Item 16 - Review and Consider FY 2026/27 CAG Applications — Yucaipa City Council, June 8, 2026 (part 1 of 2)

Item No. 16

STAFF REPORT
DATE: June $, 2026
TO: Honorable Mayor and City Council
FROM: Dr. Sean M. Moore, City Manager
PREPARED BY: Ana V. Sauseda, Director of General Services/City Clerk,4p?�' SUBJECT: Review and Consider Fiscal Year 2026-2027 Community Activity Grant Applications
RECOMMENDATION:

That the City Council:

1. Review and consider the Fiscal Year 2026-2027 Community Activity Grant awards recommended by the Community Activity Grant Application Review Ad -Hoc Committee as follows:

Appikamt
MmeripelvaofEve ou-Prograat
Fy 2026127
Finanrial
Sapp—
Requested
Fly 202CW27
In-kin&Fer
1larrer
Support
Regsested
CAA Ad Hor f onasittee
R"emmeendedAmanlc
Rntle�ea
fiararial
Relearw-"d
IL;6L LeE
Acti(e Ch=lt
TmAL m Trea
S3,W0
i S21M
Actnr Chrdt - You&
Kids abu
SIM
S0
Childhood Cancer Foura mm of scudiCal!•wns� lrrc
Spring EGCStras-aSa a
Sl y. rO
$1.250
Gardernsot*ifmKid4
Toddler Senrar•GardeaFmcara
S2.W0

52.OD0
Grace Poart Flax sly
Lasr Yuca_Wa
S4.000
S7 W
S2.0D0
_
S" 5
Creep Vzmey Clair M Chwch•Yuc aFours ante Clutch
Clr.T. (Csrouing in Faidr Together)
S1,000
S1.000
hnhndLeaders Charter Sdnol
VolerbalGaares
SS10
S310
kmrn cis Civbaf Yu,,iL,1'a3ev
A-A-C1asa;aarn
F S3,000
S2.DD0
Poima Y oudt Cents for -Music de Creative Arts
Sunnier lam Studem Recital
SS00
S62 r
Si00
S62''
FLW* Fit Rescue
YucaipaYwaipa l0D Cat Pro ert
S20,000
S2,0D0
Seeds aF H<W fa Yur-Caionrsa
Eorergerrs• Hmsits
S5,000

52.000
Suv7esfor SaWKS Foundation
Low-IncomeSemers Food As si5twwc Propraml
S1,W0
Sl.N)0
_ Yuc ' aCa6a mFsriyAssirt n e
[t ardR e ExisfingL Futilities
S 2.6Vs.95
S2.DD6
S•uc " a Calmesa Gids Sflflb3Associmam
Fseid and League lmprorrnkems
S 90009D
S2.000
Yw*&CaioaesaS-eteradsComrmmace
;026■-erases Day Cerermlry
59d2
9932
Yur " Rotary Chub
Yuc*a Christmas Pmade
S13j00
S11.02
Yucaipa Rotary Chb
A"eeldv Meetinp for Rotarians
S12,419.77
Sl1.02
Yuc a Vale - Att Association
YVAA - Tursdav & TLrsdzy \Serfs
S 3,902.13
S,1902
Yucmpa l-alcyArtAssudadon
Y%-AA •
S.r.,&W

55.850
Yuc " [-Aey Lions Club
ck D '%Vz
S 222.00
S222
Yucaipa 1•aieyLims Club
PeacrPostrr Cofl[rSt
S 548.00
S1549
Yu a Youth Raskmba0
Y,a` Ym d. Raslxtbaa Season
Is 1.000.00
S UU.00

51.090
S.y.032

TOTAL REQUESTED

BUD GETEDAMOLFXT
Y] BALANCE RLt Viw
SS5,6S'
S15.6619D
S20.00
S10.000
S20.00
S40.00
S20.000
S40-OW
S35.64.
5s.661.
5 Sh).h)0
06/08/2026 City Council Agenda 331

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; or

3. Provide further direction to staff.

BACKGROUNDIDISCUSSION:

On March 23, 2026, City Council reviewed the Community Activity Grant (CAG) program guidelines and funding levels for Fiscal Year 2026-2027 (FY26/27) and approved the following:
• FY26/27 Budget funding levels:
* $20,000 for financial grant requests
o $40,000 for in-kind/fee waiver requests
On March 31, 2026, the City issued email notices to past applicants and new contacts, announcing the FY26/27 CAG program with a firm deadline of April 30, 2026, 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 twenty-four applications requesting in -kind and/or financial support were received by the deadline. The application for the Yucaipa Valley National Little League was deemed not qualified based on the guidelines for the program and the application for The Well Outreach Center was withdrawn. The Community Activity Grant Application Review Ad -Hoc Committee (Committee), met on Monday, May 11, 2026, to review and recommend financial and/or in -kind support for City Council review and approval. The table below 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 26/27 Applications
Attachment 3 Active Church
Scope, Trunk or Treat
Requested Financial Amount
$3 500
Committee Recommended Financial Award
$2,000
Attachment 4
Active Church - Youth
Scope
Kid's Blitz
Requested Financial Amount
$2,000
Committee Recommended Financial Award
$0
06/08/2026 City Council Agenda 332

Attachment 5
Childhood Cancer Foundation of Southern California Inc.

Scope
Spring EGGStrava anza
Requested In -Kind Amount
$1 50
Committee Recommended In -Find Award
$1,250
Attachment b
GardenworksforKids
Scope
Toddler Sensory Garden Fencing
Requested Financial Amount
$2,500
Committee Recommended Financial Award
$2,500
Attachment 7
Grace pint Fellowship/First Baptist Church Yucaipa
Scope
Lave Yucaipa
Requested Financial Amount
$4 000
Requested In -Kind Amount
$750
Committee Recommended Financial Award
$2,000
Committee Recommended In -Kind Award
$750
Attachment 8
Green Valley Christian ChurchlYucai a Foursquare Church Scope
G.I.F.T.(Growing in Faith Together)
Requested Financial Amount
$1000
Committee Recommended Financial Award
$1000
Attachment 9
Tnland Leader's Charter School
Scope
Volleyball Games
Requested In -Kind Amount $810
Committee Recommended In -Kind Award $810
Attachment 10 Kiwanis Club of Yucaipa Valle
Sco e Ado t-A-Classroom
Requested Financial Amount
$3,000
Committee Recommended Financial Award
1 $2,000
Attachment 11
Poiema Youth Center for Music Sc Creative Arts
Scope
Summer Jam Student Recital
Requested Financial Amount
$500
Reguested In -Kind Amount
$627
Committee Recommended Financial Award
$500
Committee Recommended In -Kind Award
$627
Attachment 12
Ri ht Fit Rescue
Scope
Yucaipa 100 Cat Project
Requested Financial Amount
$20 000
Committee Recommended Financial Award
$2,000
06/08/2026 City Council Agenda 333

Community Activity Grant
FY26/27Applications
(Continued)
Attachment 13
Seeds of Hope for Yucai a-Calimesa
Scope
Emergency Housing
Requested Financial Amount
$5,000
Committee Recommended Financial Award
$2,000
Attachment 14
Smiles for Seniors Foundation
Sco a
Low-income Seniors Food Assistance Program
Requested Financial Amount
$1 00
Committee Recommended Financial Award
$1500
Attachment 15
Yucai a/Calimesa Family Assistance
Scope
Repair and Replace Existing Facilities
Requested Financial Amount
$2,656.95
Committee Recommended Financial Award
$2,000
Attachment 16
Yucai a/Calimesa Girls Softball Association
Scope
Field and League Improvements
Requested Financial Amount
$9 000
Committee Recommended Financial Award
$2,000
Attachment 17
Yucai a/Calimesa Veterans Committee
Soo a
2026 Veteran's Day Ceremony
Reguested In -Kind Amount
$942
Committee Recommended In -Kind Award
1 $942
AttachmentIF
Yucai a Rotary Club
Scope
70th Annual Christmas Parade
Requested In -Kind Amount
$15 00
Committee Recommended In -Kind Award
$11,028
Attachment 19
Yucaipa Rotary Club
Scope
Rotary Weekly Meetings
Requested In -Kind Amount $12,418.77
Committee Recommended In -Kind Award $11,028
Attachment 20
Yucai a Valley Art Association
Scope
Tuesday/ThursdayTuesday/Thursday Meetings
Requested In -Kind Amount
$3 902.13
Committee Recommended In -Kind Award
$3 902.13
06/08/2026 City Council Agenda 334

Community Activity Grant
FY26/27Applications
(Continued)
Attachment 21 Yucaipa Valley Art Association
Scope Wednesday Meetings
Requested In -Kind Amount
$5,850
Committee Recommended In -Kind Award
SS 850
Attachment K2
Yucaipa Valle Lion's Club
Scope
5k Dog Walk
Requested In -Kind Amount
$222
Committee Recommended In -Kind Award
$222
Attachment 23
Yucai a Valle Lion's Club
Scope
Peace Poster Contest
Requested In -Kind Amount
$548
Committee Recommended In -Kind Award
$548
Attachment 24
Yucai a Youth Basketball
Scope
Yucaipa Youth Basketball Season
Requested Financial Amount
$1,000
Requested In -Kind Amount
$3,042
Committee Recommended Financial Award
$1,000
Committee Recommended In -Kind Award
$3 M2
FISCAL IMPACT:

The draft FY26/27 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. Prioritization Worksheet

2. Financial Award Grant Tracker fiscal years 2010/11 through 2025/26

3. Active Church

4. Active Church - Youth

5. Childhood Cancer Foundation of Southern California, Inc.

6. GardenworksforKids

7. Grace Point Fellowship

8. Green Valley Christian Church/Yucaipa Foursquare Church 9, Inland Leaders Charter School

10. Kiwanis Club of Yucaipa Valley
11, Poiema Youth Center for Music & Creative Arts

12. Right Fit Rescue

13. Seeds of Hope for'Yucaipa-Calimesa
06/08/2026 City Council Agenda 335

14. Smiles for Seniors Foundation

15. Yucaipa/Calimesa Family Assistance

16. Yucaipa/Calimesa Girls Softball Association

17. Yucaipa/Calimesa Veteran's Committee

18. Yucaipa Rotary Club

19. Yucaipa Rotary Club

20. Yucaipa Valley Axt Association

21. Yucaipa Valley Art Association

22. Yucaipa Valley Lions Club

23. Yucaipa Valley Lions Club

24. Yucaipa Youth Basketball
06/08/2026 City Council Agenda 336

ATTACHMENT I
06/08/2026 City Council Agenda 337

FY 2026/27 COMMUNITY ACTIVITY GRANT (CAG) REQUESTS
1 2
3 4
5 6
7 8
9 10
11 12
13 14
15 16
17 18
19 20
21 22
r Inanclal
and in-kind/r
ee waiver
Applicant
Description of Event/Program
FY 2026/27
Financial
Support
Requested
q
FY 2026/27
In-kind/Fee
Waiver
Support
pp
Re uested
CAG Ad -Hoc Committee
Recommended Awards
Alternative #1
Alternative #2
Recommended
Financial
Recommended
Recommended
Financial
Recommended
In-kind/Fee
Waiver
Recommended
Financial
Recommended
In-kind/Fee
Waiver
In-kind/Fee
Waiver
Active Church
Trunk or Treat
$3,500
$2,000
Active Church - Youth
Kid's Blitz
$2,000
$0
Childhood Cancer Foundation of Southern California, Inc.

Spring EGGStravaganza
$19250
$19250
GardenworksforKids
Toddler Sensory Garden Fencing
$2,500
$2,000
Grace Point Fellowship
Love Yucaipa
$4,000
$750
$2,000
$750
Green Valley Christian Church/Yucaipa Foursquare Church G.I.F.T. (Growing in Faith Together)
$1,000
$1,000
Inland Leaders Charter School
Volleyball Games
$810
$810
Kiwanis Club of Yucaipa Valley
Ado t-A-Classroom
$3,000
$2,000
Poiema Youth Center for Music & Creative Arts
Summer Jam Student Recital
$500
$627
$500
$627
Right Fit Rescue
Yucaipa 100 Cat Project
$20,000
$2,000
Seeds of Hope for Yucaipa-Calimesa
Emergency Housing
$5,000
$29000
Smiles for Seniors Foundation
Low -Income Seniors Food Assistance Program
$1,500
$1,500
Yucaipa/Calimesa Family Assistance
Repair and Replace Existing Facilities
$ 2,656.95
$29000
Yucai a/Calimesa Girls Softball Association
Field and League Improvements
$ 9,000.00
$2,000
Yucaipa/Calimesa Veteran's Committee
2026 Veteran's Day Ceremony
$942
$942
Yucaipa Rotary Club
Yucaipa Christmas Parade
$15,300
$11,028
Yucaipa Rotary Club
Weekly Meetings for Rotarians
$129418.77
$11,028
Yucaipa Valley Art Association
YVAA - Tuesday & Thursday Meetings
$ 3,902.13
$3,902
Yucaipa Valley Art Association
YVAA - Wednesday Meetings
$5,850
$5,850
Yucaipa Valley Lions Club
5k Dog Walk
$ 222.00
$222
Yucaipa Valley Lions Club
Peace Poster Contest
$ 548.00
$548
Yucaipa Youth Basketball
Yucaipa Youth Basketball Season
$ 1,000.00
$ 3,042.00
$1,000
$3,042

TOTAL REQUESTED

BUDGETED AMOUNT

BALANCE REMAINING
$55,657
S45,661.90
S20,000
$40,000
$0
$0
$0
$0
$20,000
$40,000
$20,000
$40,000
$20,000
$40,000
$20,000
$40,000
-$35,657
$0
$0.00
$20,0001
$40,0001
$20,0001
$40,000

Page 338 ends

ATTACHMENT 2
06/08/2026 City Council Agenda 339

Grant - TRACKER
FY2m,h2 FY2m2h3 FY2m3/14 FY2m4115 FY2m5h6 FY2m6h7 FY2a17h8 FY2mg/l9 FY2m9/w NWW/en FY 2a21/= FY m=/23 NW23/ 4 FY w24/25 NY 5/ 6 Total Awarded Applicant1fl
1 Finantial Awards
41h of July Celebration
4th of July Celebration
Committee
$6,000
$6,000
Audio Vision Radio Reading
Svcs For The Blind, Inc.

Radio Reading Services for the Blind
$3,000
$3,000
$61000
Family Promise of
Operational Expenses
$2,000
$2,000
Yucaipa Outreach Project (also
Budgeted - Non -Department. Not -for -
Family Service Association of
Profit Fundino, Account)
$5,000
$4,000
$2,000
$5,000
$3,587
$3,500
$2,000
$2,500
$27,587
Redlands
Housing Assistants/Advocacy
$3,000
Roof for Storage Shed
$1,000
I
I
1 $1,000
Children's Garden
$2,500
$2,500
$1,875
$2,000
$1,500
$8,875
Gardenworksforkids
Autism Patio Cover
$1.000
$1,000
Cement Walkway for Wheelchair
Access
$1,500
$1,500
Grape Point Fellowship/First
Love Yucaipa
Baptist Church Yucaipa
$4,000
$4,000
Mesa View Middle School
Destination Imagination Global Finals
$1,500
1 1
1 1
1 $1,500
Redlands Bicycle Classic, Inc.

Yucaipa Circuit Race
$165
$165
Rotary Club of Yucaipa
Christmas Parade
$700
$700
Smiles For Seniors
Low Income Senior Assistance
Foundation
$5,000
$4,000
$4,000
$4,000
$4,000
$3,587
$2,800
$3,000
$3,000
$3,000
$36,387
Spartans FC
YVYSO/Spartans Cup
$1,800
$1,800
Our Neighbors Clothing Closet
The Well Outreach Center
Program (Assistance to Students &
Families)
$1,000
$2,000
$3,000
$3,000
Valley Elementary School
Leadership Day Event
$1,000
$750
$1,000
$L500
$4,250
Yucaipa Animal Placement
EZ{UP Tents and Tables
Society (YAPS)
$1,2001
$1,200
BMX Park Upgrades
$9,580
$9,580
Yucaipa BMX
Replacement of Loaner BMX Bikes
$3,000
$3,000
Yucaipa Community
Install Brick Pavers in Support of the
Foundation
Arts
$4,000
$4,000
Yucaipa Elks Lodge #2389
Elks National Hoop Shoot Free Throw
Program
$1,000
$1,000
$1.300
$960
$1;000
$1,000
$1,200
$500
$500
$6,460
Yucaipa/Calimesa Family
Various Improvements
$2,500
$1,875
$2,500
$2,000
$1,500
$10.475
061OW026 City Council Agwda 340

Grant - TRACKER
FY2m,h2 FY2m2h3 FY2m3114 FY2m4115 FY2m5h6 FY2m6h7 FY2a17h8 FY2m8h9 FY2m9/w NWW/en FY 2a21/= FY m=/23 NW23/4 FY w24125 NY 5/26 Total Awarded ApplicantM
1 Financial Awards
Assistance
Computer Hardware & Service
Contracts
$1,680
$1,680
YHS Baseball Team to travel to NC for
Yucaipa High School
NHSI Invitational
$1,000
$1,000
Yucaipa Pickleball Inc.

Clinics and Play
$2,450
$2,820
$1,300
$5,270
Yucaipa Valley Gem &
Youth Classess for Sciences,
Mineral Society
Silversmithing, Faceting, etc.
$2,5001
$1,875
$4,375
Teaching Children ut istory
Program
$4,850
$4.850
Yucaipa Valley Historical
Society
Decades Book
$2,500
$2,500
Firestation Museum
$3 500
$3,500
Yucaipa Valley Lions Club
4th of July Celebration
$500
$500
Yucaipa Valley Welfare, Inc.

Security Cameras
$2,500
$2,500
Yucaipa Valley Wine Alliance
American Viticultural Area
$3,035
1 1
$3,035
Yucaipa Youth Basketball
2023/24 Basketball Season
$7.000
S1,aao
Yucaipa Womans Club
Facility Improvements
$5,000
$10,000
$9,500
$6,500
$5,500
$4,000
$6,840
$3,935
$2,951
$3,500
$2,050
$3,000
$1,500
$64,276
Fiscal Year Totals $11,500 $3.000 $6.350 $11,000 $19.580 $14,500 $17,500 $17,500 $17.500 $17.500 $16.435 $17.500 $18.700 $17,500 $20,000 $18.700
dedt th �a^tt-^ Grand Total Awarded)
$234,965
tgures are roun o eneares
O&OW026 City Council Agenda 341

ATTACHMENT 3
06/08/2026 City Council Agenda 342

Pr
2026 SUBMIT TO—. CITY OF YUCAIPA
FISCAL YEAR: GENERAL SERVICES/CITY CLERIC DEPARTMENT

3.4272 YUCAIPA BLVD.

DATE SUBMITTED: 04/1712026 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. rNotp• Financial grant awarded funds will require 100% financial match by the applicant. For example, if your total programlproject cost is S1,00, 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 applicant's match of funds.

Name of Applicant/Organization: Active Church
Applicant/Organitation 12954 Bryant St, Yucaipa, CA 92399 Mailing Address:

Applicant/Organization Phone Number: 9097971108
CONTACT(1) Ryan Sanchez

NAME PHONE NUMBER
ryan@activechurches,com
E-Mail
CONTACT (2) Joseph Valenzue(a

NAME PHONE NUMBER
[email protected]
E-Mail
06/08/2026 City Council Agenda 343

YES NO
is your organization located in another community? Z
Will the program/event take place in another community? F7 7 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.

Your organization must be an established 501 (c) to be considered for Community Activity Grant funding.

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

YES No
Is your organization a 501 (c)? W1 Li
If so, please provide Tax ID# and attach all supporting 95-298 1752 Ze documents.

Does this application include submittal of YES No
documentation verifying 501 (c) status? 10
How long has your 501 (c) organization been in existence? 1960 Number of employees working for organization? 15
Number of volunteers working for organization? 300
Is a current City Council Member on your board?
How many Yucaipa residents does your organization 3000
currently serve?
YES NO
21 Does the organization charge admission, membership YES No fees, due, etc.? 1:1Z
If yes, please describe:
2 06/08/2026 City Council Agenda
344

Name of the program/event: Trunk or Treat
Date(s) of the program/event: 10/31 /2026
Total estimated cost for program/event: $10,000
Describe the program/event that the organization is seeking support for:
(Attach any eventlprogram promotional materials associated with the programlevent) Active Church has hosted its annual Trunk or Treat event every Halloween night since 2016.

What started as a small community gathering has grown into one of the largest free family events in Yucaipa, drawing approximately 4,000 attendees each year. The event takes place on our campus on Bryant Street and features over 50-70 decorated trunks, thousands upon thousands of pieces of candy, live music, and interactive experiences for children and families, alongside small businesses which came as vendors.

What is the goal of this program/event and how will it positively impact the community? The goal of Trunk or Treat is to provide Yucaipa families with a safe, free, and memorable Halloween experience. For many families, especially those with young children, trick -or -treating in neighborhoods raises safety concerns around traffic, visibility, and unfamiliar environments.

Trunk or Treat offers a well -lit, supervised, walkable alternative where kids can enjoy Halloween in a secure setting. Over 10 years, this event has become a staple of the Yucaipa community. It draws families from across the city, creeating a gathering point where neighbors connect with neighbors. For families facing financial hardship, it provides an experience their children can enjoy without any cost barrier. Active Church will be abte to address the growing logistical demands that come with serving 4,000+ attendees, particularly traffic safety on Bryant Street and ensuring we have enough supplies to serve every family that shows up.

Program/event primary target population (check all that apply):
©
Children or Youth
©
Entire Community
Homeless
❑ tow Income
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) YES NO
❑ ❑
Administrative Approval
YES NO
Estimated attendance 1000+ persons © ❑ THIS BOX IS FOR STAFF USE ONLY Alcohol Service YES NO
[excluding Community Centers & YPAQ ❑ © This event requires City Council Approval: ❑ ❑ Street Closure • Traffic Management © ❑
3 06/08/2026 City Council Agenda
345

Please identify what your organization is seeking:

YES NO
Financial Support: V] ❑ $3,500
In -Kind Support: $ $
OTIReassigned Staff CS/Rental
Total Amount $ $ 3,500 $
of Request
In -Kind Financial Support
YES NO
$300 SEP Fee Waiver: ❑ W1
Scherer other
Community Center
$ 3,500 $3,500
S300 SEP Fee Financial Match Total Overall
Waiver Request
Provide a detailed description of how the financial support will be used:

The event is completely free and open to all Yucaipa residents. Active Church funds the entire event at an annual cost of approximately $10,000, with no admission fees or charges of any kind. We are requesting $3,500 in grant funding to enhance this year's event in three key areas:

Traffic Management ($1,000)
On -Site Safety Team ($1,000)
Experience Enhancements ($1,500)
Total event cost with grant funding: $13,500. Active Church's direct financial investment:
$10,000 (exceeding the 100% match requirement). If in -kind suppport can be offered for traffic, that would be greately received and honored as well!
Describe any City Funding received by your organization in the past three years (required)? In -Kind
Program Support
financial
Support
53 o SEP
Fee Waiver
bate Received Total Received
❑
❑
❑
$
❑
❑
❑
$
❑
❑
❑
$
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the last three years?
Funding Source Amount Received Date Received
$
$
$
4 06/08/2026 City Council Agenda 346

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.
_�e�
Provide Hope Center Director 04/17/2026
Signature Title Date
Date Received: L4 /'Z'� f J'A'a Date Reviewed:

Amount Funded: City Council Meeting:

Type of Grant '"'Kind Financial 5005EP
❑ Support ® support ❑ Fee3Waiver
Date City Council received follow-up report:
06/08/2026 City Council Agenda
347

STATE 01: CALIFORNIA
Office of the Secretary ofState

STATEMENT OF INFORMATION

CA NONPROFIT CORPORATION
California Secretary of State
1500 11th Street
Sacramento, Caldornia 9sa 14
(916) 653 3516
Entity oetats
Co"ration Name
Entity No.

Formed I n
Biree[Addfess ofCadornia Pro- pal p`re of ,,.orporat+o, Street Address of California Office
MS&g Address of Cgrpaiatin
Maiiing Address
Attention
afticers
1111111111111111111111111111111111111111111111111111111111111111111111111 ea2022aa40729
=or Office Use Only
-FILED -
File No.: BA20220040729
Qate Filed: V1312022

ACTIVE CHURCHES NETWORK
d50S739

CALIFORNIA
12954 BRYANT ST
YUCAIPA. CA 92399
12954 BRYANT ST
YUCAIPA CA 92399
Tina Collins
❑fh(Ger Na.*e
Officer Addie�-s
PosAbnts)

MICHAEL PAUL FRISCH
12954 BRYANT ST
YUCAIPA, CA 92399
Chief Executive Officer
W96eFl NW4
SeWel,
3�w4pa' &A Wag
I
Addrtrortal 01kers
officer Name
Otfrcer Address
Position
Stated Position
0 Devyn R Goss
Chairperson of Board
0 Jonathan R Florence
Vice President
Agent far Service of Process
Agent Name ROBERT BRDCKMAN
Agent Address
Emal N rY ft atiq n 5
Opt -in Email Nolificatians No, I do NOT want to receive entity n0fificatims via ernail. I prefer notifications by USPS rnail.

Electronic Signature
® By signing, I affirm [Wait Me information herein is true and correct and that 1 am authorized by California law to sign.

Tina Collins 04/1312022
Sigitature Da1e
Page t of
06/08/2026 City Council Agenda
KM

ATTACHMENT 4
06/08/2026 City Council Agenda 349

2026-27 SUBMIT TO: CITY OF YUCAIPA
FISCAL YEAR: GENERALSERVICES/CITY CLERKDEPARTMENT
34272 YUCAIPA BLVD.

DATE SUBMITTED: 4-16-26 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: 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.

EIe prepared to show proof of program/project cost in your Wrap-up Report JAccountability Report), detailing the applicant's match of funds.

Name of Applicant/Organization. Casey Dickerson, Kids Pastor, Active Church Applitant/Oyganitation 12954 Bryant st. Yucaipa, CA 92399 Mailing Address:

ApplicanVOrganization Phone Number: 951-415-6951
CONTACT (1) Casey Dickerson
NAME
Casey(a7activechurches.com
E-Mail
CONTACT (2) Joe Valenzuela
NAME
Joseph9activechurches.com
E-Mail

PHONE NUMBER

CITY OF MAIN
APR 19'26 pH3: �
06/08/2026 City Council Agenda 350

YES No
Is your organization located in another community? ❑❑
Will the program/event take place in anothercommunity? ❑ 191 Are you aware of any otherCity programproviding this service? ❑ Q If so, which one?
*lfyouanswered"Yes"toanyofthequestionslistedabave,yourrequestisnot eligible for the Community Activity Grant.

Your organization must be an established 501 {c) t❑ be considered for Community Activity Grant funding.

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

YES N4
Is your organization a 501 fc)? ® ❑
If so, please provide Tax ID# and attach all supporting 95-298 1752 documents.

Does this application include submittal of YES NO
documentation verifying 501 (c) status? X❑ ❑
How long hasyour 501 (c) organization been in existence? Since 1950's Number of employees working for organization? 13
Numberof volunteers working for organization? 250-300
YES NQ
Is a current City Council Member on your board? ❑
How many Yucaipa residents does your organization
currently serve? 3500-4000
Does the organization charge admission, membership YES No fees, due, etc.? ❑ ❑X
If yes, please describe:
x
Z
06/08/2026 City Council Agenda
351

Nameof the program/event:

Date(s) of the program/event.

Kids Blitz
June 9th-11th 2026
Totalestimatedcost for program/event: $15,000
Describe the program/event that the organization is seeking support for:
(Attach any event/program promotional materials associated with the program/event) Kids Blitz is a free three -night summer experience for children hosted by Active Church on Bryant Street in Yucaipa. Running June 9-11 from 6:00-8:30pm each evening, Kids Blitz gives kids a high energy, camp -style experience complete with live music, team competitions, games, interactive rotations, live entertainment, and snacks - all at no cost to families.

No in its eighth year Kids Blitz has grown steadily since 2018 and currently serves approximately 400 children each summer. The program serves children in Transitional Kindergarten through 5th grade and is planned and run by over 200 volunteers. Kids are placed on teams and rotate through activities each night, creating the feel of a multi -day summer camp - completely free and held in the evening so working families can participate.

What is the goal of this program/event and how will it positively impact the community? Over eight years, Kids Blitz has become an event that Yucaipa families build their summer around. Children return year after year. For three nights, every kids who walks through the door has a team, has a place, and is known by name by the adult volunteers surrounding them.

In a community where summer options for Kids are limited and often expensive, Kids Blitz provides something that cannot be replicated at the that scale for free anywhere else in the city.
program/event primary target population (check all that apply}:
0 Children or Youth ❑ Entire Community F1 Homeless ❑ Low Income Women MPersons with Disabilities Seniors 7 Victims 7 Welfare Recipients Please answer the following to determine if your program/event requires a Special Event Permit (SEP):

YES NO
Estimated attendance 300-999 personsLlnJ
Amplified Sound ❑
[excluding Special Event Facilities] FRI
WA k'IH
Estimated attendance 1000+ persons El ❑X
Alcohol Service ❑
{excluding Community Centers & YPAQ
Street Closure . Traffic Management ❑ —X
THIS EOX 15 FOR STAFF USE ONLY
This event requires City Management/ YES NO
Administrative Approval: ❑ ❑

THIS BOX IS FOR STAFF USE ONLY
YES
NO
This event requires City Council Approval: ❑
❑
3 60 2026 ty unc gen
352

Please identify what your organization is seeking:

YES NO YES NO
Financial Support: ❑X ❑ $ $2000 $300 SEP Fee Waiver: X ❑ In -Kind Support: $ $ $ $
OT/Reassigned Staff CS/Rental Scherer Other
Community Center
Total Amount
of Request $ $ $2000 $ $ $15,000 $ $2000
In -Kind Financial Support 5300 SEP Fee Financial Match Total Overall Waiver Request
Provide a detailed description of how the financial support will be used:

The $2,000 in grant funding will go directly toward improving the experience for every child who attends - getter food and higher - quality activities across all three nights. Active Church's $15,000 investment covers the full cost of production, staffing, entertainment, and operations. This grant simply helps us serve Yucaipa's kids better.

Describe any City Funding received by your organization in the past three years (required)? In -Kind
Financial
$300 SEP
Program support
Support
Fee Waiver
Date Received Total Received
NIA ❑
❑
❑
$
❑
❑
❑
$
❑
❑
❑
$
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the last three years?
Funding Source Amount Received Date Received
NIA $
H
$
4 60 2026 ty unc gen
353

Casey Dickerson
Signature
Active Church Children's Pastor 05/01/2026
Title
Date Received: CA Date Reviewed:

Amount Funded: !• �-( City Council Meeting:

In -Kind Financial 5300 SEP
Type of Grant: Support Support ❑ Fee Waiver
Date City Council received follow-up report:

Date
5 6 0 2026 ty unc gen
354

STATE OF CALIFORNIA
Office of the Secretary of Stare

STATEMENT OF INFORMATION
CA NONPROFfr CORPORATION
California Secgetary of state
1500 11ih Sheet
Sacramento, California 95814
(916) 553-3516
III�IYIIIINI�IRIYIYIIIfI�ll�ll�llll IIIIInNI 11IlNnllll BA20220040729
For Offim Use Only
-FILED -
Pie No.: BW22MO729
Date Fled: 4113022
Ercty Oet"s
Corporation Nyrrte

ACTIVE CHURCHES NETWORK
Entity No.
0505739
Former! In

CALIFORNIA
Sheet Address or Cafiur nia PT nr pal of re al k.orporaow Street Address of CWiforrua puce
12954 BRYANT ST
YUCAIPA. CA 92399
Mailing Address of Cap ratior
Mailing Address
12954 BRYANT ST
YIJCAIPA, CA 92399
Attention
Tina Collins
officers
ORrcer Nacre
Officer Address P0SK9ntgj

MICHAEL PAUL FRISCH
12954 BRYANT 5T
Chief Executive Officer
YIJCAIPA, CA 92M
eR-INat i�+
t
9 Seem!i►
Addltartal officers
Officer Name
Otker Address
P05404
Stawd POsban
0 DevYn R Gass
Chairperson of Board
0 Jonathan R Florence
Vice President
Agent for Service at Process
Agent Name

ROBERT BROCKMAN
Agent Address
Ema1 Nobkatbrts
Opl-in Email Notifications
No, I do NOT want to receive entity notifications via email. I Prefer notifications by LISPS mail.

Electronic Signature
® By signing, I affirm tnai tree information herein is true; and Correct and that I am authorized by California law to sign.

Tno Collins
W312022
Signature
Date

Page 1 of 1 ends

6 0 2026 ty unc gen 355

ATTACHMENT 5
6 0 2026 ty unc gen 356

2026-2027 SUBMIT TO: CITY aF YUCAIPA
FISCAL YEAR: GENERAL SERVICESICITY CLERIC DEPARTMENT
34272 YUCAIPA BLVD.

DATE SUBMITTED : 4/28/26 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: Financial grant awarded funds will require 100% financial match by the applicant. For example, if your total programlproject cost is $1,000, your financial grant request should be for no more than $500.

Be prepared to show proof of programlproject cost in your Wrap-up Report (Accountability Report), detailing the applicant's match of funds.

Name of Applicant/organization: Childhood Cancer Foundation of Southern California, Inc.

Appiican t/Organization 330 Alabama Street, Suite K, Redlands CA 92373 Mailing Address:

Applicant/Organization Phone Number: 909-253-1608
CONTACT (1) Angelica Tapia 909-253-1608

NAME PHONE NUMBER
[email protected]
E-Mail
CONTACT (2) Stephanie Avila 909-253-1608

NAME PHONE NUMBER
[email protected]
E-Mail

CITY OF YUCAI
W 29 126 pm3*C
60 2026 ty unc gen
357

YES No
Is your organization located in another community?❑ ❑
Will the program/event take place in another community? E Q Are you aware of any other City program providing this service? Q 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.

Your organization must be an established 501 (c) to be considered for Community Activity Grant funding.

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

YES NO
Is your organization a 501 (c)? .❑LJ
If so, please provide Tax ID# and attach all supporting 33_0536599 documents.

Does this application include submittal of YES No
documentation verifying 501 (c) status? 0
How long has your Sol (c) organization been in existence? 44 years Number of employees working for organization? 3
Number of volunteers working for organization?a00{
YES NO
Is a current City Council Member on your board? ❑ ❑�
How many Yucaipa residents does your organization 171
currently serve?
Does the organization charge admission, membership YES No fees, due, etc.? ❑ ❑�
If yes, please describe:
2 gen
358
6 0
2026
ty unc

Name of the pr❑gramievent: Spring EGGstravaganza
Date(s) of the program/event: March 13, 2027
Total estimated cost for program/event: $17,500
Describe the program/event that the organization is seeking support for:
(Attach any event/program promotional materials associated with the programlevent) We are kindly seeking in -kind support of the Amphitheater and Large Shelter 2 at Yucaipa Community Park for our Spring EGGstravaganza, a family Easter event for families who have a child with cancer. We have found these facilities to be ideal for hosting our event, as they provide a safe, open environment for children and their families to enjoy. The event creates opportunities for connection, relief, and positive shared experiences during a challenging time.

