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110921 CC Agenda
In compliance with the Americans with Disabilities Act, if you need special assistance to participate in this meeting, please contact the office of the City Clerk (951) 694-6444. Notification 48 hours prior to a meeting will enable the City to make reasonable arrangements to ensure accessibility to that meeting [28 CFR 35.102.35.104 ADA Title II]. AGENDA TEMECULA CITY COUNCIL REGULAR MEETING COUNCIL CHAMBERS 41000 MAIN STREET TEMECULA, CALIFORNIA NOVEMBER 9, 2021 - 7:00 PM CLOSED SESSION - 6:00 P.M. LABOR NEGOTIATIONS — The City Council will meet in closed session with its designated representatives to discuss labor negotiations pursuant to Government Code Section 54957.6. The City's designated representatives are City Manager Aaron Adams, City Attorney Peter Thorson, Assistant City Manager Kevin Hawkins, Director of Finance Jennifer Hennessy, Director of Human Resources and Risk Management Isaac Garibay, Deputy City Manager Luke Watson and Senior Human Resources Analyst Becky Obmann. The employee organization is the California Teamsters Public, Professional and Medical Employees Union Local 911. CALL TO ORDER: Mayor Maryann Edwards INVOCATION: Pastor Russell Holliday of Reliance Church FLAG SALUTE: Mayor Maryann Edwards ROLL CALL: Alexander, Edwards, Rahn, Schwank, Stewart PRESENTATIONS Proclamation for World Pancreatic Cancer Awareness Day Proclamation for National Veterans and Military Families Month Proclamation for National Native American Heritage Month BOARD / COMMISSION REPORTS Community Services Commission, Old Town Local Review Board, and Public/Traffic Safety Commission PUBLIC SAFETY REPORT California Department of Forestry and Fire Protection (CAL FIRE) PUBLIC COMMENTS - NON -AGENDA ITEMS A total of 30 minutes is provided for members of the public to address the City Council on matters not Page 1 City Council Agenda November 9, 2021 listed on the agenda. Each speaker is limited to three minutes. Public comments may be made in person at the meeting by submitting a speaker card to the City Clerk or Deputy City Clerk or by submitting an email to be read aloud into the record at the meeting. Email comments must be submitted to CouncilComments@temeculaca.gov. Speaker cards for in -person comments will be called in the order received by the City Clerk or Deputy City Clerk and then, if time remains, email comments will be read. Email comments on all matters must be received prior to the time the item is called for public comments. All public participation is governed by the Council Policy regarding Public Participation at Meetings adopted by Resolution No. 2021-54. CITY COUNCIL REPORTS Reports by the members of the City Council on matters not on the agenda will be made at this time. A total, not to exceed, ten minutes will be devoted to these reports. CONSENT CALENDAR All matters listed under Consent Calendar are considered to be routine and all will be enacted by one roll call vote. There will be no discussion of these items unless members of the City Council request specific items be removed from the Consent Calendar for separate action. A total of 30 minutes is provided for members of the public to address the City Council on items that appear on the Consent Calendar. Each speaker is limited to three minutes. Public comments may be made in person at the meeting by submitting a speaker card to the City Clerk or Deputy City Clerk or by submitting an email to be read aloud into the record at the meeting. Email comments must be submitted to CouncilComments@temeculaca.gov. Speaker cards for in -person comments will be called in the order received by the City Clerk or Deputy City Clerk and then, if time remains, email comments will be read. Email comments on all matters must be received prior to the time the item is called for public comments. All public participation is governed by the Council Policy regarding Public Participation at Meetings adopted by Resolution No. 2021-54. 1. Waive Reading of Standard Ordinances and Resolutions Recommendation: That the City Council waive the reading of the text of all standard ordinances and resolutions included in the agenda except as specifically required by the Government Code. Attachments: Agenda Report 2. Approve Action Minutes of October 26 and November 2, 2021 Recommendation: That the City Council approve the Action Minutes of October 26 and November 2, 2021. Attachments: 10/26/2021 Action Minutes 11/02/2021 Action Minutes 3. Approve List of Demands Recommendation: That the City Council adopt a resolution entitled: RESOLUTION NO. Page 2 City Council Agenda November 9, 2021 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA ALLOWING CERTAIN CLAIMS AND DEMANDS AS SET FORTH IN EXHIBIT A Attachments: Agenda Report Resolution List of Demands 4. Annrove Recommendation for Communitv Service Funding Program for Fiscal Year 2021-22 (At the Request of Subcommittee Members Council Member Alexander and Council Member Schwank Recommendation: That the City Council approve the recommendation to allocate a total of $100,000 to fund 23 out of 33 grant applications received from nonprofit organizations for the Fiscal Year 2020-21 Community Service Funding Program. Attachments: Agenda Report CSF 2021-2022 Application Summary Applications 1-10 Applications 11-20 Applications 21-33 5. Authorize Citv Manager to