answer the following to determine if your program/event requires a Special Event Permit (SEP):

Estimated attendance 300-999 persons
Amplified Sound
(excluding Special Event Facilities)
YES
n
NO
THIS BOX I5 FOR STAFF USE ONLY
This event requires City Management/
Administrative Approval:

YES NO
Estimated attendance 1000+ persons
Alcohol Service
(excluding Community Centers & YPAC)
Street Closure - Traffic Management
YES NO
R
n
THIS BOX 15 FOR STAFF USE ONLY
YES
This event requires City Council Approval:

NO
3 SECTION 5 - GRANT FUNDING REQUEST
Please identify what your organization is seeking:

Financial Support:

In -Kind Support: $
Total Amount
of Request
YES NO
OT/Reassigned Staff CS/Rental
If other, please explain:

I5. i 3`'
In -Kind
Financial Support
$200 SEP Fee Waiver:
$
Scherer
Community Center
YES
Other
NO
S, Ic--"1_'3
$ $ $ .""
5200 SEP Fee
Waiver
Provide a detailed description of how the financial support will be used:

Financial Match
Total Overall
Request
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 Financial
Amount Support Amount
Total Funds Received to Date: $ 0 $ 0
Total Funds Requested via Grant Application: $ 0
$0
Remaining Balance that will be Funded by Organization: $ $ 4 SECTION 6 - FINANCIAL CAPABILITIES/BUDGET icoNr!NuED) Describe any City Funding received by organization in the past three years (required)? Program
YVAA Tues & Thur Mtgs.

Wednesday Art Mtgs.
2023 Spring Art Show
In -Kind
Support
Financial
Support
S200 SEP
Fee Waiver
Date Received
6/2024
6/2024
6/2022
Total Received
$ 2.892.78
$ 4,212.00
1,999.51
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.

President
Title

SUBMIT FORM
Date

TO BE COMPLETED BY THE CITY
Date Received:

Amount Funded:

Type of Grant:

Date Reviewed:

City Council Meeting:

In -Kind Financial $200 SEP
Support Support Fee Waiver
Date City Council received follow-up report:
5 INTERNAL REVENUE SERVICE
P. O. BOX 2508
CINCINNATI, OH 45201
Date:

JUN232012

YUCAIPA VALLEY ART ASSOCIATION
PO BOX 404
YUCAIPA, CA 92399
Dear Applicant:

DEPARTMENT OF THE TREASURY
Employer Identification Number:
95-3701090
DLN:
17053096355012
Contact Person:

PAUL F CAPPEL II ID# 31665
Contact Telephone Number:
(877) 829-5500
Accounting Period Ending:

December 31
Public Charity Status:
170(b) (1) (A) (vi)
Form 990 Required:

Yes
Effective Date of Exemption:

May 15, 2010
Contribution Deductibility:

Yes
Addendum Applies:

Please see enclosed Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, for some helpful information about your responsibilities as an exempt organization.

Enclosure: Publication 4221-PC
Sincerely,
Lois G. Lerner
Director, Exempt Organizations
Letter 947 (DO/CG)

FACILITY RESERVATION APPLICATION
City of Yucaipa Community Services Department
Step One - Information
Zully Martinez
Applicant Name (please print clearly) Phone Number
P.O. Box 404
Yucaipa 92399
Street Address
City Zip
Yucaipa Valley Art Association P.O. Box 404, Yucaipa, CA Organization Name (if applicable) Address Phone Number
Is applicant a City of Yucaipa resident? (Proof of residency required) ❑ Yes ❑ No Applicant email: [email protected]
Alternate contact person: Enrique Lima, Treasurer
Name Phone Number
Step Two - Event
Event Name: Art Meetings on Tues & Thurs from Sept. 2025 to May 2026. See attached for dates.

Type of Event: Meeting ❑Birthday ❑Family Gathering ❑ Reception/Banquet ❑ Shower -baby or Bridal ❑Wedding - ❑Other:
# of Attendees: 35-40 Date(s) of Use: q/2025 to 5i2026 Day: ❑M 2Tu OW 2Th OF ❑Sa ❑Su Set-up Time: 6:00 pmto 6:30 pm Guest Arrival: 6:31 pm Clean-up Time:8:45 pmto9:15 pm *Hours requested include the time it takes to set up and clean up the day of event. Total Number of Hours: 5.25 hour (No set-up day(s) prior to event).