What is the goal of this programlevent and how will it positively impact the community? Our goal is to help families that have a child diagnosed with cancer feel less isolated, giving them a way to connect with other families going through the same journey in a relaxed and safe environment. The event provides opportunities for the community members to volunteer and give back. This event positively impacts the community by promoting inclusion, supporting family bonding and creating a safe, joyful experience for children and families.

Programlevent primary target population (check all that apply):

Z
Children or Youth
Entire Community
❑
Homeless
Z Low Income
women
Q
Persons with Disabilities
seniors
❑
Victims
❑ Welfare Recipients
Please answer the following to determine if your programlevent requires a Special Event Permit (SEP):

YES NO THIS BOX 15 FOR STAFF USE ONLY
Estimated attendance 300-999 persons ❑.� YES No
This event requires City Management) � ❑
Amplified Sound Administrative Approval:
[excluding Special Event Facilities] Z
YES NO
Estimated attendance 1000+ persons ❑ Z THIS BOX IS FOB STAFF USE ONLY YES NO
Alcohol Service ❑ 7 This event requires City Council Approval: ❑ {excluding Community Centers & YPAQ 11
Street Closure - Traffic Management ❑�
x. _
0 3
60 2026 ty unc gen
359

Please identify what your organization is seeking:

YES NO YES NO
Financial Support: ❑ 0 $300 SEP Fee Waiver: 0 ❑
In -Kind Support: $ $ 950 $ $
OT/Reassigned Staff CS/Rental Scherer other
Community Center
Total Amount $ 950 $ $ 300 $ $ 1,250
of Request In -Kind Financial Support $300 SEP fee Financial Match PP Total overall
Waiver Request
Provide a detailed description of how the financial support will be used:

No financial support is being requested.

Kindly requesting in -kind donation for amphitheater, large shelter 2 and SEP fee.

Describe any City Funding received by your organization in the past three years (required)? Program
In -Kind
Support
Financial
Support
S300 SEP
Fee Waiver
Date Received
Total Received
Spring EGGstravaganza 2026
0 ❑
❑
6/12/25
$1,050
Spring Egg Hunt 2025
6/11/24
$1,000
Spring Egg Hunt 2024
❑
❑
6/28/23
$1,000
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the last three years?
Funding Source Amount Received Date Received
In -Kind Donations (food, activity tables, egg hunt, etc) $ 15,300.00 3/1/2026 Monetary Donations from Individuals
$ 950.00 12/13/2025
$
4 60 2026 ty unc gcn
360

Program Director
Title
Date Received: tfl I,,) pate Reviewed:

Amount Funded: City Council Meeting:

Type of Grant: O'Kind Financial $300 SEP
Support ❑ Support ❑fee Waiver
Date City Council received follow-up report:
4/28/2026
Date
7 6 0 2026 ty unc gen 361

CHILDHOOD CANCER FOUNDATION
of SOUTHERN CAUwRNIA, INC.

April 28, 2026
Dear friends at The City of Yucaipa,
First, I would like to extend a sincere and heartfelt 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 EGGstravaganza to be held on March 13, 2027, Receiving non-profit status in September of 1981, Childhood Cancer Foundation of Southern California, Inc. (CCFSC) is now more than 920 families strong committed to serving children with cancer and their families throughout Southern California emotionally, financially, educationally and with emergency assistance. The Spring Egg Hunt is an excellent opportunity for the families to interact in a relaxed setting and enjoy an activity with other parents and families experiencing childhood cancer. The Egg Hunt has an average attendance of 150 patients, siblings and parents.

Every two minutes a parent hears the devastating news, "Your child has cancer." With these words, normal life stops and a difficult newjourney 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) 253-1608 Childhood Cancer Foundation is a 501c3 Registered Non -Profit Organization, 33-0536599.

Respectfully,
Program Director
"lNheYe there LS LLCAkt, there is lope.'
P.O. BOX 1663 LAMA LINDA, CA 92354 I (909) 253-1608 1 www.ccfsocal.org 6 0 2026 ty unc gen 362

City of Yucaipa Community
PHONE:(909) 790-7460
Services
PAk:(909) 790-2589
34272 Yucaipa Blvd
EMAIL:communityservices@yucaipaorg
Yucaipa, CA 92399
Orgar&ation Name
Childhood Cancer Foundation Of Southern
Calif. - 27
Customer Type
Non-Prcft (NR)
Orgmtz ton Addran
PO Box T663
Loma Linda, CA 92354
Agent Name
Angelica Tapia
Sj+stem User
Karen Ruiz
Easter Egg Hunt
Booking Summary

COMMILINITY
Park:,
5ER1110E5
Bge lert
Permit # FSM
Stahm Tentative
Date of lasun Apr 7, 202611:55 AM
Expiration Date Apr 7, 2027
Organization Phort6l
-
Numbar
Horne RW* NurrdW -
EffWAdCkM
Rental Fee
5950.00
Discounts
$0.00
Subtotal
$960,00
Deposits
$100.0o
Deposit Discounts
$0.00
Total Permit Fee
$1,050.00
Total Payment
$0.00
Refunds

50.00 Balance
$1,050,00
2 resource(s) 2 hooking(s) 8tbti0d! $LDS 0

START DATE/TIME

END DATE/TIME
ATTENDEE AMT W10 TAX
Sat, Mar 13, 2027 7:00 AM
Sat. Mar 13, 2027 8:00 PM
250 S0.00
Resource level fees
$700,00
Deposit
$100.00 j Each K 1
$100.00
Rental - Daily
$600.4c Day x t
$600.00

START DATEFIME
END DATEfTiME
ATTENDEE AMT W10 TAX
Sat, Mar 13, 2027 7:00 AM
Sat Mar 13, 20278:00 PAA
1 $0,00
Resource level fees
$350.00
Pents3 - Da.,iy
$350.00 Day X 1
$350.0C
Custom Questions

QUESTION ANSWER
# R8526 SbOM Tentative Pape 1 of 3
6 0 2026 ty unc gen 363

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 pernvtted at designated Acknowledge shelters. Community Park; Shelters Z 3, 4, & 7 Ave I Park: Shelters 1, 2, 3, 4 7th Street Park: Shelters i, 2, 3 Wildwood Park: Shelter 1
I acknowledge and agree the following Bounce House rules: l)Bounce houses are to be Acknowledge set up only by the bounce house company. 2)Bounce house companies wi11 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)Bcunce 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: 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'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 Halder/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 Hoider/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 Acknowledge and City organized activities shall have priority use over all requests. Sufficient prior notification of canceled requests will be given by the City when possible.

I agree and acknowledge to follow the following park shelter rules: 1) No food trucks Acknowledge permitted in parks or parking lot 1) No amplified sound permitted. 2) Smoking is prohibited in all City parks and facilities (reference City Park Ordinance No. 256). 3) Alcoholic beverages prohibited. 4)No wood burning campfires or propane grills permitted. Charcoal only. 5)NO VEHICLES ARE ALLOWED IN CITY PARKS, ON TURF, OR ON WALKWAYS.

What is your type of event?
Other (May require approval)
Will there be a bounce house? If yes, I acknowledge and agree that bounce houses 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.jotlyjurnps.net or (877)694-1994 Jump N lump www. jumpnjump.com or (909)873-8487
Deposit
a R8526 Status Tentative Page 2 of 3
6 0 2026 ty unc gen 364

EVENT RESOURCE DEPOSIT FEE CHARGE
Easter Egg Amphitheater Deposit $100.00
Hunt
Payment Schedules

DUE DATE AMOUNT DUE
Feb 27, 2027 $1,050.00
# R8526 Stems Tentative

TAX AMOUNT PAID REFUNDS BALANCE
$0.00 $0.00 $0.00 $100.00
Original Balance: $1,050.00 Current Balance: $1,050.00

AMOUNT PAID WITHDRAWAL ADJUSTMENT BALANCE
$0.00 $0.00 $1,050.00
Pups 3 of 3
6 0 2026 ty unc gen
365

` YID IQ Department of die Treastery
J. Internal Revenue Service
In reply refer to: 044186].293
OGDEN LIT 84201-0038 Mar. 12, 2009 LTR 4168C En
33-0546599 000000 00 OOD
00029688
HODC: TE

CHILDHOOD CANCER FRUNDATIDN OF

SOUTHERN CALIFORNIA INC
P❑ 81311 1663
_ LOMA LINDA CA 92354-1663
002488
Employer Identification Number: 33-0536599
Person to Contact: Erin Johnson
Toll Free Telephone Number: 1-87'I-829-5500
Dear 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)Cvi].

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 of they meet the applicable provisions of sections 2955, 2106, and 2522 of the Code.

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

Sincerely yours,
Debcrah Hingham
Accounts Management I
Monday April 20 2009.max
60 2026 ty unc gen
366

EGGSTRAVAGANZA
Saturday, March 13, 2027

YUCAIPA COMMUNITY PARK
34900 OAK GLEN RD, YUCAIPA CA 92399
1 1 AM - 2PM
Lunch - Giveaways - Egg Hunt and more!
FAMILIES MUST PRE -REGISTER BY FEBRUARY 20
www.ccfsocal.org/egg
0 60 2026 ty unc gcn
367

ATTACHMENT b
6 0 2026 ty unc gen 368

FISCAL YEAR., L� rr� r SUBMIT TO: CITY OF YUCAIPA

GENERAL SERVICESICITY CLERIC DEPARTMENT
34272 YUCAIPA BLVD.

DATE SUBMITTED:

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: 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 applicant's match of Funds.

Name of ApplicantfOrgarixation: &O'V4ex1wv�s�0ckt�S
Mai ling Address: tian V� W l� � YNA S � I ' �
tLJ ,,� ti �cu �
Mailing Address: )
, 42-399
ApplicanVOrganixation Phone Number: qoc( i;3s� — 9 L4 3a CONTACT(1) -DoNrinq � mQ
NAME
Wall
CONTACT (2) Token l- 4�1� f Y. _ � ftoon

NAME PHONE NUMBER
U
6 0 2026 ty unc gen 369

YES NO
Is your organization located in another community? ❑ Z
Will the program/event take {dace in another community? ❑ 91 Are you aware of any other City program providing this service? ❑ 91 if so, which one?
*If you answered "Yes" to any of the questions listed above, your request is nat eligible for the community Activity Grant.

Your organization must be an established 501 (c) to be considered for Community Activity Grant funding.

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

YES NO
Is your organization a 501 (c)? ® ❑
tf so, please provide Tax II]# and attach all supporting LA L-242�59(o9 documents.

Does this application include submittal of YES No
documentation verifying 501 (c) status? ❑ ❑
Now long has your 501 (c) organization been in existence? t I ao I Number of employees working for organization?
Number of volunteers working for organization?
YES No
Is a current City Council Member on your board? ❑
How many Yucaipa residents does your organization 3 ejo Q -a rnonA'� currently serve? J
Does the organization charge admission, membership YES NO 'Fees, due, etc.? � ❑
If yes, please describe: -��ere 1S a J�cr j � S��G�a1 e, \��` �0 r SGNIoo 5 C,�n & +OA&�er C,n a& A
n 5 lccU�� 1055e5 W'� o er
Pla• c s `E1ke- P06111c
ck � 5o
6 0 2026 ty unc gcn 370

Name of the program/event: -Tb &�Xer- -tSey)5ocj
Garden-Fencir�g
Date(s) of the program/event: j1 c3 Q 3 2D2—[p
Total estimated cost for program/event: '95 f aD
J
Describe the program/event that the organization is seeking support for:
(Attach any eventlprogram promotional materials associated with the pro ram/event) tAlvlcl. 0. � � C.�� C� ,l-r�un c� � r• s ►rf-�cc � l e C,h I �d rah � C6 ri �5 +o Y-5
What is the goal of this program/event and how will it positively impact the community? 1-0 (.� ,ve 5 im GL\ l e r Gh 1 1 & r-e-r) OL S Ima 11'er- earn in .

Program/event primary target population (check all that apply):
®
Children or Youth ZlEntire Community
❑ Homeless
® Low Income
Persons with Disabilities ❑
Seniors
❑ victims
© Welfare Recipients
KI
PI ay3('nUP3
1Z Women
Please answer the following to determine if your programlevent requires a Special Event Permit (SEP):

YES NO THIS 8OX 15 FOR STAFF USE ONLY
Estimated attendance 300-999 persons ❑ ❑ YES NO
This event requires City Management) ❑ t.,q.,
Amplified Sound Administrative Approval:
(excluding Special Event Facilities) ❑ ❑
YES NO
Estimated attendance 1000+ persons ❑ ❑
Alcohol Service ❑
(excluding Community Centers & YPAQ
Street Closure - Traffic Management ❑ ❑
I L16 BOX 15 MP. ,TAFF 115E ONLY
YES No
This event requires City Council Approval: ❑
6 0 2026 ty unc gen 371

Please identify what your organization is seeking:

YES NO YES No
Financial Support: � ❑ s 2'J 5 $add SEP Fee Waiver:ff ❑ In -Kind Support: $ _f)_ $ - $ —q9-~ $ ^>�
OT/Reassigned Staff CS/Rental Scherer Other
Community Center
Total Amount $ J S S �� G� ��
of Request
In -Kind Financial Support $300 SEP Fee Fir►�ancial Match Total Overall Waiver Request
Provide a detailed description of how the financial support will be used:
-Tv bu►1A -70
5e ,soc'y g4.r-&ex-%s 1ptiCc--1 rou.An6 ►�� Gc,c�� 5 P lay 410vses �rt �m�,<r,�,-�4on Tay•
Describe any City Funding received by your organization in the past three years (required)? Program
to -Kind
support
Financial
Support
S300 SEP
Fee Waiver
Date Received Total Received
G rune,
❑
®
❑
�7 r 2,n23
C.►�� GrGn�
❑
®
❑
- ao_4 $
❑
FC7
❑
7 /do.25 $
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the last three years?
Funding Source Amount Received Date Received
S
S
E
6 0 2026 ty unc gen 372

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 Dattl
Date Received:
date Reviewed:

Amount Funded:

City Council Meeting.
of Grant:

Ifi-KindType
❑ Suppo-r[
.pp.r
Support
1 Fiupporti
Wii p
❑Fee Waiver
Flee
Date City Council received follow-up report:
:7
6 0 2026 ty unc gcn 373

pBPAiLi'NIBNi OF Tim TREASI�IZY
�L g$V S$RSTICS
p. ❑_ BOX 2508
C-MCTNNAT:E , OH 45201
BTaployer identification Number:
46-2428869
Date:

DLN :
17053240328033

GARDENWORKSFORKIDS
Contact; Person'!
ID# 31052

C O POSEMA SOLON

SAY Q WAIF
Contact Telephone Number:
(877) 929--SSOO
Accounting Period. Ending:

December 31
public Charity Status:

Form 990 Prequired
Yes
Effective Date of Fbremption:

February 13, 2013
contri-bur-ion Deductibility:
--
Yes
Addendum applies:

Lao
Dear Applicant;
f
TAe are pleased to inform yo- that a an rev e, of your a0p3 .,-_atlon for tax exerupt status ve have determined that you are e,e- t from Federal income tax under section. 5 01 (C ) (3) of the Internal Revenue Code- COrrltr'ttions to you are deductible der section 170 of the Code. You are alse qualified to receive tax deductible bequests, dev-'tsQs, transfers [ar gifts urde7r section 2Q55, 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 - of
Omani .ation.a exempt sander section 5a1 (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 sect-ion(s) listed in the heading of this letter.

Please see enclosed publication 4221-PC"_, CoWii.ance Guide fox: 5771(c) (3) ?Ublic Cbarit~ies, for sogne b)elpfvl Lnformaation about: your responsibilities as az exempt organization_
h
:.et a 94. . J.. �..
6 0 2026 ty unc gcn
374

ATTACHMENT 7
6 0 2026 ty unc gen 375

- 31
APR 29'2G AHS L
2026to 2Q27 SLIBMIT TQ_ CITY OF YUCAIPA
FISCAL YEAR: GENERAL SERVICE51CITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

DATE SUMITTED: 4129/26 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.

Nate: 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 applicant's match of funds.

Name of Applicant/organization: Grace Point Fellowship
Applicant/Organization 34784 Yucaipa Blvd, Yucaipa CA 92399 Mailing Address:

ApplicantlOrganization Phone Number: 909-790-1971
CONTACT (1) Randy Bailing

NAME PHONE NUMBER
pasta rrandy,5g pfyucai pa.org
E•Mail
CONTACT (2) Lidian Mansinon
NAME PHONt NUMBER
ImansinonCdgpfyucaipa.org
E-Mail
60 2026 ty unc gen
376

YES NO
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.

Your organization must be an established 501 (c) to be considered for Community Activity Grant funding.

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

YES NO
Is your organization a 501 (c)? ✓❑
If so, please provide Tax ID# and attach all supporting 951875979 documents.

Does this application include submittal of YES NO
documentation verifying 501 (c) status? 0 ❑
How long has your 501 (c) organization been in existence? 103 years 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:
21 3a+
YES
❑
NO
Z
YES
❑
NO
0 60 2026 ty unc gcn
377

Name of the program/event. Love Yucaipa/Calimesa 2027
Date(s) of the program/event: April 17, 2027
Total estimated cost for program/event: $8,000.00
Describe the program/event that the organization is seeking support for:
(Attach any event/program promotional materials associated with the program/event) What is the goal of this program/event and how will it positively impact the community? Program/event primary target population (check all that apply):
❑
Children or Youth ❑� Entire Community
❑ Homeless
❑ Low Income
Persons with Disabilities F1 Seniors
❑ Victims
❑
Welfare Recipients
❑
❑ Women
Please answer the following to determine if your program/event requires a Special Event Permit (SEP):

YES NO THIS BOX 15 FOR STAFF USE ONLY
Estimated attendance 300-999 persons YES No
This event requires City Management) ❑
Amplified Sound Administrative Approval:
(excluding Special Event Facilities)
YES NO
Estimated attendance 1000+ persons ❑ �✓
Alcohol Service
{excluding Community Centers & YPAC]
Street Closure - Traffic Management ❑ 0

THIS BOX IS FOR STAFF USE ONLY
YES _��N---❑qqq
This event requires City Council Approval: ❑ �[
3 6 0 2026 ty unc gen 378

Please identify what your organization is seeking:

YES NO YES NO
Financial Support: ❑✓ ❑ $ 4,000.00 $300 SEP Fee Waiver: 0 ❑ In -Kind Support: $ $ $ $
OTIReassigned Staff CS/Rental Scherer other
Community Center
4,-7b-0
Total Amount If -� $ 4,000.00 $ 300.00 g 4,000.00 $ -8;390.06-- of Request $ in -Kind Financial Support $300 SEP Fee Financial Match PP Total Overall
Waiver Request
Provide a detailed description of how the financial support will be used:

Describe any City Funding received by your organization in the past three years (required)? In -Kind
Program support
Financial
Support
$300 SE
Fee Waiver Date Received
Total Received
Community Activity Grant ❑
0 ❑ 8/19/25
$4,000.00
❑
❑
❑
$
❑
❑
❑
$
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the last three years?
Funding Source Amount Received Date Received
4 6 0 2026 ty unc gen 379

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 rant re uest.
�[, cam! n.7 �'S `.� � •� �? � ��
Signature Title 1 e
Date Received: LA IZA/Ey Hate Reviewed:

Amount Funded: City CounciI Meeting:

Type ¢f Grant, -In -Kind Financial MOSEP
y"" I S�ppar[ F21 Support ❑ leewai�er
Date City Council received follow-up report:
6 0 2026 ty unc gen 380

Name of the program/event: Love Yucaipa 2027
Date(s) of the program/event: April 17, 2027
Total estimated cost for program/event: $8,000.00
Describe the program/event that the organization is seeking support for: (Attach any event/program promotional materials associated with the program/event)
Love Yucaipa & Calinesa is a coordinated. citywide day of service designed to mobilize residents, businesses. non -profits, churches and community groups to address tangible needs within public spaces and community -serving properties.
• The initiative aligns with the City's priorities of enhancing quality of life, fostering civic engagement, and strengthening community partnerships.

Community Impact & Participation
• 23 service projects completed across Yucaipa and Calimesa (21 of 23 were in Yucaipa) • 340+ volunteers engaged in the rally and organized service efforts • Projects supported public parks, school campuses, senior mobile home parks, and nonprofit organizations.

Project Scope & Deliverables
Projects were developed in coordination with community leaders and focused on visible, high - impact improvements, including:
• Park and public space beautification (landscaping, debris removal, planting) • School campus enhancement and maintenance projects
• Painting and restoration of community -use structures • Assistance to senior residential communities (yard work, exterior improvements) • Installation of neighborhood community libraries in partnership with Kiwanis Partnerships & Collaboration
The 2025 event demonstrated strong cross -sector collaboration, including participation from:
• Civic and service organizations (e.g., **Kiwanis Club, Rotary International, Lions Clubs International)
• Local churches and volunteer groups
• Schools within the Yucaipa-Calimesa Joint Unified School District • Local businesses providing materials and in -kind support • Engagement with public safety personnel, including local fire departments 6 0 2026 ty unc gen 381

Community Engagement & Event Activation
The event launched with a coordinated kickoff rally designed to unify volunteers and recognize community partners. This gathering:
• Facilitated volunteer organization and project deployment • Promoted civic pride and awareness of community needs • Provided a structured environment for collaboration between residents and organizations Outcomes & Public Benefit
The event produced measurable and visible benefits aligned with municipal goals:
• Improved maintenance and appearance of public and community -use spaces • Increased volunteerism and resident engagement in civic activities • Strengthened partnerships between nonprofits, businesses. and local stakeholders • Delivered cost-effective community improvements through coordinated volunteer labor Future Growth & Alignment
Love Yucaipa & Calimesa continues to expand in both scale and impact. Future goals include:
• Increasing the number of service projects and volunteer participation • Expanding partnerships with city departments and community organizations ■ Targeting projects that align with identified community and municipal priorities What is the goal of this program/event and how will it positively impact the community?
The goal of Love Yucaipa & Calimesa is to mobilize residents, community organizations, and local partners in a coordinated, citywide day of service that addresses tangible community needs while strengthening civic pride and unity.

This program is designed to deliver visible, immediate improvements to public spaces and community -serving properties through organized volunteer efforts. By completing projects such as park beautification, school campus enhancements. assistance for senior communities, and support for local nonprofits, the event directly contributes to the City's priorities of maintaining safe. clean, and welcoming environments for residents.

Beyond physical improvements, the program fosters long-term community benefit by increasing civic engagement and strengthening partnerships between residents, businesses. nonprofits, and service organizations. It creates opportunities for individuals to take ownership of their community. resulting in increased volunteerism, stronger neighborhood connections, and a greater sense of shared responsibility for public spaces.

Additionally, the event provides a cost-effective solution for completing community improvement projects by leveraging volunteer labor and donated resources, maximizing the impact of limited funding.

Ultimately, Love Yucaipa & Calimesa positively impacts the community by:
6 0 2026 ty unc gen 382

• Enhancing the appearance and usability of public and community spaces • Supporting vulnerable populations through targeted service projects • Strengthening collaboration across community sectors
• Building a culture of service, unity, and civic pride that extends beyond the event itsel What would 2027 funds be used for?
2027 grant funds will be used to directly support the planning, coordination, and execution of Love Yucaipa & Calimesa as a safe, efficient, and high -impact citywide day of service.

Funds will be allocated in the following key areas:
• Project Materials & Supplies: Purchase of landscaping materials (mulch, plants, soil), paint, tools, safety equipment, and other supplies necessary to complete community improvement projects at parks, schools, senior communities, and nonprofit sites. • Volunteer Support & Safety: Provision of water, light refreshments. first aid supplies, signage, and safety materials to ensure a well -organized and secure experience for all participants.
■ Event Coordination & Logistics: Costs associated with event infrastructure, including staging support, sound equipment, volunteer check -in systems, project coordination, and site management.
• Community Outreach, Website & Advertising: Funding will support digital and print outreach efforts, including website hosting and maintenance (e.g.. loveyucaipa.com and lovecalimesa.com), online registration systems, social media promotion. targeted advertising, and printed materials to recruit volunteers and communicate event details effectively to the community.
• Project Leadership Development: Training and equipping project leaders to effectively manage volunteers and complete projects safely and successfully.

These funds will be leveraged alongside donated materials, volunteer labor, and partnerships with local businesses and organizations to maximize impact. This approach ensures that grant dollars are used efficiently while delivering measurable improvements to the community. 6 0 2026 ty unc gen 383

4130126, 8:00 AM
PermitContract
Permit
City of Yucaipa Community
Services
34272 Yucaipa Blvd
Yucaipa, CA 92399
PHONE'(909) 790a450
FAX:(909) 790-2589
EMAIL:cornmunityservices n yucaipa.org
organization Name Grace point Fellowship - 43
Customer Type Non -Profit [R]
Organization Address 34784 Yucaipa Blvd
Yucaipa, CA 92399
Agent Name Randy Selling
System User Dick Johnson
4r- COMMUNITY
qPr

SERVICES
{
4 �
Permit # R8573
Status Tentative
Date of Issue Apr 30, 2026
7:58 AM
Expiration Date Apr 30, 2027
organization Phone 1
Number
Home Phone Number
Email Address pastormndy@gpfyucaipaorg
Rental Fee
$5D0,00
Discounts
-$50.o0
Subtotal
$450,00
Deposits
$100,00
Deposit Discounts
$0.00
Total Permit Fee
$550.00
Total Payment
$0.00
Refunds
$0.00
Balance
$550.00
Lave Yucaipa Event
Booking Summary
1 resource(s) 1 beokhg(s) Subtotal: $550DO
START DATEITIME END DATE/TIME ATTENDEE I AMT W10 TAX
Sat, Apr 24, 2027 TOO AM Sat, Apr 24, 2027 8:00 PM 100 $0.00 Resource level fees $550.00
Custom Questions
QUESTION ! ANSWER
A. Any Cancellation of a rental less than 30 days will result in loss of 100% of the Acknowtedge rental fees and deposit (if appficable). B. Any cancellations prior to 30 days will result in a loss of 50% of the rental lees 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 shatter reservation. Refund request form must be submitted within 7 days after reservation to be honored. htips:Ilanprod.achve.com/yucaipa/ui.do?method=showPerrnitContract&permit_id=FO670EBCDB9AC W3 6 0 2026 ty unc gen 384

4130126. 8 : 0 0 AM PermitContract
I acknowledge and agree that bounce houses are only permitted at designated Acknowledge shelters. Community Park: Shelters 2, 3, 4, & 7 Ave I Park: Shelters i, 2, 3, 4 7th Street Park: Shelters 1, 2, 3 Wildwood Park. Shelter 1
I acknowledge and agree the following Bounce House rules:l]Bounce houses are Acknowledge to be set up only by the bounce house company. 2}Bounce house companies will be responsible for providing a generator for the inflation of the bounce house. The City does not provide electricity. The generator must be quiet rated at 6OdB or less and not generate noise in excess of City standards. 3]Bcunce houses are not allowed in City parks overnight.

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

I acknowledge and agree to: 1}permit Holder/Requestor(s) and event attendees Acknowledge 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.

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

I agree and acknowledge that the information provided to this application is Acknowledge 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 parse shelter rules! 1) No food Acknowledge trucks permitted in parks or parking lot. ij No amplified sound permitted. 2] Smoking is prohibited in all City parks and facilities (reference City Parts Ordinance No. 256). 3]Alcoholic beverages prohibited. 4]No wood burning campfires or propane grills permitted, Charcoal only. S)NO VEHICLES ARE ALLOWED IN CITY PARKS, ON TURF, OR ON WALKWAYS.

EVENT RESOURCE I DEPOSIT FEE I CHARGE I TAXI AMOUNT PAID I REFUNDS I BALANCE https:llanprod. active.com/yuca ipa/ui.do?method=showPermitContract&perm it_id=FOB70ESCOE39AC 213
6 0 2026 ty unc gen 385

4/30/26, 8:00 AM
Love Yucaipa
Event
PerrnitContract
Amphiti-eate Deposit $100.00 $0.00 $0.00 WDO $100.DO
r
Payment Schedules Original Balance: $550,00 Current Balance: $550.00

DUE DATE AMOUNT DUE AMOUNT PAID WITHDRAWAL ADJUSTMENT I BALANCE Apr 1Q 2027 $550.00 $O.DO $0.00 $550,00
https:llanprod.active.00mlyucaipalui.do?method=showPermitContract&permit id=FOB70EBCOE39AC 3i 3
6 0 2026 ty unc gen 386

rrrl, l f„i lii 5,4nlr .lrr 11r,•
E.O. 0a` 2508 111 repl.v refer to: 0249562363
Cinci11118t] OH f+5201 Mar. ]1, 2008 LTR 4167C E0
36-2181949 fl0QD00 00 000
00018017
SOOC: TE
IIAP rrS` GENLRAL CONFERENCE
2002 S ARLINGTON HFTCHTS RO
r+.

ARLING'ON TITS IL 60005-4102020
Cu�uloyer' Identificatian Number: 36-218194g
Person to contact : his. hierrill
;a11 Free lele;)hone Number; 1•-877.829-5500
liPelr I7)yIIaywr t
111as is in response to your- Mar. 04, 2008, request for inforr.:atinrti about yaur tax-exempt status.

OLS" records indicate th@t You were issued i; determination letter in 1972, and that you are currently exempt under section 50L(c)(3) of tile =nter•nal Revenue Code.

Based on the information supplied, we recognized the suhordinates t"l-Wed on the last you Submitted �s exempt from Federal income tax tinder sectiol3 501(c)f3) of the Cade.
❑o,iors tlrav t3rdrrct contributions to you as vr•ovided in section 170 of the Code. Bequests, lfegacies, devises, transfers, or gifts Lo you or for your 05e are deductible for Federal estate and gift tax p:,rposes if they meet the applicable provisions of Sections 2055, 2106 and 2522 or the Code.
[f yuu have arty questions, please call us at t[re telephone number shown ;ri the heading of this letter.

Sitic er•eIy yours,
Michele M,. Sullivan, finer. Mur .

AcCounts Hanagemeot Operations I
6 0 2026 ty unc gen 387

CONNECT • IGNITE -TRANSFORM
CONV..ARGE

WORLDWIDE
Baptist General Conference . 2002 S. Arlington Heights Road a Arlington Heights, [L 600054193 847/228-0200 ■ 800/3234215 . Fax 847/228-5376
May 29, 2012
First Baptist Church
34794 Yucaipa Blvd
Yucaipa, CA
92399
Re: Group Tax Exemption Inclusion
Enclosed please find three letters to show inclusion in the group tax exemption for Baptist General Conference, dlbla Converge Worldwide.

1. Certification Letter with your church's information

2. IRS Determination Letter dated March 31, 1972

3. IRS Affirmation Letter dated March 11, 2008
Please contact me at 847-879-3242 with any questions.

Sincerely,
Hope Williams
60 2026 ty unc gen
0 TON HEIGHTS ROAD *ARLINGTON

GHTS, IL
BAPTIST GENERAL CONFERENCE • 2002 S. RRLIN 800 /323/4215 a 947/226/ 0200 b AX'647r 226 6353776 May 29, 2012
TO WHOM IT MAY CONCERN:

This is to certify that First Baptist Church, located at 34784 Yucaipa Blvd Yucaipa CA, 92399 is included in the Baptist General Conference's group exemption letter issued by the Internal Revenue Service. Our group number is 2269. The Federal Employer Identification Number for First Baptist Church is 95- 1875979. First Baptist Church has been a part of the Baptist General Conference group exemption since December 17,1982. A copy of our Letter of Determination issued by the Internal Revenue Service is attached.

Sincerely,
Stephen Schultz
Chief Financial Officer
6 0 2026 ty unc gcn 389

Baptist General confe►ence 2002 S. Arlington heights Road 3121228.0200 8001323-4275 IP; Arlington Heights, u_ 60005
office of Business Affairs
December 22, 1982
First Baptist Church
34784 Yucaipa Blvd.

Yucaipa, CA 92399
Gentlemen:

I am in receipt of your letter of authorization requesting tax exempt status for First Baptist Church. Enclosed is a letter of certification verifying that you are a tax exempt affiliate. Also enclosed is a copy of the IRS letter of determination. These documents should be kept in the church file for use when applying for tax exemption.

If I can be of further assistance, please let me know.

Yours truly,
Richard S. Henry
Administrator of Business Affairs
RSH:vad
Enclosures
6 0 2026 ty unc gen 390

a
Address any reply ta:

Internal Revenue Service
❑a I In reply refer to:

A 00198il EP/30/2021A.a�
LBaptist General Conference
2002 South Arlington Heights Road
Arlington Heights, Illinois 60005
Date of Exemption: K*rCh 31 a 197 2
Internal Revenue Code Section: 501(op)
Gentlemen:

Thank you for submitting the information shown below. We have made it a part of your file.

The changes indicated do not adversely affect your exempt status and the exemption letter issued to you continues in effect.

Please let us know about any future change in the character, purpose, method of operation, name or address of your organization.

This is a requirement for retaining your exempt status.

Thank you for your cooperation.

S' erely your
Annie Barrett
Group Manager
Item Changed From To
Address 1233 Central Street 2002 South Arlington
Evanston, Illinois 60201 Heights Road
Arlington Heigh60UoI11•
Letter 976 (DO) (7-77)
6 0 2026 ty unc gen
391

First Baptist Church of Yucaipa
34784 Yucaipa Boulevard ■ Yucaipa, Califomia 92399 + Phone (714) 790.1971 Richard 13, Emmons
Senior Pastor
Everett Backlin
Pastoral Assistant December 17, 19B2
George W- Bedlion
Pastor of Christian Education
Floyd Bergfalk
Minister of Music
Russell 3- Snyder Baptist General Conference
Minister of Youth 2002 S. Arlington Heights Road
Michael G. Vanlaningham Arlington Heights, i l 1 i not s 60005 Minister, Pastoral Services
Kurt A. Ahistrom Attn : Richard S. Henry, Administrator of Business Affairs Business Administrator
Gentlemen:

The First Baptist Church of Yucaipa, Yucaipa,California wishes to be included in the group exemption letter which you requested from Internal Revenue Service.

We hereby authorize you to include us as an affiliate.

This letter rescinds our letter of December 3, 1982, since the Southwest Baptist Conference has informed us that they do not intend to renew its blanket exemption.

FIRST BAPTIST CHURCH OF YUCAIPA
1K,u'r4-jtA Ahistrom
Business Administrator
KAA/j n
"for the equipping of the Saints"
6 0 2026 ty unc gen 392

Osptlst Dsnerel Conference 2002 S. Arlington Heights Road 312a2g-0200 8001323-4215 Arlington Freights, IC 60005
Office of Business Affairs
To Whom It May Concern:

This is to certify that First Baptist Church, 34784 Yucaipa Boulevard, Yucaipa, California 92399 is now included as an affiliate in our annual group tax exemption letter to the Internal Revenue Service. Attached is a copy of the Church's letter of authorization on file in our office.

Also attached is a copy of the IRS letter ❑f determination.

BAPTIST GENERAL CONFERENCE
/ r �
by
Richard S. Henry
Administrator of Business Affairs
6 0 2026 ty unc gen 393

-4
Internal Revenue Service
❑atr M�3 197 in reply refer to :R 3 I l[ T.�,r�-rr
Baptist General Conference
1233 Central Street
Evanston, Illinois 60201
Gentlemen:

This refers to the information submitted for use
in determining; the status of your district conferences and affiliated churches for Federal income tax purposes.