Execute the License Agreement Between the Citv of Temecula and Steve Y. Kim Living Trust for the Use of Property for Public Parking Purposes Recommendation: That the City Council authorize the City Manager to execute the license agreement between the City of Temecula and Steve Y. Kim and Hwa Seel Lee, Co -Trustees of the Steve Y. Kim Living Trust for the use of property for public parking purposes. Attachments: Agenda Report License Agreement 6. Authorize Citv Manager to Execute Memorandum of Understanding Between the Citv of Temecula and RTA Rancho Highlands, LLC Pertaining to the Ynez Road Improvements Recommendation: That the City Council authorize the City Manager to execute the Memorandum of Understanding between the City of Temecula and RTA Rancho Highlands, LLC pertaining to the Ynez Road improvements. Attachments: Agenda Report Memorandum of Understanding 7. Approve Agreement with Mariposa Tree Management, Inc., for Citywide Tree Trimming Maintenance Services for Fiscal Year 2021-2022 Recommendation: That the City Council approve an agreement with Mariposa Tree Page 3 City Council Agenda November 9, 2021 8. 9. Management, Inc., for citywide tree trimming maintenance services for Fiscal Year 2021-2022, in the amount of $500,000. Attachments: Agenda Report Agreement Approve Agreement for Construction Support Services with STC Traffic, Inc. for Fiber Optic Communication System Upgrade, PW 18-05 Recommendation: That the City Council: 1. Approve an agreement for construction support services with STC Traffic, Inc., in the amount of $154,670, for the Fiber Optic Communication System Upgrade, PW 18-05; and 2. Authorize the City Manager to approve extra work authorization not -to -exceed the contingency amount of $15,467, which is equal to 10% of the contract amount. Attachments: Agenda Report Agreement Accept Improvements and File the Notice of Completion for Pavement Rehabilitation Pro rg am _ Butterfield Stage Road and Pauba Road, PW 19-08 Recommendation: That the City Council: 1. Accept the improvements for the Pavement Rehabilitation Program - Butterfield Stage Road and Pauba Road, PW 19-08, as complete; and 2. Direct the City Clerk to file and record the Notice of Completion, release the Performance Bond, and accept a one-year Maintenance Bond in the amount of 10% of the final contract amount; and 3. Release the Labor and Materials Bond seven months after filing the Notice of Completion, if no liens have been filed. Attachments: Agenda Report Notice of Completion Maintenance Bond Affidavit and Final Release RECESS CITY COUNCIL MEETING TO SCHEDULED MEETINGS OF THE TEMECULA COMMUNITY SERVICES DISTRICT, THE SUCCESSOR AGENCY TO THE TEMECULA REDEVELOPMENT AGENCY, THE TEMECULA HOUSING AUTHORITY, AND/OR THE TEMECULA PUBLIC FINANCING AUTHORITY Page 4 City Council Agenda November 9, 2021 TEMECULA COMMUNITY SERVICES DISTRICT MEETING CALL TO ORDER: President Zak Schwank ROLL CALL: Alexander, Edwards, Rahn, Schwank, Stewart CSD PUBLIC COMMENTS - NON -AGENDA ITEMS All matters listed under Consent Calendar are considered to be routine and all will be enacted by one roll call vote. There will be no discussion of these items unless Members of the Community Services District request specific items be removed from the Consent Calendar for separate action. A total of 30 minutes is provided for members of the public to address the Board of Directors on items that appear on the Consent Calendar. Each speaker is limited to three minutes. Public comments may be made in person at the meeting by submitting a speaker card to the City Clerk or Deputy City Clerk or by submitting an email to be read aloud into the record at the meeting. Email comments must be submitted to CouncilComments@temeculaca.gov. Speaker cards for in -person comments will be called in the order received by the City Clerk or Deputy City Clerk and then, if time remains, email comments will be read. Email comments on all matters must be received prior to the time the item is called for public comments. All public participation is governed by the Council Policy regarding Public Participation at Meetings adopted by Resolution No. 2021-54. CSD CONSENT CALENDAR All matters listed under Consent Calendar are considered to be routine and all will be enacted by one roll call vote. There will be no discussion of these items unless Members of the Community Services District request specific items be removed from the Consent Calendar for separate action. A total of 30 minutes is provided for members of the public to address the Board of Directors on items that appear on the Consent Calendar. Each speaker is limited to three minutes. Public comments may be made in person at the meeting by submitting a speaker card to the City Clerk or Deputy City Clerk or by submitting an email to be read aloud into the record at the meeting. Email comments must be submitted to CouncilComments@temeculaca.gov. Speaker cards for in -person comments will be called in the order received by the City Clerk or Deputy City Clerk and then, if time remains, email comments will be read. Email comments on all matters must be received prior to the time the item is called for public comments. All public participation is governed by the Council Policy regarding Public Participation at Meetings adopted by Resolution No. 2021-54. 