Step Three - Details
Is applicant a non-profit?
Ifyes, non-profit # 95-3701090
2Yes ❑No
Is the event a fundraiser? 2Yes ❑No
Is the event open to the public? 2Yes ❑No
Is there an admission fee for the event? ❑Yes iallo
Will any items be sold? 2Yes ❑No
Will alcoholic beverages be sold? ❑Yes lallo
If ves. ABC license will be required. License must be
received by staff no later than 1 week prior to event date.

Will alcoholic beverages be served? ❑Yes 12No
If ves. additional fees will be charged.

Will food he served? 2Yes ❑No
Will you have any of the following?
OD) ❑Band ❑Caterer:

Insurance (Required - please check one):

Insurance fee is dependent on the size and nature of the event.

No Alcohol: 2
With Alcohol: ❑
*Events with alcohol are required to purchase designated insurance and mandatory liquor liability.

Step Four - Facility
Community Center -34900 Oak Glen Rd:
❑Banquet Room ❑Meeting Room ❑Kitchen ❑Dance Room Activity Room ❑Gymnasium Scherer Center - 12202 1st St:
❑Banquet Room: 2Room A 2Room B 12Room C ❑Kitchen ❑Arts & Crafts Room ❑Nutrition Center Yucaipa Performing Arts Center —12062 California St:
❑Mountain View Room: ❑Room A ❑Room B
❑Theater Rental: ❑Banquet Setup ❑Theater Setup
❑Kitchen ❑Front Lobby ❑Blackbox
❑Dressing Rooms: 01 OH ❑III ❑IV ❑Green Room
❑Outdoor Stage ❑Outdoor Stage with Park
Will you require the use of City -owned equipment? thes No *If yes, an additional cost and is sold as a bundle. Please check items:
2Microphone {a Projector {Sound System ❑Stage (YPAC only) Step Five - Signature, Please Read Carefully Before Signing Applicant(s) 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(s) 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. Applicant(s) agrees to protect and hold 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 Applicant's failure to comply with this requirement. I have read and agree to abide by all of the City of Yucaipa policies stated above and in the Facility Rental Policies.

Applicant Signature : _
Print Applicant Name: Zully Martinez, YVAA President
Date: 5/13/25

Yucaipa Community Center & Scherer Community Center
Facility Rental Use Policies & Agreements
The rules and regulations herein have been developed to ensure that facilities are used in a responsible manner and that the public investment in these facilities is adequately safel?uarded. v Application Process
ZM
A reservation is not confirmed until a Facility Reservation Application has been completed, signed, and all deposits have been paid. Quotes and telephone/email inquiries are not binding and do not constitute a reservation. Applications and availability based on a first come, first serve basis.

Initial
Initial
Fees, Cancellations & Refunds
Full payment is due thirty (30) days prior to the event date. Cancellation of a rental more than thirty (30) days prior to the event date will result in a loss of the deposit(s).

Cancellation requests between twenty-nine (29) and sixteen (16) days prior to the event will result in a loss ZM
of 50% of rental fees paid and loss of the deposit(s).

Cancellation of a rental fifteen (15) days prior to the event will result in Toss of 100% of rental fees and deposit(s).

Initial
Deposit Refund Process
A security deposit will be required for all reservations. The security deposit is in addition to the reservation fees. The deposit is refundable provided the facility is returned in the same condition in which it was found.

ZM
Initial
Alcohol..,
For alcohol to be permitted, applicant must pay an alcohol permit fee and purchase liquor liability prior to their event. Types of alcohol are restricted to beer, wine, and champagne only, unless permitted by the Director of Community Services. If the Applicant is approved by the City to have alcoholic beverages at the event, it must be served over a bar by a person at least 21 years of age designated by the Applicant. All alcohol must be served in individual, non -breakable containers, and not set out to be self -served. Bottles of any kind may not be placed on the tables or be used as centerpieces. Alcohol must remain in the designated rented facility. Alcohol is not allowed in the facility lobby or outside of the facility.

