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City of Santee Ana <br />Conation Request <br />u' <br />City manager's Off" - M -J'1 <br />20 Civic Cooler ihom <br />P.D. Box 1988 <br />Santa Ann. CA 92702 <br />(714) 647-6200 <br />a <br />Name: Tanta Pantoja Title: Communications Coordinator <br />Address: 450 W. 4th Street <br />City, state, zip: Santa Ana, CA, 92701 Phone: 714-542-7792 <br />Email! tpantoja@lalinohealthaccess.org Fax: 714-542.4853 <br />Name: Latino Health Access <br />Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as $elect one: Q <br />defined under Section 501(c)(3) of the Internal Revenue Code? Yes No <br />If No, you Will only quality Por a credit for City -related costs for yourrequest (to, permit fees, <br />stall time, rental rotas for facilities or equipment,etc.), Costs for City services very and if If Yes,����-� <br />approved, credit may or may not cover full cost of requested City services. Tax 10 N: <br />Latino Center far Prevention & Actien in Healfih & 1Nolfare <br />City Services Credit $ pate Needed; April 8, 2017Amount Requested: MayorlCouncllmember; Benavidas <br />Direct eAmount $1,000 Event pate; Aril 8, 2017 Event Time; <br />Requested: p 7:00am-2.00pm <br />Event Location: Centennial Park, 3000 W. Edinger Avenue, Santa Ana, CA, 92704 <br />Address, City, share. Zip <br />Description of <br />Event/Purpose: <br />Community Benefit: <br />Applicant Signature: <br />A healthy family and community result from healthy orators In an envlrentrnt that supporta shared maponsibllity. In ladno Heart Acceea, we want to be pati or <br />the environment tatpmmeem the amara, of exemim I m a purpose in mind. Some of as 0 walk fora parent with dlabotes, a Old wlih special rade, In ban <br />welght or to Slay GC Some of us want on walk for steel-' families, a mom mUualye roomy. and Is, wmmuefte Ws,).bay.. your pmpase Is, wme late us In at <br />first Health Walk In Santa Ana and le® us who or net will YOU walk rat. <br />This is an event that will promote wellness for all residents in the city of Santa <br />Ana, <br />Mall: City Manager's Office—M-31 <br />20 Civic Center Plaza <br />P.O. Box 1988 <br />Santa Ana, CA 92702 <br />Donation Request: DR <br />Eligibility Met: Yes <br />City Manager Signature: <br />Date: 03/17/2017 <br />Email: donationrfiqueat(gisanta-milcorg <br />Fax: (714) 647-6054 <br />Council Meeting Date <br />Approved Amount: <br />Date: <br />29G-3 <br />04/04/2017 <br />$1,000 <br />Revised 01/05/2017 <br />