10. Approve Action Minutes of October 26, 2021 Recommendation: That the Board of Directors approve the action minutes of October 26, 2021. Attachments: Action Minutes 11. Approve Second Amendment with M & J Paul Enterprises dba Jolly Jumps for Additional Event Services Recommendation: That the Board of Directors approve the second amendment with M & J Paul Enterprises dba Jolly Jumps for additional event services and increase payment in the amount of $30,000, for a total agreement amount Page 5 City Council Agenda November 9, 2021 of $90,000. Attachments: Agenda Report Amendment CSD DIRECTOR OF COMMUNITY SERVICES REPORT CSD GENERAL MANAGER REPORT CSD BOARD OF DIRECTOR REPORTS CSD ADJOURNMENT The next regular meeting of the Temecula Community Services District will be held on Tuesday, November 23, 2021, at 5:30 p.m., for a Closed Session, with regular session commencing at 7:00 p.m., at the Council Chambers located at 41000 Main Street, Temecula, California. Page 6 City Council Agenda November 9, 2021 SUCCESSOR AGENCY TO THE TEMECULA REDEVELOPMENT AGENCY CALL TO ORDER: Chair Maryann Edwards ROLL CALL: Alexander, Edwards, Rahn, Schwank, Stewart SARDA PUBLIC COMMENTS - NON -AGENDA ITEMS A total of 30 minutes is provided for members of the public to address the Board of Directors on matters not listed on the agenda. Each speaker is limited to three minutes. Public comments may be made in person at the meeting by submitting a speaker card to the City Clerk or Deputy City Clerk or by submitting an email to be read aloud into the record at the meeting. Email comments must be submitted to CouncilComments@temeculaca.gov. Speaker cards for in -person comments will be called in the order received by the City Clerk or Deputy City Clerk and then, if time remains, email comments will be read. Email comments on all matters must be received prior to the time the item is called for public comments. All public participation is governed by the Council Policy regarding Public Participation at Meetings adopted by Resolution No. 2021-54. SARDA CONSENT CALENDAR All matters listed under Consent Calendar are considered to be routine and all will be enacted by one roll call vote. There will be no discussion of these items unless Members of the Successor Agency to the Redevelopment Agency request specific items be removed from the Consent Calendar for separate action. A total of 30 minutes is provided for members of the public to address the Board of Directors on items that appear on the Consent Calendar. Each speaker is limited to three minutes. Public comments may be made in person at the meeting by submitting a speaker card to the City Clerk or Deputy City Clerk or by submitting an email to be read aloud into the record at the meeting. Email comments must be submitted to CouncilComments@temeculaca.gov. Speaker cards for in -person comments will be called in the order received by the City Clerk or Deputy City Clerk and then, if time remains, email comments will be read. Email comments on all matters must be received prior to the time the item is called for public comments. All public participation is governed by the Council Policy regarding Public Participation at Meetings adopted by Resolution No. 2021-54. 12. Approve Action Minutes of October 26, 2021 Recommendation: That the Board of Directors approve the action minutes of October 26, 2021. Attachments: Action Minutes SARDA EXECUTIVE DIRECTOR REPORT SARDA BOARD OF DIRECTOR REPORTS Page 7 City Council Agenda November 9, 2021 SARDA ADJOURNMENT The next regular meeting of the Successor Agency to the Redevelopment Agency will be held on Tuesday, November 23, 2021, at 5:30 p.m., for a Closed Session, with regular session commencing at 7:00 p.m., at the Council Chambers located at 41000 Main Street, Temecula, California. Page 8 City Council Agenda November 9, 2021 TEMECULA HOUSING AUTHORITY - NO MEETING TEMECULA PUBLIC FINANCING AUTHORITY - NO MEETING RECONVENE TEMECULA CITY COUNCIL PUBLIC HEARING Any person may submit written comments to the City Council before a public hearing or may appear and be heard in support of or in opposition to the approval of the project(s) at the time of the hearing. If you challenge any of the project(s) in court, you may be limited to raising only those issues you or someone else raised at the public hearing or in written correspondence delivered to the City Clerk at, or prior to, the public hearing. For all Public Hearings each speaker is limited to five minutes. Public comments may be made in person at the meeting by submitting a speaker card to the City Clerk or Deputy City Clerk or by submitting an email to be read aloud into the record at the meeting. Email comments must be submitted to CouncilComments@temeculaca.gov. Email comments on all matters, including those not on the agenda, must be received prior to the time the item is called for public comments. At Public Hearings involving land use matters the property owner or the applicant/property owner has the burden of proof and, therefore, shall be allowed fifteen (15) minutes for an initial presentation and an additional ten (10) minutes for rebuttal by its development team following other comments on the matter. The Mayor may allow more time if required to provide due process for the property owner or applicant. An appellant, other than the property owner or applicant, and the spokesperson for an organized group of residents residing within the noticed area of the property, which is the subject of the Public Hearing, shall be allowed fifteen (15) minutes to present the appellant's position to the Council. The Mayor may allow more time if required to provide due process for the appellant. All other members of the public may speak during the Public Hearing for a maximum period five (5) minutes each. Deferral of one speaker's time to another is not permitted. In the event there is a large number of speakers, the Mayor may reduce the maximum time limit for members of the public to speak. All public participation is governed by the Council Policy regarding Public Participation at Meetings adopted by Resolution No. 2021-54. 