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''p�=' City of Santa Ana City Manager's Office -M-31 <br />�, Y 20 Civic Center Plaza <br />Donation Request P.O. Box 1988 <br />•L� Santa Ana, CA 92702 <br />—' (714) 647-5200 <br />Contact Information <br />Name: <br />Nati Alvarado <br />itie: <br />Executive Director <br />Address: <br />11920 E. 17th Suite 202 <br />city, State, zip:' <br />Santa Ana, Calif. 92705 Phone: 714-267-_7.747 <br />Email• <br />nati@ngservices.org <br />Pax: - <br />--, <br />Name: INatis House DBA Neutral Ground <br />empt Status: Is your organization a non-profit or public tax-exempt organization as <br />under Section 501(cX3) of the Internal Revenue Code? <br />ou will only qualify for a credit for City -related costs for your request (i.e. permit fees, <br />e, rental rates for facilities or equipment, etc.). Costs for City services vary and if <br />d, credit may or may not cover full cost of requested City services. <br />Select One: Z Yes ❑ No <br />� If Yes, <br />i ax ID #: 1 45-4041042 <br />Donation <br />City Services Credit <br />ount Requested: <br />Date Needed: 6-23-2018 I <br />r Ma ar/Councilmember: <br />Solodo - <br />Direct Payment Amount <br />1000.00 'Event Date; Event Time: <br />Requested: <br />Event Location: <br />1825 Civic Center Dr Santa Ana, Ca. 92706 <br />Address, City, State, Zip <br />provides mediation and intervention services to Santa Ana youth andDescription <br />of <br />EventI Purpose: <br />FNasHouse <br />lies in need. The funds from this sponsorship will go towards on -going <br />ram cost and services throuqh June 30, 2018. <br />he community benefits from Natis House services and program by overcoming <br />Community Benefit: <br />life challenges, learning workforce skills, completing educational opportunities. <br />Applicant Signature: <br />.1YCCtGQ�RQ1LQl�Q ,Date: <br />06-0$-2018 <br />Return completed form via: <br />Mail: City Manager's Office -M-31 Email: donationrequest@santa-ana.org <br />20 Civic Center Plaza Fax: (714) 647.6954 <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request#: <br />Reference 0 on all related DPVs <br />DR- <br />Council Meeting Date: <br />JUNE 19, 2018 <br />Eligibility Met: <br />YES / NO YES <br />Approved Amount: <br />$1,000 <br />City Manager Signature: <br />Data. <br />Revised 01/05/2017 <br />