Selling Alcohol: If alcohol is sold at an event (i.e. cash bar, tickets, and drinks for a fee), the Applicant will be ZM
required to provide a license from the State Alcoholic Beverage Control Department. The Applicant must provide a copy of the permit from the Alcoholic Beverage Control office to the City seven (7) days prior to the event. Injuries caused to any person as a result of alcoholic beverages being served and/or consumed by a minor on City premises shall be the sole responsibility of the Applicant, user, group, organization, its sponsors, or the adult representative.
** Events found serving or containing any alcohol beverage without approval, will result in the event being immediately canceled and 100% of fees will be forfeited**

Initial
Decorations
Signs or decorations all must be freestanding and cannot be nailed or permanently affixed to the facility's walls, ceilings, windows, or drapes. All decorations and signs are permitted in the privately rented facility only. Decorations must be fireproof. Glitter, rice, birdseed, open flame candles, smoke, fog, bubble machines or other similar items are not permitted in or around the facility. All decorations must be completely removed and disposed of at the end of the event. No alteration of existing facilities is permitted.

Any events found with decorations that do not comply with the policies may result in loss of deposit and any additional incurred fees for damages and/or additional cleaning required.

ZM
Initial
Hours and Permitted Time
The applicant, guests, vendors, etc., will not be permitted into the facility prior to the rented space at the time indicated on the permit. The applicant must account for their set-up time, decorating, and clean-up time when submitting the original request. Set-up day(s) prior to the event is not permitted, all set-up times must be on the event date. Storage or pre -staging of event items prior to the contracted start time is not allowed. This includes both personal as well as professionally delivered items. The rental ending time means the facility must be empty of all guests and event staff. The clean-up time means all decorations, food, etc. must be removed and the facility cleaned according to the checklist provided to the renter. The event time for facilities may not go past 11:00 p.m., with clean up time not exceeding 12:00 a.m.

Fa
Initial
YVAA
provides
Insura nce
The Applicant shall purchase special event general liability insurance through the City of Yucaipa and cannot be provided. insurance premiums are dependent on the size and nature of the event and are subject to change annually. General Liability coverage is in the amount of $1 million for bodily injury, personal injury, and property damage. If alcoholic beverages are served, then liquor liability in the amount of $1 million, for bodily injury and property damage, will be required to be purchased.

Use of the facility will be denied if required insurance is not purchased prior to the event. liability insurance coverage with COY as additional insured.

Initial
Cleaning Fee
A cleaning fee is required for any event and rental exceeding seventy-five (75) guests. Events with less than 75 guests, a cleaning fee is optional. If opted out, general cleanup is the Applicant's responsibility.

If a cleaning fee is paid for:

1. Clean-up time is still required in the reservation request. Clean-up time means event time has concluded and means time requested for all personal belongings to be removed.

2. The Applicant shall make sure all decorations, food, gifts, personal belongings, and any equipment is removed and cleaned from the facility at the end of the event.

3. The rented facility, parking lot, grounds, and/or equipment shall be left in the same condition as prior to the event.

4. After your event, staff will conduct a post -event inspection walk-through with the Applicant. This inspection will determine if any damage or vandalism to City property has occurred.

Deposit will be forfeited if cleaning policies and requirements are not met. ❑

Cleaning - Renter Responsibility
If cleaning fee is opted out, general clean-up is renters' responsibility and includes:

1. Applicant shall make sure all decorations, food, gifts, and rental equipment is removed from the facility at the end of the event.

2. All trash must be bagged and removed and placed into the dumpster located in the Community Center Parking Lot.

3. The Applicant must sweep floors of the facility.

4. The rented facility, parking lot, grounds, and/or equipment shall be left in the same condition as they were prior to the event.

5. Staff are there to help you with your event and will advise what needs to be done for your deposit to be refunded.

Deposit will be forfeited if cleaning policies and requirements are not met.