13. Receive and File Assembly Bill (AB) 1600 Financial Reports - Fiscal Year 2020-21 Development Impact Fee Expenditures Recommendation: That the City Council receive and file Assembly Bill (AB) 1600 Financial Reports - Development Impact Fee Expenditures. Attachments: Agenda Report Development Impact Fees SummgU AB 1600 Financial Reports Notice of Public Hearing Page 9 City Council Agenda November 9, 2021 BUSINESS Any member of the public may address the City Council on items that appear on the Business portion of the agenda. Each speaker is limited to five minutes. Public comments may be made in person at the meeting by submitting a speaker card to the City Clerk or Deputy City Clerk or by submitting an email to be read aloud into the record at the meeting. Email comments must be submitted to CouncilComments@temeculaca.gov. Speaker cards for in -person comments will be called in the order received by the City Clerk or Deputy City Clerk and then, if time remains, email comments will be read. Email comments on all matters must be received prior to the time the item is called for public comments. All public participation is governed by the Council Policy regarding Public Participation at Meetings adopted by Resolution No. 2021-54. 14. Approve Assignment and Assumption Agreement for Transfer of Rights and Obligations of Development Agreement Between City of Temecula and Temecula West Village, LLC and Settlement Agreement from Temecula Valley West, LLC to SBT Altair, LLC Recommendation: That the City Council approve an Assignment and Assumption Agreement for Transfer of Rights and Obligations of Development Agreement between City of Temecula and Temecula West Village (TWV), LLC dated January 9, 2018 and Settlement Agreement dated October 26, 2020, from Temecula Valley West, LLC to SBT Altair, LLC. Attachments: Agenda Report Agreement DEPARTMENTAL REPORTS CITY MANAGER REPORT CITY ATTORNEY REPORT ITEMS FOR FUTURE CITY COUNCIL AGENDAS Any Council Member, including the Mayor, may request an item be placed on a future agenda. Any such request will be discussed under this section. In making the request, a Council Member may briefly describe the topic of the proposed agenda item and any timing associated with the placement of the item on the agenda. This description shall not exceed three (3) minutes unless extended by a majority vote of the City Council. No substantive discussion on the subject of the motion may occur. General discussion amongst the City Council on items listed under this section of the agenda shall be limited to 15 minutes. Items may only be placed on the agenda by Council Members pursuant to policy or by the City Manager based on administrative or operational needs of the City. Public comments on the placement of these agenda items shall be limited to a maximum of 30 minutes. Individual comments shall not exceed three (3) minutes. All public participation is governed by the Council Policy regarding Public Participation at Meetings and Agenda Placements by Council Members adopted by Resolution No. 2021-54. A. Memorial and Monument Policy (At the Request of Council Member Stewart) Page 10 City Council Agenda November 9, 2021 ADJOURNMENT The next regular meeting of the City Council will be held on Tuesday, November 23, 2021, at 5:30 p.m., for a Closed Session, with regular session commencing at 7:00 p.m., at the Council Chambers located at 41000 Main Street, Temecula, California. NOTICE TO THE PUBLIC The full agenda packet (including staff reports, public closed session information, and any supplemental material available after the original posting of the agenda), distributed to a majority of the City Council regarding any item on the agenda, will be available for public viewing in the main reception area of the Temecula Civic Center during normal business hours at least 72 hours prior to the meeting. The material will also be available on the City's website at TemeculaCa.gov. and available for review at the respective meeting. If you have questions regarding any item on the agenda, please contact the City Clerk's Department at (951) 694-6444. Page 11 Item No. 1 CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Randi Johl, Director of Legislative Affairs/City Clerk DATE: November 9, 2021 SUBJECT: Waive Reading of Standard Ordinances and Resolutions PREPARED BY: Randi Johl, Director of Legislative Affairs/City Clerk RECOMMENDATION: That the City Council waive the reading of the text of all standard ordinances and resolutions included in the agenda except as specifically required by the Government Code. BACKGROUND: The City of Temecula is a general law city formed under the laws of the State of California. With respect to adoption of ordinances and resolutions, the City