In our ruling addressed to you on March 28, 1944,
under your former name The Swedish Baptist General
Conference of America, it was held that you are exempt
from Federal income tax under the provisions of suction 101(6) of the Internal Revenue Code of 1939, which
corresponds to section 501(c)(3) of the 1954 Code. This ruling; was applicable only to you and did not include
any of your district conferences and affiliated churches.

Based on the information supplied, we rule that your
district conferences and affiliated churches named in the

3.971 annual of the Baptist General Conference you submitted are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code, as it is shown that your
district conferences and affiliated churches are organized and operated exclusively for religious purposes.

We have further determined that your exempt district
conferences end affiliated churches are not private
foundations within the meaning of section 509(a) of the Code because they are organizations described in section 1'70(b)(1)(A)(i) of the Code.

Your exempt district conferences and affiliated
churches are not required to file Federal income tax
returns so long as the exempt district conferences and
affiliated churches retain a tax exempt status, un'css
they are subject to the tax on unrelated business income under section 511 of the Code. If the exempt district
conferences end affiliated churches are subject to this 60 2026 ty unc gen
394

Baptist General Conference - 2
tax, it will be necessary to file an income tax return
on Form 990-T. In this letter we are not determining
whether any of their present or proposed activities is
unrelated business as defined in section 513 of the Code.

Further your exempt district conferences and affiliated churches are not required to file the Return for Organi- zations Exempt From Federal Income Tax, Form 990, as they come within the specific exceptions contained in section 6033(a)(2)(A)(i) of the Code.

Organizations that are not private foundations are not
subject to the excise taxes under Chapter 42 of the Code.

However, your exempt district conferences and affiliated churches are not automatically exempt from other Federal excise taxes.

Your exempt district conferences and affiliated churches are not liable for the taxes under the Federal Insurance Contributions Act (social security taxes) unless such
district conferences and affiliated churches file a waiver of exemption certificate as provided in that Act. Your
exempt district conferences and affiliated churches are not liable for the tax under the Federal Unemployment Tax Act. However, your exempt district conferences and
affiliated churches are required to withhold Federal income taxes of their employees. Inquiries about the waiver of exemption certificate for social security taxes, or any questions concerning excise, employment, or other Federal taxes should be addressed to the District Director,
Internal. Revenue Service, 1114 Market Street, St. Louis, Missouri 63101, which is your key district for exempt
organizations matters.

Donors may deduct contributions to your exempt
district conferences and affiliated churches as provided by section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to ar for the use of your exempt
district conferences and affiliated churches are deductible for Federal estate and gift tax purposes under section
2055, 2106 and 2522 of the Code.

Each year, within 45 days after your annual accounting
period closes, please send us two copies of the following information about your district conferences and affiliated churches:
6 0 2026 ty unc gcn 395

Baptist General Conference - 3 -

1. A statement describing any changes during
the year in the purposes, character, or
method of operation of your district conferences
and affiliated churches.

2. A lisp of the names, mailing addresses;
including Postal ZIP Codes and employer
identification numbers (if required for group
exemption letter purposes) of district conferences
and affiliated churches on your group exemption
roster that during the year:
a. changed nerves or Address;
b. were deleted from the roster;
c. were added to the roster.

A directory of district conferences and affiliated
churches may be substituted for this list if it includes the required information and identifies the affected
District conferences and affiliated churches according
to the three categories above.

3. For district conferences and affiliated
churches added to the roster, a letter signed
by one of your principal officers containing
or attaching:
a. a statement that information upon
which your present group exemption letter
Is based applies to the new district con-
ferences and affiliated churches.
b. a statement that each has given you
written authorization to add its nsx+:e tc
the roster.
c. a list of those to which the Service
previously issued rulings or determination
letters relating to exemption, and;
d. e statement that none of the new district
conferences and affiliated churches are
private foundations as defined in section
509(a) ❑f the Code.
60 2026 ty unc gen
396

Baptist General Conference — 4 --

4. If applicable a statement that your group
exemption roster did not change during the year.

This ruling is not applicable to any of your
district conferences or affiliated churches organized
and operated in a foreign country.

This ruling aupersedes the rulings or determination
letters issued to any of your district conferences or
affiliated churches. You should advise them accordingly.

You should advise each of your exempt district
conferences and affiliated churches of the exemption and the pertinent provisions of this ruling.

The District Directors of Internal Revenue concerned
are being advised of this action.

Sincerely yours,
11L Tedesco
Chief, Rulings Section
Exempt Organizations Branch
Enclosure:

Rev. Prot. 68-13
for your information
Courtesy- copy of this letter
60 2026 ty unc gen
397

ATTACHMENT 8
6 0 2026 ty unc gen 398

FIKAL YEAR: 2026127 SUBMIT TO: CITY OF YUCAIPA
GENERAL 5ERVICESICITY CLERK DEPARTMENT
34272 YVCAlPA 11LVD.

DATE SLIBMMED: 40 4I29 ► UCAIPA, CA 92399
All sections of the application mast be retumed complete, anti ati supporting docurnentatlon must he Included as part of the submittal. Incomplete applicacitans received will de returned to the applicant.

Note: Financial grant awarded funds will require 100vahittancial match by the applicant. For example, if your total program/project cost Is 91,00, your financial grant reques, should be for no more than SSW.

Be prepared to show proof or progranniproject cost In your wrap-up Report (Accountability Report), detailing the appiicanVs match of funds.

Name of Applicantivrganiaation: Green Valley Christian ChurchlYucaipa Foursquare Church ApplicantlOrganixation 11656 Bryant St, Yucaipa, CA 92399 M a Ili ng Address:

Applicant/Organization Phone Number: 909-797-1526
CONTACT(l) Brenda Var Meter

NAME PHONE NUMBER
EAt. aII
CONTACT (2) Deb Vaughan
NAME
E-!rta I

PHONE NUMBER
APR 14'26 PsG:3
60 2026 ty unc gen
399

t
YES c .�
Is your organization located in another community? ❑ ✓❑ Will the programievent take place in another community? ❑ ❑✓ Are you aware of any other City program providing this service? ❑ 0 if so, which one?
"if you answered "des" _u any of the questions listed anode, your request Is Meligibie for the Community Activity Grant.

Your organization must be an established 501 (c) to be considered for Community Activity Grant funding.

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

YES NO
is your organization a 501 (c)? ❑✓ ❑
If so, please provide Tax 1D# and attach all supporting 95-1684062 documents.
laves this application include submittal of YES
0 documentation verifying 501 (c) status?
How long has your 501 (c) organization been in existence? 1977 Number of employees working for organization? 3
Number of volunteers working for organizations? 26
YES No
Is a current City Council Member on your board? ❑ R
How many Yucaipa residents does your organization 100
currently serve?
Does the organization charge admission, membership YES
fees, due, etc.?
If yes, please describe:
6 0 2026 - ty unc gen

Name of the program/event: G.I.F.T. Growing in Faith Together Date(s) of the program/event.- Third Wednesday of each month Total estimated cast for programlevent: $2000
Describe the programlevent that the organization is seeking support for:
(Attach any event/program prurn atlonal materials associated with the program leventI The program is called GIFT (Growing in Faith Together). It is held once a month on the third Wednesday of the month. We have music and a brief Bible study, then a food distribution. We are currently able to provide bread, milk, and sweets which are provided through our sister church in Colton. We hope to supplement these items with monetary donations. Our church members are also donating dry goods for the distribution. We have shelving and a small refrigerator in the pantry room. All are welcome. Groceries distributed on a first come, first serve basis while supplies are available. We have distributed from the pantry as people have expressed a need thru the church office.

What is the goal of this program/event and how will it positively impact the community? The goal of the program is to address food insecurity within our community.

Programlevent primary target population (check all that apply):
❑ Children or Youth ❑� Entire Community ❑ Homeless ❑ Low Income ❑ women ❑ Persons with Disabilities ❑ Seniors ❑ Victims ❑ Welfare Recipients Please answer the Following to determine if your program/event requires a 5pecial Event Permit (SEP):

YES NO
rMS fLO% IS FOR STJ.iF 115E O'il"
Estimated attendance 300-999 persons ❑ ►❑ This event requires City Management) YES NO Amplified Sound Administrative Approval: Li
(excluding Special Event Facilities) ❑ F/
YES NO
Estimated attendance 1000+ persons ❑ ❑
Alcohol Service ❑
(excluding Community Centers & YPAC)
21 Street Closure • Traffic Management ❑❑

THIS BOX IS FOR STAFF USE ONLY
YES NO
This event requires City Council Approval: ❑
?-
3 6 0 2026 ty unc gen
401

Please identify what your organization is seeking:

YES NO YES NO
Financial Support: ❑✓ ❑ $1000 $300 SEP Fee Waiver:

In -hind Support: $ $ $ $
OT/Reassigned Staff CSIRental Scherer Other
Community Center
Total Amount --cam - c r)
s $1000 - — s sr�B-- I ,
o€ Request In -Kind Financial Support $300 SEP Fee Financial Match pP° nancTotal Overall
Waiver Request
Provide a detailed description of stow the financial support will be used:

Financial support will be used to purchase groceries for the pantry (dry goods).

Describe any City Funding received by your organization in the past three years (required)? '"ind
Financial
$300 SEP
Program suppurc
Supparc
Fee waive,
Date Received Total Received
❑
❑
❑
$
❑
❑
❑
$
❑
❑
❑
$
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the last three years?
Funding Source Amount Received Date Received
:4
6 0 2026 _ y unc gen 402

N
1, the undersigned, do hereby attest that the above information is true and correct to the hest of my knowledge, and understand that the awarded financial grant amount needs to be spent prior to submitting another grant request.
i
qj�nature T1 e I Date
Date Received: 'T� i L4 Date Reviewed:

Amount Funded City Council Meeting:
❑ in -Kind Financial 3300 UP
Type of Grant: SUPPGrt SUPPort EJ :ee Waiver
Date City council received follow-up report:
6 0. 2026 ty unc _ gen
403

IRST77 C' Department of the Treasury
•1 Internal Revenue Service
P.D. Box 2508
Cincinnati OH 45201
M
M4
028130

INTERNATIONAL CHURCH OF THE

FOURSQUARE GOSPEL
1910 W SUNSET BLVD STE 200
LOS ANGELES CA 90026-3295
In reply refer to: 0752284926
Feb. 06, 2019 LTR 4168C 0
95-1684062 000000 00
00008004
BODC: TE
Employer ID number: 95-1684062
Form 990 required: No
Dear INTERNATIONAL CHURCH OF THE F:

We're responding to your request dated Jan. 28, 2019, about your tax-exempt status.

We issued you a determination letter in October 1949, recognizing you as tax-exempt under Internal Revenue Code CIRC) Section 501(c) (3)..

We also show you're not a private foundation as defined under IRC Section 509(a) because you're described in IRC Sections 509(a)(1) and 170(b)(1)(A)(i).

Donors can deduct contributions they matte to you as provided in IRC:

Section 170, You're also qualified to receive tax deductible bequests, legacies. devises, transfers, or gifts under IRC Sections 2055, 2106 and 2522.

In the heading of this letter, we indicated whether ;you must file an annual information return. If you're required to file a return, You must file one of the following by the 15th day of the 5th month after the end of your annual accounting period
- Form 990, Return of Organization Exempt From Income Tax - Form 990E1, Short Form Return of Organization Exempt From Income Tax
Form 990-N, Electronic Notice (e-Postcard) for Tax -Exempt organizations Not Required to File Form 990 or Form 990-E2 Form 990-PF, Return of Private Foundation or Section 4947(a)(i) Trust Treated as Private Foundation
According to IRC Section 6033(j), if you don't file a required annual information return or notice for 3 consecutive years; we'll revoke your tax-exempt status on the due date of the 3rd required return or notice.

You can get IRS forms or publications you need from our website at www.irs.gov/forms-pubs or by calling 800-TAX-FORM (800-829-3676).

If you have questions, call 877-829-5500 between 8 a.m. and 5 p.m-, 60 2026 ty une gen
i I i

0752284926
Feb. 06, 2019 LTR 4168C 0
95-1684062 000000 00
00008005

INTERNATIONAL CHURCH OF THE

FOURSQUARE GOSPEL
1910 W SUNSET BLVA STE 200
LOS ANGELS CA 90026-3295
local time, Monday through Friday (Alaska and Hawaii follow Pacific time).

Thank you far your cooperation.

Sincerely yours,
/'�� -N /oti—
Teri M. Johnson
Operations Manager, AM Ops• 3
6 0 2026 ty unc gen 405

THE H G 11

FOURSQUARE ADAM DAVMSON'
CHURCH
c�r�s��
August 23, 2022
Dear Sir or Madam.

This letter is to verify that Yucaipa Foursquare Church, in Yucaipa, CA (Eft 95-2542742) also known as "Green Vailey Christian Church" is a subordinate unit local church in good standing with the parent organization International Church of the Foursquare Gospel (ICFG) and has been in existence since February 20,1949. Rev. Rodella Subio Vaughan is the senior pastor, As a subordinate unit local church, the church operates under the same Bylaws and Articles of incorporation of ICFG. The Bylaws of International Church of the Foursquare Gospel, authorizes the church councils, senior pastors, and treasurers of our subordinate unit local churches to conduct business on behalf of the local church, and instruct that the senior pastor and treasurer of a subordinate unit local church be designated signers on the church's bank account. This is further expiained and clarified in the copy of our Corporate Resolution date July 20, 2017, which has been provided for your review. As such, Rev. Vaughan is authorized to conduct business on behalf of Yucaipa Foursquare Church, without the need for any signatures of corporate officers of ICFG. We are not required to fife IRS Form 990 because we are a church.

Our bylaws provide two provisions that are instructive.

1. The opening statement of Article XIII of our bylaws states that "'The Board shall have the power to determine the requirements, procedures and regulations of every local Foursquare church." Our board has passed a resolution that focal churches (e.g.. our local church in Ocoee) has the authority to open a bank account in the name of the local church, using the local church's EIN, and having the senior pastor of the locai church and others at the local church as authorized signers of the bank account.

2. Section 16.1 is our section on "Church Councils". A church council is the local church's body of leaders that assists the senior pastor with stewardship of the local church. Section 16.1.F. lists the powers and duties of the church council, and item 1.1.3 states "The Church Council shall authorize the pastor and treasurer and, if deemed advisable, one or two other people, all unrelated by blood or marriage, to sign on church bank accounts." [side note: the reference to "treasurer' is to the local church treasurer, not the ICFG corporations CFO/treasurer]
For your convenience, we are providing you with the churches current address:

Yucaipa Foursquare Church
PO Box 1046 Yucaipa, CA 92399-1046
Yucaipa Foursquare Church is under Group Exemption Number 1061 of International Chruch of the Foursquare Gospel and is tax exempt. This if verified by the enclosed copy of the letter from the Department of the Treasury of the Internal Revenue Service which remains in effect.

CORPORATE SECRL'TARY
SR. DDIECTOR OF coRPORATE BUSINS55 & FINANCE
Intcrnational Church of the Foursquare Gospel
PO Boa 26902, L,9# AnWks, CA 9W26 1 213.989.4257 1 a&vkbnr s>�+ f0umquatc.or9 6 0 2026 ty unc gen 406

As stated in IRS Publication 4573, "Subordinates in a group exemption do not have to file and the IRS does not have to process separate applications for exemption. Consequently subordinates do not receive individual exemption letters." Please use this letter along with the enclosed IRS letter verifying that ICFG and its subordinates are exempt from federal income tax under IRS Section 501(c)(3),
International Church of the Foursquare Gospel, which includes its subordinates unit local churches, is registered with the California Secretary of State as a religious nonprofit corporation (Entity Number C0126840). The enclosed copy of the letter from the California Franchise Tax Board verifies this fact, which remains in effect.

International Church of the Foursquare Gospel became incorporated under the laws of the State of California on December 30,1927. This is verified by a copy of the Certificate of Status as Domestic Corporation issued by the State of California; copy of the Articles of Incorporation, copy of the Statement of Information Biennial Report: and a copy of the Business Entity Detal page, all on file with the California Secretary of State.

International Church of the Foursquare Gospel is located at the following address:
1132 Glendale Blvd. Los Angeles, CA 90026-0176
Thank you,
Adam Davidsor.

Corporate Secretary
The Foursquare Church
AD:att
Enc.: Copy of IRS Determination letter
Copy of CA FTB Entity Status Letter
Copy of CA Certificate of Status
Copy of Articles of Incorporation
Copy of Statement of Information,
Copy of Business Entity Detail page
Copy of Corporate Resolution

CORPORATE SECRETARY
SR. DTRE(`roR OF CORPORATE BUSINESS & FINANCE
Intem doml Church of the Pomgaaze Gvspd
Po Box 26902, Las Angels, CA 9W26 1213.959.42S7 I adavidson faursqu=-0fg 6 0 2026 ty unc gen 407

ATTACHMENT 9
6 0 2026 ty unc gen 408

FISCAL YEAR: 2026 SUBMIT Ti): CITY OF YUCAIPA

GENERAL SERVICES/CITY CLERIC DEPARTMENT
34272 YUCAIPA BLVD.

DATE SUBMITTED: 4-15-25 YUCAIPA, CA 923"
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: Financial grant awarded funds will require 109%tinancini match by the applicant. For example, IF your total program/project cost is $1,000, yourfinancial grant request shoufd be for no more than $500.

Be prepared to show proof of program/projeet cost in your Wrap-up Report (Accountability Report), detailing the applicant's match of funds.

NarneofApplicantfDrganization: Inland Leaders Charter School AppIIcantl0rganization 12375 California St. Yucaipa, CA 92399 Mailing Address:

Ap p I Ica ntlOrpnintlon Phone Number: 909-446-1100
CONTACT (1) Jeremy Hach
NAME.
[email protected]
F•LIall
Josh Osborn
NAME
[email protected]
E-Mail

r
YES NO
Is your organization located In another community? ❑ ✓❑ Will the programlevent take plate in another community? ❑ 0 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 ng eilgible for the Cornmunity Activity Grant.

Your organization must be an established 501 (c) to be considered for Community Activity Grant funding.

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

YES NO
Is your organization a 501 (c)? 0 ❑
If so, please provide Tax 100 and attach all supporting 20-8343378 documents.

Does this application Include submittal of YES NO
N
documentation verifying 501 [c] status? 11
Now long has your 501 (c) organization been In existence? 18 years Number of employees working for organization? 120
Number of volunteers working for organlzation? 100
YES NO
Is a current City Council Member on your board? ❑ ❑
How many Yucaipa resldents does your organization 700
currently serve?
Does the organization charge admission, membership Y
ES NO
fees, due, etc.? 0 ✓
If yes, please describe:

Name of the programlevent: Volleyball Games
Date(s) of the program/event: September 15, 22, 24, 29. October 6 Total estimated cost for program/event: $650 for Referee fees Describe the program/event that the organization Is seeking support for. (Attach any eve nVprogram promotional materials assoclated with the programlevent) We play 5 to 6 home volleyball games each year. Games are rally scoring to 25 pts. The winner is the team that wins 2 of the 3 games. We play all 3 games reguardless of who wins the first two. This allows for more game time.

What is the goat of this program/event and how wlII it positively impact the community? We believe that athletics are an important an important part of the educational experience at Inland Leaders Charter School. Our students benefit from learning how to handle success and disappointment. Athletics help build good leadership qualities in students that will help them be leaders in our community.

Programlevent iprimary target population (check ail that apply):
0 Children or Youth
❑
Entire Community
❑ Homeless
❑ Low Income
❑ Women
❑
Persons with Disabilities
❑
Seniors
❑ Victims
❑ Welfare Recipients
Please answer the following to determine If your programlevent requires a Special Event Permit (SEP):

YES NO
Estimated attendance 30D-999 persons ❑ ❑✓
Amplified Sound ❑
(excluding Special Event Faciiitles)
YES NO
Estimated attendance 1440t persons ❑ 0
Alcohol Service ❑
[excluding Community Centers & YPAQ
Street Closure -"traffic Management ❑ ❑✓

THIS BOX IS FOR STAFF USE ONLY
YES No
This event requires City Management/ ❑ ,
Administrative Approval: lju�— jt

THIS BOIL IS FOR STAFF USE ONLY
YES NO
This event requires City Council Approval: ❑ Q
3 Please identify what your organization is seeking:

YES NO YES NO
Financial Support: ❑ ❑✓ $ $300 SEP Fee Waiver: ❑ Er
�--ev
In -Kind Support: $ $ $. G $
OT/Reassigned Staff CS/Rental Scherer Other
Community Center
-moo
Total Amount $ $ $ $ $ U
of Request fin -Hind Financial Support $300 SEP Fee financial Match ` Total overall
Waiver Request
Provide a detailed description of how the financial support will be used:

The In -Kind support will only go to pay the cost of using the community center for our games.

Describe any City Funding received by your organization In the past three years (required)? Program
In -Kind
support
Zandal
support
$300 SOP
Foawa a
Date Received
Total Received
ILCS
✓❑
❑
❑
Spring 2025
$ 842.00
ILCS
❑✓
❑
❑
Spring 2024
$ 15G4
ILCS
✓❑
❑
❑
Spring 2023
$ 1500
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the last three years? i
Funding Source Amount Received Date Recelved
$ i
i
$
,
4AMEMM
;
1l
{

SECTION 6 ■
I M�W��
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 rant re nest.

Tkle Date

TO BE COMPLETED BY THE C IT
I.

Date Received: pate Reviewed:

Amount Funded: City Council Meeting
Type of Grant: in'p p.r ❑ Financial ee Wal P
5 uppor[ support FCe Walver
Date City Council received follore-up report:
5 6 0 2026 ty unc. gen 413

INTERNAL REVENUE SERVICE
P. 0. BOX 2508
CINCINNATI, OH 45201
Date: Nov 2 r 2`10B

INLAND LEADERS CHARTER SCHOOL
Dear Applicant:

DEPARTMENT OF THE TREASURY
Employer Identification Number:
20-834337B
DLN:

G08233024
Contact Person:

JOYCE DARBY ID# 95011
Contact 'telephone Number:
(877) 829-5500
Accounting Period Ending:

June 30
Public Charity Status?
170 (b) (1) (A) (ii)
Form 990 Required:

Yes
Effective Date of Exemption:

October 2, 20D6
Contribution Deductibility:

Yes
Addendum Applies:

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 sections) 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.

Letter 947 (DQ/CG)
6 0 2026 ty unc gen 414

-2-

INLAND LEADERS CHARTER SCHOOL
Enclosures: Publication 4221-PC
Sincerely,
/07
Robert Choi
Director, Exempt Organizations
Rulings and Agreements
Letter 947 {DOICG)
6 0 2026 ty unc gen 415

-3--

INLAND LEADERS CHARTER SCHOOL

INFORMATIM FOR CHARTER SCHOOLS
You are not subject to the specific publishing requirements of Revenue Procedure 75-50, 1975-2 C.B_, page 587, as long as you are operating under a contract with the local government. If your method of operation changes to the extent that your charter is terminated, cancelled, or not renewed., you should notify us. You will also be required to comply with Revenue Procedure 75-50.

Letter 947 (DO/CG)
6 0 2026 ty unc gen 416

PermK
City of Yucaipa Community PHONE(909) 790-7460
Services FAX:(909) 790-2589
34272YucaipaBlvd EMAIL-corrrnunityserAcces[ayucapaorg
Yucaipa, CA 92399
Organization Name Inland Leaders Charter School -170
Cuetww Type Non -Profit (R)
Orgariention Addnm 1375 California St
Yucaipa, CA 92399
Apertt Name Jeremy Hoch
System hoer Karen Ruiz
VoIkWtall Home deffm
Booking Summary

COMMUNITY
SERVICESl{
Par
get�er�
Permit # R8674
Status Tentative
Date of Isaue Apr 30. 2026 8:13 AM
Expkkation pate Apr 30, 2027
Organization Phone 1
Number
Home Phone Number -
EnW Address ch@inland<eaders.com
Rentai Fee
$900.D0
Discounts
-$90.00
Subtotal
$810-00
Deposits
$250-00
Deposit Discounts
$0.00
Total Permit Fee
$1,060-00
Total Payment
$0.00
Refunds
$0.00
Balance
$1,060m
1 resource(s) 6booking(s) &A*o at$%,06M

START DATEITIME
END DATEITiME
ATTENDEE AMT W!p TAX
Tue. Sep W 2Q20 M PIA
Tue. Oct 6. 2M S.'% PM
Setup
cworw
2:0 PM - M6 PM
&-00 F4A - &S PM
Queers on selected dates effective 09/15,WA until 10YO612026 Tue, Sap 15, 20262.15 PM
Tue, Sep 16.2026 &15 PM
1 $162.00
Setup
Clearup
2:15 PM - 2,45 PM
5DO PM - 5:15 PM
Rertal - Hourly $60.00 j Hour x 3
$18C.00
Resident D sccunt - 10% (YCC & SCC) -10% x 1
Tue, Sep 22. 2026 2:15 PM
Tue, Sep 22, 2025 5.15 PM
1 $ie2o0
setup
Cleanup
2:15PM-2:45PM
5:00PM-5:15PM
Rental - Hourly $60.00 Hour x 3
$180.0G
Resident Discount - 100J6 {YCC & SCQ -10 e x 1
-$18.00
0 R8574 Sbdm Tentative Pa91go 1 of 2
6 0 2026 ty unc gen 417

Thu, Sep 24, 2026 2:15 PM
Thu, Sep 24, 2028 5:15 PM
1 $162.00
Setup
Cleanup
2:15PM-2:45PM
5:00PM-5:15RIM
Rental - dourly $60.00 / hour x 3
$180.00
Resident Discount - 10% [YCC & SCQ -10% x 1
Tue, Sep 29.2026 2:15 PM
Tue, Sep 29, 2026 5:15 PM
1 $162.00
Setup
Cleanup
215PM-2:45PM
5:00 PM - 5:15 PM
Rental - Hourly $60.00 Hour x 3
$180.00
Resident Discount - 10% {YCC & SCC) -10% x 1
Tue, Oct 6, 2026 215 PHA
Tue, Oct 6, 2026 5:15 PM
1 $162.00
Setup
Cleanup
2:15 PM - 2:45 PM
5:00PM-515PM
Rental - Hourly $60.00 Hour x 3
$180.00
Resident Discount -10% (YCC & SCC) -10% x 1
-$18.0C
Resource level fees
$250.00
Deposit $250.00 / Each x 1
$250.00
Waivers and Information

INFORMATION DESCRIPTION SIGNING STATUS
Proof of Liability Insurance Checked

WAIVER NAME DUE DATE FOR SIGNING STATUS
Facility Usage Waiver Sep 15. 2026 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 VAIIful misconduct of the City of Yucaipa Permittee shall have received any and all permission or Ncense(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 Deposit

EVENT RESOURCE

DEPOSIT FEE CHARGE TAX AMOUNT PAID

REFUNDS

BALANCE
Volleyball Gymnasium,
Deposit $250.00 $0.00 $0.00
$0.00
$250.00
Home South
Games
Payment Schedules
Original Balance- $1,060.00
Current Balance: $1,060.00

DUE DATE

AMOUNT DUE AMOUNT PAID WITHDRAWAL ADJUSTMENT

BALANCE
Sep 1, 2026
$1,060,00 $0.00
$0.00
$1,060.00
# R8574 Status Tentative Page 2 of 2
6 0 2026 ty unc gen 418

ATTACHMENT 10
6 0 2026 ty unc gen 419

CITY Y OF yirCP1Pf4
-iqPR 15'26 Amg:15
029.2027 SUBMIT TO: CITY OF YUCAIPA
FISCAL YEAR: GENERAL SERVICESICITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

DATE SUBMITTED: 4115/26 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: Financial grant awarded funds will require 100% financial match by the applicant. For example, if your total programlproject 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 applicant's match of funds.

Name of Applieantlorganization: Kiwanis Club of Yucaipa Valley ApplicantlOrganization 11629 Grove Dr Yucaipa, CA
Mailing Address=
Applicantlorganization Phone Number:

CONTACT(1) John Reece

NAME PHONE NUMBER
E-Mail
CONTACT (2) Kellie Coulstc)n

NAME PHONE NUMBER
[email protected]
E-Mail
6 0 2026 ty unc gen
420

YES No
Is your organization located in another community? ❑ Q
Will the program/event take place in another community? ❑ Q Are you aware of any other City program providing this service? ❑ Q If so, which one?
If you answer _ u "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.

Your organization must be an established 501 (c) to be considered for Community Activity Grant funding.

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

YES NO
Is your organization a 501 (c)? ❑
If so, please provide Tax ID# and attach all supporting 33-0419876 documents.

Does this application include submittal of YES NO
documentation verifying 501 (c) status? 0 ❑
How long has your 501 (c) organization been in existence? 79 years Number of employees working for organization? 0
Number of volunteers working for organization? 21
YES NO
Is a current City Council Member on your board? El
How many Yucaipa residents does your organization 14000 currently serve?
Does the organization charge admission, membership Y
ES NO
fees, due, etc.? Z
El
If yes, please describe: Kiwanis International plus our local and district dues are $190.00 USD per annurn
6 0 2026 ty unc gen 421

Name of the program/event: Adopt -A -Classroom
Date(s) of the program/event: Mid -May through August 6, 2026 Total estimated cost far programlevent: $10,500 US❑
Describe the programlevent that the organization is seeking support for:
(Attach any event/program promotional materials associated with the programlevent) Our club reaches out to teachers in the Unified School District asking for wish lists of resource and supplemental items that were unable to be procured through the District's supply system because of State of California budget restrictions. These items must then be funded out of the teacher's own pocket or forgone completely. Kiwanis of Yucaipa Valley takes these requests and fill as many as we can within the club's budget.

What is the goal of this program/event and how will it positively impact the community? The goal of the program is to provide as much enriched learning as possible across our community while reducing the personal financial burden on many of our teachers. Last year, Kiwanis of Yucaipa Valley was able to support 35 classrooms across YCJUSD. With this grant, we will be able to increase the impact by supporting 50 classrooms.

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

YES NO
Estimated attendance 300-999 persons
Amplified Sound ❑ El
Special Event Facilities)
YES NO
Estimated attendance 1000+ {persons
Alcohol Service El
Community Centers & YPAC]
Street Closure - Traffic Management
THIS BOX 15 FOR STAFF USE ONLY
This event requires City Managementl YES NO
❑ N
Administrative Approval:

THIS Box IS FOR STAFF USE ONLY

YES ENO
This event requires City Council Approval: Elf ti;l
60 2026 ty unc gen
422

Please identify what your organization is seeking:

YES NO
Financial Support: ,I❑ ❑ $ 3000
In -kind Support: $ $
OT/Reassigned Staff CSIRental
YES NO
$300 SIP Fee Waiver: ❑ ❑-
� S
Scherer Other
Community Center
Total Amount
of Request � � 3000 $
In -Kind Financial Support $300 SEP Fee
Waiver
$ 2 , C 0 $ 3000
Financial Match Total Overall
Request
Provide a detailed description of how the financial support will be used:

The requested $3000 will supplement the Kiwanis Club's contribution of $7500 so that the number of supported classrooms can be increased from 35 to 50. Further detail can be provided once the teachers' wish lists have been received and the specific items to be procured are known. We intend to allocate approximately $200 to each classroom chosen to be supported
Describe any City Funding received by your organization in the past three years (required)? in -Kind
Financial
$300 UP
Program Support
support
Fee Waiver
Date Received Total Received
❑
❑
❑
$
❑
❑
❑
$
❑
❑
❑
$
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the last three years?
Funding Source Amount Received Date Received
F
60 2026 ty . unc gen

Digitally signed by John
John Reece pg� 22026-04.131636:29 President
•GTW
Signature
Title
Date Received- r-i I S- 12 . Date Reviewed:

Amount Funded- City Council Meeting:

Type of Grant: In -Kind Financial Sapp SEP
El Support 5upport ❑Fee Waiver
Date City Council received follow-up report:

Date
6 0 2026 ty unc gen

AM Dapartmant of t1.0 Trl jury
fgtotnsi Revenua 8arviw
In reply refer to: 0422897266
06DEH UT 84201-0046 Nar. 07, 2025 LTR 2697C 1
33-0419876 2024C9 44
00025145
$ODC: SD

KIWANIS CLUB OF YUCAIPA VALLEY

FOUNDATIDN, INC
PO SOX 691
YUCAIPA CA 92399
Employer identification nuobert 53--0419876
Forme 990--PF
Tax period: Sep. 30, 2024
6 0 2026 ty unc gen 425

of the Treasury
Date:
jrjDepartment
internal Revenue Service
December 29, 2023
Tax Exempt and Government Entities
IDQ P.O. Box 2508
Employer ID number-
33-0419876
Cincinnati, OH 45201
Person to contact -
Name: Ariona N. Williams
ID number: 76012
Telephone: (877) 829-5500

KIWANIS CLUB OF YUCAIPA VALLEY
Accounting period ending:

FOUNDATION INC
September 30
PC BOX 691
Public charity status-
YUCAIPA, CA 92399
50%a)(2)
Form 990 f 990-EZ 1990-N required:

Yes
Effective date of exemption:

February 15, 2022
Contribution deductibility:

Yes
Addendum applies:

No
DLN:
26053525005233
Dear Applicant:

We're pleased to tell you we deternined 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(e)(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.

Based on the information you submitted with your application, we approved your request for reinstatement under Revenue Procedure 2014-11. Your effective date of exemption, as listed at the top of this letter, is retroactive to your date of revocation.

If we indicated at the top of this letter that you're required to file Born; 9901990-EZ1990-N, our records show you're required to file an annual information return (Form 990 or Form 990-EZ) or electronic notice (Fonn 990-N, the c -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 addenduun applies, the enclosed addendum is an integral part of this letter.

Letter 947 (Rev. 2-2020)
Catalog Number 35152P
6 0 2026 ty unc gen 426

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,
,� - • Nta;,t{l
Stephen A. Martin
Director, Exempt Organizations
Rulings and Agreements
Letter 947 (Rev. 2-2020)
Catalog Number 35152P
6 0 2026 ty unc gen 427

't`4� L OF
f'4 S.k•iii:�i:
:8 California Secretary of State
�* I Business Programs Division
1500 11 th Street, Sacramento, CA 95814

KIWANIS CLUB OF YUCAIPA VALLEY FOUNDATION,
INC.
12461 BIRCH STREET
P❑ BOX 691
YUCAIPA, CA 92399
Business Amendment Filing Approved
May 14, 2024
Entity Name: KIWANIS CLUB OF YUCAIPA VALLEY FOUNDATION, INC.

Entity Type: Nonprofit Corporation - CA - Public Benefit Entity No.: 1666836
Document Type: Statement of Information
Document No.: BA20240950525
Fife Date: 05/14/2024
The above referenced document has been approved and filed with the California Secretary of State. To access free copies of filed documents, go to bizfIeOnline.sos.ca. ov and enter the entity name or entity number in the Search module.

What's Next?
The most up to date records may be obtained by searching for the Entity Name or Entity Number in the Search module at bizfiieOnline.sos.ca. ov.

For further assistance, contact us at (916) 657-5448 or visit bizfiieOnline.sos.ca.gov_.

