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4 �. <br />ON N City f � <br />Donation <br />City Manager's Office — M-31 <br />20 Civic Center plaza <br />RO. Box 1988 <br />Santa Ana, CA 92702 <br />(714) 847.5209 <br />Contact Information <br />Name: John Herpy Title: President <br />Address: 8632 Masters Drive, Suite 1000 <br />C(ty,state,zip: Huntington Beach <br />Ernst; jherpy@ix,netcom.com <br />Phone: 562.221.7145 <br />'.Fax: <br />'Organization <br />Name. Roadrunner Football Boosters <br />Tax -Exempt Status: Is your organization a non-profit or public tax-exempt organization as Select One: f t <br />defined under Section 501(5)(3) of the Internal Revenue Code? I J P Yes ❑ No <br />If No, you will only qualify for a credit for Cily-related costs for your request (i.e. permit fees, <br />staff time. rental rates for facilities or equipment, etc.). Casts for City services vary and if If Yes, <br />approved, credit may or may not cover full cost of requested City services. Tax ID x: <br />D. .Request <br />City Amount <br />e Credit $ Date Needed:' Fall 2017 Ma or/Counciimember. Tina ero <br />Amounk Requested; Y 1 <br />Direct payment Amount <br />Requested: $2500.00 Event Date: Fall 2017 :Event Time: <br />Event Location: Saddleback High School, 2802 South Flower St, Santa Ana, CA 92707 <br />Address. Chy, State, Zip <br />Description of Saddleback High School Varsity Football Team support. <br />Event/Purpose: <br />PROVIDING SUPPORT FOR ON-GOING SERVICES TO THE SADDLEBACK HIGH <br />Community Benefit: SCHOOL FOOTBALL TEAM, WHICH PROMOTES HEALTH, FITNESS, AND ACADEMICS, <br />Applicant Signature: state: 09/05/2017 <br />Mall: City Manager's Office—M-31 small: donationrequest@wnta-ana.org <br />20 Civic Center Plaza Fax: (714) $47.8994 <br />P.O, Box 1988 <br />Santa Ana, CA 92702 <br />Donation Rau _ DR, <br />1 71. �. Council Meeting Date: SEPTEMBER 19, 2017 <br />Eligibility Mei; YES i NO YES <br />City 141a-r7ager Sirgnatura: <br />Approvod Amount: $2,500 <br />EXHIBIT 3 <br />Date: <br />Revised 0110612017 <br />