adheres to the requirements set forth in the Government Code. Unless otherwise required, the full reading of the text of standard ordinances and resolutions is waived. FISCAL IMPACT: None ATTACHMENTS: None Item No. 2 ACTION MINUTES TEMECULA CITY COUNCIL REGULAR MEETING COUNCIL CHAMBERS 41000 MAIN STREET TEMECULA, CALIFORNIA OCTOBER 26, 2021 - 7:00 PM CLOSED SESSION - 6:00 PM CONFERENCE WITH LEGAL COUNSEL - PENDING LITIGATION. The City Council convened in closed session with the City Attorney pursuant to Government Code Section 54956.9(d)(1) with respect to one matter of pending litigation: In re National Prescription Opioid Litigation, MDL No. 2804 (Federal District Court N.D. Ohio). LABOR NEGOTIATIONS The City Council convened in closed session with its designated representatives to discuss labor negotiations pursuant to Government Code Section 54957.6. The City's designated representatives are City Manager Aaron Adams, City Attorney Peter Thorson, Assistant City Manager Kevin Hawkins, Director of Finance Jennifer Hennessy, Director of Human Resources and Risk Management Isaac Garibay, Deputy City Manager Luke Watson and Senior Human Resources Analyst Becky Obmann. The employee organization is the California Teamsters Public, Professional and Medical Employees Union Local 911. CONFERENCE WITH LEGAL COUNSEL - POTENTIAL LITIGATION. The City Council convened in closed session with the City Attorney pursuant to Government Code Section 54956.9(d)(2) with respect to one matter of potential litigation. A point has been reached where, in the opinion of the City Attorney, based on existing facts and circumstances, there is a significant exposure to litigation involving the City. The City and the owner of the Warehouse at Creekside, Keith Shibou, are involved in a dispute concerning their respective interpretations of the loan documents and the regulatory agreement for the Project that might result in litigation. See Keith Shibou's letter to the City Council of September 23, 2021. CALL TO ORDER: Mayor Maryann Edwards INVOCATION: Aaron Adams, City Manager FLAG SALUTE: Mayor Maryann Edwards ROLL CALL: Alexander, Edwards, Rahn, Schwank, Stewart PRESENTATIONS - NONE BOARD / COMMISSION REPORTS Planning Commission and Race, Equity, Diversity and Inclusion Commission PUBLIC SAFETY REPORT Riverside County Sheriffs Department PUBLIC COMMENTS - NON -AGENDA ITEMS The following individual(s) addressed the City Council on non -agenda item(s): • Kristi Necochea • John Roosh • Bob Kowell • Bob Quaid • Mary Ann Tams PUBLIC COMMENTS - AGENDA ITEMS The following individual(s) addressed the City Council on agenda item(s): • Bob Kowell (Item # 17) The following individual(s) submitted an electronic comment on agenda item(s): • Martha Howard (Item # 18) CITY COUNCIL REPORTS CONSENT CALENDAR Unless otherwise indicated below, the following pertains to all items on the Consent Calendar. Approved the Staff Recommendation (5-0): Motion Schwank, Second by Alexander. The vote reflected unanimous approval. Waive Readiniz of Standard Ordinances and Resolutions Recommendation: That the City Council waive the reading of the text of all standard ordinances and resolutions included in the agenda except as specifically required by the Government Code. 2. Approve Action Minutes of October 12, 2021 Recommendation: That the City Council approve the action minutes of October 12, 2021. 3. Approve List of Demands Recommendation: That the City Council adopt a resolution entitled: RESOLUTION NO. 2021-58 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA ALLOWING CERTAIN CLAIMS AND DEMANDS AS SET FORTH IN EXHIBIT A 4. Approve City Treasurer's Report as of July 31, 2021 Recommendation: That the City Council approve and file the City Treasurer's Report as of July 31, 2021. 5. Approve Financial Statements for the 4th Quarter Ended June 30, 2021 7. 8. 9. 10. Recommendation: That the City Council: Receive and file the financial statements for the 4th quarter ended June 30, 2021; and 2. Approve the following Fiscal Year 2021-21 appropriations: a. Increase the Emergency Management budget by $8,400 b. Increase the CIP Administration budget by $17,500 c. Increase the PERS Replacement Benefit budget by $9,100 3. Appropriate $2,000,000 of the year-end general fund surplus to the Pension Trust (PARS), in accordance with Budget Policy XII in Fiscal Year 2021-22. Rescind the Current Vehicle Policy and Approve the City Vehicle and Driver Safety Policy Recommendation: That the City Council: 1. Rescind the existing Vehicle Policy dated October 9, 1990; and 2. Approve the Vehicle and Driver Safety Policy; and 3. Authorize the City Manager, or their designee, to modify the Vehicle and Driver Safety Policy when necessary. Approve Sponsorship Agreement with Trauma Intervention Program of Southwest Riverside County, Inc. for Traumatic Incident Citizen Support Recommendation: That the City Council approve a sponsorship agreement with Trauma Intervention Program of Southwest Riverside County, Inc., in the amount of $10,000 for traumatic incident citizen support. Authorize the Purchase of Industrial Switches for the Fiber Optic Communication Upgrade Project, PW18-05 Recommendation: That the City Council authorize the purchase of industrial switches as part of the Fiber Optic Communication System Upgrade Project, PW 18-05, in the amount of $204,459.50. ADDrove Agreement with Gosch Ford