Thank you for using bizfile California, the California Secretary of State's business portal for online flings, searches, business records, and additional resources.
6 0 2026 ty une gen 428

ATTACHMENT 11
6 0 2026 ty unc gen 429

CITY DF YIIGMPA
APR 15'26 Pm2:44
2026 SUBMIT TO: CITY OFVUCAIFA
FISCAL YEAR: GENERAL SERVICES/CITY CLERK DEPARTMENT
34272 YUCAI PA BLVD,
DATE SUBMITTED: 4/14/26 YUCAIPA, CA 92399
All sections of the appacation must be returned complete, and a supporting documentation rilum he includiM c-i part of the submittal. lr►complete applications retesvea will be returned to the appiicant.

Note: Financial grant awarded funds will require 100%financial match by the applicant. For example, if your total prograrrtfpcoject cost is $1.000. ytius• financial grant request should be for no more than S500.

Be preparad to *;how }goof of prngratniptoject cast in your Wrap-up Report (AccoontabJity ReporC). detailing the applitar►t's match or funds.

Name of Applicant/Organization: Poiema Youth Center for Music & Creative Arts Applicant/Organization 34181 Yucaipa Blvd
Mailing Address
Applicant/Organization Phone Number: t909) 797-8000
CONTACT (1) David Enos

NAME PHONE NUMBER
poiemayouthcenter@g mail.com
E•Mail
CONTACT (2) Gina Enos

NAMF PHONE NUMBER
F Mail
60 2026 ty unc gen 430

YES NO
Is your organization located in another community? ❑ ✓❑ Will the program/event take place in another community? ❑ Q Are you aware of any other City program providing this service? ❑ 0 If so, which one?
'I-f you answerP143 "Yas" :o any of the questior:a',:.: ti abovo. your request is r.Lg!,_tijgib€e for the Community Activity Grant.

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?
YES NO
✓❑ ❑ /Alp
33 -19 t�F�SiP
YES NO
✓❑ ❑
How long has your 501 (c) organization been in existence? 1.3 years Number of employees working for organization? 0
Number of volunteers working for organization? 3
YES NO
Is a current City Council Member on your board? ❑ ❑
How many Yucaipa residents does your organization All
currently serve?
Does the organization charge admission, membership Y
ES NO
fees, due, etc.?
If yes, please describe:
2 Name of the program/event: Summer Jam Student Recital Date(s) of the program/event: Est. June 26th, 2026
Total estimated cost for program/event: $500
Describe the programlevent that the organization is seeking support for:
(Attach any event/program promotional materials associated with the program/event) The program is called GIFT (Growing in Faith Together). It is held once a month on the third Wednesday of the month. We have music and a brief Bible study, then a food distribution. We are currently able to provide bread, milk, and sweets which are provided through our sister church in Calton. We hope to supplement these items with monetary donations. Our church members are also donating dry goods for the distribution. We have shelving and a small refrigerator in the pantry room. All are welcome. Groceries distributed on a first come, first serve basis while supplies are available. We have distributed from the pantry as people have expressed a need thru the church office. The program targets food insecurity in our community.

What is the goal of this program/event and how will it positively impact the community? This is an event sponsored by Poiema Youth Center for Music and Creative Ants. We are sponsoring the event on behalf of Psalm 33 Music. This event is an end of school year recital for all of Psalm 33 Music's roster of students. The even includes students, parents, family, and friends. The purpose of having Poiema sponsor the event is to focus on revealing our mission of reaching the youth of Yucaipa, and other nearby communities. Our mission is to reach out to disenfranchised youth through music and the arts. There are 45 churches in the city of Yucaipa, yet there is nothing being offered as a means to reach our youth. We're hoping to start off by offing scholarships for classes in the arts, while eventually opening our own facility here in Yucaipa, which will be similar in model to'Solid RockYouth Centers' located in Phoenix, Arizona, as well as surrounding communities.

Program/event primary target population (check all that apply):
0 Children or Youth Entire Community Homeless Low Income Women 2 Persons with Disabilities Seniors Victims Welfare Recipients Please answer the following to determine if your programlevent requires a Special Event Permit (SEP):

YES NO
Estimated attendance 300-999 persons This event requires City Managernentl YES NO Amplified Sound � ❑
Administrative Approval: ❑
(excluding Special Event Facilities)
YES NO
Estimated attendance 1000+ persons
YES NO
Afcnhal Service
(excluding Community Centers & YPAC) This event requires City Council Approval: ❑ Street Closure - Traffic Management ❑
60 2026 ty unc geris. " 432

Please identify what your organization is seeking:

YES NO
Financial Support: Q ❑ 500
In -Kind Support: $ S
OTIReassigned Staff CS/Rental
YES ff—to
S300 SEP Fee Waiver: x
Scherer Other
Community Center
Total Amount i f „17— s 5 -6 $ - � 0 $
of Request
In -Kind Financial Support $300 S P Fee Financial Match Total overall Waiver Request
Provide a detailed description of how the financial support will be used:

We are looking to have the event funded. Nothing else.

We would eventually like to apply for grants to possibly help with providing scholorships for prospective students who would otherwise not be able to afford it.

Describe any City Funding received by your organization in the past three years (required)? In -Kind
Program Support
Financial
Support
$300 SEP
Fee Waiver
Date Received Total Received
N/A ❑
❑
❑
$
❑
❑
❑
s
❑
❑
❑
s
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the last three years?
Funding Source Amount Received Date Received
NIA $
s
6 0 2026 ty unc. gep:.y.j 433

i, the undersigned, do hereby attest [hat the above information is true and correct to the best of my knowledge, and understand.that the awarded financial grant amount needs to he spent prior to submitting another rant r uest.

CEO
title
-lirDate Received: zl 1 o gil Date Reviewed:

Amount Funded: City CounciI Meeting:

In kind sfriancial s3oo SEP
Type of Grant El Support � Support � FeeWaiver
Date City Council received follow-up report-
04/14/26
Date
434

Permit
COMMUNITY P a��
�401e' SERVICES
City of Yucaipa Community PHONE:(909) 79C-7460
Services FAX: (909) 790-2589
34272 Yucaipa Blvd EMAIL;comrnunrtysenrices@yucaipaarg
Yucaipa, CA 92399
Cuatorner Nana David Enos - 22751
Cuetorrier Type General Public
Meing Address
System Ubw Karen Ruiz
Summer Jam Youth Recital
Permit # R8568
Statue Tentative
Date of Issue Apr 21. 2026 9:46 AM
Expiration pate Apr 21, 2027
Car Phone Number APR 22 '26 Am-13: 53
Email Address [email protected]
Rental Fee $687.00
Discounts-$60.00
Subtotal $627.00
Deposits $100.00
Deposit Discounts $0.00
Total Permit fee S777.00
Total Pa}znent $0.00
Refunds $0.00
Balance S727.00
t rssource{s} 1 booking(g) Subtotal: 5727.00
tiiJ!I summary
r.

START DATE/TIME END l3ATEj7I1I ATTENDEE AMT WIC TAX
Fri, Jun 26, 2026 7:00 AM Fri, Ain 26.2026 8.00 PM 260 $0.00 Resource level fees $727.00
Deposit S100.00 1 Each x t $100.00
Liability Insurance $87-00 / Each x I $87.00
Rental - Daily $600.00 / Day x t $600.00
Rental - Daily -10°% x 1 460.100
Custom Questions

QUESTION ANSWER
A. Any Cancellation of a rental Ness than 30 days will result in loss of 100% of the rental Acknowl edga fees and deposit (if applicable). B. Any cancellations prior to 30 days will r=Sint 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 Acknowledge shelters. Community Park: Shelters 2, 3, 4, & 7 Ave I Park: Shelters 1, 2, 3, 4 7th Street Park: Shelters 1, 2, 3 bVildwood Park: Shelter
# R8558 StJ" Tentative
6 0 2026 ty unc gen
Pepe 1 of 3
435

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 fallowing 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 Wii result in Company and/or event to be shut down. 2) The City reserves the right to limit the number and size of bounce houses being used. Only small bounce houses are permitted [18'x18'x18' max]. Larger sized bounce houses are permitted only with a Special Event Permit and with Director approval.

I acknowledge and agree to:1)Permit Holder/Requestor(s) and event attendees must Acknowledge adhere to the rules and regulations governed by the City- 2) Failure by the Permit Holder /Requester 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 finandai responsibility of the Permit Holder/Requestor.

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

EVENT RESOURCE DEPOSIT FEE CHARGE
Summer Amphitheater Deposit $100.00
Jam Youth
Recital
Payment Schedules

DUE DATE AMOUNT DUE

TAX AMOUNT PAID REFUNDS BALANCE
$0 00 S0.00 $0.00 $100.00
Original Balance: $727.00 Current Balance: $727.00

AMOUNT PAID WITHDRAWAL ADJUSTMENT BALANCE
# R8558 Statuia Tentative
60 2026 ty unc gen
43Gf 3

Jun 12, 2026 $727.00 $0.00 $0.00 $727,00
# R8558 Statue Tentative Paps 3 of 3
6 0 2026 ty unc gen 437

tFACILITY RESERVATION APPLICATION
City of Yucaipa Community Services Department
Step One - Inform-10011
David Enos
Applicant Name (please printcleariy) Phone Number
Street Add ress City Z i p
Poiema Youth Center far Music & Creative Arts 34181 Yucaipa Blvd. Yucaipa. CA. 92399 Organization Name (if applicable) Address
Is applicant a CiLy of Yucaipa resident? (Proofof residency required) 0 Yes Applicant email; [email protected]
Phone Number
❑ No
Alternate contact person: Gina Enos
Name Phone Number
Step Two - Event
Event Narne: Summer Jam Student Recital
Type of Event: ❑Meeting ❑Birthday ❑Family Gathering ❑ Reception/Banquet ❑ Shower -baby or Bridal ❑Wedding- ❑other: Student Recital
# of Attendees: 250
Date(s) of Use- 06/26/26
Set-up Time: 3PM to 4PM
Guest Arrival: 5PM
Day: ❑M ❑Tu ❑W ❑Th OF ❑Sa ❑Su
Clean-up Time: $PM to9PM
*-Hours requested include the time it takes to set up and clean upthe day of event Total Number of Hours: 6 [No set-up day(s) prior to event).

Step Three - Details
Isapphcanta non-profit? i]Yes ❑No
l fyes, iiv,j-profit #B4a5383
Is the event fundraiser? ❑Yes !]No
1q thUyentOpen to the public? DYes ❑No
Is there as admission fee for the event? ❑Yes ElNo
jLjlldk(2ji _Iis beverages he s-e�ye�i?
lfyes• additional Pees will be charged.

Will food be sewed?
Will you leave any-0 f the following
❑DJ pBand ❑Caterer:
❑YPs E]Nn
❑Yes E]No
Insurance (Required - please check one)
Will an.y items be sold? Dyes ElNo Insurance fee is dependent on the size and nature of the event
Will alcoholic beverages be sold? []Yes l]No
if y s ACC license will be required. License mast be
received by staff no later than 1 week prior to event date.

No Alcohol: 0
With Alcohol: ❑
*Eventswith alcoholare required to purchase designated
insurance and mandatory liquor liability.
6 0 2026 ty unc gen 438

Step Four - Facility
Community Center -34900 Oak Glen Rd -
El Ba nq ue t Room ❑MeetingRoom ❑Kitchen
�-i�M pH r�fiwt �I:P�
❑Dance Room ❑Activity Room ❑Gymnasium
ererCenter- 122021ti0 St:
❑Banquet Room: ❑Rooni A ❑Room 13 []Room C ❑Kitchen ❑Arts& Crafts Room ❑Nutrition Center Yucaipa Performing Arts Center - 12062 California St:
❑Mountain View Room: ❑Room A ❑Room B
fJTheater Rental: ❑Banquet Setup ❑Theater Setup
Kitchen ❑Front Lobby ❑Blackbox
Dressing Rooms: ❑1 ❑I1 ❑111 ❑IV ❑Green Room
'[outdoor Stage ❑outdoor Stage with Park
Will you require the use of City -owned equipment? ❑Yes l]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 Applicants) 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 I icense(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 th `
Applicant Signature; Dale: 04/14/26
Print Applicant Name. David Enos
6 0 2026 ty unc gen 439

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 adeouately safeguarded.

Application Process
r
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 Initial
reservation. Applications and availability based on a first come, first serve basis.

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 eve ntwiII result in a loss ° of rental fees paid and loss of the deposit(s).

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

Deposit Refund Process
A security deposit will be required far all reservations. The security deposit is ig_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 V)
will be returned via credit card if the reservation was paid with a credit card. If the refund deposit was paid Initial
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.

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 Initial
the adult representative.

Selling o1. 1 f alcohol is sold at an event (i.e. cash bar, tickets, and drinks for a fee), the Applicant will be required to provide a license from the State Alcoholic Beverage Control Department The Applicant must provide a copy of the permit from the Alcoholic $,eve rage 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 bein im ediately canceled and 100% of fees will be forfeited** 6 0 2026 ty unc gen 440

Cleanin — Renter Responsibility
If cleaning fee is opted out, general clean-up is renters'responsibilityand includes:

1. Applicant shall matte 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 floot's of the facility.

4. The rented facility, parking lot, grounds, andfor equipment shall be left in the same condition as Initial
they were print, to the event

5. Staff are there to help you with your eventand will advise what needs to be done for your deposit to be refunded.
b. After your event, staff will conduct 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.

Equipment
Initial
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).

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 (i.e. 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 chair's 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 diagram is not submitted, sample set-up will be utilized, or tables and chairs will not be set up until the startof 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. [,the utide isigned applicant, agree to abide by and enforce the rules, regulations, and policies governing this facility asset 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 A reements can result in immediate cancellation of the reservation and forfeiture of all fees and deposits.

Applicant Signature: Date: Q4/14/26
PrintApplicantNamc: David Enos
6 0 2026 ty unc gen 441

Decorations
Signs or decorations all must he freestanding and cannot he 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 Initial
removed and disposed of at the end of the event No alteration of existing facilities is permitted.

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

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.

Initial
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. 1 f an applicant or event stays after per•initted time, overtime charges will incur fees at the rate of tune and half (1.5) For the room and staff- No refunds For any unused Dental time. Rentals that do not comply with the contracted time may result in a minimum Ioss of deposit and additional fees incurred.

Insurance
The Applicant shall purchase special eve ntgeneraI Iiability 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 lniri:�l
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.

Cleaning Fee
A cleaning fee is required for any event and rental exceeding seventy-five 75guests. 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.

Initial

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. 6 0 2026 ty unc gen 442

SHELTER RESERVATION APPLICATION
City of Yucaipa Community Services De artment
Step One- Information

DAVID ENDS
Narne of Rental Applicant (please print clearly) Phone Number Address: Street City Zip
POIEMA YOUTH CENTER FOR MUSIC 8 CREATIVE ARTS 34181 YUCAIPA BLVD YLICAIPA 923" (909) 797-moo Organization Name (if applicahie) Address Phone Number
Primary ernail of Rental Applicant: davldCftgernayouthoenterorg Designated Everrt Representative (if Applicant will not be present):

Name Phone Number
Step Two- Event
Type of Event: ❑Meeting ❑Birthday ❑Fancily Gathering 11 Reception/Banquet © Shower- Baby ❑ Bridal/Wedding
Names of Event: SUMMER JAAA YOUTH RECITAL o6ther: STUDENT RECITAL CONCERT f # of Attendees:25o pates] of Use: o6R626 clay: GM ❑Tu ❑W ❑Th QF ❑Sa ©Su 'Hours requested include the time it takes to set up and clean-up the event Total Nu mber of Hours: 6 Step Three- Details
Will there be food? ❑Yes ❑No
Is the event a fundraiser? ❑Yes 0No
' ifyes, no food trucks/carts/tents permitted unless approved by Special Event Permit.

Will there be a bounce house? ❑Yes ❑No
' If yes, must book Bounce House through Authorized lu
Step Four- Facility
Amphitheater ❑Large Shelter 2
❑Small Shelter 1 ❑small Shelter 3
❑Shall Sheltet-7 ❑Small Shelter 8
Wildwood Park:

ElSinall Shelter 1
Will you have any of the following: CD] ❑ Band
anies only
❑Medium Shelter 3 & 4 L]Mediunr Shelter 5 & 6
❑Small Shelter 4 05mall Shelter S DSrnall Shelter 6
Aved Park:
❑Simill Shelter 1 ❑Small Shelter z ❑Medium Shelter 3 ❑small Shelter 4 ❑Small Shelter 5 71h Street Park
❑Small Shelter 1 ❑Medium Shelter 2 ❑Medium Shelter 3 ❑Large Shelter 4 -.a
'^Small Shelter' 1
Step Five - Review City Policies
Insurance
A. The Applicant shall purchase special eventgeneral liability insurance through the City of Yucaipa and cannot be provided- Insurance fees are included in shelter pricing, and Insurance premiunis are subject to change annually.

General liability coverage is in the amotint 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 resuit in loss of 1D0% of the rental fees and deposit (if applicable).

B. Any cancellations prior to thii-ty days (30) will result in a loss of 50% of the rental fees and deposit (if applicable). All refund requests are subject to;A SZo.00 processing fee. 6 0 2026 ty unc gen 443

C. Refunds will be approved if rain or inclement weather occurs an the day ul shelter reservation. A refund request form must be completed and sutunicted wiWitseven (7) days after reservation for refunds to be honored.

Park Shelters Rules
A. City tlrgt.irllLed a,.tlVlt3V% slull have pttority Ilse overall requests When passible, neither user shall Interfere with the other's use- Suffitirnt prior notification of canceled requests witl he gwen by the City whenpossible.

8. [. Pcrmat HolllerfReiltivilw[c] :toil event attendees must adhere to rite rates and regulations governed by the City {reference City Park C rdirtant a No. 127). Failure of atlticrencc to suzh rules andl regulations tnay re sulr ul suspension of use or dastnissal irnm the tat dity
D. No sinllibcd sound peritnned
F. Due to the nnavutdable seasonal and recreational rirrumstarrres/acuvtties,there is no guarantee concerning the condition of the sheik r and the %uri ounding Arta• The City will maintain the shelter to the best of their ability prior to fire eveiat F. Smoking isprohibitcdinall City parksandiatihticstreferenceCity ParkOrdmanecNo. 2S61 G. Alcoholic beverages prohibited winless. priorappnstal as a Condition of a Special Event perrniL H. No wood burning tampfireti or propane grills permitted, Charcoal only t. No motor vehicles are permitted in the parks, an turf, walkways, and on surfaces unless approved by a special event permit ti-derenti, City Park Ordinance No, 127). NOTE: If motor vehicles are found on prohibited surfaces, additional fees can be incurred.

Bounce Houses/Jumpers
A. niuct first olitain a Facility Use Agro'etment for the use of th-c! park and inditate on the Agreement that a hountc houw wdlbc used a+part uttheewnt [Yucaipa Municipal Code 12-04.2811.

S. Porinit HoldcrfRtquc%torarc! houncr lkluse company mu%t executea written agreement (between the two pa rues) and agree to Indemnity and defend the City front any Iwbility related to the use of bourice h❑use- A Certificate of insttratx t• and Endorsement is required for all buuncers in Cory parks. The Ccrtifitate of insurance and Endorsement must list the City as additionally insured (per Section VIiI of this dux toment1. The Bounce Housr Rulcs and Reg ulattons term and insuranc a dot umetile must be rot cived by the Corn rnunity Services Departmrnt fourteeit 1141 days prtor to the event elate.

D. T'he city rewrvv. the right to limit the number and size of bounce houses being used. Only sinall bounce houses are Permitted 11TxjTx1B'maxi- NoohstA Ic%❑rwarerjumperspermitted.Largersv.edtrounceILOUCC•r.arc[•Wrenfitted❑nlywithaSpecialEvent Pcr in u a nil +vi ill pirrttnr appn�val
E. BtittlKV howws are tube set uptmlyhy the himincehouse company in compliance with manufacnirerxpcl afuatums F. Botinte I)(Kise companies will be responsible for providing age neratorfor the iWalton of the hounce house. The C.14y does not The generator trust be quirt rated at 60dE or less and not generate noise in excess of City standards. The gvni razor %stall be placed a sale disu inty fronn thi - tnlunce house and riettrical curds covered to prevent tripping hazards- AIII ditt�ai d ga•tdinn taitc KUST NOibe stored next to the gcneTatar.

G- rht• hound• himise t iiinpany rrust provide a fire exrangtlasher that is eyutpptYl to extinguish any fire that may utrllr H- Botmtc h❑u.cs anJ generators will be placed at Ititatians desiglratcd ❑Il the Fagdlty U+e 4reement application- Comi iunuV Park:

IShelte r+ 2, 3.4. & 71. Ave I Park [Shelters 1, 2.3, 4). 1ih Street Park: [Shelters 1, 2.3 j, anti Wddwood Park- I Shelter 11 I. Bounte Muses must lit, under supervision by an adult at all times. Permit Holdcr/Requcst❑r must provide adciluate supervimorr. 5o that the use I% w utmpllaixe with manufatturcr re esimmcnttatious and reficds safe Ievcls of operation- J. 8u1Inar hPtJ%C$JrV rest permitted iwtkrnight unlescapprnved by 5pt•tual Event Permit IC Bounty houst•s must he free etanihng; a nil weil,•ltted. Stakes are prohibited in City park% unless approved as a special condition of a Special U% Pvrinit. Bounce Manses inust niit he tied or tethered totrees. tables• or other park ainenthes.

L. Permit Hokler/Requestor is responsible for all damage causrd by their use of the park or bounce house Damage to City property or turf may result to additamal fees incurred.

M. Tile City IS nsx re+ps+n+tdllL ftir any dr inag C to the Uounce hutass N. FailurebydwcPermetHottlerJRequesturorveudortoadhurctothew policies will resultintheimmediate reinovulofbouncchouse from the perk and may rrcwdt in flit' denial of future Ice of City park+ and facilities. Damage,, rn the park resulting from use of a btnmte huu+c err die Rnantial re+ponxihility of the Permit Holdcr/Requestor

0. Authorized jumper Companies!
Jurnp N jump Rentals. 909-873-8487 1 jolly Jumps B77.6%1994 Step Fire -Signature, Please Read Carefully Before Signing Facility user hereby agrees to indcnintty, dcicnd and hsild harnticsx City of Yucaipa, its officers. ❑fflcials, erttployers and volunteurs front and against all claims, darmigcx. I ntitia ti ,uuf cx11t•nx•+ that 11my artsedu ring; or he routed inany way by ;ueh occupancy or use of Facihtic3. but the facility ukrr shall lint he Liable fur any rlamts. ddntaltcs. losses and exlrenics caused by the stile negligence or willful misctandutt of die City of Yutaipa Perim"ce +hall lmvc refcivt•d any and all perimsoon or ltwnse(5) ds may be required to perform or ww any prntcttcd maren.rl, in n-; use ill the Piivmitie+ Permittee igrefs to prntect and save harmless the City, its elected officials, employees and agent% lnma .ind igaiti.i any and all damns, pc iulties, and/or damages which uiay acrrue as a result of Permittee's failure to comply with this requirement l have read and agree to by all of the City of Yucaipa Cummunity Center pcalincs stated above and in the Ctiminu nity Cerro 11%;
Applicant Signature- Date: 0q
6 0 2026 ty unc gen 444

ATTACHMENT 12
6 0 2026 ty unc gen 445

26.27 SUBMITTO: CITY OF YUCAIPA
FISCAL YEAR: GENERAL SERVICESICITY CLERIC DEPARTMENT
�,, 34272 YUCAIPA BLVD.

DATE SUBMITTED: �/ /� l-Lqu z,YUCAI PA, 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: 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 applicant's match of funds.

Name of Applicant/Organization: Right Fit Rescue
Applicant/Organization 33730 Yucaipa Blvd #1045
Mailing Address:

Applicant/organization Phone Number: 909-504-9570
CONTACT (1) Jessica Cook 9095049570

NAME PHONE NUMBER
CONTACT (2)
[email protected]
E-Mail
NAME
E-Mail

PHONE NUMBER
OF VUCAFPq
22 '26 AM18: 52
art
t

YES NO
Is your organization located in another community? ❑ Z
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.

Your organization must be an established 501 (c) to be considered for Community Activity Grant funding.

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

YES NO
Is your organization a 501 (c)? W] ❑
If so, please provide tax ID# and attach all supporting 88.1622681 Zw documents.

Does this application include submittal of YES NO
documentation verifying 501 (c) status? 121 7
How long has your 501 (c) organization been in existence? 4 years Number of employees working for organization? d
Number of volunteers working for organization? 20
YES NO
Is a current City Council Member on your board? ❑ 171
How many Yucaipa residents does your organization
currently serve? everyone
Does the organization charge admission, membership YES
NO
fees, due, etc.? LJ
If yes, please describe:
2 447

Name of the programlevent: Yuca+pa 100 Cat project
Date(s) of the program/event; 2026
Total estimated cost for program/event. 40000
Describe the program/event that the organization is seeking support for:
[Attach any event/program promotional materials associated with the program/event} Right Fit Rescue is seeking support to implement a Trap -Neuter -Return (TNR) and feral kitten rescue program serving the City of Yucaipa. This program provides humane trapping, sterilization (spay/neuter), vaccination, and return of community cats to prevent reproduction and stabilize local populations. In addition to TNR, the program includes the rescue of kittens and friendly or socialized cats identified during trapping.

When feasible, kittens are cared for with their mother until fully weaned, then socialized, vaccinated, sterilized, and placed into foster homes for adoption. Adult cats that are determined to be adoptable are also removed from colonies and placed into foster care when capacity allows. When placement is not immediately available, cats are managed in accordance with humane TNR best practices. The program also includes community outreach and education, coordination with property owners and caregivers, and ongoing data tracking to monitor the number of cats treated, colony stabilization, and program outcomes. This comprehensive approach addresses both immediate population control and long-term community impact.

What is the goal of this program/event and how will it positively impact the community? The primary goal of this program is to reduce the number of unsterilized, free -roaming cats in Yucaipa through a humane, effective, and cost-efficient approach. By preventing reproduction, the program stops the cycle of exponential population growth, which ultimately reduces the number of stray and feral cats over time. This program will positively impact the community in several measurable ways. First, it reduces nuisance concerns such as noise, odors, spraying, and property damage commonly associated with unsterilized cat populations. Second, it improves public health by reducing disease transmission and environmental contamination associated with unmanaged colonies. TNR also directly benefits municipal resources by reducing future intake into animal shelters, lowering euthanasia rates, and decreasing the need for costly animal control interventions. Healthier, sterilized cats are less likely to roam, fight, or require emergency care, which further reduces strain on local systems. Additionally, by rescuing and adopting out kittens and friendly cats when possible, the program reduces the number of animals living outdoors and increases positive human -animal interactions within the community. Overall, this program provides a long-term, sustainable solution that improves neighborhood quality of life while reducing costs for the City.

Programlevent primary target population (check all that apply):

Children or Youth
©
Entire Community
Nameless
Low Income
❑ Women
71 Persons with Disabilities
❑
Seniors
❑
Victims
Welfare Recipients
Please answer the following to determine if your programlevent requires a Special Event Permit (5EP):

YES NO
T05 BOX IS FOR STAFF 115E ONLY
Estimated attendance 300-999 persons © YES No
This event requires City Management)
Amplified Sound Administrative Approval: 0
(excluding Special Event Facilities) El 7
YES NO
Estimated attendance 1000+ persons 7 © THIS BOX15 FOR STAFF 11SE ONLY YES NO
Alcohol Service El © L
This event requires City Council Approval:
{excluding Community Centers & YlJ L._.JJ Li
PAQ
Street Closure - Traffic Management ❑
3 I I •

Please identify what your organization is seeking:

YES No
Financial Support: [7 ❑ $20000
In -Kind Support: $ O $ o
oT/Reassigned Staff CS/Rental
Total Amount $ o s 20000
of Request
in -Kind Financial Support
YES 'NO�P
$300 SEP Fee Waiver:
$0 $o
Scherer other
Community Center
so $ 20000 $ 20000
$300 SEP Fee Financial Match Total overall
Waiver Request
Provide a detailed description of how the financial support will he used:

Grant funding will be used to support the direct costs associated with implementing a TNR and feral kitten rescue program in Yucaipa. This includes veterinary services such as spay/neuter surgeries and vaccinations, which are essential to preventing reproduction and improving the health of community cats.

Funds will also support transportation costs required to bring cats to and from partner clinics, particularly due to clinic capacity limits that require multiple trips. Additional expenses include deworming treatments, basic medical care, and a designated emergency medical fund to address unexpected illnesses or post -surgical complications.

Administrative support is also a critical component of the program, ensuring accurate tracking of each cat's medical history, vaccination records, and overall outcomes. This data is essential for program accountability, reporting, and measuring effectiveness.

By covering these essential costs, the funding will allow flight Fit Rescue to efficiently treat approximately 100 community cats, maximizing the impact of each dollar spent. Combined with the organization's financial contributions, volunteer labor, and donated resources, the grant funding will be leveraged to deliver a comprehensive, measurable, and cost-effective program for the City of Yucaipa.

Describe any City Funding received by your organization in the past three years (required)? In -Kind
Program 5upport
Financial
Support
$300 SEP
Fee Waiver Date Received
Total Received
0 ❑
❑
❑
$a
❑
❑
❑
$0
❑
❑
❑
$0
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the last three years?
Funding Source Amount Received date Received
petco love grant $ $500 311125
sun lakes grant $ $2000 12/1125
Morango $ 6000 1111125
4 EM

i, the undersigned, do hereby attest that the above Information is true and correct to the best of my knowledge, and understand that tht awarded financial grant amount needs to be spent prier to submitting another grant request.

Date Received: LA .� ' date Reviewed:

Amount Funded; j City Council Meeting:

Type of Grant:1rt}Cind Financial saoo sra
Suppert Supparr ree Waiwr
Date City Council received follow-up report:
4/ 18/2026
Date
S
450

Yucaipa 100 cat project
1) Describe the program/event that the organization is seeking support for:

Right Fit Rescue is seeking support to implement a Trap -Neuter -Return (TNR) and feral kitten rescue program serving the City of Yucaipa. This program provides humane trapping, sterilization tspay/neuter), vaccination, and return of community cats to prevent reproduction and stabilize local populations.

In addition to TNR, the program includes the rescue of kittens and friendly or socialized cats identified during trapping. When feasible, kittens are cared for with their mother until fully weaned, then socialized, vaccinated, sterilized, and placed into foster homes for adoption. Adult cats that are determined to be adoptable are also removed from colonies and placed into foster care when capacity allows. When placement is not immediately available, cats are managed in accordance with humane TNR best practices.

The program also includes community outreach and education, coordination with property owners and caregivers, and ongoing data tracking to monitor the number of cats treated, colony stabilization, and program outcomes. This comprehensive approach addresses both immediate population control and long-term community impact.
2) What is the goal of this program/event and how will it positively impact the community? The primary goal of this program is to reduce the number of unsterilized, free -roaming cats in Yucaipa through a humane, effective, and cost-efficient approach. By preventing reproduction, the program stops the cycle of exponential population growth, which ultimately reduces the number of stray and feral cats over time.

This program will positively impact the community in several measurable ways. First, it reduces nuisance concerns such as noise, odors, spraying, and property damage commonly associated with unsterilized cat populations. Second, it improves public health by reducing disease transmission and environmental contamination associated with unmanaged colonies.

TNR also directly benefits municipal resources by reducing future intake into animal shelters, lowering euthanasia rates, and decreasing the need for costly animal control interventions. Healthier, sterilized cats are less likely to roam, fight, or require emergency care, which further reduces strain on local systems.

Additionally, by rescuing and adopting out kittens and friendly cats when possible, the program reduces the number of animals living outdoors and increases positive human -animal interactions within the community. Overall, this program provides a long-term, sustainable solution that improves neighborhood quality of life while reducing costs for the City. 3) Provide a detailed description of how the financial support will be used:

Grant funding will be used to support the direct costs associated with imp lementing a TNR and feral kitten rescue program in Yucaipa. This includes veterinary services such as spay/neuter surgeries and vaccinations, which are essential to preventing reproduction and improving the health of community cats.

Administrative support is also a critical component of the program, ensuring accurate tracking of each 6 0 2026 ty unc gen 451

cat's medical history, vaccination records, and overall outcomes. This data is essential for program accountability, reporting, and measuring effectiveness.

By covering these essential costs, the funding will allow Right Fit Rescue to efficiently treat approximately 100 community cats, maximizing the impact of each dollar spent. Combined with the organization's financial contributions, volunteer labor, and donated resources, the grant funding will be leveraged to deliver a comprehensive, measurable, and cost-effective program for the City of Yucaipa. 6 0 2026 ty unc gen 452

11111111111111111111111 IN
BA20240760842

STATE OF CALIFORNIA
Office of the Secretary of Stale

STATEMENT OF INFORMATION

CA NONPROFIT CORPORATION
California Secretary of state
1500 11th Street
Sacramento, California 95814
(916) 657-5448
For Office Use Only
-FILED -
File No.: BA20240760a42
Date Filed: 4/1412024
Entity Details
Corporation Name

RIGHT FIT RESCUE INC
Entity No.
4863149
Formed In

CALIFORNIA
Street Address of California Principal Office of Corporation Street Address of California Office
Mailing Address of Corporawn
Mailing Address
Attention
Officers
Officer Name
Officer Address Position(s)
Jessica Maye Cook
Chief Executive Officer
0 Randy Moore
Chief Financial Officer
0 Brad Bahlust
Secretary
Additional Officers
Officer Name Offirer Address Position Stated Position
None Entered
Agent for Service of Process
Agent Name
Jessica Cook
Agent Address
Email Notifications
Opt -in Email Notifications
Yes, I opt -in to receive entity notifications via email.

Electronic Signature
® By signing, I affirm that the information herein
is true and correct and that I am authorized by California law to sign. -jessico Cook
041I412024
Signature
Date
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N
Y
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Y
0 0
Y
N
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Y
N-
rn
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6 0 2026 ty unc gen 453 Page 1 of 1

Example Cost Breakdown: Recent Project in Yucaipa (Yucaipa Valley Inn Area)
The following is a real example of veterinary costs associated with one of our recent projects in Yucaipa, near the Yucaipa Valley Inn. This project included a combination of feral (community) cats addressed through TNR efforts, as well as kittens taken into faster care and prepared for adoption.

All pricing below is based on published rates from the Mary S Roberts clinic's website Feral Cats (3 Total) - TNR Services
Three feral cats were humanely trapped, sterilized, vaccinated with FVRCP, and returned as part of our Trap -Neuter -Return {TNR} program.

Per Cat:
• Spay/Neuter: $130
• FVRCP Vaccine: $24
Total per feral cat: $154
Total for 3 feral cats: $462
Kittens (4 Total) - Intake and Full Veterinary Care
Four kittens from the same project were taken into foster care and received comprehensive veterinary services to prepare them for adoption.

Per Kitten:
• Spay/Neuter: $130
• FVRCP Vaccine Series (3 rounds): $72
• Rabies Vaccine: $15
• Microchip: $28
• FeLV/FiV Test: $44
• Deworming: $10
■ Flea Treatment: $18
Total per kitten: $317
Total for 4 kittens: $1,268
6 0 2026 ty unc gen 454

Medical Treatment
Two of the kittens required additional medical care due to pre-existing conditions, including one kitten presenting with a missing eye. Necessary veterinary treatment was provided.