ZR1
Initial
Equipment
—
ZM
Access to AV equipment, including a sound system, microphones, and projector, is available for an additional fee and must be requested and paid prior to the event. Equipment is rented as a complete package and bundle. Events opting out of equipment or requesting use the day of the event will be denied access. Any damage or loss of equipment will be deducted from the deposit(s).

Initial
Other
• Any and all changes to the contract be made no later than fourteen (14) days prior to the scheduled event. • It is the Applicant's responsibility to check their equipment's compatibility with the facility's equipment prior to their rental date (Le. laptop, slideshow, audio/visuals). Equipment testing may occur by an appointment.
• Smoking and vaping are prohibited in all City parks and facilities (reference City Park Ordinance #256). • Tables and chairs are provided and will be set up and taken down by staff. Set up diagrams must be submitted at least two (2) weeks prior to the event. If a diagram is not submitted, sample set-up will be utilized, or tables and chairs will not be set up until the start of the reservation. • The maximum number of participants for the facility cannot be exceeded. • Staff are responsible for, and have authority over, the facility, equipment, and activities. Staff shall have the authority to request changes in activities or termination of activities for public safety and well-being.

ZM
Initial
1, the undersigned applicant, agree to abide by and enforce the rules, regulations, and policies governing this facility as set forth by the City of Yucaipa. I understand that by signing this document I accept responsibility for any damages to premises, furniture, equipment, or grounds resulting from the use of the facility. I further agree that any violation of the Facility Use Policies and Agreements can result in immediate cancellation of the reservation and forfeiture of all fees and deposits.

Applicant Signature:

V
Print Applicant Name: Zully Martinez, YVAA President
Date: 5/13/25

Permit

COMMUNITY
ai � SERVICES
rifga
Better)
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 Valley Art Association - 49
Customer Type Non -Profit (R)
Organization Address PO Box 404
Yucaipa, CA 92399
Agent Name Zully Martinez Home Phone Number
System User Karen Ruiz
YVAA Tues/Thurs Monthly Meetings
Booking Summary
Permit # R7556
Status Tentative
Date May 14, 2025 6:00 PM
Expiration Date May 14, 2026
Rental Fee S5.765.67
Discounts-S576.54
Subtotal $5,189.13
Deposits S300.00
Deposit Discounts $0.00
Total Permit Fee $5,489.13
Total Payment $0.00
Refunds $0.00
Balance $5,489.13
2 resource(s) 19 booking(s) Subtotal: $5,489.13
SrC Activity Room (Indoor Reservations) Center: Yucaipa Senior Center

START DATE/TIME
Tue, Sep 16, 2025 10:00 AM
Occurs on selected dates effective 09/16 2025 unto 051r9/2026.

Tue, Sep 16, 2025 10:00 AM
Rental - Hourly $36.00 / Hour x 2
Resident Discount - 10% -10% x 1
Tue, Oct 14, 2025 10:00 AM
Rental - Hourly 536 ' Hour x 2
Resident Discount 10% -10% x 1
Tue, Nov 18, 2025 10:00 AM
Rental - Hourly
Resident Discount - 10%
Tue, Dec 9, 2025 10:00 AM
Rental • Hourly
Resident Discount - 10%
Tue, Jan 13, 2026 10:00 AM

END DATE/TIME
Tue, May 19, 2026 12:00 PM
Tue, Sep 16, 2025 12:00 PM
572.00
-$7.20

ATTENDEE
1 AMT W/O TAX
$648.00
$64.80
Tue, Oct 14, 2025 12:00 PM 1 S64.80
S 72.00
-$7.20
Tue, Nov 18, 2025 12:00 PM 1 $64.80
S36 00 / Hour x 2 $72
10°o x 1 -$72
Tue, Dec 9, 2025 12:00 PM 1 $64.80
$36.00 / Hour x 2 $72.00
-10% x 1 -$7.20
Tue, Jan 13, 2026 12:00 PM 1 S64.80
# R7556 Status Tentative

Page 1 of 4 ends

Yucaipa City CouncilJune 9, 2025

Yucaipa City Council
June 9, 2025