Temecula for the Purchase of Four (4) 2021 Ford Ranger 4X4 XL Trucks Recommendation: That the City Council approve an agreement with Gosch Ford Temecula for the purchase of four (4) 2021 Ford Ranger 4X4 XL Trucks, in the amount of $121,734.76. Award Construction Contract to Atom Engineering Construction, Inc. for the Flood Control Reconstruction and Repair Project, PW 11-10 Recommendation: That the City Council: 1. Award a construction contract to Atom Engineering Construction Inc., in the amount of $998,398, for the Flood Control Reconstruction and Repair Project, PWI I-10; and 2. Authorize the City Manager to approve change orders up to $99,839.80, which is 10% of the contract amount; and 3. Authorize payment of up to $7,428.84 to the Regional Conservation Authority (RCA) for the project Multiple Species Habitat Conservation Plan (MSHCP) fee. 11. Approve First Amendment to the Minor Maintenance Agreement for Landscape Maintenance Services with Nieves Landscape, Inc. Recommendation: That the City Council approve the first amendment to the minor maintenance agreement for landscape maintenance services with Nieves Landscape, Inc., in the amount of $607,225.60 for Fiscal Year 2021-2022, and approve contingency for extra work in the amount of $121,445, which is approximately 20% of the agreement amount. 12. Receive and File Temnorary Street Closures for 2021 Winterfest Events Recommendation: That the City Council receive and file the temporary closure of certain streets for the following 2021 Winterfest Events: ROD RUN, PU'ESKA MOUNTAIN DAY, SANTA'S ELECTRIC LIGHT PARADE, TEMECULA ON ICE, CHILLED IN THE PARK, NEW YEAR'S EVE GRAPE DROP RECESS: At 7:50 PM, the City Council recessed and convened as the Temecula Community Services District Meeting and Successor Agency to the Temecula Redevelopment Agency Meeting. At 8:00 PM the City Council resumed with the remainder of the City Council Agenda. RECONVENE TEMECULA CITY COUNCIL BUSINESS 17. Receive and File Report on the Arrive at Rancho Highlands Project Planning Application Number PA19-1448) Recommendation: That the City Council receive and file report on the Arrive at Rancho Highlands Project. Receive and file only, no action. 18. Approve American Rescue Plan Act of 2021 (ARPA) SpendingPlan lan (At the Request of Maw Edwards and Mayor Pro Tern Rahn) Recommendation: That the City Council: 1. Establish Fund 108 - American Rescue Plan Act of 2021 (ARPA); and 2. Appropriate $14,079,507 in ARPA revenue and a corresponding transfer to the General Fund to provide funding for public safety services ($7,039,753.50 in Fiscal Year 2021-22 and $7,039,753.50 in Fiscal Year 2022-23); and 2. Establish the COVID-19 Pandemic Community Reinvestment Program and agree upon the funding categories noted below. Appropriate $7,040,000 in Fiscal Year 2021-22 and recommend $7,040,000 be programmed for Fiscal Year 2022-23 using available General Fund Balance for various community support grants, in accordance with the attached Exhibit A - COVID-19 Pandemic Community Reinvestment Program; and 3. Authorize the Strategic Fiscal Planning Ad Hoc Subcommittee to work with staff to develop the program criteria, administration and details for each category of funding. Approved the Staff Recommendation (5-0): Motion Schwank, Second by Alexander. The vote reflected unanimous approval. DEPARTMENTAL REPORTS (Receive and File) 19. Community Development Department Monthly Report 20. Fire Department Monthly Report 21. Police Department Monthly Report 22. Public Works Department Monthly Report CITY MANAGER REPORT CITY ATTORNEY REPORT The City Attorney stated there was no reportable actions from closed session. ITEMS FOR FUTURE CITY COUNCIL AGENDAS ADJOURNMENT At 9:26 PM, the City Council meeting was formally adjourned to Tuesday, November 9, 2021, at 5:30 PM for Closed Session, with regular session commencing at 7:00 PM, City Council Chambers, 41000 Main Street, Temecula, California. Maryann Edwards, Mayor ATTEST: Randi Johl, City Clerk [SEAL] ACTION MINUTES TEMECULA CITY COUNCIL SPECIAL MEETING CONFERENCE CENTER 41000 MAIN STREET TEMECULA, CALIFORNIA NOVEMBER 2, 2021 - 9:00 AM CALL TO ORDER at 9:10 AM: Mayor Maryann Edwards FLAG SALUTE: Mayor Maryann Edwards ROLL CALL: Alexander (absent), Edwards, Rahn, Schwank, Stewart RITCINF.CC 1. Conduct Media Relations Training Workshop Recommendation: That the City Council conduct a media relations training workshop. Workshop conducted, no action. ADJOURNMENT At 12:13 PM, the City Council meeting was formally adjourned to Tuesday, November 9, 2021, at 5:30 PM for Closed Session, with regular session commencing at 7:00 PM, City Council Chambers, 41000 Main Street, Temecula, California. Maryann Edwards, Mayor ATTEST: Randi Johl, City Clerk [SEAL] Item No. 3 CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Jennifer Hennessy, Director of Finance DATE: November 9, 2021 SUBJECT: Approve the List of Demands PREPARED BY: Jada Shafe, Senior Accounting Technician RECOMMENDATION: That the City Council adopt a resolution entitled: RESOLUTION NO. 2021- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA ALLOWING CERTAIN CLAIMS AND DEMANDS AS SET FORTH IN EXHIBIT A BACKGROUND: All claims and demands are reported and summarized for review and approval by the City Council on a routine basis at each City Council meeting. The attached claims represent the paid claims and demands since