Total medical cost for 2 kittens: $4,1oo
Total Veterinary Cost
• Feral Cats t3j- $462
• Kittens [4] $1,266
• Medical Care (2 kittens). $1,100
Total Veterinary Cost: $2,830
Average Veterinary Cost Per Animal
$2,830 7 animals = $404 per cat
Summary
This example reflects the veterinary costs required to provide humane care, population control. and adoption readiness All costs are based on standard pricing published by the clinic and represent baseline expenses for care This total does not include additional operational costs such as food. litter, foster supplies, transportation, or fuel, all of which are necessary to support these animals.
6 0 2026 ty unc gen 455

ATTACH MEN T 13
6 0 2026 ty unc gen 456

. a;o3
I" R AM :
_2�>
2026-2027 SUBMIT TO: CITY OF YUCAIPA
FISCAL YEAR: GENERAL SERVICES/CITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

DATE SUBMITTED: 4/26/26 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. Financial grant awarder{ 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/protect cost In your Wrap-up Report (Accountability Report), detailing the applicant's match of funds.

Name of Applicant/Organization: Seeds of Hope for Yucaipa-Calimesa Applicant/Organization P.0 Box 72 Yucaipa, Ca 92399
Mailing Address:

Applicant/organization Phone Number: 909-712-8430
CONTACT(1) Monica Cauldweil
NAME
[email protected]
E-mail
CONTACT (2) Johanne Dyerly
NAME
[email protected]
E-Mail
951-557-1412

PHONE NUMBER
951-532-9325

PHONE NUMBER
1 6 0 2026 ty une —gen —__Y� �` 457

YES NO
Is your organization located in another community? ❑ ❑� Will the program/event take place in another community? ❑ 0 Are you aware of any other City program providing this service? If so, which one? nla
*If you answered —Yes -to any of the questions listed above, your request is =eligible for the Community Activity Grant.

Your organization must be an established 501 (c) to be considered for Community Activity Grant funding.

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

YES NO
Is your organization a 501 (c)?❑
If so, please provide Tax ID# and attach all supporting 82.5498565 I/T documents.

Does this application include submittal of Y❑ NO
documentation verifying 501 (c) status? ✓
How long has your 501 (c) organization been in existence? 2024 Number of employees working for organization? 1
Number of volunteers working for organization? 8
YES NO
Is a current City Council Member an your board? ❑ ❑7
How many Yucaipa residents does your organization
currently serve? unknown
Does the organization Charge admission, membership YES NO fees, due, etc.? ❑ LJ
If yes, please describe: n/a
qr'
6 0 2026 ty une gen 458

Name of the program/event: Emergency Housing
Date(s) of the program/event, year round
Total estimated cost for program/event: 10,000
Describe the program/event that the organization is seeking support for:
(Attach any event/program promotional materials associated with the programtevent) This is emergency housing for families with student's specifically in the Yucaipa -Cali mesa Joint Unified School District who are experiencing homelessness. This program is to insure our community's children have a safe and stable environment and continue to come to school. We have an MCU with the Yucaipa Valley Inn to provide the emergency housing.

What is the goal of this program/event and haw will it positively impact the community? The goal of providing emergency housing is to keep our students in school and help their families stablize.

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

Children or Youth
0 Entire Community
0 Homeless
Z Law Income
0 Women
Persons with Disabilities
❑
Seniors
Lr l
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)
I HIS BOX 15 FOR 57AFi USE ONLY
This event requires City Management/ YES MQ
Administrative Approval: ❑ 0
YES
NO
Estimated attendance 1000+ persons
❑
❑
THIS BOX IS FOR STAFF #JSEONLY
YE5 NO
Alcohol Service
F1
1-1mmunity
This event requires City Council Approval:
❑
Centers & YPA
(excluding CpC)
Street Closure - Traffic Management
F1
❑
3 6 0 2026 ty unc gen 459

Please identify what your organization is seeking:

YES NO
YES NO
Financial Support:
0 ❑ $ 5000
$300 SEP Fee Waiver:
❑ ❑
In -Kind Support:
$ #
$ $
OT/Reassigned Staff CS/Rental
Scherer Other
Community Center
Total Amount
#
# 5,�0 #
# S i u �: c; _
# c Cs
of Request
R
In
-Kind Financial Support
$300 SEP Fee Financial Klatch
Total Overall
Waiver
Request
Provide a detailed description of how the financial support will be used:

Financial support would be used to provide emergency housing to families with children in the Yucaipa-Calimesa school district. This housing will help students have stabilty, a warm place to sleep, and to be able to be clean for school.

Describe any City Funding received by your organization in the past three years (required)? In•Kind
Program Support
Finandal
Support
$300 SEP
Fee Waiver
Oate Received Total Received
nla ❑
❑
❑
#
❑
❑
❑
#
❑
❑
❑
#
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the last three years?
funding Source Amount Received Date Received
nla #
s
0 6 0 2026 ty unc gen 460

Signature
Director
Title
Date Received: Date Reviewed:

Amount Funded: I rf r City Council Meeting:

Type ai Grant: �n•Kind 3 1 Financial $300SEP
Support I},j-(—/�I #upper[ No Waiver
Date City Council received follow-up report:
4/26/26
Date
i
Ak 6 0 2026 ty unc gen 461

i mrii mmin imunuuu ii�uini ummi �u m� mmr iui
400 STATE OF CALIFORNIA
Office of the Secretary of State

CERTIFICATE OF AMENDMENT

CA NONPROFIT CORPORATION
California Secretary of State
1500 11th Street
Sacramento, California 95814
(916) 657-5448
For Ofrlw Use Only
-FILED -
File No.: BA20260075450
Date Filed t 11412026
Corporation Details
Corporation Name FAMILY PROMISE OF YUCAIPA-CALIMESA
Entity No. 4207958
Amendment Details
Article 1 of the Articles of Incorporation is amended to read:

Corporation Name Seeds of Hope for Yucai pa -Cali mesa
Approval Statements
Approval Statements
1) The Board of directors has approved the amendment of the Articles of Incorporation. 2) Member approval was by the required vote of the members (in accordance with California Corporations Code sections 5812, 7812, and 12502.)
Signatures
® By signing, I declare under penalty of perjury under the laws of the State of California that the information herein is true and correct of my awn knowledge and that I am authorized by California taw to sign.

Secretary Cali Binks 0111212026
Officer Title Officer Signature Date
President Tyson Lingen felter 01/1212026
Officer Title Officer Signature Date
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6 0 2026 ty unc gen 462 r'a (T, 'I of 1

INTERNAL REVENUE SERVICE
P. 0. Box 2509
CINCINNATI, OH 45201
(Rate: J U L 17 2019

FAMLY PROMISE OF YUCAIPA-CALIMESA

CIO CALI SINKS
PO BOX 72
YUCAIPA, CA 92399
Dear Applicant:

OEPARTMENT OF THE TREASURY
Employer Identification Humber:
e2-5498565
DLN:
17053130306039
Contact Person:

MICHAEL 1 UPSHAW ION 17310
Contact Telephone Number:
(877) 829-5500
Accounting Period Ending:

December 31
Public Charity Status:
170(b)(1)(A)(vi)
Form 9901990-EZ1990-N Required;
Yes
Effective Date of Exemption:

October 26, 2018
Contribution Oeductibility;
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)(a)_ 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 9901990-EZ/990-H, Our records show you're required to file an annual information return (Form 990 or Form 990-FZ) or electronic notice (Fors 990-t1, the e.-Postcar(l). If you don't file a required return or notice for three consecutive years, your exempt status will pe 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, 90 to www.irs.govlcharitzes . Enter "4221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(e)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements.

Letter
6 0 2026 ty unc gen 463

ATTACHMENT 14
6 0 2026 ty unc gen 464

2026-2027 SUBMIT TO: CITY OF YUCAIPA
FISCAL YEAR: GENERAL SERVICESICITY CLERIC DEPARTMENT
34272 YUCAIPA BLVD.

DATE SUBMITTED: 4129126 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: Financial grant awarded funds will require 100%financial match by the applicant. For example, if your total programlproject 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 funds.

Name of Applicant/Organization: Smiles for Seniors Foundation Applicant/Organization 34045 Yucaipa Blvd. Ste 104
l4Ma iii ng Address :

Applicant/Organization Phone Number: 909-790-6671
CONTACT(l) Catherine Serianni
NAME
[email protected]
E-Mail
CONTACT(2) E. Andrew Woravka
NAME
[email protected]
E-Mail
909-790-6671

PHONE NUMBER
909-790-6671

PHONE NUMBER
A" a•I
1910 JZ40
LJ
6 0 2026 ty unc gen 465

YES NO
is your organization located in another community? Q
Will the program/event take place in another community? Q Are you aware of any other City program providing this service? �✓ If so, which one?
`1f you answered "Yes" to any of the questions listed above, your request is note Foithe Community Activity Grant.

Your organization must be an established 501 (c) to be considered for Community Activity Grant funding.

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

YES NO
Is your organization a 501 (c)? Q i
Tax ID# and attach all supporting
If so. please provide pP g 2fi-�3736�2
documents.

Does this appiication include submittal of YES NO
documentation verifying 501 (c) status? Z
How long has your 501 (c) organization been inexistence? 19 Years Number of employees working for organization? 2
Number of volunteers working for organization? 35
Is a current City Council Member on your board?
YES
❑
No
F
How many Yucaipa residents does your organization 500
currently serve?
Does the organization charge admission, membership
YES
NO
fees, due, etc.?
If yes, please describe:
2 6 0 2026 ty unc gen 466

Name of the program/event: Low -Income Seniors Food Assistance Program Date(s) of the programlevent: 2026-2027 Ongoing
Total estimated cost for programlevent: 3000
Describe the program/event that the organization is seeking support for:
rAttach any even tlprogram promotional materials associated with the programlevent] We are seeking support for our food card program. We provide grocery store gift cards that our seniors can use to get fresh meat, vegetables and dairy products. These items are not usually provided by church, missions or food pantries. We also hold free food drives once a year and deliver food and meals to home bound seniors along with providing valuable resources to local food programs We are very proud of the fact that during the pandemic, Smiles for Seniors was able to provide hundreds of low-income seniors with food boxes at a time in our history when the grocery store shelves were bare, and no food was to be found anywhere because of the hoarding and shipping related issues. In the first days of the Pandemic the Federal and State food/feeding programs had not yet been rolled out, however, Smiles for Seniors and volunteers were able to procure pack and deliver food to the seniors in the community. Nothing stopped us.

We had an army of volunteers, and we went to restaurant supply stores from here to L.A. and Inarlarl i in manta rontori nnri rinnnharl fri irk-. anti franc with mi irh naarlorl fnnrf Tni lot nnnor What is the goal of this program/event and how will it positively impact the community? With this funding, our goal is to help at least 100 low-income seniors with grocery store food cards in increments of 25.00 and 50.00. Our low- income seniors are struggling with high cost of rent, gas, utilities, and medication but nothing is more important than having fresh healthy food.

Our seniors are going hungry and making tough decisions about whether to buy food or medication. The situation is dire and many are in crisis mode. 25.00 or 50.00 food card is not much but it helps when your stomach is growling and twisting from hunger pangs. One of our local seniors called in need of food, I'm saddened to say, but she had been eating cat food for a few days before she called our hot line. (We actually hear this more than you could imagine) Smiles 4 Seniors was able to bring her some food and give her food cards along with a list of other food and basic assistance resources. We paid her water bill, so she didn't have to worry about where that money would come from. She was able to get on track again because someone was there when she needed help. Smiles for Seniors is that someone... and thanks to Program/event primary target population (check all that apply):
❑
Children or Youth
❑
Entire Community
Z
Homeless
✓0
Low Income❑
Women
✓❑
Persons with Disabilities
RI
Seniors
❑
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 ❑ ❑
Amplified Sound ❑ El
Special Event Facilities)
YES No
Estimated attendance 1000+ persons ❑ ❑
Alcohol Service ❑ El
Community Centers & YPAC]
Street Closure - Traffic Management ❑ ❑
THIS BOX 15 MR 5
YES NO
This event requires City Management/ ❑
Administrative Approval: PC_
I nis Box 4 FOR STAFF USE ONLY
YES No
This event requires City Council Approval: ❑
3 60 2026 ty unc gen
467

Please identify what your organization is seeking:

YES NO
Financial Support: ❑✓ ❑ s 1500
In -Kind Support- S $
OT/Reassigned Staff CS/Rental
Total Amount �*l
s $ 1500 z
of Request In -Kind Financial Support
YES No
$300 SEP Fee Waiver: ❑ ❑
S $
Scherer Other
Community Center
$1500 s 3000
$300 SEP Fee Financial Match Total overall
Waiver Request
Provide a detailed description of how the financial support will be used:

Financial support will be used to buy Stater Brothers and Aldi Food cards in increments of $25.00 -50.00 for approximately 100-120 low income seniors.

We will provide the grocery gift cards when a senior is referred to us for assistance. We also provide food cards to various low- income mobile home park residents as well as senior center patrons known to be struggling. We also give food cards for the holidays such as Easter, Thanksgiving and Christmas. They're so appreciative and grateful for the bit of assistance.

Describe any City Funding received by your organization in the past three years (required)? Program
in-Krn¢
Support
Financial
Support
$300 SEP
Fee waiver
bate Received
Total Received
Low- Income Senior Assistance
❑
❑�
❑
7/15/25
z 3000
Low- Income Senior Assistance
❑
❑✓
❑
7/24/24
s 3000
Law- Income Senior Assistance
❑
❑✓
❑
7/27/23
s 3000
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the fast three years?
Funding Source Amount Received hate Received
All Income from 2023 990 $ 101,300 12/31/23
All Income from 2024 990
All Income from 2025 990
$ 123,306 12/31/24
$ 116,903 12/31 /25
4 60 2026 ty unc gen
1m

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.
.g"ature Title date
Date Received: Date Reviewed:

Amount Funded: City Council Meeting:

Type O# Grant In Nind Finannal %3W SEi
❑ Support ❑ support Fee Waiwr
Date City Council received follow-up report:

LA
6 0 2026 ty unc gen 469

Smiles for Seniors Foundation A Non Profit 501 Q Organization Tax ID # 26-0373602 P.O. Box 1113 Yucaipa Ca. 92399 Ph. 909-790-6671 - www.smiles4seniors.org - [email protected] -:^ri'cilr,L PXVFNUV-' saw. rer,
F. C. BOX 2S0a
-_:`:C: UNATI. 0-,q 4S201
Date. OCT 2 3 ZX7
SMILES POP. SIMORS FCr• NdATiON
14910 AVE C
TXA_ 'A, CA 72s99
7nar Appliva :.

DERMTi M-- OF TH? TREASUWj
:v"er Sdentification Niscuier:
26-:373602
Mr':
1-333291361037
�eataat Person-
OEL TRZrMLE IRi1 31309
�oa--act '=Z1Bphon.. P7liRIhR;:
'877: F29.5F.00
Acicur.ttng Periori Ending:

Decem--er 3:

Publ:'; Char_` Status:

Farm [aye, !!aiutrpci
Tea
EiAoeti.ve Date of 8x'erptiori: - -
JUne 8, 2007
Contribution 7eductibility:

Yen
Advance. eculing $::cii.nrg Date:

December 31, 2011
Addendum Applies:

NU
ex are please. tc in_arm you that uyun re•;ieer Of •.r_-yx applicat:IOn far tax exempt rtatas we have determined chat yot: atc+ exerVt from Federal i_}come tax under aectior. SOl;cy (3) Of tl_e Internal ae+rorue Code. Coneribstiars to you ire deductible tindar section 170 of t:1e Lade, You are W-Fjo (Vai,_fied to rsce:ive tax ded:icriblr. bmgllesta. devises, tranefars or gifts under uection 2055, 210c, nr 2523 of c:ho SoiP. Because this ln'rar could l:alp resplve .tny q+r�ti_,ac rejarding }aur exempt atacur. you should keep it in ).Our permaner.: sacaxcl".

Organ lzar.inn4 exempt under seeticn SCI(r)i3} of the Cadre are Carther ^lastlf:�d ac CL+ner Public charities or private foundations. r)uring }rays advan(•c rtilinq Ncerius, vol.'
kill be treated as -a ptib3,i.c charity, Your advance raying peril hegine With =:ie effective date Of yaur eX=1pt_un and onda with advance rt:111,c3 ending date shown in the heading of the letter.
sk:c:rtl} lnf03-n ti3r ,;nd of )-O'U advance ruling periac, •0& wiI.l send you rerat 8734. SupForC Schedule for Advance Ruling PArio(`- You will have 90 deyn aftrr the e4d : f .•u.:r aarirtc4 rulixig period to ret,,rn the cOmplpCed °Ux�a. We Will the;t aoriff you, in writing, about your p:aLlic charity status.

Please 8'e e:1C:osed PUallcat.on 4221-YC, CertgI:arcr r,=ids' tc:z 501?c) {3' F:tbl_c Charities. for nomc ro helpfu? infaration about ,-Qux reS�onsiLil;ties as an orgAniaatinn.

If you dtsrr+'tkirm furide :o vt3;er orgauizationa, Your recnrdc: must shew v+l!cther t !P .irk Fvn'7 ::7 iC L' 3f ^.: 1^il S0= .. i l , . =n --:1.^. en Wh ere `. 1F•
Letter 1045 ;DOJ"t;r
6 0 2026 ty unc gen 470

ATTACHMENT 15
6 0 2026 ty unc gen 471

2026/27 SUBMIT TO: CITY OF YUCAIPA
FISCAL YEAR: GENERAL SERYICESMITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

DATE SUBMITTED. 4/20/26 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.

Be prepared to show proof of programlproject cost in your Wrap-up Report (Accountability Report), detailing the applicant's match of funds.

Name of Applicant/Organization: Yucaipa / Calimesa Family Assistance Applicant/Organization PO Box 100, Yucaipa CA 92399
Mailing Address:

Applicant/Organization Phone Number: (909) 797-0244
CONTACT (1) Holly Kirkwood (909) 797-0244

NAME PHONE NUMBER
opcoordinator@a ycfamilyassist.org
E-Mali
CONTACT (2) Paul Kielhold (909) 797-02444

NAME PHONE NUMBER
[email protected]
E-Ma I I
60 2026 ty une gen
472
1 YES NO
Is your organization located in another community? 0
Will the programievent take place in another community? 0 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 ellgible fort he Community Activity Grant.

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.

YNO
Is your organization a 501 (c)? ] 0
If so, please provide Tax ID# and attach all supporting 95.6102982 ` documents.

Does this application include submittal of YES
NO
documentation verifying 501 (c) status?
How long has your 501 (c) organization been in existence? 77 years 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
1 41
YES NEl O
i' 1
2,900 monthly
YES NO
1:1 0
2 6 0 2026 ty unc gen 473

Name of the program/event: Repair and replace existing facilities Date(s) of the program/event: Ongoing throughout the year Total estimated cost for program/event: $36,756.95
Describe the program/event that the organization is seeking support for; (Attach any eventiprogram promotional materials assoclated with the program/event) Roof repair $35,800
Replace ramp to food storage shed $956.95
What is the goal of this program/event and how will it positively impact the community? To maintain facilities to serve our community in perpetuity.

Program/event primary target population (check all that apply):
✓❑
Children or Youth ❑ Entire Community
Q Homeless
❑v Low income
❑
Persons with Disabilities 0 Seniors
Victims
0 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)
YES NO
Estimated attendance 1000+ persons ❑ ❑
Alcohol Service I�I ❑
(extluding Cammunity Centers & YPAC) LJ
Street Closure -Traffic Management ❑ ❑
Try I$ BOX f5 FOR STAFF USE ONLY
This event requires City Management! YES
Administrative Approval: 0 �
TWS BOX 15 FOR _S7AFF USE ONLY
YES
Nb
This event requires City Council Approval: El
60 2026 ty une gen
474
3 Please identify what your organization is seeking:

YES NO ter' YES NO
Financial Support: ❑ ❑ $ k (o5i�.oj$300 SEP Fee Waiver: ❑ ❑ In -Kind Support: $ $ $ $
OT/Reassigned Staff CS/Rental Scherer Other
Community Center
Total Amount $ 0 S 2,656.95 $ 0 $ '� �'5� I95 $ 2,656.95 of Request +
In -Kind Financial Support $300 SEP Fee Financial Match Total Overall Waiver Request
Provide a detailed description of how the financial support will be used:
$1,700 will be applied of the cost of roof repair
$956.95 will be applied to purchase a ramp with handrails for our food storage shed = $2,656.95 total requested
Describe any City Funding received by your organization in the past three years (required)? Program
In -Kind
support
Financial
Support
Sapp SEP
Fee Waiver
Date Received Total Received
CAG 25/26
$ 1,600.00
CAG 24125
❑
❑
$1,679.37
CAG 23124
❑
9 ❑
$ 2,000.00
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the last three years?
Funding Source Amount Received Date Received
Community donations, thrift store sales s various
S
4 6 0 2026 ty unc gen 475

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.
te
�'?_G
VdI LW
I
Date Received: I IA Date Reviewed:

Amount Funded: City Council Meeting:

Type of Grant' ^-Kind StA'potFinancia#eWaly
' ❑ Support Support ❑ fC61M11A�M4Y
Date City Council received follow-up report:
5 6 0 2026 ty unc gen 476

g G r na S 1
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6 0 2026 ty une gen 477

Department of tha Treasury
Internal Revenue Service {Sate:

Tax Exempt and Government Entities October 6, 2021
ID10
PO Box 2508 Employer 10 numbor:

Cincinnati, OH 45201 Form�5-00 2982
Perm �9D rortulrod:
990, YF7s
Person tc Contact
YUGAIPAIGALIMESA FAMILY ASSISTANCE Name; Ms. Wiles
PO ROX 130 ID nurnber: 0,196728
YUCAIPA, CA 92399
Dear Sir or Madarn:

We're respanding to your request dated January 13, 2021, about your tax,-cxcntpt stawz , We issued you a dewrmination letter in May 1953, recognizing you as tax-cxcmt7t under Internal Revenue Code Ulk(''; Section 501(c)(3).

We also show you're not a private foundation as defined under IRC Section 509(a) because you're described in IRC Section 509(a)(1) and 170(b)(1)(A)(vi).

Donors can deduct contributions they make to you as provided in IRC Section 170. You're also qualified to receive tag, -deductible bequests, legacies, devises, transfers, or gifts under IRC Sections 2055, 2106, and 2522.

In. the heading, we indicated whether you must file an annual information return. if you're required to file a re=i, you must file one of the following by the l Sth day of the 5th month after the end of your annual accounting period. 0 1'otm 990, Return ofOrganizatiort Excmpt Froin Income Tax • Form 990-EZ, Short Farm Return of Organization Exempt From Income Tax Form 990-N, Etectmmc,Notice [e-PostcaZd) for Tax -Exempt Organizations Nlot Required to File Form 990 or Fonri 990EZ
• Form 990-PP, Retwni of Private Fuundatiory or Section 4947(a)(1) Trust Treated as Privatc Foundation According to IRC Section 6033�), if you don't file a required annual information return or notice for 3 consecutive years, we'll revoke your tax-exempt status on the due date of the 3rd required return or notice.

You can got IRS forms or pubtieatioms you need frorn our website at www.ivs.gov/formb-pubs or by calling 800-TAX, FORM (800-829-3676).

If you have questions, call 877-829-SSOO between 8 a,rz. and 5 p.m-, local time, Mooday through Friday (Alaska Arid Hawaii follow Pacific time),
Thank you for your cooperation.

Sincerely,
Stephen A. Martin
Director, Exempt Organizations Rulings and Agrecinont5
latter 4100 (ltev, 09-N?-51
Catalog Number 66666G
6 0 2026 ty unc gen 478

ATTACHMENT 16
6 0 2026 ty unc gen 479

In
2026/2027 SUBMIT TO: CITY OF YUCAIPA
FISCAL YEAR: GENERAL SERVICESICITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

DATE SUBMITTED: ] r "T L +7r� YUCAIPA. CA92399
LI i h. ti•�•` �i i
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: 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 S500.

Be prepared to show proof of program/project cost in your Wrap-up Report (Accountability Report), detailing the applicant's match of funds -
Name of Applicant/Organization: Yucaipa Calimesa Girls Softball Applicant/Organization PO Box 1482, Yucaipa; CA 92399
Mailing Address:

Applicant/Organization Phone Number:

CONTACT(l) Christine Fulmer

NAME PHONE NUMBER
E-Mail
CONTACT (2) Haley Flower

NAME PHONE NUMBER
E•Mail
1 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.

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)? I
If so, please provide Tax ID# and attach all supporting 33-0492117 documents.

Does this application include submittal of YES NO
documentation verifying 501 (c) status? 0 ❑
How long has your 501 (c) organization been in existence? 1994 Number of employees working for organization? 2
Number of volunteers working for organization? 14
❑ ❑✓
Is a current City Council Member on your board?
How many Yucaipa residents does your organization 234
currently serve?
Does the organization charge admission, membership 0
fees, due, etc.?
If yes, please describe:

Players pay registration fees for spring and
fall seasons, which goes to pay for uniforms,
city permits and lights, insurance, etc.
.
481

Name of the program/event: Field and league improvements for Yucaipa Calimesa Girls Softball Date(s) of the programlevent: Ongoing
Total estimated cost for program/event: $18,000
Describe the program/event that the organization is seeking support for:
(Attach any eventlprogram promotional materials associated with the program/event) Backstop netting for upper field. Goal is to reduce risk of injury to fans and minimize loss of balls to the ditch behind the field.

Estimated cost $1237.50 plus installation, parts, and labor.

Softball pitching machine. Goal is to provide additional training opportunities for all players at our fields. Estimated cost $2,699 ID Badge Machine. Goal to efficiently print badges identifying background checked volunteers to ensure compliance with governing body (USA Softball) requirements for those allowed on playing fields. Estimated cost $2,178.

Clay for pitching mounds. All three fields have significant wear at the pitching mounds and require clay to fill in and reduce future wear caused by repeated use and pushing off during pitching. Estimated cost $1,696.88 Scoreboard for main field. The existing scoreboard at main field is non -operational. To update and repair, estimated cost is $10,000 including install.

What is the goal of this program/event and how will it positively impact the community? Yucaipa Calimesa Girls Softball serves over 330 families from Yucaipa, Calimesa, Beaumont, and mountain communities. Our program is year-round and with tournaments and other competitive play, brings other communities, teams and leagues to our fields. I Street Park's fields need improvements to allow us to continue offering a competitive, safe, youth and community focused program. The improvements we intend to do with this grant money directly impact the girls and families we serve while also elevating the City of Yucaipa's property, appearance and reputation reflected at I Street Park.

Backstop netting and the la badge machine improve safety for our participants. Clay at the pitching mounds improves safety and playing conditions. A softball pitching machine gives the league the opportunity to offer hitting clinics and other development without requiring families to travel out of Yucaipa for batting cages. Having an unusable scoreboard reflects negatively on the league. This improvement is a great visual of the league and the city's investment in the youth of the league and community.

Program/event primary target population (check all that apply):
e
Children or Youth
e
Entire Community
H
Homeless
H
Low Income
11 Women
Persons with Disabilities
Seniors
Victims
Welfare Recipients
Please answer the following to determine if your programlevent requires a 5pecial Event Permit (5EP):

YES ❑ THIS BOX IS FOR STAFF USE ONLY
Estimated attendance 300.999 persons ❑✓ This event requires City Management/ YES Amplified Sound ❑
Administrative Approval:
(excluding Special Event Facilities) 21
YES NO
Estimated attendance 1000+ persons ❑ �✓ THIS BOX 15 FOR STAFF USE ONLY Yes No
Alcohol Service
(excluding Community Centers & YPAC) E This even[ requires City Council Approval: ❑ Street Closure - Traffic Management ❑�
3 51 •
6 13
Please identify what your organization is seeking:

YES NO
Financial support: Q ❑ $9,000.00
In -Kind Support: $ $
OT/Reassigned Staff CS/Rental
Total Amount $ $ 000 00 $
of Request
In -Kind Financial Support
YES NO
$300 SEP Fee Waiver: ❑ 0
Scherer Other
Community Center
$ IuU(. CC $ I
$300 SEP Fee Financial Match Total Overall
Waiver Request
Provide a detailed description of how the financial support will be used:

If financial support is granted, we will use funds to make improvements to the three softball fields at I Street Park. We will proceed with purchase and install of backstop netting at the upper field, purchase a softball pitching machine, purchase an ID badge machine, quote and install clay at all three pitching mounds, and move forward with purchasing and installing a main field scoreboard to replace the existing, nonoperational scoreboard.

Describe any City Funding received by your organization in the past three years (required)? In-K:nd
Program S❑"
Financial
Support
S300SEP
Fee waiver
Date Received Total Received
❑
❑
$
❑
❑
❑
$
❑
❑
❑
$
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the last three years?
funding Source Amount Received Date Received
$
4 IM

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.
0 YCGS Board Member, Fundraising Coordinator 04.30.2026 Signature Title Date
Date Received: Date Reviewed:

Amount Funded: City Council Meeting:

Type in -Kind Financial ❑ $300SEP
T
Yp ❑ Support ❑ Support Fee Waiver
Date City Council received follow-up report:

I ; I
0 efile GRAPHIC Tint - Do NOT PROCESS I As Filed Data - DLN: 93492244002353 Short Form OMB No. 1545-0047
Form990EZ Return of Organization Exempt From Income Tax �y2� DTarimentofthr Under section 501(c), 527, or4947(a)(1) of the internal Revenue Code (except private foundations) VV Treasury
Internal Revemir Semee ■ do not enter social security numbers on this farm as it may be made public. Open - ' Public ► Go to www.Fr9.Qov1Form990EZ for instructions and the latest information. Trispection A For the 2022 calendar year, or tax year beginning 08-01-2022 and ending 07-:

B Check if applicable: C Name of croanization
❑ Address change YUCAIPA CALIM ESA GIRLS SOFTBALL
❑ Name change Number and street (or R 0. box, iF mail is not delivered to street address) ❑ Initial return PO BOX 1482
❑ Final return/terminated
❑ Amended retum City or town, state or province, country, and 2IP or foreign postal code YQCAIPA, CA 92399
❑ Application pending
o Employer identification number
E Telephone number
F Group Exemption
Number 0.

G Accounting Method: 0Cash ❑ Accrual Other (specify) ■
H Check ► 0 W the organization is not
required to attach Schedule B
(Form 990, 990-EZ, or 990-PF)_
I Website: ►WWW.YCASA.COM
3 Tax-exempt status (check only one) - 0 501(c)(3y ❑ 501(c)( ) A (insert no.) ❑ 4947(a)(1) or ❑ 527 K Form of organization: @Corporation ❑ Trust ❑ Associatlon ❑ Other L Add lines 51b, Uc, and 7b to line 9 to determine gross receipts. If gross receipts are $200,000 or more, or if total assets (Part I1, column (B) below) are $500,OOD or more, file Form 990 instead of Form 990-EZ . . . . . . . . . . . . . . . . . . . ■ $ 143,639 Revenue, Expenses, and Changes in Net Assets or fund Balances (see the instructions For Part 1) Check if the 0rganizatien used Schedule 0 to respond :o any question in this Part I , , 0 1 Contributions, gigs, grants, and similar amounts received . . . . . . . . . . . . . . . . . . . . 1 2
125,513
2 Program service revenue including government Fees and contracts . . . . . . . . . . . . . . . . 3 Membership dues and assessments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 4 Investment income . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 5a Gross amount from sale of assets other than inventory . . . . . . 5a b Less: cost or other basis and sales expenses . . . . . . . . . . . 5b c Gain or (loss) frarn sale of assets other than inventory (Subtract line 5b From line 5a) - Sc
6 Gaming and fundraising events
a Gross income from gaming (attach Schedule G if greater than $15,000) 6a b Gross income from fundraising events (not including $ of contributions from fundraising events reported on line 1) (attach Schedule G if the sum of such gross income and contributions exceeds $15,000) 6b 18,126 c Less: direct expenses from gaming and fundraising events fie d Net income or (loss) from gaming and fundraising events (add lines Ga and 6b and subtract line 6c) 6d
18,126
7a Gross sales of inventory, less returns and allowances . . . . . 7a b Less: cost of goods sold . . . . . . . . . . . . 7b
c Gross profit or (loss) From sales of inventory (Subtract line 7b from line 7a) . . . . . . . . . 7c
8 Other revenue (describe in Schedule 0) . . . . . . . . . . . . . . . . . . . . 8 9 Total revenue. Add lines 1, 2, 3, 4, 5c, 6d, 7c, and 8 . . . . . • 9 143,639
V) Grants and similar amounts paid (list in Schedule 0) 10 11 Benefits pair to or for members . . . . . . . . . . . . . . . . . . . . . . 11 12 Salaries, other compensation, and employee benefits . . . . . . . . . . . . . 12 u
13 Professional fees and othe- payments to independent contractors . . . . , , . , . . . . 13 33,251
e.
x
W
14 Occupancy, rent, utilities, and maintenance . . . . . . . . . . . . . . . . . . is Printing,. . . . . . . . . . . . . . . . . publications, postage, and shipping . 14 15
236
16 Other expenses (describe in Schedule 0) . , . . . . . . . . . . . . . . . . . 16 128,147
17 Total expenses. Add lines 14 through 16 •
17 161,634
LO Excess or (deficit) for the year (Subtract line 17 from line 9) . . . . . . . . . . . . 19 Net assets or fund balances at beginning of year (from line 27, column (A)) (must agree With 1s
-17,995
A
"
4 erd-of-year figure reported on prior ear's return . . . . . . . . . . . . . .

P y )�
19 70,726
20 Other changes in net assets or fund balances (explain in Schedule C) - . . . . . . . . . . 20 21
52,731
21 Net assets or fund balances at end of year. Combine lines 18 through 20 . . . . . . . . . .

For Paperwork Reduction Act Notice, see the separate instructions. Cat. Nn. 1064ZI Form 990-EZ (2022) 6 0 2026 ty unc gen 485

Form 990-EZ (2022) Page 2
Balance Sheets (see the instructions for Part II)
Check if the organization used Schedule O to respond to any question in this Part II . IZ A Beginninq of vear
B End of year
70,726
221
52,731
22Cash, savings, and investments . . . . . . . . . . . . . . . . 23 23 Land and buildings . . . . . . . . . . . . . . . . . . . . 24 24 other assets (describe in Schedule O) . . . . . . . . . . 25 Total assets . . . . . . . . . . . . . . . . . . . . . . 70,726
25 52,731
26 26 Total liabilities (describe in Schedule 0) . , , , , , , , , , , , , 70772
27 52,731
27 Net assets or fund balances (line 27 of column (8) must agree with line 21) Statement of Program Service Accomplishments (see the instructions For Part In) Expenses
Check if the organization used Schedule O to respond to any question in this Part III ❑ (Required for section 501(c)
(3) and 501(c)(4)
organizations; optional for
others.)
What is the organization's primary exempt purpose?
EDUCATION OF YOUTH VIA THE GAME OF SOFTBALL.

Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses. In a clear and concise manner, describe the services provided, the number of persons benefited, and other relevant information for each program title. 28 See Additional Data Table
•.............•............--..--
(Grants $ ) If this amount includes foreign grants, check here . ■ ❑ 28a
29 29a
(Grants $ ) If this amount includes foreign grants, check here . ■ ❑ 30 30a
(Grants 3 ) If this amount includes foreign grants, check here . ■ ❑ 31 Other program services (describe in Schedule 0) . .
(Grants $ ) If this amount includes foreign grants, check here ■ El31a 32 Total program service expenses (add lines 28a through 31a) 1 32 142,149
List or o"scers, Ulrectors, Trustees, and Key Employees (list each one even if not compensated ; see the instructions for Part IV) Check if the organization used Schedule 0 to respond to any question in this Part IV. . . . . . . . . . . . p (a) Name and title
(b) Average
hours per week
devoted to position
(c) Reportable
compensation
(Forms W-211099-
MISC) (if not paid,
enter -0-)
(d) Health benefits,
contributions to employee
benefit plans, and
deferred compensation
(e) Estimated amount
of other compensation

IEFF LOZANO

PRESIDENT

5.00 0

JENNIFER MITCHELL

VICE PRESIDE

5.00 0

HEATHER CASE

SECRETARY
5,00
0 IOANN SMITH

TREASURER

5.00 0

SIMON SMITH

FIELD & EQUI

2.00 0

KAT LANGE

SOCIAL MEDIA

2.OD
0 6 0 2026 ty unc gen
Form 990-EZ (2022)

ATTACHMENT 17
6 0 2026 ty unc gen 487

COMMUNITY ACTIVITY GRANT APPLICATION INSTRUCTIONS
2026/2027 SUBMIT TO: CITY OF YUCAIPA
FISCAL YEAR: GENERAL SERVICES/CITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

DATE SUBMITTED: 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: Financial grant awarded funds will require 100%financial match by the applicant. For example, if your total programlproject cost is $1.000, 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 applicant's match of funds.

Marne of Applicantf0rganizatinn: YUCAIPA CALIMESA VETERANS COMMITTEE AppIicantl0rganization P CIBOX 124, YUCAIPA 92399
Mailing Address:

Applicant/Organization Phone Number:

CONTACT (1 ) George Sardeson
NAME PHONE NUM13ER
E-Vdil
CONTACT (2) Rachael Gustuson

NAME PHONE NUMBER
rgustuson C timeslocafinedia.com
E•N1ae.
1 YES NO
Is your organization located in another community? ❑ 7
Will the program/event take place in another community? El Q Are you aware of any other City program providing this service? 0 Q 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.

Your organization must be an established 501 (c) to be considered for Community Activity Grant funding.

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

YES NO
Is your organization a 501 (c)? Z
If so, please provide Tax ID# and attach all supporting 99.1 B743a ,%14V documents.

Does this application include submittal of YES NO
documentation verifying 501 (c) status? 0
How long has your 501 (c) organization been in existence? 2 YEARS Number of employees working for organization? Q
Number of volunteers working for organization? i 1
YES No
Is a current City Council Member on your board? ❑ 0
How many Yucaipa residents does your organization NIA
currently serve?
Does the organization charge admission, membership YES NO fees, due, etc
If yes, please describe:
2 Name of the program/event: 2026 VETERANS DAY CEREMONY Date(s) of the program/event: NOV. 11,2026
Total estimated cost for programlevent: $1300
Describe the programlevent that the organization is seeking support for:
(Attach any eventlprogram promotional materials associated with the program/event) This is an annual event that is held at the community park amphitheater.

What is the goal of this program/event and how will it positively impact the community? This event provides the residents of Yucaipa the opportunity to observe the national holiday locally.

Program/event primary target population (check all that apply):
❑ Children or Youth
21 Entire Community
❑ Homeless
❑ Low Income ❑ 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)
YES NO
Estimated attendance 1000+ persons ❑ ✓❑
Alcohol Service ❑
[excluding Community Centers & YPAQ
Street Closure -Traffic Management ❑ Q

THIS BOX IS FOR STAFF USE ONLY
This event requires City Management) YES NO1-1Administrative Approval:

THIS BOX €5 FOR STAFF USE ONLY
YES �N.O
This event requires City Council Approval: ❑ I ��{�+

Please identify what your organization is seeking:

YES NO +Aeq `'i Z_ C7o YES NO
Financial Support: ❑ Q $ 419"A� $300 SEP Fee Waiver: ❑ ❑ In -Kind Support: $ $ $ $
OT/Reassigned Staff CS/Rental Scherer Other
Community Center
Total Amount '31+2— 00
of Request IN �
In -Kind Financial Support $300 SEP Fee Financial Match Total Overall Waiver Request
Provide a detailed description of how the financial support will be used:

Describe any City Funding received by your organization in the past three years [required]? Program
In -Kind
Support
Financial
Support
S300 SEP
Fee Waiver
Hate Received Total Received
2025 Veterans Day Ceremony
0 ❑
❑
s g52.00
2024 Veterans Day Ceremony
✓❑
❑
❑
s 720.00
2023 Veterans Day Ceremony
❑✓
❑
❑
S
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the last three years?
Funding Source Amount Received Date Received
E3
Gl
s;�

1, the undersigned, do hereby attest that the above information is true and correct to the hest of my knowledge, and understand that the awarded financial grant amount needs to be spent prior to submitting another grant request.

Treasurer
Signature Title Date
Date Received: If/ 1512,4 pate Reviewed:

Amount Funded: City Council Meeting:

I"-KInd Financial S300 SEP
Type of Grant:

Support Support ❑fee Waiver
Date City Council received follow-up report:

of the Treasury
Date:
raDepartment
Internal Revenue Service
03120/2024
Tax Exempt and Government Entities
IRS P.O. Boa 2508
Employer ID number:
99-1674306
Cincinnati. OH 45201
Person to contact:

Name, Customer Service
0 number, 31954
Telephone: 877-829-5500

YUCAIPA CALI MESA 'VETERANS COMMITTEE
Accounting period ending:

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

Yes
Effective date of exemption:

March 1, 2024
Contribution deductibility:

Yes
Addendum applies:

No
❑LN:
26053473005324
Dear Applicant:

We're pleased to tell you we determined you're exempt frann federal income tax tmdtr Internal Rc ventic Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to yatt under IRC Section 170. You'l•t also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106. or 2522. -['his letter could help resolve questions on your exempt status. Please keep it for your records.

Organizations exempt tinder IRC Section 501(c)(3)) are further classified as either public charities or private foundations. We deterinined 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 Forth 9901990-EZ1990-N. our records show you're required to file an annual information return {Foam 990 or Form 994-EZ) or electronic notice (Form 9%-N. the e-Posteard). If yQu don't file a required return or notice for three consecutive years. your exempt status will be autorrnatically revoked.

If we indicated at the top of this letter that an addendum applies. the enclosed addendurn is an integral part of this letter.

For important information about your responsibilities as a tar -exempt organization. go to www.irs.-oyicharilleS .

Linter "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.

Sincerer•.
, aCr Q- - ojX,?
Stephen A. Ndartin
Director, Exempt Organizations
Rulings and Agreements
6 0 2026 ty unc gen
Letter 947 (Rev. 2-2020)
Catalog Number35152P
493

4115126, 3:40 PM
Permit
City of Yucaipa Community
Services
34272 Yucaipa Blvd
Yucaipa CA 92399
PermitContract
' COMMUNITY �3
?jat��SERVICES Ei f
PHONE:(909) 790-7460 Permit # R8467
FAX:(909) 790-2589 Status Tentative
EMAIL:[email protected] Elate of Issue Mar 17, 2026 9:45 AM Expiration Date Mar 17, 2027
customer Name George Sardeson - 46909 Home Phone Number Customer Type General Public Email Address
Mailing Address
System User Priscilla Alejo
Rental Fee
$1.037,00
Discounts
-$95.00
Subtotal
$942DO
Deposits
$100100
Deposit Discounts
$0.00
Total Permit Fee
$1,042.00
Total Payment
$0A0
Refunds
$ODO
Balance
$1,042,00
2026 Veterans Day Ceremony
Soaking Summary
Amphitheater (Shelter Facilities)

START DATEITIME

END DATE/TIME
2 resource(s) 2 booking(s) Subtotal: $1,042.00
Center: Yucaipa Community Center

ATTENDEE I AMT W/O TAX
Wed. Nov 11, 2026 7,00 AM
Wed, Nov 11. 2026 &00 PM
1 $0-00
Resource level fees
$640.00
Facility Deposit
$100.00 / Each x 1
$100.00
Rental - Daily
$600-00 / day x 1
$600-00
Rental - Daily
Shelter #2 Large Facilities)
-10% x 1
-$6cwo
Center: Yucaipa Community Center
(Shelter

START DATEITIME

END DATE/TIME
ATTENDEE I AMT W/0 TAX
Wed, Nov 11, 2026 7:00 AM
Wed, Nov 11, 2026 8:00 PM
1 $0.00
Resource level fees
$402.00
Liability Insurance
$87.00 / Each x 1
$87.00
Rental - Daily
$360-04 / pay x 1
8350,00
Rental - Daily
-10% x 1
-$35.00
6 0 2026 ty unc
gen

4/15126, 140 PM
PermitContract
Custom Questions

QUESTION I ANSWER
A. Any Cancellation of a rental less than 30 days wilt result in loss of 100% of the Acknowledge rental fees and deposit (if applicable). B. Any cancellations prior to 30 days will result in a loss of 50% of the rental fees and deposit (if applicable). All refund requests are subject to a $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 Acknowledge shelters. Community Park: Shelters 2, 3, 4, & 7 Ave I Park: Shelters 1, 2, 3, 4 7th Street Park: Shelters 1, 2, 3 Wildwood Park: Shelter t
I acknowledge and agree the following Bounce House rules: l)Bounce houses are Acknowledge to be set up only by the bounce house company. 2)Bounce house companies will be responsible for providing a generator for the inflation of the bounce house. The City does not provide electricity. The generator must be quiet rated at 60dB or less and not generate noise in excess of City standards. 3)Bounce houses are not allowed in City parks overnight.

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

I acknowledge and agree to the following rules and policies regarding Bounce Acknowledge Houses: 1) Bounce Houses/Jumpers must be booked through authorized companies only. Failure to do so will result in Company and/or event to be slut 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.
l acknowledge and agree to: 1)Permit Holder/Requestor(s) and event attendees Acknowledge 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.

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

I agree and acknowledge that the information provided to this application is Acknowledge 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 rule s:1) No food Acknowledge 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. 5)NO VEHICLES ARE ALLOWED IN CITY PARKS, ON TURF, OR ON WALKWAYS.

What§s�ogP*e OeveMw gen
Gathering
495
F.i f..a-•�l�nn.nrt —4:....:d-Cn0nnF-QFn7%2AR 7;Z

4/15126, 3:40 PM PermitContract
Will there be a bounce house? If yes, I acknowledge and agree that bounce No houses are 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 lumps www.jollyjumps.net or (877)694-1994 Jump N lump www.lumpnjump.com or (909)873-8487
Deposit

EVENT RESOURCE I DEPOSIT FEE I CHARGE I TAXI AMOUNT PAID I REFUNDS I BALANCE 2026 Veterans Amphitheate Facility $100.00 $0.00 $0.00 $0.00 $100,00 Day Ceremony r Deposit
Payment Schedules
Original Balance: $1,042.00
Current Balance: $1,042.00

DUE DATE I

AMOUNT DUE

AMOUNT PAID WITHDRAWAL ADJUSTMENT I BALANCE
Mar 17, 2026
$100.00
$0.00
$0.00 $100,00
Apr 15, 2026
$90.00
$0.00
$0.00 $90.00
Oct 28, 2026
$852.00
$0.00
$0.00 $852.00
6 0 2026 ty unc gen 496

ATTACHMENT 18
6 0 2026 ty unc gen 497

GITV CI YUCAIPA
VIR 1 F21 PH3.40
2026_2027 SUBMIT TO: CITY OF YUCAIPA
FISCAL YEAR: GENERAL SERVICFSrCITV CLERK DEPARTMENT
34272 YUCAIPA BLVD.

DATE SUBMITTED: 4/16126 YUCAIPA, CA 92399
All sections of the application must be returned complete, and all supporting documentation must bg, included as part of the submittal, Incomplete applications received will he returned to the applicant. (vote: Financial grant awarded funds will require 10091 financial match by the applicant. For example, if your total program/project cost is S1,oUo, your financial grant request should be for no more than 5500 Be prepared to show proof of programfproject cost in your Wrap-up Report (Accountability Report,,+. detailing the applicant's match of funds.

Name of Applicant/Organization: Yucaipa Rotary Club
Applicant/Organization
Mailing Address=
ApplicantfOrganization Phone Number:

CONTACT(1) Christopher Markarian

NAME PHONE NUMBER
CONTACT t2j Helena Garcia

NAME PHONE NUMBER
E•Mail
1 it

YES NO
Is your organization located in another community? ❑ 0
Will the program/event take place in another community? ❑ ❑✓ Are you aware of any other City program providing this service? ❑ ❑✓ If so, which one?
'lf you ariswcred "Yes" to any of the questions listed above, your request is not eligible for the Community Activity Grant.

Your organization must be an established 5o1 {c) to be considered for Community Activity Grant funding.

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

YES NO
Is your organization a 501 (c)? ❑✓ ❑
If so, please provide Tax ID# and attach all supporting 45-5149308 documents.

Does this application include submittal of YES No
documentation verifying 501 (c) status? ❑ ❑
How long has your 501 (q organization been iin existence? 40+ years Number of employees working for organization? None
Number of volunteers working for organization? 38
YES N❑
Is a current City Council Member on your board? ❑
How many Yucaipa residents does your organization
Thousands
currently serve?
Does the organization charge admission, membership YES No fees, due, etc.? ❑ ❑
If yes, please describe: We pay local club dues and rotary international dues. 2 499

Name of the program/event: Yucaipa Christmas Parade
Date(s) of the program/event: 12-12-2026
Total estimated cost for program/event: 5000
Describe the program/event that the organization is seeking support for:
(Attach any eventlprogram promotional materials associated with the program/event) This is the Yucaipa annual Christmas Parade where thousands of citizens come out to enjoy and celebrate our town with a large gathering that stretches over 7 blocks of roadway in the hear of our town coming down Yucaipa Blvd from California all the way to Sixth Street.

What is the goal of this programlevent and how will it positively impact the community? It's a loved and cherished tradition that many enjoy every year in our town to bring people together and celebrate the holiday season.

Program/event primary target population (check all that apply):
❑
Children or Youth
Z
Entire Community
❑
Homeless
❑ Low Income
❑ 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 ❑ Z
Amplified Sound ❑
(excluding Special Event Facilities)
YES
NO
Estimated attendance 1000+ persons
❑✓
❑
Alcohol Service
❑
(excluding Community Centers & YPAC)
Street Closure - Traffic Management
✓❑
❑

TWS BOX IS FOR STAFF USE ONLY
YES NO
This event requires City Management/ ❑ ❑
Adminl: istrative Approva
rIIIS ROX 15 FOR STAFI USI ONLY
YES NO
This event requires City Council Approval: ❑ ❑
3 .,500

Please identify what your organization Is seeking:

YES NO YES NO
Financial Support: ❑✓ ❑ $ 2500 $300 SEP Fee Waiver: Q ❑ in -Kind Support: $ $ $ s 12500
OT/Reassigned Staff CS/Rental Scherer Other
= Community Center ^
ts, 3poµlvj.

Total Amount $ �50(, $ $ �� $ $ �--
of Request in -Kind financial Support $300 SEP Fee Financial Match PP Total Overall
t-' 0 Waiver Request
Provide a detailed description of how the financial support will be used:

The cost of the event is mainly spent on providing portable bathrooms throughout the event route for the public to use and golf carts for the organizers to use to maintain the safety and flow of the 120t participants in the parade.

Describe any City Funding received by your organization in the past three years (required)? Program
In-%ind
Svppurt
Financial
support
S300 SEP
F« waiver
Date Received
Total Received
2023 Christmas Parade
0 Z
❑
1211/23
$1000 Financia
2024 Christmas Parade
❑✓
❑.�
❑
1211/24
s 1000 Financia
2025 Christmas Parade
❑✓
❑✓
❑
12/1125
s 1000 Financia
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the last three years?
Funding Source Amount Received Date Received
Club and Community Members s Varies 1211123
Club and Community Members
Club and Community Members
$ Varies 1211124
s Varies 1211125
4 501

I
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.
--------------
VNI�rO ey alFl�x
Signature
2026 Yucaipa Christmas Parade Chairman
Title
Date Received: + •Zj I -,U Date Reviewed:

Amount Funded: City Council Meeting:

Type of Grant I"-Ki.d Financial S300SEP
Supporx ❑ Support ❑Fee Waiver
Date City Council received follow-up report:
04162026
Date -

60 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

CITY OF
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/1n-Kind (Community Activity Grant Application required)
APPLICATION �
1IPage
6 0 2026 ty unc gen

Organization and Applicant Information 45-5 1 49308
❑ Commercial {For -profit} ❑■ Noncommercial [Nan -profit] Tax I.D. #:

Organization
Name
Rotary Club of Yucaipa
Applicant Name
Chris Markarian
Address
PO Box 661
Email
Phone Number
On -Site Contact
Chris MarkarianiJennifer Crawford
Phone Number
Event information
Type of Event: ❑ Athletic/Recreation ❑ Festival/Celebration ❑ Outdoor Market ❑ Circus/Carnival
❑Concert/Performance ❑■ Parade/Procession/March ❑other (specify):

Event Title
71 st Annual Christmas Parade
Event Location
Yucaipa Blvd (California St l Yucaipa Blvd. l 6th St.)
Event
The 71st Annual Christmas Parade will be held on Saturday, December 12, 2026.

Description
The Parade will start at the corner of Avenue ❑ 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.

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

Date(s) Daily Activity
Start Time
End Time
12/12/26
■❑ Set-up ❑ Event Day ❑ Clean-up
8:00 AM
12:00 PM
12/12/26
❑ set-up ❑■ Event Day ❑ Clean-up
12:00 PM
3:00 PM
12112l26
Ll Set-up Lj 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 0 Clean-up
Has this event taken place before? 0 Yes ❑ No
.1- to,000
Total anticipated attendance: Participants:

How many years? 70 Years
1,0CC Spectators: 9,000
2 1 P a g e
60 2026 ty unc gen

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

Indicate the site for these on your diagram.

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

When planning a moving route, the Yucaipa Police Department is available to assist you in planning your route. Consider the following in your planning:

Impedance of emergency fire, police or paramedic vehicles.

Conflict with public transportation, such as buses.

Interference with people trying to reach their own residences, businesses, places of worship and public facilities.

If your event involves street closures, you may be required to obtain traffic safety equipment, and a certified traffic control plan. Depending on the type of event, barricades, traffic cones, signs, etc., may be required. Depending on the type of event and after evaluating roadway conditions, you may be required to properly place this equipment prior to commencing the event. If the closure creates a potential hazard, your organization will be required to contract traffic service from the Yucaipa Police Department and/or Street Division. 3 1 P a g e
6 0 2026 ty unc

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 fisted below require closures on Saturday, 12/12/26 from 8:00 a.m.-4:00 p.m. California Street:

Acacia Ave. to 11SPS; Acacia Ave: Entrance of YPAC Parking Lot to California; Avenue A: 2nd St to Bryant St - Maybe scaled back to 1 st St to Adams St; Avenue B. 2nd St to Bryant St - Maybe scaled back to 1 st St to Adams St; Avenue C: 2nd St to Bryant St - Maybe scaled back to 1 st St to Adams St; Avenue D:
2ns St to Bryant St - Maybe scaled back to 1 st 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:
❑■ City of Yucaipa to handle (cost to be specified) ❑ Event to handle per CalTrans standards
List street(s) requiring the posting of "No Parking" signs. Indicate days, dates, and times needed and an explanation of necessity of "No Parking" zone:

California Street: Yucaipa Blvd to just north of post office. Avenue A: 1 st St to Adams St,
Avenue B: 1 st St to Adams St, Avenue C: 1st St to Adams St, Avenue ❑: 1 st 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 bespecifed upon reviewofthe application by Citystajj Food and Beverage
Please describe how food will be served at the event:

None
Will food be cooked in the event area? Yes 101 No
Method: ❑ Gas ❑ Electric ❑ Charcoal ❑ Other (specify):

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

Will Event Organizer provide portable restroom facilities? ❑■ Yes ❑ No 41Page
6 0 2026 ty unc gen

Company Diamond Envi ron mental
Name
Contact Name Victor Jackson
Phone Number 760-533-3626
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 site man which details streetlights, portable lights, and other illuminating devicmj None
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 follo ing information.

Company Rotary representative will coordinate with Burrtec thru Ana Sauseda Name
Contact Name
Phone Number
If not hiring a professional sanitation company, please provide the following information for heperson(s) responsible for waste removal.

Contact Name I Yucaipa Rotary Club
Phone Number
Cal Fire/Medical
In case of an emergency, the on -site contact will call 9-1-1. If event requires an ambulance Cornimny to be on -site, please provtde the tollowing information:

Company Cal Fire
Name
Contact Name
Phone Number
5 I_P a g e
6 0 026 ty unc gen

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

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

Is there a professional security orkTanixation hired for this event? n Yes n No Company
Name

S B G S D
Contact Name
Phone Number
Please describe your security plan including crowd control, internal security or venue safety, �r attach the plan to this application:

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

Are there any musical entertainment features for this event? ❑■ Yes ❑ No Name of Act Various bands in the parade & sound from various floats Contact Name
Phone
Number
How many stages? 1 Number of bands? 3-4 Genre of music: Various Will fireworks, rockets, or other pyrotechnics be used? ❑ Yes ❑■ Na Company
Name
61Pagg'
6 0 2026 ty unc
gen

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

Has a permit been issued: I I Yes I I No
(Note. Additional permits maybe 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 : $300.00
* Other Fees may apply (e.g. street closures, Fire Permit/ Inspections, utilities, facility rental, etc.)
71Page
6 0 2026 ty unc

Application Checklist
❑ 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:

Signature:

Bate:
8 1 P a g e
60 2026 ty unc gen

ATTACHMENT 19
6 0 2026 ty unc gen 511

Docusigr Ervelope ID: 5A947224-6ECE-824F-8389-116406BEF18F FY 26/2 7 SUBMIT TO: CITY OF YUCAIPA
FISCAL YEAR: GENERAL SERVICES/CITY CLERK DEPARTMENT
34272 YUCAIPA
DATE SU6MITTED:
4/16/26 YUCAIPA,CA 23D 99
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: 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 5500.

Be prepared to show proof of program/prcject cost in your Wrap-up Report (Accountability Report), detailing the applicant's match of funds.

Name of Applicant/Organization; Rotary C1 ub of YuCai pa Applicant/Organization PO Box 661
Mailing Address
Applicant/Organization Phone Number:

CONTACT(1) [_hri s Makarl an '
CONTACT (2)

NAME PHONE NUMBER
E•Mail

NAME PHONE NUMBER
E-Mail
I
512

❑ocusign Envelope 10: 5A947224-6EC6-824F-8389-116406BEF18F YES NO
Is your organization located in another community? ❑ ❑
Will the program/event take place in another community? 0 Are you aware of any other City program providing this service? Q 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.

Your organization must be an established 501 (c) to be considered for Community Activity Grant funding.

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

YES NO
Is your organization a 501 [c]? Q
If so, please provide Tax 1D# and attach all supporting 45-- 5149308 documents.

Does this application include submittal of YES No
documentation verifying 501 (c) status?
How long has your 501 [cy organization been in existence? 1956 Number of employees working for organization? 0
Number of volunteers working for organization? 40
Is a current City Council Member on your hoard?
How many Yucaipa residents does your organization 5S,000 currently serve?
Does the organization charge admission, membership
fees, due, etc.?
If yes, please describe: $18O/per month
YES NO
-1
x
YES NO
x❑ ❑

6.__ t u 513

Docusign Envelope ID: 5A947224-6EC6-824F-8389-116406BEF18F Name of the program/event: Weekl y Meetl ngs for Rotari ans Date(s)ofthe program/event: Every Tuesday (3uly 14, 2026 -3uly 29, 2027) Total estimated cost for program/event: $10 , 4 56
Describe the programlevent that the organization is seeking support for:
(Attach any eve ntlprogram promotional materials associated with the programlevent) weekly Rotary club meetings, open to the public.

What is the goal of this program/event and how will it positively impact the community? The weekly club meetings allow Rotarians to discuss, plan, and implement community events, programs, and services that benifit 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 Blvde. for the 4th of ]uly, Memorial & Labor day.

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

X]
Children or Youth x❑
Entire Community
x❑ Homeless
L'J
Low Income LJ Women
x❑
Persons with Disabilities ❑
Seniors
x❑ Victims
Q
Welfare Recipients
Please answer the following to determine if your programlevent requires a Special Event Permit (SEP):

YES NO
Estimated attendance 300-999 persons ❑ x❑
Amplified Sound ❑ ❑
[excluding Special Event Facilities]
YES NO
Estimated attendance 1000+ persons ❑ x❑
Alcohol Service ❑ ❑
[excluding Community Centers & YPAC]
Street Closure - Traffic Management ❑ 0

THIS BOX IS FOR STAFF USE ONLY
This event requires City Management/ YES NO
❑ ❑
Administrative Approval:

THIS BOX IS FOR STAFF USE ONLY
YES NO
This event requires City Council Approval: ❑ ❑
3 oocuslgn Envelope ID: 5A947224-6EC6-824F-8389-116406BEF18F Please identify what your organization is seeking:

YES NO YES NO
Financial Support: ❑ Q $ $300 SEP Fee Waiver: ❑ 0
In -Kind Support: $ $ $12 , 668.77 $
OT/Reassigned Staff CS/Rental Scherer Other
Community Center
Total Amount $12 , 668.77 $ $ $ $12 , 668.77
of Request In -Kind Financial Support $300 SEP Fee Financial Match PP Total Overall
Waiver Request
Provide a detailed description of how the financial support will be used:

N/A
Describe any City Funding received by your organization in the past three years (required)? Program
1n-Kind
5upport
Financial
Support
$300 SEP
Fee Wafer
Date Received
Total Received
25/26 meeting space
❑
❑
❑
6/9/25
s10,206
24/25 meeting space
❑
❑
❑
6/10/24
s9,956
23/24 meeting space
0 ❑
❑
6/27/23
s10,155
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the last three years?
Funding Source Amount Received Date Received
s
E�
s
4 0Oeusign Envelope ID- 5A947224-6EC6-824F-8389-1164066EF 18F 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.

PPocuSig nod by'
db�" hm6rialA,
ig a
Membership Chairman 4/16/26
Title
Date Received: I Date Reviewed:

Amount Funded: City Council Meeting:
n-KindSEP
Type of Grant: iUppor ❑ Support ❑ Fee
Waiver
' Supporx Support Fee Wairer
Date City Council received follow-up report:

Date
516

City of Yucaipa Comrnunity PHONE:(909) 790-7460
Services FAX(909) 790-2589
34272 Yucaipa Blvd [email protected] Yucaipa, CA 92399
Organization Name Rotary Club Of Yucaipa - 336
Cueonw Type Non -Profit (R)
Organlzation Addro" PC) Box 661
Yucaipa, CA 92399
Agent Name Daniel Hudec
Systom User Karen Ruiz
Yucaipa Rotary Club Weekly Meetings
Horne Phone Number
Email Address
Permit #
R8582
Status
Tentative
Date of Isaue
Apr 30, 2020 2:31 PM
Expiration Date
Apr 30, 2027
Rental Fee $13,798.59
Discounts-$1,379.82
Subtotal $12,418.77
Deposits $250.00
Deposit Discounts $0.00
Total Permit Fee $12.668.77
Total Payment $0.00
Refunds $0.00
Balance SIZ668.77
1 resource(s) 30 booking(s) Subtotai: M668.77
Booking Summary
START DATEfFIME END DATE[FIME ATTENDEE AMT W/O TAX
Tue, Jul 7, 2028 6 00 AM Tue. km 22 2027 M AM — $12,41&77 Occurs on sefecred dares effective 0710712026 unO 06,=12027 Tue, Ju17, 2025 6.00 AM Tue, Jul 7, 2026 8:15 AM 1 $318.43 n8nta+ cur S14.0.00 / Hour K 2.25 331a.OG
Rental - Week:ay Evert .Assistant (12A-830A) 225 5383t
:)isccunt - 10% (YCC -.per SCC) -10% n + -S3E38
Tue, Jul 14, 2026 6,00 AM Tue, Jul 14. 2025 8.15 AM 1 $318.43 Rantai - !- _, / S" i0.G0 / c_ 2.25 a315-cc
Rental - V'leekday Event Assistant (12A-830A) $17.25 / dour x 2.25 $38.31 s.uert Oisceum - 10%(YCC & SCC) -10°% x1 S353a
Tue, Jul21, 2026 6:00 AM Tue, Jul 21, 2025 815 AM $318,43 Rental - �-Duey $140001 Hour x 2,25 a315. ju
Rental - Weekday _gent Assistant (12,A-900Aj ,S17.25 / Hour x 2.25 336 ?1 _�-_Sijert DISCcunt - 13'No (YCC & SCC) -10:/. x 1 $3538 Tue, Aug 4, 2026 &DO AM Tue, Aug 4, 2026 8:15 AM $318.43 6 0 2026 ty unc gen 517

Rental - Weekday Event Assistart (12A-830A1 $17251 Hour x 2,25 S38 4' Resident Discount - 10"', ,YCC & SCC) -10% x 1-535.38
Tue, Aug 11, 2026 6:00 AM Tue, Aug 11, 2026 8:15 AM
1 $318.43
Renta! - Hourly $140,001 Hour x 2.25 $315.00
Rertal - Weekday Event Assistant (12A-830A) $17 25 1 Hour x 2.25 $38.81 Resident Di=:r ,nt - 10% ;YCC & SCC] -10% x 1 -5 38
Tue, Aug 18, 2026 6:00 AM Tue, Aug 18, 2026 8:15 AM
1 $318.43
Rentaj - Hourly $140.00 1 Hour x 2.25 _... _
Rental - Weekday Event Assistant (12A-830A) 51725 225 $38.81 Resident Discount - 10°% (YCC & SCC) -1C' <-$35.38
Tue, Sep 1, 2026 6:00 AM Tue, Sep 1, 2026 8:15 AM
1 $318.43
e�ral - Hourly $140.00 1 Hour x 2-25 $315.00
Rental - Weekday Event Assistant (12A-830Ai $17,251 Hour .c 225 $33.31 Resident Discount - 10% (YCC & SCC) -10% x 1-S35.38
Tue, Sep 8, 2026 6:00 AM Tue, Sep 8, 2026 8:15 AM
1 $318.43
Rental - Hourly $140.00 1 Hour x 2.25 5315.00
Rental - Weekday Event Assistant (12.A-830A) $17,25 i Hour x 2.25 $38.81 Resident Discount - 10% (YCC & SCC) -10% x 1 -53&38
Tue, Sep 15, 2026 6:00 AM Tue, Sep 15, 2026 8:15 AM
1 $318.43
:Rental - Hourly $140.00 1 rCLr:c 2.25 $315.00
Rental - Weekday Event Assistant (12A-830A) $11.25 1 Hour x 225 538.81 ?2sidert Discount 1C% IYCC & SCC) -1C% x 1 •535.38
Tue, Sep 22, 2026 6:00 AM Tue, Sep 22, 2026 8:15 AM
1 $318.43
Rental - Hourly $140.001 Hour x 2.25 5313.CL'
Rental - Weekday -Vert .Assistant (12A-830A) $17251 Hour x 2.25 $38.31 Resident ❑iscourt - 10% (YCC .& SCC) -10% x 1-$35.38
Tue, Oct 6, 2026 6:00 AM Tue, Oct 6, 2026 8:15 AM
1 $318.43
Rental - Hourly $140.00 1 --cur x 2.25 $315.00
Rental - Weekday Evert Assistant (I2A-33GA) $17.25 J »cur x 2.25 $38.81 Resident Discount - 10% (YCC & SCC) -10% x t-S35.38
Tue, Oct 13, 2026 6:00 AM Tue, Oct 13, 2026 8:15 AM
1 $318.43
Rsrtai - Hourly $140 �00 1 Hour x 2.25 $315.00
Rental - Weekday Event Assistant (12A-830A) 517.25 / Hour x 2.25 $38.81 Resident Discount - 10% ;YCC & SCC1 -10% x 1-$35.38
Tue, Oct 20, 2026 6:00 AM Tue, Oct 20, 2026 8:15 AM
1 $318.43
Rental - Hour,, $140.00 1 Hour x 220 S315.00
Rental - Weekday Event Assistant (12A-830A) $17.25 1 Hour x 225 $38.81 D-=:nent Discount - 10% {YCC & SCC} -10% x 1-$35.38
Tue, Nov 3, 2026 6:00 AM Tue, Nov 3, 2026 8:15 AM
1 $318,43
Rental - Hourly $140.00 1 Hour x 225 5315.00
Rental - Weekday Event Assistant (12A-830A; 517.251 Hour x 2.25 533.31 Resident Discount - 10% (YCC & SCC) -10% x 1-$35.38
Tue, Nov 10, 2026 6:00 AM Tue, Nov 10, 2026 8:15 AM
$318.43
6 0 2026 ty unc gen
518

Rental - Weekday Event Assistant (12A-830A) $17.25 1 Hour x 2,25 $38.81 Resident Discount - 10% (YCC & SCC; -10% )e 1-S35.38
Tue, Nov 17, 2026 &00 AM Tue, Nov 17, 2026 8:15 AM
1 $318.43
tal - Hour $140.00 i Hour x 225 $315.00
aen-tal - Weekday Event Assistant (12A-830A� $17.25 / Hour x 225 $38.81 Resdent -Discourt - 10% (YCC & SCC) -1c% x 1-$35.38
Tue, Dec 1, 2026 6:00 AM Tue, Dec 1, 2026 8:15 AM
1 $318.43
Rental - Hourly S140.00 / Hour x 2.25 S31
Rertal - Weekday event Assistant (12A-83CA) S17.25 / Hour x 2.25 $38.81 Resident Discount - 10% (YCC & SCC) -10% x 1 -S3&38
Tue, Dec 8, 2026 6:00 AM Tue, Dec 8, 2026 8:15 AM
1 $318,43
Rental - H! _.r!y $140.00 ,' Hour x 2.25 S315:OG
Rental - Weekday --,ent Assistant (12A-83CA) $17.25 / Haur x 2.25 $38.81 Resident Discount • iC''o `YCC & SCC) -10'�' x 1-$35.38 Tue, Dec 15, 2026 6:00 AM Tue, Dec 15, 2026 8:15 AM
1 $318.43
Rental - Hour : 8140,00 / Hour x 2.25 $315.10C
Rental - Weekday E-lent Assistant (12A-83CA) S17.25 / your x 2.._ . 338 Resident Discount - 10% (YCC & SCC) -1CQ% x 1-$35.38
Tue, Jan 5, 2027 6:00 AM Tue, Jan 5, 2027 8:15 AM
1 $318,43
a Hcurly $140.00 / Hour x 2,25
-. -r ta, - Weekday Event Assistant (12A-830A) S17.' - _ Qes:r;an.t Discourt - 10% (YCC & SCC) -IC% x 1 :..