the last City Council meeting. FISCAL IMPACT: All claims and demands were paid from appropriated funds or authorized resources of the City and have been recorded in accordance with the City's policies and procedures. ATTACHMENTS: 1. Resolution 2. List of Demands RESOLUTION NO.2021- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF TEMECULA ALLOWING CERTAIN CLAIMS AND DEMANDS AS SET FORTH IN EXHIBIT A THE CITY COUNCIL OF THE CITY OF TEMECULA DOES HEREBY RESOLVE AS FOLLOWS: Section 1. That the following claims and demands as set forth in Exhibit A, on file in the office of the City Clerk, has been reviewed by the City Manager's Office and that the same are hereby allowed in the amount of $9,160,072.07. Section 2. The City Clerk shall certify the adoption of this resolution. PASSED, APPROVED, AND ADOPTED by the City Council of the City of Temecula this 9th day of November 2021. Maryann Edwards, Mayor ATTEST: Randi Johl, City Clerk [SEAL] STATE OF CALIFORNIA ) COUNTY OF RIVERSIDE ) ss CITY OF TEMECULA ) I, Randi Johl, City Clerk of the City of Temecula, do hereby certify that the foregoing Resolution No. 2021- was duly and regularly adopted by the City Council of the City of Temecula at a meeting thereof held on the 9th day of November, 2021, by the following vote: AYES: COUNCIL MEMBERS: NOES: COUNCIL MEMBERS: ABSTAIN: COUNCIL MEMBERS: ABSENT: COUNCIL MEMBERS: Randi Johl, City Clerk CITY OF TEMECULA LIST OF DEMANDS 10/14/2021 TOTAL CHECK RUN: 10/21/2021 TOTAL CHECK RUN: 10/14/2021 TOTAL PAYROLL RUN: 10/21/2021 TOTAL PAYROLL RUN: TOTAL LIST OF DEMANDS FOR 11/9/2021 COUNCIL MEETING: DISBURSEMENTS BY FUND: CHECKS: $ 5,620,931.41 2,916,639.21 602,679.60 19,821.85 $ 9,160,072.07 CITY OF TEMECULA LIST OF DEMANDS 001 GENERAL FUND $ 6,273,270.55 125 PEG PUBLIC EDUCATION & GOVERNMENT 9,936.92 140 COMMUNITY DEV BLOCK GRANT 5,876.94 165 RDA DEV LOW/MOD 20% SET ASIDE 5,248.41 170 MEASURE A FUND 1,242,517.22 190 TEMECULA COMMUNITY SERVICES DISTRICT 233,869.34 192 TCSD SERVICE LEVEL "B" STREET LIGHTS 18,977.77 194 TCSD SERVICE LEVEL "D" REFUSE/RECYCLING 1,235.88 196 TCSD SERVICE LEVEL "L" LAKE PARK MAINT. 14,143.01 197 TEMECULA LIBRARY FUND 21,784.13 210 CAPITAL IMPROV PROJ FUND 379,747.45 300 INSURANCE FUND 5,416.67 305 WORKER'S COMPENSATION 23,549.82 320 INFORMATION TECHNOLOGY 114,685.98 330 SUPPORT SERVICES 4,585.12 340 FACILITIES 72,820.53 472 CFD 01-2 HARVESTONA&B DEBT SERVICE 2,238.33 473 CFD 03-1 CROWNE HILL DEBT SERVICE FUND 4,858.33 475 CFD 03-3 WOLF CREEK DEBT SERVICE FUND 2,724.51 476 CFD 03-6 HARVESTON 2 DEBT SERVICE FUND 2,647.83 477 CFD 03-02 RORIPAUGH DEBT SERVICE FUND 2,690.02 478 CFD 16-01 RORIPAUGH PHASE II 2,276.66 501 SERVICE LEVEL"C"ZONE 1 SADDLEWOOD 2,100.01 502 SERVICE LEVEL"C"ZONE 2 WINCHESTER CREEK 1,450.57 503 SERVICE LEVEL"C"ZONE 3 RANCHO HIGHLANDS 2,862.86 504 SERVICE LEVEL"C"ZONE 4 THE VINEYARDS 292.24 505 SERVICE LEVEL"C"ZONE 5 SIGNET SERIES 1,978.57 506 SERVICE LEVEL"C"ZONE 6 WOODCREST COUNTRY 750.57 507 SERVICE LEVEL"C"ZONE 7 RIDGEVIEW 500.01 508 SERVICE LEVEL"C"ZONE 8 VILLAGE GROVE 6,411.65 509 SERVICE LEVEL"C"ZONE 9 RANCHO SOLANA 75.01 510 SERVICE LEVEL"C"ZONE 10 MARTINIQUE 250.57 511 SERVICE LEVEL"C"ZONE 11 MEADOWVIEW 62.51 512 SERVICE LEVEL"C"ZONE 12 VINTAGE HILLS 3,633.85 513 SERVICE LEVEL"C"ZONE 13 PRESLEY DEVELOP. 2,093.35 514 SERVICE LEVEL"C"ZONE 14 MORRISON HOMES 450.01 515 SERVICE LEVEL"C"ZONE 15 BARCLAY ESTATE 400.01 516 SERVICE LEVEL"C"ZONE 16 TRADEWINDS 963.37 517 SERVICE LEVEL"C"ZONE 17 MONTE VISTA 70.84 518 SERVICE LEVEL"C"ZONE 18 TEMEKU HILLS 3,880.35 519 SERVICE LEVEL"C"ZONE 19 CHANTEMAR 3,604.96 520 SERVICE LEVEL"C"ZONE 20 CROWNE HILL 5,767.27 521 SERVICE LEVEL"C"ZONE 21 VAIL RANCH 14,247.53 522 SERVICE LEVEL"C"ZONE 22 SUTTON PLACE 162.51 523 SERVICE LEVEL"C"ZONE 23 PHEASENT RUN 342.11 524 SERVICE LEVEL"C"ZONE 24 HARVESTON 9,252.99 525 SERVICE LEVEL"C"ZONE 25 SERENA HILLS 1,798.21 526 SERVICE LEVEL"C"ZONE 26 GALLERYTRADITION 62.51 527 SERVICE LEVEL"C"ZONE 27 AVONDALE 250.57 528 SERVICE LEVEL"C"ZONE 28 WOLF CREEK 18,908.13 529 SERVICE LEVEL"C"ZONE 29 GALLERY PORTRAIT 133.84 700 CERBT CALIFORNIA EE RETIREE-GASB45 9,712.22 $ 8,537,570.62 CITY OF TEMECULA LIST OF DEMANDS 001 GENERAL FUND $ 334,803.46 140 COMMUNITY DEV BLOCK GRANT 786.51 165 AFFORDABLE HOUSING 4,165.30 190 TEMECULA COMMUNITY SERVICES DISTRICT 156,633.13 194 TCSD SERVICE LEVEL D REFUSE RECYCLING 1,335.46 196 TCSD SERVICE LEVEL "L" LAKE PARK MAINT. 543.25 197 TEMECULA LIBRARY FUND 2,992.00 300 INSURANCE FUND 2,496.56 305 WORKERS' COMPENSATION 1,893.20 320 INFORMATION TECHNOLOGY 37,084.39 330 SUPPORT SERVICES 5,484.31 340 FACILITIES 8,100.96 472 CFD 01-2 HARVESTONA&B DEBT SERVICE 28.08 473 CFD 03-1 CROWNE HILL DEBT SERVICE FUND 28.08 475 CFD03-3 WOLF CREEK DEBT SERVICE FUND 84.19 476 CFD 03-6 HARVESTON 2 DEBT SERVICE FUND 28.08 477 CFD 03-02 RORIPAUGH DEBT SERVICE FUND 84.23 478 CFD 16-01 RORIPAUGH PHASE II 56.15 501 SERVICE LEVEL"C"ZONE 1 SADDLEWOOD 0.07 502 SERVICE LEVEL"C"ZONE 2 WINCHESTER CREEK 0.51 503 SERVICE LEVEL"C"ZONE 3 RANCHO HIGHLANDS 0.51 504 SERVICE LEVEL"C"ZONE 4 THE VINEYARDS 0.51 505 SERVICE LEVEL"C"ZONE 5 SIGNET SERIES 0.51 506 SERVICE LEVEL"C"ZONE 6 WOODCREST COUNTRY 0.51 507 SERVICE LEVEL"C"ZONE 7 RIDGEVIEW 0.07 508 SERVICE LEVEL"C"ZONE 8 VILLAGE GROVE 267.28 509 SERVICE LEVEL"C"ZONE 9 RANCHO SOLANA 0.07 510 SERVICE LEVEL"C"ZONE 10 MARTINIQUE 0.51 511 SERVICE LEVEL"C"ZONE 11 MEADOWVIEW 0.07 512 SERVICE LEVEL"C"ZONE 12 VINTAGE HILLS 133.64 513 SERVICE LEVEL"C"ZONE 13 PRESLEY DEVELOP. 