Tue, Jan 12, 2027 6:00 AM Tue, Jan 12, 2027 8:16 AM
1 $318.43
-Rental - riour!y $140.00 /-lour x 2,25 $315.36
Rental - Weekday Event Assistant (12A-830A? S17.25 / Hour x 2.25 $38,51 Resident Discount -10°'0 (YCC & SCC) -10% x 1-$35.38
Tue, Jan 19, 2027 6:00 AM Tue, Jan 19, 2027 8:15 AM
1 $318.43
Rental - Hourly $140.00 / Hour x 2.25 $315.00
Rental - Weekday Evert Assistant (12A-830A) $1725 / Dour x 2.25 $38.81 Res;de^t Discount - (YCC & SCC) 10°; x 1-$35.38
Tue, Feb 2, 2027 6:00 AM Tue, Feb 2, 2027 &Z AM
1 $318.43
$140.00 / Hcur x 2.25
Rental - Weekday Event Assistant (12A-830A) $17.25 / Hour.,( 2.25 $38.81 Resident Discount - 10% (YCC & SCC) -10% x 1-S35.38
Tue. Feb 9, 2027 6:00 AM Tue, Feb 9, 2027 8:15 AM
1 $318.43
Rental - Hourly $140.00 / hour x 2.25 S315.00
Rental - Weekday -,ent Assistant (12A-330 A) $17.25 J Hour x 2.25 $38,31 Resident Discourt - 10% (YCC & SCC) -10`a x 1-335.38
Tue, Feb 16, 2027 6:00 AM Tue, Feb 16, 2027 8:15 AM
1 $318.43
Ra^*3l - Hourly 8140.00 / Hour x 2.25 $315.00
..seta: - NJeekday Event Assistant (12-A-830A) a"' 25 / Hour x 2.22�1 S38.81 Resident Discount - 10% (YCC & SCC) -10%,( ,-$35.3a
Tue, Mar 2, 2027 6:00 AM Tue, Mar 2, 2027 815 AM
1 $318.43
6 0 2026 ty unc gen 519

Rental. - Weekday Event Assistant '12A-830A) .' 25 ! Naur x 2.25 $38-51 Resident -Discourt - 10% (YCC & SCC) -10%,(! -S35-38
Tue, Mar 9. 2027 6:00 AM Tue, Mar 9, 2027 8.15 AM
1 $318-43
Rental - Houry $140-00 / Hour x 2.25
Rental - 4Veex..o�,• -;e t Assistant (12A-830A) $1725 r - .' 2.25 $38,31 Res;.--e^t Disccurt - 1C ;. .YCC 3 SCC) -10% x 1-335.38 Tue, Mar 16, 2027 6:00 AM Tue, Mar 16, 2027 8:15 AM
1 $318-43
Rental - Hourly $140-00 1 Hour x 2.25 $315-:,u
Rectal - Weekday Evert Aas:start (12A-830A) $17.25 j amour x 2.25 538.31 Resident ,Discount - 10% (YCC & SCC) 1-$35-38
Tue, Mar 23, 2027 6:00 AM Tue, Mar 23, 2027 &15 AM
1 $318-43
Rental - Hourly 8140.001 Hour x 2-Z'= S315.00
Rental - Weekday Event Ass;stant (12A-830A) $17.7 . -four Y 225 $38.81 Resident OIscoLnt - 10"� (YCC & SCC) -10% x 1-$35.38
Tue, Apr 6, 2027 6:00 AM Tue, Apr 6, 2027 8:15 AM
1 $318-43
Rectal - Hourly $140 00 ,' Hour x 225 S315-OC
RantaJ - Weekday Event Assistant (12A-830A) $17.25 1 Four x 225 $39.31 Resident Discount - 10% (YCC & SCC) -to% x 1-$35.38
Tue, Apr 13, 2027 6:00 AM Tue, Apr 13, 2027 8:15 AM
1 $318-43
Rental - Hourly $140.00 / Hour x 2.25 $315.00
Rental - Weekday -,ent Assistant (12A-830A; - - _ our x 2.25 832 Resident Discount - 1G",-, (YCC & SCC} -10L"- -S35 35
Tue, Apr 20, 2027 6:00 AM Tue, Apr 20, 2027 8:15 AM
1 $318,43
Rental - Hour y S1.10.00 j Hour x 2.25 S3,5.0c
Rental - Weekday - :.rt Assistant (126-830A) $17-25 ; - : L:: x 2.25 $32 Resident Discount - 10% (YCC & SCC) -10% x 1-$35.38
Tue, May 4, 2027 6:00 AM Tue, May 4, 2027 8.15 AM
1 $318-43
Rental - Hourly $140.00 j Hour x 2.25 S315.10C
Rental - Weekday Event Assistant (12A-830A) $17 25 1 Hour x 2.25 $38,81 Resident Disccurt -10 'YCC & SCC} -10.b x 1-535.38
Tue, May 11, 2027 6:00 AM Tue, May 11, 2027 8:16 AM
1 $318.43
Rentai - �ocry $14C 00 / Hour x 2.25 S315-OC
Rent al - Weekday Event Assistant (12A-830A) S17.25 J Hour x 2.25 S38.81, Resident Discount - 10% (YCC & S= -10% x 1-S35.38
Tue, May 18, 2027 6:00 AM Tue, May 18, 2027 8:15 AM
1 $318.43
RantaJ - Hour., $140-00 / Hour x 2.25 S315.00
Rental - Weekday Event Assistant (12A-830A) $17-25 ! _ r x 2.25 $38,81 Resident DisCOLnt - 10% {YCC & 5CC} -10% x 1-S35.38
Tue, Jun 1, 2027 6:00 AM Tue, Jun 1, 2027 8:15 AM
1 $318.43
Rental - Hourly S140.00 J dour x 2-25 S315.00
Rental - Weekday Event Assistant (12A-830A) $17.251 Hour x 225 $3881 Oent Discount - 10°5 (YCC & SCC) -10% x 1-$35.33
Tue, Jun 8, 2027 6:00 AM Tue, Jun S. 2027 8:15 AM
1 $318.43
6 0 2026 ty unc gen 520

Rental - Weekday Event 4ssistant !12A-830A', 517.25 1 Hour x 2.25 $38.81 Resident Discount - 10% (YCC & 5CC] 10'•5 x 1-S35.38
Tue, Jun 15, 2027 6:00 AM Tue, Jun 15, 2027 8:15 AM 1 $318.43 Rental - Hourly 514C.0C i Nour k 2.25 . _ . .

Rental - Weekday Evert Asastart 1,12A-830A; $17.25 ; ?ur x 2.25 $38-8i Resident Discount - 10'% ;YCC & SCC) -10 k 1 $35.38
Tue, Jun 22, 2027 6:00 AM Tue, Jun 22, 2027 8:15 AM 1 $318.43 Rental - iiouriy S140,&-- 2.' $315 v
RerntaJ - Weekday Event Ass1srart {12A-830A S17 25 / Hour x 2.25 $38.81 resident Discount - 10% (YCC & SCC) -10% "(1 -S35.38
Resource level fees $250.00
S25G.Cn , =ar_^ x 1 $250.010
Waivers and Information

INFORMATION DESCRJPTION SIGNING STATUS
Proof of Liability Insurance Checked

WAIVER NAME DUE DATE FOR SIGNING STATUS
Facility Usage Waiver Jul 7, 2026 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, lasses and expenses that may arise during cr be caused in any way by such occupancy or use of facilities, but the facility user shall not be Iiab€e 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 S0.00 $0.00
$O.Co
$250.00
Rotary Club
Nutrition
Weekly
Center
Meetings
Payment Schedules
Original Balance: $12,668.77
Current Balance:
$12,668.77

DUE DATE

AMOUNT DUE

AMOUNT PAID WITHDRAWAL ADJUSTMENT

BALANCE
Jun 23, 2026
$12,668.77

80.00 $0.00
$12.668.77
6 0 2026 ty unc gen 521

ATTACHMENT 20
6 0 2026 ty unc gen 522

2026-2027 SUBMIT TO: CITY OF YUCAIPA
FISCAL YEAR: GENERAL SERVICES/CITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

DATESUBMITTI D- 4127126 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: Financial grant awarded funds will require 100% financial match by the applicant. for example, if your total program/project cost is $1,0 0, 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 applicant's match of funds.

Name of Applicant/Organization: Yucaipa Valley Aft Association Applicant/Organization P.O.Box 404, Yucaipa, CA 92399
Mailing Address:

Applicant/Organization phone Number: (951) 755-4114
CONTACT(l) Zolly Martinez (951) 755-4114

NAME PHONE NUMBER
[email protected]
E-Mail
CONTACT (2) Ennque Lima

NAME PHONE NUMBER
yvaacontact[7a gmail.com
[-Mail
1 523

YES NO
Is your organization located in another community? 0
Will the program/event take place in another community? 0 0 Are you aware of any other City program providing this service? ❑ 0 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.

Your organization must be an established 501 (c) to be considered for Community Activity Grant funding.

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

YES NO
Is your organization a 501 (c)? 0
If so, lease provide Tax ID# and attach all supporting
P p pp g 95-3701090
documents.

Does this application include submittal of YES No
documentation verifying 501 (c) status?❑ ❑
How long has your 501 (c) organization been in existence? 45 Number of employees working for organization? 0
Number of volunteers working for organization? 9
YES NO
Is a current City Council Member on your board? ❑ ❑�
How many Yucaipa residents does your organization 75
currently serve?
Does the organization charge admission, membership YES NO fees, due, etc.? Z ❑
If yes, please describe:

There is an annual membership of $30.00.

Name of the program/event: YVAA Art Meetings, twice a month on Tuesday & Thursdays.

Date(s) of the program/event. 9/15/26 - 5/20/27
Total estimated cost for program/event: 3,902.13
Describe the program/event that the organization is seeking support for:
(Attach any eventiprogram 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 1 st Street, Yucaipa. Meeting dates as detailed in Permit #R8562.

The In -kind CAGrant support will be used to cover the cost to reserve rooms monthly at the Scherer Center twice a month Tuesday r lannina meetina (2 hr) in SrC Activity/storage room What is the goal of this programlevent and how will it positively impact the community? 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 pri ma ry ta rget population (check all that apply):
❑
Children or Youth
Entire Community
❑
Homeless
❑ Low Income
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) ❑
YES NO
Estimated attendance 1000+ persons ❑ FZI
Alcohol Service
(excluding Community Centers & YPAQ
Street Closure - Traffic Management ❑ ❑�
THIS BOX IS FOR STAFF 175E ONLY
YES No
This event requires City Management/ ❑
Administrative Approval:

THIS BOX 15 FOR STAFF 115E ONLY
YES NO
This event requires City Council Approval: ❑ 0
3 525

Please identify what your organization is seeking:

YES NO YES NO
Financial Support: ❑ r'❑ s $300 SEP Fee Waiver: ❑ ❑�
In -Kind Support: $ $ s 3,902.13 $
OT/Reassigned Staff CS/Rental Scherer Other
Community Center
Total Amount
of Request s 3,902.13 $ $ $ S 3,902.13
In -Kind Financial Support $300 SEP Fee Financial Match Total Overall Waiver Request
Provide a detailed description of how the financial support will be used:

Describe any City Funding received by your organization in the past three years (required)? Program
In -Kind
Support
Financial
Support
$300 SEP
Fee Waiver
Date Received
Total Received
YVAA Tues & Thur Mtgs.

J❑
❑
❑
6/9/25
$3,902.13
Wednesday Art Mtgs.
0 ❑
❑
6/9/25
$5,733.00
❑
❑
❑
$
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the last three years?
Funding Source Amount Received Date Received
NIA s 0
s
4 526

I, the undersigned, do Thereby 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
Date Received: 2.1 2-4 F pate Reviewed:

Amount Funded: City Council Meeting:

Type of Grant: p �n "d ❑ Support
❑ S36V SEF
F -r Siuppo Su aft Fee Waiver
Date City Council received follow-up report:
4/27/26
Date
527

Permit
1 City of Yucaipa Community
Servi ces
34272 Yucaipa Blvd
Yucaipa, CA 92399
PHONE:(909) 790-1460
FAX(909) 790-2589
E MAJ [email protected] rg
Of gofta On No, YucaipaValby Art Association - 49
CuaWw Type Non -Profit (R)
Clilgiiiiihadolr Addnm PO Box 404
Yucaipa, CA 92399
Agent Ni1me gully Martinez
Syotom UW Karen Ruiz
YVAA Mar"M wWw - Tum & Tmm
Booking Summary
COMMUNITY P rk§
SERVICES JOKe
if
rl
Permit 0 RSM
Sbhm Tentative
Date of bil a Apr 21, 2026 5:19 PM
6' 1Grt Das Apr 21, 2027
Rental Fee
$4,335-60
Discounts
-$433A7
Subtotal
$3.902.13
Deposits
$350.00
Deposit Discounts
$0.00
Total Permit Fee $4,252,13
Total Payment $0.00
Refunds som
Balance $4262-13
2 resource(s) 19 booking(s) BubOdl>rk $0111213

START DATE/TIME

END DATE/TIME

ATTENDEE AMT WJO TAX
Tug Sep jk 2M VM AM
Tue, May it 21W WIG PIN
-- S1,OBa a4
Gccws on Selected dates effwm6 08/I512026 Lentil 05M1 W7- Tue, Sep 15, 202610:00 AM
Tue, Sep 15, 202612:00 PM
1 $f08.00
Rental - Hourly $60.001 Hour x 2
SY3 :.•.;;.

Resident D*count - i0% (YCC & SCC) -10% x 1
-512 00
Tue, Oct 13, 202610:00 AM
Tue, Oct 13, 202612:00 PM
1 $10&00
Rental - Hourly $60.00 J Hour x 2
M2000
Resident D5ccunt -10% (YCC & SCC) -10% x1
Tue, Nov V, 2026 *00 AM
Tue, Nov V, 202612:00 PM
t $108.00
Rental - Hourly $60.00 J Hour )( 2
"1 -:i1
Resident Discount - 1Gg'o (YCC & SCC) -10% x 1
-5 !�Jjc:

Tue, Dec 8, 202610:00 AM
Tue, Dec 8, 202612.00 PM
1 $108.00
Rental - Hourly $60.00 J Hour x 2
::..

Resident Discount • 1C% (YCC & SCC) -10% x 1
5'2
Tue, fan 19, 202710:00 AM
Tue, Jan 19, 202712:00 PM
1 $108.00
# R8562 Skates Tentative PWO i of 4
6 0 2026 ty unc gen 528

Rental - Hourly $60.00 / Hour x 2
8120.00
Resident Discount - 10% (YCC & SCC) -10% x 1
-$12.00
Tue, Feb 16, 202710-00 AM
Tue, Feb 16, 202712:00 PM
1 $108.00
Rental - Hourly $60.00 / Hour x 2
Resident Discount -10% (YCC & SCC) -10% x 1
Tue, Mar 16, 202710:00 AM
Tue, Mar 16, 202712:00 PM
1 $108.00
Rental - Hourly $60 00 / Hour x 2
00 Residen! Disccunt -10% (YCC & SCC) -10% x 1
Tue, Apr 13. 202710:00 AM
Tue, Apr 13, 202712:00 PM
1 $108,00
Rental - Hourly $60.00 / Hour x 2
$120.00
Resident Discount -10% (YCC & $CC) -10% x 1
-S12.00
Tue, Apr 27, 202710:00 AM
Tue, Apr 27, 202712:00 PM
1 $108.00
Rental - Hourly $60,001 Hour x 2
$120,00
Resident discount - 10°% (YCC & SCC) -10% x 1
-$12.00
Tue, May 18, 2027 ID-00 AM
Tue, May 18, 202712:00 PM
1 $108.00
Rental - Hourly $60.00 / Hour x 2
$120.00
Resident Discount -10% (YCC & SCC) -10% x 1
-$12.00
Resource level fees
$100.0o
Deposit $100.00 / Each x 1
$100.00

START DATEITIME
END DATEjfIME

ATTENDEE

AMT W/O TAX
Thu, Sep 17, 2026 e-00 PM
Tb4 May 2D, 2027 916 PM
--
02=13
Occurs on seiecred dares effective 09IY712026 unra 0512012027 Thu, Sep 17, 2026 6:00 PM
Thu, Sep 17, 2026 9:15 PM
1 $313,57
Rental - Hourly $85,00 / Hour x 3.25
$27626
Rental - Weekday Event Assistant (4P-12A) $22.20
/ Hour x 3.25 $72.15
Resident Discount - 100% [YCC & SCC] -10% x 1
-$34.83
Thu, Oct 15, 2026 6:00 PM
Thu, Oct 15, 2026 9:15 PM
1 $313,57
Rental - Hourly $85.001 Hour x 3.25
$276.26
Rental - Weekday Event Assistant (4P-12A) $22.20
/ Hour x 3.25 $72.15
Resident Uus ount - 10% {YCC & SCC) -10% x 1
-$34 83
Thu, Nov 19, 2026 6:00 PM
Thu, Nov 19. 2026 9:15 PM
1 $313.57
Rental - Hourly $85.00 / Hour x 3.25
$276.25
Rental - Weekday Event Assistant (4P-12A) $2220
/ Hour x 3.25 $72,15
Resident Discount - 10% (YCC & SCC) -10% x 1
-834.93
Thu, Dec 10, 2026 6:00 PM
Thu, Dec 10, 2026 9:15 PM
1 $313,57
Rental - Hourly $85.00 / Hour x 3.25
$276,26
Rentaf - Weekday Event Assistant (4P-12A) $2220
/ Hour x 325 $72.15
Resident Discount -10°I (YCC & SCC) -10% x 1
-$34.83
Thu, Jan 0, 2027 6:00 PM
Thu, Jan 21, 2027 9,15 PM
i
$313.57
Rental - Hourly $85,00 / Hour x 3.25
$27625
Rental - Weekday Event Assistant (4P-12A) $22.20 / Hour x 3.25 $72.15 Resident Discount -10% {YCC & SCC} -10% x 1
-S34.83
# R8562 Sh" Tentative Pape 2 of 4
6 0 2026 ty unc gen 529

7 Thu, Feb 18, 2027 6:00 PM Thu, Feb 18, 2027 9:15 PM
i $313,57
Rental - Hourly $85.00 / Hour x 3 25 $27625
Rental - Weekday Event Assistant (4P-12A) $22.20 / Hour x 325 $72.15 Resident Discount - 10% (YCC & SCC) -10% x 1-$34.83
Thu, Mar 18, 2027 6:00 PM Thu, Mar 18, 2027 9:15 PM
1 $313.57
Rental - Hourly $85.001 Hour x 3.25 $276.25
Rental - Weekday Event Assistant (4P-12A) $2220 / Hour x 3.25 $72.15 Resident Discount - 10% (YCC & SCC) -10% x 1-$34.83
Thu, Apr 15. 2027 6,00 PM Thu, Apr 15, 2027 9:15 PM
1 $313.57
Rental - Hourly $85.00 / Hour x 3.25 $276.25
Rental - Weekday Event Assistant (4P-12A) $22.20 / Hour x 3.25 $72.15 Resident Discount -10% (YCC & SCC) -10% x 1-$34.83
Thu, May 20, 2027 6:00 PM Thu, May 20, 2027 9:15 PM
f $313.57
Rental - Hourly $85.00 / Hour x 325 $276.25
Rental - Weekday Event Assistant (4P-12A) $22.20 / Hour x 325 S72.15 Resident Discount - 10% (YCC & SCC) -10% x 1-$34.83
Resource level fees
$260.00
Deposit $250.00 / Each x 1 $250.00
Waivers and Information

INFORMATION DESCRIPTION

SIGNING STATUS
Proof of Liability Insurance
Checked

WAIVER NAME DUE DATE FOR

SIGNING STATUS
Facility Usage Waiver Sep 15, 2026
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 Deposit

EVENT RESOURCE
YVAA SrC Activity
Monthly Room
Meetings -
Tues. &
Thurs.

DEPOSIT FEE CHARGE
Deposit $100.00

TAX AMOUNT PAID
$0.00 $0,00

REFUNDS BALANCE
$0.00 $100.00
# R8562 Statm Tentative PVe 3 of 4
6 0 2026 ty unc gen 530

I�
YVAA
Monthly
Meetings -
Tues. &
Thurs.

SrC Deposit $250.00 $0.00 $0.00 $0.00 $250.00
Banquet
Room A/B
Payment Schedules Original Balance: $4,252,13 Current Balance: $4,252.13 DUE DATE AMOUNT DUE AMOUNT PAI❑ WITHDRAWAL ADJUSTMENT BALANCE Jul 1, 2026 $350.00 $0.00 MOO $350,00
Sep 8, 2026 $3,902.13 $0.00 $0.00 $3,90213
# R8562 Status Tentative Pope 4 of 4
06/08/2026 City Council Agenda 531

INFERNAL REVENUE SERVICE
P. O. BOX 2508
CINCINNATI, off 45201
Date: J U N 23 #cwv%'%12-

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 IT 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.

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, (7
Lois G. Lerner
Director, Exempt organizations
Letter 947 (DO/CG)
06/08/2026 City Council Agenda
532

ATTACHMENT 21
06/08/2026 City Council Agenda 533

FISCAL YEAR: 2426-2027 SUBMIT TO: CITY OF YUCAIPA

GENERAL SERVICES/CITY CLERIC DEPARTMENT
34272 YUCAIPA BLVD
DATE SUBMITTED: 4127/26 YUCAIPA, CA973"
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: Financial grant awarded funds will require 100% financial match by the applicant. For example, if your total pragramfproject 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 applicant's match of funds.

Name of Applicant/Organization: Yucaipa Valley Art Associatbn Applicant/Organization P.O. Box 494, Yucaipa, CA 92399
Mailing Address:

Applicant/Organization PflonG Number- (951) 755-4114
CONTACT (1) Zully Martinez
NAME
[email protected]
E-Mail
CONTACT (2) Enrique Lima
NAME
[email protected]
E_Mail
(951) 755-4114

PHONE NUMBER

PHONE NUMBER
1 LJ
06/08/2026 City Council Agenda A" 534

1�I
YES NO
Is your organization located in another community? Q
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.

Your organization must bean established 501 (c) to be considered for Community Activity Grant funding.

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

YES NO
Is your organization a 501 (c)? 0 ❑
If so, please provide Tax ID# and attach all supporting 95-3701090 ' 4 documents.

Does this application include submittal of YES No
documentation verifying 501 (c) status? Z ❑
How long has your 501 (c) organization been in existence? 45 Number of employees working for organization? 0
Number of volunteers working for organization? 9
YES NO
Is a current City Council Member on your board? ❑ Z
How many Yucaipa residents does your organization 75
currently serve?
Does the organization charge admission, membership YES NO fees, due, etc.? ❑� ❑
If yes, please describe:

There is an annual membership of $30.00.
7 06/08/2026 City Council Agenda 535

Name of the program/event: YVAA Art Meetings, weekly on Wednesdays at the Scherer Center.

Date(s) of the program/event: 7/1 /26 to 6/30/27
Total estimated cost for program/event: 5,850.00
Describe the programlevent that the organization is seeking support for:
(Attach any event/program promotional materials associated with the programlevent) 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. 8 of the 2026 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 1 st Street, Yucaipa. Meeting schedule is outlined in Permit #R8563.

The in -kind CAGrant support will be used to cover the cost to reserve a room for two 0 hours What is the goal of this programlevent and how will it positively impact the community? 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):
❑
Children or Youth❑
Entire Community
❑
Homeless
❑ Low Income
❑ Women
❑
Persons with Disabilities
❑
Seniors
❑
victims
❑ welfare Recipients
Please answer the following to determine if your programlevent requires a 5pecial Event Permit (SEP):

YES NO
Estimated attendance 300-999 persons ❑ ❑�
Amplified Sound ❑
(excluding Special Event Facilities)
THI5 BOX IS FOR STAFF USE ONLY
This event requires City Management/ YES NO
Administrative Approval- ❑
YES
NO
Estimated attendance 1000+ persons
❑
Wd

THIS SOX IS FOR STAFF USE ONLY
Alcohol Service
/excluding Community Centers & YPACj
❑
�
YES NO
This event requires City Council Approval: ❑
street Closure • Traffic Management
❑
F7
3 06/08/2026 City Council Agenda 536

Please identify what your organization is seeking:

YES NO YES NO
Financial Support: ❑ ❑ $ $300 SEP Fee Waiver: ❑ ❑/
In -Kind Support: $ $ x 5,850.00 $
❑TIReassigned staff CS/Rental Scherer other
Community Center
Total Amount $ 850.00 $ $ $ $ 5,850.00
of Request In -Kind Financial Support $300 SEP Fee Financial Match pP Total overall
Waiver Request
Provide a detailed description of how the financial support will be used:

Describe any City Funding received by your organization in the past three years (required)? Program
In -Mind
Support
Financial
Support
$300 SEP
Fee Waiver
Date Received
Total Received
YVAA Tues & Thur Mtgs.
❑J
❑
❑
6/9/25
$ 3,902.13
Wednesday Art Mtgs.
❑
❑
❑
6/9/25
$ 5,733,00
❑
❑
❑
$
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the last three years?
Funding source Amount Received Date Received
NIA $ 0
El
4 06/08/2026 City Council Agenda
537

Wignaure
President
Title
4/27/26
Date
Date Received:
17,p �
Date Reviewed:

Amount Funded:

City Council Meeting:

Type of Grant
In -Kind ❑Financial
support support
❑ cee Walw
ee wai++er
Date City Council received follow-up report:
06/08/2026 City Council Agenda 538

INTERNAL REVENUE SERVICE
P. O. BOX 2508
CINCINNATI, OH 45201
Date: J U N 23 201Z

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 Cade. 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,
(7
Lois G. Lerner
Director, Exempt Organizations
Letter 947 (DO/CG)
06/08/2026 City Council Agenda
539

i
Permit
City of Yucaipa Community PHONE:(909) 790-7460
Services FAX: (9D9) 790-25B9
34272YucaJpaBlvd [email protected]
Yucaipa, CA 92399
OrpwillZation Name Yucaipa Valley Art Association - 49
Cust— Type Non -Profit iRi
Organlzatlon Address PO Box 404
Yucaipa, CA 92399
AgW Name Zulfy Martinez
System User Karen Ruiz
Wednesday AA Painting Session
Booking Summary
?04r COMMUNITY jltlfer!

SERVICES
Permit # R8W
Status Tentative
Date of Is%m Apr 21, 2025 5:25 PM
Explratim Date Apr 21, 2027
Rental Fee
$6,500.00
Discounts
-$550 00
Subtotal
$5.960.00
Deposits
$250-00
Deposit Discounts
$0.00
Total Permit Fee
$6,100.00
Total Payment
$0.00
Refunds
$0.00
Balance
$6,100.00
1 resource(s) 50 booking(s) Subtatak $6,100.00

START DATEITIME
END OATE(71ME

ATTENDEE AMT WIG TAX
Wed. Jul 1.2028= PM
Wea, Jun 30.2027 3.00 PM
— $5XAO0
Occurs on selected Orates artective 07AN12020 LinV 061301202).

Wed, :ul 1, 20261.00 PM
Wed, Jul 1, 2026 3:OC PM
1 $117.00
Rental - Hourly $65.00 / Hour x 2
$130Ap
Resident Dsccunt -10% [YCC & SCC) -10% x 1
S13.00
Wed, .ul B. 20261:00 PM
Wed, Jul S. 2026 3;00 PM
1 $117.00
Rental - Hourly $65.00 J Hour x 2
$130.00
Resident O secunt - 10°fa (YCC & SCC) -10% x 1
Wed, Jul 15, 20261:OC PM
Wed, Jul 15, 2026 3:00 PM
1 $117.00
Rental - Hourly $65.00 / Hour x 2
S'?C
Resident') scount -107o [YCC & SCC) -10% x 1
Wed, Jul 2Z 20261:00 PM
Wed, Jul 22, 2026 3:00 PM
1 $117.00
Rertal - Hourly $65.00 J Hour x 2
$130-00
Resident 'Jsccunt-10%(YCC & SCC] -10'b Y.'
Wed, Jul 29. 2M 1:00 PM
Wed, Jul 29, 2026 3:00 PM
1 $117.00
# R8563 die Tentative Pape 1 of 5
06/08/2026 City Council Agenda 540

Rental - Hourly $65.00 / Hour x 2
$130 00
Resident Discount -10% (YCC & SCC) -10% x 1
-S13.00
Wed, Aug 5, 20261:00 PM
Wed, Aug 5, 2026 3:00 PM
1 $117,00
Rental - Hourly $65.00 / Hour x 2
$130.00
Resident Discount -10% (YCC & $CC) -10% x 1
-$13.00
Wed, Aug 12, 20261:00 PM
Wed, Aug 12, 2026 3:00 PM
1 $117.00
Rental - Hourly $65.00 / Hour x 2
$130.00
Resident Discount -10 % (YCC & SCC) -10% x 1
-$13.00
Wed, Aug 19, 20261:00 PM
Wed, Aug 19, 2026 3:00 PM
i
$117.00
Rental - Hourly S65.00 J Hour x 2
$130.00
Resident Discount - 10% (YCC & SCC) -10% x 1
-$13.00
Wed, Aug 26, 20261:00 PM
Wed, Aug 26, 2026 3:00 PM
1 $117.00
Rental - Hourly $65.00 / Hour x 2
$130.00
Resident Discount - 10% (YCC & SCC) -10% x 1
-$13.00
Wed, Sep 2, 2026 t00 PM
Wed, Sep Z 2026 3:00 PM
1 $117.00
Rental - Hourly S65.00 / Hour x 2
$130.00
Resident Discount - 10% (YCC & SCC) -10% x 1
- a13..1.0
Wed, Sep 9, 20261:00 PM
Wed, Sep 9, 2026 3 00 PM
1 $117,00
Rental - Hourly $65.00 / Hour x 2
$130.00
Resident Discount - 10% (YCC & SCC) -10% x 1
-$13.00
Wed, Sep 16, 2028 t00 PM
Wed, Sep 16, 2026 3:00 PM
1 $i17.00
Rental - Hourly 865.00 / Hour x 2
$130.00
Resident Discount -10% (YCC & SCC) -10% x 1
Wed, Sep 23, 20261:00 PM
Wed, Sep 23, 2026 3:00 PM
1 $117.00
Rental - Hourly $65M / Hour x 2
Resident Discount - 10% (YCC & SCC) -10% x 1
-$13 00
Wed, Sep 30, 20261:00 PM
Wed, Sep 30, 2026 3:00 PM
1 $117.00
Rental - Hourly $65.00 / Hour x 2
$130.00
Resident Discount -10% (YCC & SCC) -10% x 1
-$13.00
Wed, Oct 7, 20261:00 PM
Wed, Oct 7, 2026 3,00 PM
1 $117.00
Rental - Hourly $65.00 J Hour x 2
$130.00
Resident Discount -10 % (YCC & SCC) -10% x 1
-$13 00
Wed, Oct 14, 20261:00 PM
Wed, Oct 14, 2026 3:00 PM
1 $117.00
Rental - Hourly $65.00 / Hour x 2
$130.00
Resident Discount -10% (YCC & SCC) -10% x 1
-$13.OD
Wed, Oct 21, 20261:00 PM
Wed, Oct 21, 2026 3:00 PM
1 $117.00
Rental - Hourly $65,00 / Hour x 2
$130.00
Resident Discount -10% (YCC & SCC) -10%x 1
-$13.00
Wed, Oct 28, 20261;00 PM
Wed, Oct 28, 2026 3:00 PM
1 $117.00
Rental - Hourly $65.00 / Hour x 2
$130.00
Resident Discount - 10% (YCC & SCC) -10% x 1
:"3
Wed, Nov 4, 20261:00 PM
Wed, Nov 4, 2026 3:00 PM
1 $117.00
Rental - Hourly $65.00 / Hour x 2
,
# R8563 Status Tentative
Pape 2 of 5
06/08/2026 City Council Agenda
541

Resident Discount - 10% (YCC & SCC) -10% x 1
-513.00
Wed, Nov 11, 20261:00 PM
Wed, Nov 11, 2026 3:00 PM
1 $117-00
Rental - Hourly $65.00 / Hour x 2
Resido!nt Discount - 10% {YCC & SCC) -10% x 1
00 Wed, Nov 18, 20261:00 PM
Wed, Nov 18, 2026 3:00 PM
1 $117,00
Rental - Hourly $65.00 / Hour x 2
$130.00
Resident Discount - 10% (YCC & $CC) -10% x 1
-S13.00
Wed. Dec 2, 20261:00 PM
Wed, Dec 2, 2026 3:00 PM
1 !W,00
Renal - Hourly $65.001 Hour )(2
$130 00
Resident Discount - 10% (YCC & SCC) -10% x 1
-$13.00
Wed, Dec 9, 20261:00 PM
Wed, Dec 9, 2026 3:00 PM
1 $117.00
Rental - Hourly $65.00 / Hour x 2
$130.00
Resident Discount -10% [YCC & SCC] -10% x 1
-$13.00
Wed, Dec 16, 20261:00 PM
Wed, Dec 16, 2025 3:00 PM
1 $117.00
Rental - Hourly $65-00 / Hour x 2
$130.00
Resident Discount - 10% (YCC & SCC) A0 I, x I
S' 3
Wed, Jan 6, 20271:00 PM
Wed, Jan 6, 2027 3-00 PM
1 $117.00
Rental - Hourly $65-00 / Hour x 2
-130.00
Resident (Discount -10% {YCC & SCC} -10% x 1
$`3.

Wed, Jan 13, 20271:00 PM
Wed, Jan 13, 2027 3.00 PM
1 $f17.00
Rental - Hourly $66.00 / Hour x 2
SIQi; 00
Resident Discount -10% (YCC & SCC) -10% x 1
$13 0G
Wed, Jan 20, 20271:00 PM
Wed, Jan 20, 2027 3:00 PM
1 $117.00
Rental - Hourly $65.00 / Hour x 2
$130 30
Resident Discount - 10% (YCC & SCC) -10% x 1
-S13.00
Wed, Jan 27, 20271:00 PM
Wed, Jan 27, 2027 3:00 PM
1 $117.00
Rental - Hourly $65.001 Hour x 2
$130-00
Resident Discount -10% (YCC & SCC) -10% x 1
-$13.G0
Wed, Feb 3, 20271:00 PM
Wed, Feb 3, 2027 3:00 PM
1 $117.00
Rental - Hourly $65.00 / Hour x 2
$130.00
Resident Discount -10% (YCC & SCC) -10% x 1
$' 3
Wed, Feb 10, 20271:00 PM
Wed, Feb 10, 2027 3,00 PM
1 $117.00
Rental - Hourly $65.00 / Hour x 2
$130.00
Resident Discount -10% (YCC & SCC) -10% x 1
-$13-00
Wed, Feb 17, 20271:00 PM
Wed, Feb 17, 2027 3-00 PM
1 $117.00
Rental - Hourly S65.00 / Hour x 2
$I3C.0i:

Resident Discount - 10% {YCC & SCC} -10% x 1
-513
Wed, Feb 24. 20271:00 PM
Wed, Feb 24. 2027 3:00 PM
1 $117.00
Rental - Hourly $65.001 Hour x 2
513C ) .

Resident Discount - 10% (YCC & SCC) -10% x 1
J .

Wed, Mar 3, 20Z71:00 PM
Wed, Mar 3, 2027 3:00 PM
1 $117-00
Rental - Hourly $65.001 Hour x 2
$'3i7 •_
Resident Discount -10% [YCC & SCC] -10% x i
# R8663 StMW Tentative
PV9 3 of 5
06/08/2026 City Council Agenda
542

Wed, Mar 10, 20271:00 PM
Wed, Mar 10, 2027 3:00 PM
1 $117.00
Rental - Hourly $65.001 Hour x 2
$130.00
Resident Discount -10% (YCC & SCC) -10% x 1
$�
Wed, Mar 17, 20271:00 PM
Wed, Mar 17, 2027 3:00 PM
1 $117.OD
Rental - Hourly $65-00 / Hour x 2
$130.00
Resident discount -10% (YCC & SCC) -10% x 1
513
Wed, Mar 24. 20271:00 PM
Wed, Mar 24, 2027 3:00 PM
1 $117,00
Rental - Hourly $65.00 / Hour x 2
$130,00
Resident Discount -10% (YCC & SCC) -10% x 1
-$13.00
Wed, Mar 31, 20271:00 PM
Wed, Mar 31, 2027 3:00 PM
1 $117-00
Rental - Hourly $55.00 / Hour x 2
$130.00
Resident Discount - 10% (YCC & SCC) -10% x 1
-$13.00
Wed, Apr 7, 20271:00 PM
Wed, Apr 7, 2027 3:00 PM
1 $117-00
Rental - Hourly $65.00 / Hour x 2
$130.00
Resident Discount - 10% (YCC & SCC) -10% x 1
-S13 co
Wed. Apr 14, 20271:00 PM
Wed, Apr 14, 2027 3:00 PM
1 $117,00
Rental - Hourly $65.001 Hour x 2
$130-00
Resident Miscount -10% (YCC & SCC) -10%x 1
Wed, Apr 21, 20271:00 PM
Wed, Apr 21, 2027 3:00 PM
1 $117-00
Rental - Hourly $65-001 Hour x 2
$130.00
Resident Discount -10% {YCC & SCCJ -10% x 1
-$-1 oo
Wed. Apr 28, 20271:00 PM
Wed, Apr 28, 2027 3:00 PM
1 $117.00
Rental - Hourly $65,00 / Hour x 2
$130.00
Resident Discount -10% (YCC & SCCj -10% x i
-513.00
Wed, May 5, 20271:00 PM
Wed, May 5, 2027 3:00 PM
1 $117.00
Rental - Hourly $65.00 / Hour x 2
$130.00
Resident Discount -10% (YCC & SCC) -10% x 1
i CO
Wed, May 12, 20Z71:00 PM
Wed, May 12, 2027 3:00 PM
1 $117,00
Rental - Hourly $65.00 / Hour x 2
$130.00
Resident Discount - 10% (YCC & SCC) -10% x 1
-$13.00
Wed, May 19, 20271:00 PM
Wed, May 19, 2027 3 00 PM
1 'W.00
Rental - Hourly $65.00 / Hour x 2
$130-00
Resident Discount - 10% (YCC & SCC) -10% x 1
-$13.00
Wed, May 26, 20271:00 PM
Wed, May 26, 2027 3:00 PM
1 $117.00
Rental - Hourly $65,00 / Hour x 2
S130-oo
Resident Discount -10% (YCC & SCC) -10% x 1
-$13-00
Wed, Jun 2, 20271:00 PM
Wed, Jun 2, 2027 3-00 PM
1 $117.00
Rental - Hourly $65-00 / Hour x 2
$130-00
Resident Discount -10% (YCC & SCC] -10% x 1
-$-.3 00
Wed, Jun 9.20271:00 PM
Wed, Jun 9, 2027 3-00 PM
1 $117.00
Rental - Hourly $65.00 / Hour x 2
Ou
Resident Discount -10% (YCC & SCC) -10% x 1
- S' i 0
Wed, Jun 16, 20271:00 PM
Wed, Jun 16, 2027 3:00 PM
1 $117.00
# R8563 Stahm Tentative
Pap 4 of 5
06/08/2026 City Council Agenda
543
0 Rental - Hourly $65.00 / Hour x 2
$130.00
Resident Discount -10% (YCC & SCC) -10% x 1
-$13.00
Wed, Jun 23, 20271:00 PM
Wed, Jun 23, 2027 3:00 PM 1 $117.00
Rental - Hourly $65.00 / Hour x 2
8130.00
Resident Discount -10 0 (YCC & SCC) -10% x 1
-$13.00
Wed, Jun 30, 20271:00 PM
Wed, Jun 30. 2027 3:00 PM 1 $117,00
Rental - Hourly $65.00 / Hour x 2
$130.00
Resident Discount - 10% [YCC & SCC] -10% x 1
-$13.c
Resource level fees
$250.00
Deposit $250.00 / Each x 1
$250.00
Waivers and information

INFORMATION DESCRIPTION

SIGNING STATUS
Proof of Liability Insurance
Checked

WAIVER NAME DUE DATE FOR

SIGNING STATUS
Facility Usage Waver Jul 1, 2026
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 Deposit
EVENT

RESOURCE

DEPOSIT FEE

CHARGE TAX AMOUNT PAID

REFUNDS

BALANCE
Wednesday
W
Deposit
$250.00 $0.00 $0.00
$0.00
$260,00
Art Painting
Banquet
Sessions
Room B
Payment Schedules
Original Balance: $6,100.00
Current Balance: $6,100.00

DUE DATE

AMOUNT DUE

AMOUNT PAID WITHDRAWAL ADJUSTMENT

BALANCE
Jun 24, 2026
$5,850.00
$0.00
$0.00
$5,850.00
Jul 1, 2026
$250.00
$0.00
$0.00
$250.00
# R8563 SMUS Tentative Page 5 of 5
06/08/2026 City Council Agenda 544

ATTACHMENT 22
06/08/2026 City Council Agenda 545

2026-27 SUISINIT TO: CITY DF YUCA1PA
FISCAL YEAR: GENERAL SERVICES/CITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

DATE SUBMITTED: 4/27/20 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 retumed to the applicant.

Note: Financial grant awarded funds will require 100%financial match by the applicant. For example, if your total program/project cost is L1,000, your financial grant request should be for no more than $500.

Be prepared to show proof of program1project cost in your Wrap-up Report (Accountability Report}, detailing the applicant's match of funds.

Name of ApplicantJOrganization: Yucaipa Valley Lions Club Applicant/Organization P❑ Box 1081', Yucaipa, CA 92399
Mailing Address:

ApplicantlOrganization Phone Number: (909)312-1363
CONTACT (1) Michele Beckman

NAME PHONE NUMSER
YucaipaVailey.LionsClub�U_)gmail.com
E-Mail
CONTACT (2) Janene Klocek

NAME PHONE NUMBER
E-Mail
1 06/08/2026 City Council AgendaN i''+
• •.

YES
NO
Is your organization located in another community?
❑
❑�
Will the program/event take place in another community? ❑
Q
Are you aware of any other City program providing this service? ❑
Q
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.

Your organization must be an established 501 (c) to be considered for Community Activity Grant funding.

Please submit documentation verifying organization 501 (c) status along with this application, YES NO
Is your organization a 501 (c)? ❑� H
If so, please provide Tax ID# and attach all supporting 95-5133638 documents.

Does this application include submittal of YES NO
documentation verifying 501 {c} status?❑ ❑
Now long has your 501 (c) organization been in existence? 54 years Number of employees working for organization? 0
Number of volunteers working for organization? 12
YES NO
Is a current City Council Member on your board? ❑❑
Now many Yucaipa residents does your organization 50
currently serve?
Does the organization charge admission, membership YES NO fees, due, etc.? 2 ❑
If yes, please describe: Membership fee $50 annually
7 06/08/2026 City Council Agenda 547

Name of the program/event: 5k Dog Walk
Date(s) of the program/event; Q I A �202-1
Total estimated cost for programlevent: $300
Describe the programlevent that the organization is seeking support for:
(Attach any event/program promotional materials associated with the pfogramlevent) Annually we organize and host a 5k fun walk fundraiser to benefit YAPS.

What is the goal of this programlevent and how will it positively impact the community? The goal is to come together with other dog owners to have a fun walk/run through the park to get some exercise, socialize with others and support YAPS.

Program/event primary target population (check all that apply):
❑
Children or Youth
❑�
Entire Community
Homeless
❑ Low income
❑ 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 El 0
Amplified Sound
(excludingSpecial Event Facilities)
THIS 13OX IS FOR STAFF USE ONLY
This event requires City Management) YES NO
❑Administrative Approval:

YES NO
Estimated attendance 1000+ persons ❑ THIS 8OX15 FOR STAFF USE ONLY Alcohol Service YES N4
(exctuding Community Centers & YPAQ El F71 This event requires City Council Approval: ❑ Street Closure - Traffic Management El F71
K1
06/08/2026 City Council Agenda J U C�Q
y

Please identify what your organization is seeking:

YES NO
Financial Support: ❑ ❑ $
In -Kind Support: $ $
OT1Reassigned Staff CS/Rental
YES NO
$300 SEP Fee Waiver: ❑ ❑
$ Scherer
Community Center
s 2x
ther
Total Amount Z Z
of Request $ 7 �� r $ 0 $ a $ $ '7
In-Kind Financial Support $300 SEP Fee Financial Match Total Overall Waiver Request
Provide a detailed description of how the financial support will be used:

Use of Shelter #8 at Yucaipa Community Park to have check -in, gifts/snacks/water for dogs and their owners
Describe any City Funding received by your organization in the past three years (required)? En -kind
Financial
S300 SEP
Program Support
support
Fee Waiver Date Received
Total Received
Peace Poster Contest ❑J
❑
❑ 10/2/25
$400
❑
❑
❑
$
❑
❑
❑
$
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the last three years?
Funding Source Amount Received Date Received
$
4 06/08/2026 City Council Agenda 549

I, the undersigned, do hereby attest that the above information is true and correct to the hest of my knowledge, and understand that the awarded financial grant amount needs to be spent prior to submitting another grant request.
%na ure
Membership and Activities 4/27/26
Title
Date Received: Date Reviewed:

Amount Funded: City Council Meeting:

Type Of Grant: 'In -Kind Financial S3W SEP
❑ upport ❑ Support ❑ Fee wal4er
Date City Council received follow-up report:

Date
06/08/2026 City Council Agenda 550

INTERNAL REVENUE: SERVICE
P. 0. BOX 2508
CINCINNATI, OH 45201
Date. A U G 2 8 Z414

YUCAIPA VALLEY LIONS CLUB
Po BOX 1081
YUCAIPA, CA 92399
Dear Applicant:

DEPARTMENT OF THE TREASURY
Employer identification Number:
95 6133638
DLN:
17053191180003
Contact Person:

TYRONE THOMNS IDK 95046
Contact Telephone Number:
(877) 829-5500
Accounting Period Ending:

June 30
Public charity Status:
509(a)(2)
Form 990 Required:

Yes
Effective Date ❑f Exemption:

May 15, 2012
Contribution Deductibility:

Yes
Addendum Applies:

For important information about your responsibilities as a tax-exempt organization, go to wwr,irn.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 rt-Tiirements.

Sincerely,
J
Director, Exempt organizations
Letter 947
06/08/2026 City Council Agenda 551

4/30126, 8:44AM
PermitContract
Permit
` COMMUNITY

SERVICES'
P ob
B�
City of Yucaipa Community
PHDNE:(909) 790-7460 Permit # R8576
Services
FAX:(909) 790-2589 Status Tentative
34272 Yucaipa Blvd
EMAIL:communityservices@yucaipa_org Date of Issue Apr 30, 2026 8:41 AM Yucaipa, CA 92399
Expiration Date Apr 30. 2027
Organization Name Yucaipa Valley Lions Club -131 Organization Phone 1 Customer Type Non-Profit(R) Number
Organization Address
Agent Name Michele Beckman Home Phone Number
System User Nick Johnson
Rental Fee
$237.00
Discounts
-$15.00
Subtotal
$222-00
Deposits
$0.00
Deposit Discounts
$0.00
Total Permit Fee
$222.00
Total Payment
$0,00
Refunds
$0.00
Balance
$222.00
Lions Club
Booking Summary
1 reseurce(s) 1 booking(s) Subtotal: $222.00

START DATE/TIME END DATEMME ATTENDEE I AMT W/O TAX
$at, Jun 19, 2027 7,00 AM Sat, Jun 19, 2027 8:00 PM 25 $0.00 Resource level fees $222.00
Custom Questions

I QUESTION I ANSWER
A. Any Cancellation of a rental less than 30 days will result in loss of 10D % of the Acknowledge rental flees 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 I acknowledge and agree that bounce houses are only permitted at designated Acknowledge shelters. Community Park: Shelters 2, 3, 4, & 7 Ave I Park: Shelters 1, 2, 3, 4 7th 06/08/2026 City Council Agenda
httpsdfanprod, active.comlyucaip afui,do?method=showPermitContract&perrnit_id=F3870EBCDE 39AF 552 '1/2

4/30126, 8.44 AM
Street Park: Shelters 1, 2, 3 Wildwood Park: Shelter 1
PermitContract
I acknowledge and agree the following Bounce House rules! 1)Bounce houses are Acknowledge to be set up only by the bounce house company. 2)Bounce house companies will be responsible for providing a generator for the inflation of the bounce house. The City does not provide electricity. The generator must be quiet rated at 60dB or less and not generate noise in excess of City standards. 3}Bounce houses are not allowed in City parks overnight.

I acknowledge and agree to the following policies regarding bounce houses: 1) Acknowledge Bounce houses must be free standing and weighted. Stakes are prohibited in City parks. 2) Permit Holder/Requestor is responsible for ail 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: i)Permit Holder/Requestor(s) and event attendees Acknowledge 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.

I agree and acknowledge that the information provided to this application is Acknowledge 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 Acknowledge 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. 5)NO VEHICLES ARE ALLOWED IN CITY PARKS, ON TURF, OR ON WALKWAYS.

What is your type of event?
Meeting
Will there be a bounce house? If yes, I acknowledge and agree that bounce No houses are 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
Payment Schedules Original Balance: $222.00 Current Balance: $222.00 DUE DATE AMOUNT DUE i AMOUNT PAID WITHDRAWAL ADJUSTMENT ! BALANCE Jun 5, 2026 $22Z00 $0DO $0.00 $222.00
06/08/2026 City Council Agenda
https //anprod.active.com/yucaipa/ui.do?method=showPermitContract&permit_id=F3B7OE8COE39AF 553 2/2

ATTACHMENT 23
06/08/2026 City Council Agenda 554

2026-27 SUIUMIT TO: CITY 01 YUCAIPA
FISCAL YEAR: GENERAL SERVICESICITY CLERK DEPARTMENT
34272 YUCAIPA BLVD.

DATE SUBMITTED: 4127/2026 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: 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 S500.

Be prepared to show pruuf of program/project cost in your Wrap-up Report (Accountability Report), detailing the applicant's match of funds.

Name of ApplicantlOrganization: Yucaipa Valley Lions Club AppIicantlorganization PO Box 1081; Yucaipa, CA 92399
Mailing Address:

Applicant)organization phone Number: (909)312-1363
CONTACT(1) Michele Beckman
NAME
[email protected]
f-Mail
CONTACT(2) Jar;ene Klocek
NAME
E-Mail

PMONE NUMBER
06/08/2026 City Council Agenda 555

YES N ❑
Is your organization located in another community? ❑ Z
Will the programlevent take place in another community? ❑ W1 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 Artivity Grant.

Your organization must be an established 501 (c) to be considered for Community Activity Grant funding.

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

YES NO
Is your organization a 501 (c)?
If s❑ lease provide Tax ID# and attach all supporting • p p pp g 95-6133638 documents.

Does this application include submittal of YES No
documentation verifying 501 (c) status? Z
How long has your 501 (c) organization been in existence? 54 years Number of employees working for organization? 0
Number of volunteers working for organization? 12
YES NO
Is a current City Council Member on your board? El F/I
How many Yucaipa residents does your organization 50
currently serve?
Does the organization charge admission, membership YES NO fees, due, etc.? W1 El
If yes, please describe: Membership fee $50 annually
2 Name of the program/event: Peace Poster Contest
Dates) of the programlevent: 9/26/26; 10/3/26; 10/17/26 Total estimated cost for program/event: $700
Describe the program/event that the organization is seeking support for:
(Attach any event/program promotional materials associated with the programlevent) Annually students 11-13 years old can participate in the Lions Club International poster contest with the theme for 2026: Harmony in Humanity. The program will have 2 days of guided art lessons and all supplies with snacks will be provided. The last date will be the contest and recognitions/awards.

What is the goal of this programlevent and how will it positively impact the community? The goal is to have youth imagine a world where people of every culture and background live together peacefully — celebrating differences, finding common ground and creating true harmony in humanity through art.

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

YES NO
Estimated attendance 300.999 persons ❑
Amplified Sound ❑
[excluding Special Event Facilities]
THIS BOX fS FCR STAFF USE ONLY
YES NO
This event requires City Managementl
Administrative Approval: ❑ 14
YES
NO
Estimated attendance 1000+ persons
❑
©

El
[excluding Community Centers & YPAC]
Street Closure - Traffic Management
❑
3 557

Please identify what your organization is seeking:

YES No YES NO
Financial Support: ❑ ❑ $ $300 SEP Fee Waiver: ❑
In -Kind Support: $ $ 7 ��U r $ $
OT1Reassigned Staff GCS/Rental Scherer other
Community Center
Total Amount ��5�xS $ 0 $ o $ $ L'
of Request $
In -Kind Financial Support $300 SEP Fee Financial Match Total overall Waiver Request
Provide a detailed description of how the financial support will be used:

Community Center Activity Room rental for all activity dates Describe any City Funding received by your organization in the past three years (required)? in -Hind
Program Support
Financial
Support
$ao*SEP Hate Received
Fee waiver
Total Received
Peace Poster Contest W]
❑
❑ 1012/25
$400
❑
❑
❑
$
❑
❑
❑
$
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the last three years?
Funding Source Amount Received Date Received
4 I, the undersigned, do hereby attest that the above information is true and correct to the hest of my knowledge, and understand that the awarded financial grant amount needs to be spent prior to submitting another grant request.

Membership and Activities
Title
Date Received: u Ito u',0— - t Date Reviewed:

Amount Funded: 1 City Council Meeting:
r
Type of Grant- i Kind Financial $3ad SEP
ugpart ❑ Support ❑ Fee Waiver
❑ate City Council' received follow-up report-
Date
06/08/2026 City Council Agenda C59

INTERNAL REVENUE' SERVICE
P. O. BOX 21i08
CINCINNATI, OH 45201
Datc, ! A U G Z 8 Z014
YUC:AIPA VALLEY LIONS CLUlI
PO BOX 1081
YuCAIPA, CA 92399
Dear Applicant:

DEPARTMENT OF TTIF TREASUPY
Employer Identification Number:

95.6133638
DLN:
17053191380003
Contact Person:

TYRONE THOMAS IDIJ 95046
Contact Telephone Number;
(8.17) 829-5500
Accounting Period Ending:

June 30
Public Charity status:
509(a)(2)
Form 990 Required:

Yes
Fffer-Live Date of Exemption:

May 15, 2012
Contribution deductibility:

Yes
Addendum Applies.

Yes
We are pleased to inform you that upon review or 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 tinder 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, OrganizaLians 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.

For important information aboui, your responsibilities as a tax-exempt nrganiaarior., go to :rrr.:.irs.gav�chGritics. Ente: "422i-PC" in the search bar to View Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, a-eporting, and disclosure requirements.

S i nr-e r-ee I y ,
was eJ
/-- ?-,14
Director, Exempt organizations
Letter 947
06/08/2026 City Council Agenda 560

4/30126, 8:37AM
Permit
City of Yucaipa Community
Services
34772 Yucaipa Bird
Yucaipa CA 92399
PermitContract
COMMUNITY Parks

SERVICES
r:

PHONE:{909)790-7460 Permit # R8575
FAX(909) 790-2589 Status Tentative
EMAIL:[email protected] Date of Issue Apr 30, 2026 8:37 AM Expiration Date Apr 30, 2027
Organization Name Yucaipa Valley Lions Club -131 Organization Phone 1 CustomerType Non-Profit(R) Number
Organization Address
Agent Name Jane Van Norstrancl Home Phone Number
Cell Phone Number
Email Address
System User Nick Johnson
Rental Fee
$504,40
Discounts
-$56_00
Subtotal
$548.40
Deposits
$100.00
Deposit Discounts
$0.00
Total Permit Fee
$WAD
Total Payment
$0.00
Refunds
$0.00
Balance
SWAO
Lions Club 1 resource(s) 2 booking(s) subtotal: $648A0
Booking Summary

START DATEJTIME END DATE/TIME ATTENDEE I AMT W/O TAX
Sat, Sep 26, 2026 9:30 AM Sat, Sep 26, 20261/30 PIN 40 $280.00 Sat, Oct 17, 2026 4:00 PM Sat, Oct 17, 2026 8:00 PM 40 $324.40 Resource level fees $44.00
4 7
Deposit
EVENT I PESOURCE I DEPOSIT FEE I CHARGE I TAX] AMOUNT PAID I REFUNDS I BALANCE Lions Club Kid's Club Deposit $100.00 $D.00 $000 $aw $iC0.00 (Activity
Room)
06/08/2026 City Council Agenda
https:llanprod. active. comlyucaipalui.do7method=showPermitContract&permit id=F2B70E8C0E39AE 561 112

4130126, 8 37 AM
PermitContract
Payment Schedules Original Balance: $648.40 Current Balance: $848A0

DUE DATE AMOUNT DUE AMOUNT PAID WITHDRAWAL ADJUSTMENT I BALANCE Sep 1Z 2026 $648,40 $0,00 $0.00 $648.40
06/08/2026 City Council Agenda
https:llanprod.active.00mlyucaipalui.do?method=showPermitContract&permit_id=F2B70E8COE39AE 562 212

ATTACHMENT 24
06/08/2026 City Council Agenda 563

OF YUCAIPA
IN '''0'26 Psi 12:00
2026127 SUBMITTO: CITY OFYUCAIPA
FISCAL YEAR: GENERAL SERVICESICITY CLERK DEPARTMENT
34272 YUCAIPA BLVO.

DATE SUBMITTED: 4130126 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: Financial grant awarded funds will require 100%financial match by the applicant. For example, if your total programlproject 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 applicant's match of funds.

Name of Applicant/Organization: Yucaipa Youth Basketball Applicant/Organization PO Box 31 Yucaipa, CA 92399
Mailing Address:

Applicant/organization Phone Number:

CONTACTO) Ryan Kerns

NAME PHONE NUMBER
CONTACT (2)
[email protected];om
E-mail

NAME PHONE NUMBER
:-Mail
1 06/08/2026 City Council Agenda > 564

YES N❑
Is your organization located in another community? ❑ JC� Will the program/event take place in another community? ❑ ❑J Are you aware of any other City program providing this service? L1 ❑� 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.

Your organization must be an established 501 (c) to be considered for Community Activity Grant funding.

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

YES NO
Is your organization a 501 (c)? OJ
If so, please provide Tax ID# anti attach all supporting 33_0862817 `/W documents.

Does this application include submittal of YES NO
documentation verifying 501 (c) status? El R71
How long has your 501 (c) organization been in existence? 27 years Number of employees working for organization? Q
Number of volunteers working for organization? 15
YES NO
Is a current City Council Member on your board? ❑ 0
How many Yucaipa residents does your organization 550 kids currently serve?
Does the organization charge admission, membership YES
NO
fees, due, etc.? LJ
If yes, please describe:
2 06/08/2026 City Council Agenda 565

Name of the program/event: Yucaipa Youth Basketball Season Date(s) of the programlevent: Nov 1 2026 - March 20 2027 Total estimated cost for program/event: $0000
Describe the program/event that the organization is seeking support for:
(Attach any event/program promotional materials associated with the program/event) We are seeking assistance for the following items

1. Help with the cost of storage. YYB storage has become too small. We have grown in providing the best possible experience for our youth. We are seeking a larger storage unit to better contain our equipment in one place

2. Use of the Yucaipa Community Center for referee clinics and board meetings.

What is the goal of this program/event and how will it positively impact the community? Our program as a whole provides a safe and fun experience playing basketball. We strive to teach and affirm principles such as teamwork, communication and building character for our youth.

Using YCC for our referee clinics will help ensure consistency in how our games are played. In addition, YYB would use the available meeting rooms to conduct monthly meetings to keep YYB an track operationally.

YYB is also seeking a monetary component to this grant. We currently have a small storage unit to store various items we use through the year. We also store additional items at our personal residences. We would like to keep everything centralized. This will allow all board members better access to equipment as needed
Program/event primary target population (check all that apply):

QChildren
or Youth
❑
Entire Community
❑
Homeless
F1 Low Income
Women
❑
Persons with Disabilities
❑
Seniors
El
Victims
❑ Welfare Recipients
Please answer the following to determine if your programlevent requires a Special Event Permit (SEP):

YES NO
THIS DOX 15 FOR STAFF USE ONLY
Estimated attendance 300-999 persons YES No
This event requires City Management) ❑
Amplified Sound Administrative Approval:
[excluding Special Event Facilities}
YES NO
Estimated attendance 1000+ persons ❑ THIS BOX 15 FOR57AFF USE ONLY YES N.0
Alcohol Service Iv]This event requires City Council Approval: ❑ {excluding Community Centers & YPAQ /ICI
Street Closure -Traffic Management F1❑
3 06/08/2026 City Council Agenda 566

Please identify what your organization is seeking:

YES NO YES NO
Financial Support: ❑d ❑ $1000 $300 SEP Fee Waiver: ❑ ❑
In -Kind Support: $ t7� $ $
OT/Reassigned Staff CS/Rental Scherer Other
Community Center
Total Amount _-
of Request S��;f 5 1000 $ $ IrtiL�' ��il:�t 2
In -Kind Financial Support $300 SEP Fee Financial Match Total Overall Waiver Request
Provide a detailed description of how the financial support will be used:

Monetary Support would be used for increased cost of a larger storage unit In Kind use of Community Center for referee clinics and use of meeting rooms to conduct YYB board meetings
Describe any City Funding received by your organization in the past three years (required)? Program
In -hind
Support
Financial
Support
S100 SEP
Fee Waiver
Date Received
Total Received
YYB Jerseys
❑
❑J
❑
7/20/23
$ 1000
YYB Season
0 ❑
❑
7/20/23
$ 4080
❑
❑
❑
$
Has your organization applied for and/or received any additional funding outside of the Community Activity Grant within the last three years?
Funding Source Amount Received Date Received
None $
S
4 06/08/2026 City Council Agenda 567

I, the undersigned, d❑ 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.
1)igitaily signed by Ryan
Kern
Ryan erns Daies2026.04.3011:16:32 Treasurer
-OTOO'
Signature
Title
Date Received: a �� Date Reviewed -
Amount Funded: 111 City Council Meeting:

Type of Grant: In -Kind Financial ❑ $300SEP
Support I f`Y Support Fee Waiver
Date City Council received follow-up 7re—port:
4/30/2026
Date
06/08/2026 City Council Agenda 568

0 ULVAR1MENT OF THE TREASURY

INTERNAL REVENUE SERVICE
FRESNO CA 93888

YUCAIPA YOUTH BASKETBALL LEAGUE
.10E MENDEZ
DATE OF THIS NOTICE: 07-08-1999
NUMBER OF THIS NOTICE: CP 575 E
EMPLOYER IDENTIFICATION NUMBER: 33-0862817
FGRM: SS-4
8916806117 0
FOR ASSISTANCE CALL. US AT:
1-800-629-1040
OR WRITE TO THE ADDR E53
SHOWN AT THE TOP LEFT.

IF YOU WRITE, ATTACH THE
STUD OF THIS NOTICE.

WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER (EIN) Thank you for your Form SS-4, Application for Employer Identification Number (EIN). We assigned vau EIN 33-0862617. This EIli will identify your business accoun-t-, tax returns, and documents, even if you have no employees. Please keep this notice in your permanent records,
Use your complete name and EIN as shown above on all federal tax forms, payments, and related correspondence. If you use any variation in your name or EIN, it may cause a delay in processing, incorrect information in your account, or cause you to be assigned more than one EIN.

If you want to receive a ruling or a determination letter recognizing your organization as tax exempt, you should file Form 1023/lOZ4, Application for Recognition of Exemption, with your IRS Key District office. Publication 557, Tax Exempt Status for Your Organization, is available at most IRS offices and has details an how you can apply.

Thank you for your cooperation.

Keep this part for your records.

Return this Part with any correspondence
so we may identify your account. Please
correct any errors in your name or address.

Your Telephone Number
C 3 -
CP 575 E (Rev. 1-1999
CP 575 E
8916806117
Best Time to Call BATE OF THIS NOTICE: U7-08-1999
EMPLOYER IDENTIFICATION NUMBER: 33-086Z817
FORM: SS-4

INTERNAL REVENUE SERVICE
FRESNO CA 93688

YUCAIPA YOUTH BASKETBALL LEAGUE
% JOE MENDEZ
----------------------------
06/08/2026 City Council Agenda �anned with
am$canner

Permit
COMMUNITY P 1ke
SERVICES 1�i
Bet&rl
City of Yucaipa Community PHONE.:(909) 790-7460
Services FAX (909) 790-2589
34272 Yucaipa Blvd EMAIL:-oFnrnunityservice5@yuc:ajpa.org Yucaipa, CA 92399
4rgardxaifon Narne Yucaipa Youth Basketba4 -17
Customer Type Non -Profit (R)
Organtra311on Addrms PO Box 31
Yucaipa, CA 92399
Agent Nerne Ryan Kerns
System User Karen, Ruiz
Mont* Board Meatingsl Referee Clinics
Ofganaallon Phone 1
Number
Work Phone Number
Home Phone Number
Cal Phone Number
EMW Atittess
Permit # R85M
Statue Tentative
Date of Issue Apr 30, 2026 3:16 PM
Expiration Date Apr 30, 2027
Rental Fee
$3,140.00
Discounts
-S98-00
Subtctai
$3.042DO
Deposits
$350,00
Deposit Discounts
WOO
Total Permit Fee $3,392.00
Total Payment $0.00
Refunds $0.00
Balance $3,392,00
2 resource(s) 119 booking(s) Sit $3139 00
Booking Summary

START DATE/TIME
END DATE171ML

ATTENDEE
AMT W/0 TAX
Mort Aug 3, 2W8 S.W PM
Mw6 Mw1.2W &WPM
--
$682W
occurs on sa+ecteo was emcrrve GW03f2M until Q3/i WOZ7.

Mon, Aug 3, 2026 6:00 PM
Mon, Aug 3, 2026 8:00 PM
10 $126.00
RPntai - ,ijriy $7000 / Hour x 2
$14C.QO
Resident Discount - 10% (YCC & SCC) -10"o xl
-514 ,;,
Mori, Sep 7, 2026 6-00 PM
Mon, Sep 7, 2026 8.00 PM
10 $126.00
Reritai - Hourly $70.00 1 Hour x 2
S140-00
Redolent D.sceunt - 10% (YCC & SCQ -10% x 1
Mon, Oct 5, 2026 6:00 PM
Mon. Oct 5, 2026 8:00 PM
10 $126-00
Rental - Hourly $70.00 / Hour x 2
$140.OG
Resident D:scount - 101r (YCC & SCC) -10% x 1
-314-OC
Mon, Dec 7, 2026 6:00 PM
Mon, Dec 7, 2026 8:00 PM
10 $126.00
Rental - Hourly $70.00 / Hour x 2
# R8583 Stadie Tentative Pqp I of 3
06/08/2026 City Council Agenda 570

Resident Discount -10 e (YCC & SCC) -10% x I
Mon, tan 4, 2027 6:00 PM
Mon, Jan 4, 2027 8:00 PM
10 $126.00
Rental - Hourly $70.00 / Hour x 2
S140 00
Resident Discount - 10% (YCC & $CC) -10% x
1 Mon, Fah 1, 2027 6:00 PM
Mon, Feb 1, 2027 8:00 PM
10 $126.00
Rental - Hourly $70,00 / Hour x 2
0 Resident Discount - 10% (YCC & SCC) -10% x
1 Mon, Mar 1, 2027 6:00 PM
Mon, Mar 1, 2027 8:00 PM
10 $128.00
Rental - hourly $70-00 / Hour x 2
$140.00
Residert Discount -10% (YCC & SCC) -10% x 1
-$14.0C•
Resource level fees
$100-00
_^•enoa S1i;0 Cr! ; Each x 1
$100.00
e

START DATE/TIME

END DATEJTIME

ATTENDEE
AMT W10 TAX
SaL Oct %2= Q= Mil
Sat; Oec 1% 2028 QW PM
--
$2.100.00
0=" on selected dates arnsc" 1010312026 unto!VIVr2026-
Sat Oct 3, 2026 9:00 AM
Sat, Oct 3, 2026 12: 00 PM
10 $180-00
Rental - Hourly $60-00 J Hour x 3
Sat, Oct 10, 2026 9:00 AM
Sat, Oct 10, 202612:00 PM
10 $180,00
Rental - Hourly $60.00 J Hour x 3
$180 00
Sat, Oct 17, 2026 9:00 AM
Sat, Oct 17, 202612:00 PM
10 $180-00
Rental - Hourly $60-00 I Hour x 3
Sat, Oct 24, 2026 9:00 AM
Sat, Oct 24, 202612:00 PM
10 $180,00
- Elul-,ri; $60.00 / Hour x 3
Sat, Oct 31, 2026 9:00 AM
Sat, Oct 31, 202612:00 PM
10 $180.00
Rental - Hourly $60.001 Hour x 3
8 :;
Sat, Nov 7, 2026 9:00 AM
Sat, Nov 7, 202612:00 PM
10 $180.00
Rental - Hourly $60.00 / Hour x 3
1?CI I:

Sat, Nov 14, 2026 9-00 AM
Sat, Nov 14, 202612:00 PM
10 $180.00
Rental - Hourly $60.00 / Hour x 3
S.Ia".:KI
Sat, Nov 21, 2026 9:00 AM
Sat, Nov 21, 202612:00 PM
10 8180.00
Rental - Hourly $60-00 J Hour x 3
;' :: -
Sat, Nov 28. 2026 9:00 AM
Sat, Nov 28, 202612,00 PM
10 $180.00
Rental - Haurly $60,001 Hour x 3
Sat, flee 5.2026 9:00 AM
Sat, Dec 5, 202612:00 PM
10 $180.00
Rental - Hourly $60-001 Hour x 3
S180.1]11:

Sat, Dec 12, 2026 9:00 AM
Sat, Dec 1Z 202612:00 PM
10 $180.00
$60.00 J Hour x 3
S180-00
Sat, Dec 19, 2026 9:00 AM
Sat, Dec 19, 202612:00 PM
10 $180,00
Rental - Hourly $60-001 Hour x 3
$180.00
Resource level fees
$250,00
$250.00 / Each x 1
8250.00
# R8583 9taba Tentative

Page 2 of 3 ends

Yucaipa City CouncilJune 8, 2026

Yucaipa City Council
June 8, 2026