13.38 514 SERVICE LEVEL"C"ZONE 14 MORRISON HOMES 0.07 515 SERVICE LEVEL"C"ZONE 15 BARCLAY ESTATES 0.07 516 SERVICE LEVEL"C"ZONE 16 TRADEWINDS 13.38 517 SERVICE LEVEL"C"ZONE 17 MONTE VISTA 0.07 518 SERVICE LEVEL"C"ZONE 18 TEMEKU HILLS 80.16 519 SERVICE LEVEL"C"ZONE 19 CHANTEMAR 112.20 520 SERVICE LEVEL"C"ZONE 20 CROWNE HILL 267.24 521 SERVICE LEVEL"C"ZONE 21 VAIL RANCH 507.84 522 SERVICE LEVEL"C"ZONE 22 SUTTON PLACE 0.07 523 SERVICE LEVEL"C"ZONE 23 PHEASENT RUN 0.96 524 SERVICE LEVEL"C"ZONE 24 HARVESTON 213.81 525 SERVICE LEVEL"C"ZONE 25 SERENA HILLS 26.72 526 SERVICE LEVEL"C"ZONE 26 GALLERYTRADITION 0.07 527 SERVICE LEVEL"C"ZONE 27 AVONDALE 0.51 528 SERVICE LEVEL"C"ZONE 28 WOLF CREEK 534.51 529 SERVICE LEVEL"C"ZONE 29 GALLERY PORTRAIT (0.03) 700 CERBT CALIFORNIA EE RETIREE-GASB45 63,698.82 TOTAL BY FUND: 622,501.45 $ 9,160,072.07 apChkLst Final Check List Page: 1 10/12/2021 2:41:39PM CITY OF TEMECULA Bank: eunion EFT UNION BANK Check # Date Vendor Description 501193 10/14/2021 009374 ALLEGRO MUSICAL VENTURES PIANO TUNING/MAINT: THEATER DBA, ALLEGRO PIANO SERVICE 501194 10/14/2021 018941 AZTEC LANDSCAPING INC SEP MAINT SVCS: PARKS/SCHOOLS PW 501195 10/14/2021 021349 CASA CENTER AGAINST SART EXAMS: TEM SHERIFF SEXUAL, ASSAULT OF SW RIV CO SART EXAMS: TEM SHERIFF SART EXAMS: TEM SHERIFF SART EXAMS: TEM SHERIFF 501196 10/14/2021 017542 COX, KRISTI LYN TCSD INSTRUCTOR EARNINGS 501197 10/14/2021 010650 CRAFTSMEN PLUMBING & PLUMBING SVCS: MEADOWS PARK: HVAC INC PW 501198 10/14/2021 020436 CRONBERG, RICHARD N TCSD INSTRUCTOR EARNINGS 501199 10/14/2021 003945 DIAMOND ENVIRONMENTAL portable restroom & sink rental: tern SRVCS TEMPORARY FENCING: JRC 501200 10/14/2021 019720 DIVERSIFIED WATERSCAPES SEP WTR QUALITY MAINT: DUCK INC PNG/HARV. 501201 10/14/2021 004192 DOWNS ENERGY FUEL FUEL FOR CITY VEHICLES: PARKS MAINT FUEL FOR CITY VEHICLES: STREET MAI FUEL FOR CITY VEHICLES: TRAFFIC DIV FUEL FOR CITY VEHICLES: BLDG INSPE FUEL FOR CITY VEHICLES: FIRE DEPT FUEL FOR CITY VEHICLES: CIP: PW FUEL FOR CITY VEHICLES: LAND DEV: F FUEL FOR CITY VEHICLES: POLICE DEP' 501202 10/14/2021 012217 DUDEK URBAN FOREST MGMT PLAN & INVENTORY 501203 10/14/2021 004068 ECALDRE MANALILI-DE VILLA, TCSD INSTRUCTOR EARNINGS AILEEN 501204 10/14/2021 021412 EIDE BALLY LLP CITY FINANCIAL STATEMENTAUDIT: FINANCE FINANCIAL STATEMENT AUDIT - FIELDW 501205 10/14/2021 018098 ELITE CLAIMS MANAGEMENT SEP'21 3RD PARTY CLAIM ADMIN: INC WRKRS COM Amount Paid Check Total 225.00 225.00 9,766.50 9,766.50 1,200.00 800.00 800.00 800.00 3,600.00 287.00 287.00 1,299.40 1,299.40 84.00 84.00 114.21 95.00 209.21 7,213.00 7,213.00 1,702.75 1,515.83 479.61 308.49 266.13 149.17 146.29 36.55 4,604.82 23,256.27 23,256.27 1,696.80 1,696.80 4,200.00 3,000.00 7,200.00 1,250.00 1,250.00 Page:1 apChkLst Final Check List Page: 2 10/12/2021 2:41:39PM CITY OF TEMECULA Bank: eunion EFT UNION BANK (Continued) Check # Date Vendor Description 501206 10/14/2021 014865 FREIZE UHLER KIMBERLY DBA, PROMOTIONAL ITEMS: ECO DEV CLEAR BLUE PROMOTIONS RIBBON FOR STATE OF THE CITY: CITY 1 501207 10/14/2021 001937 GALLS LLC Misc equipment: Police: CAP 501208 10/14/2021 021308 GILLIS + PANICHAPAN ARCHITECTURAL SVCS: CRC PW19-07 ARCHITECTS, INC 501209 10/14/2021 000177 GLENNIES OFFICE PRODUCTS MISC OFC SUPPLIES: CIP: PW INC 501210 10/14/2021 020628 HASA INC Pool Sanitizing Chemicals:various pools 501211 10/14/2021 022530 HINER, DOUGLAS, DOUGLAS SEP SPORTS OFFICIATING SVCS: HINER UMPIRING TCSD 501212 10/14/2021 020673 INTEGRITY SUPPORT PRE -EMPLOYMENT SCREENINGS - HR SERVICES INC, EMPLOYMENT SCREENING RESO PRE -EMPLOYMENT SCREENINGS - HR 501213 10/14/2021 021370 MARK THOMAS AND COMPANY DSGN & ENVIRO SVCS: CONG INC RELIEF:PW19-02 501214 10/14/2021 022598 MCE CORPORATION SEP LDSCP MAINT: SCHOOLS/SPORTS PARKS 501215 10/14/2021 012264 MIRANDA, JULIO C TCSD INSTRUCTOR EARNINGS 501216 10/14/2021 004043 MISSION ELECTRIC SUPPLY ELECTRICAL SUPPLIES: PARKS: PW INC ELECTRICAL SUPPLIES: CRC ELECTRICAL SUPPLIES: IWTCM ELECTRICAL SUPPLIES: CRC ELECTRICAL SUPPLIES: PARKS: PW 501217 10/14/2021 004040 MORAMARCO ANTHONY J, TCSD INSTRUCTOR EARNINGS DBA BIGFOOT GRAPHICS 501218 10/14/2021 002925 NAPA AUTO PARTS 501219 10/14/2021 022599 NIEVES LANDSCAPE INC AUTO PARTS & MISC SUPPLIES: FIRE STA 92 AUTO PARTS & MISC SUPPLIES: FIRE S1 SEP LDSCP MAINT: PW SLOPES SEP LDSCP MAIN-F. PARKS/MEDIANS PVC SEP LDSCP MAINT: PARKS/MEDIANS: PV SEP LDSCP MAIN-F. CITY FACS Amount Paid 587.74 332.69 22.88 12,330.00 42.87 1,068.76 3,402.00 176.06 54.93 44,779.55 66,484.53 1,461.60 1,345.63 185.45 72.62 16.55 6.84 913.50 34.22 34.22 58,553.00 54,150.00 20,230.00 10,150.00 Check Total 920.43 22.88 12,330.00 42.87 1,068.76 3,402.00 230.99 44,779.55 66,484.53 1,461.60 1,627.09 913.50 68.44 143,083.00 Paget apChkLst Final Check List Page: 3 10/12/2021 2:41:39PM CITY OF TEMECULA Bank: eunion EFT UNION BANK (Continued) Check # Date Vendor Description 501220 10/14/2021 014173 NPG INC DBA, GOLDSTAR ASPHALT REPAIRS: COLINA VERDE ASPHALT PRODUCTS STREET 501221 10/14/2021 021121 OCCUPATIONAL HEALTH CTR 8/30 MEDICAL SCREENINGS: TCSD OF CA, DBA CONCENTRA MEDICAL CTR 9/7 MEDICAL SCREENINGS: TCSD 9/15 MEDICAL SCREENINGS: HR 8/30 MEDICAL SCREENINGS: HR 9/7 MEDICAL SCREENINGS: HR 501222 10/14/2021 021998 OLD TOWN TIRE AND SERVICE CITY VEHICLE MAINT SVCS: PW INC STREETS CITY VEHICLE MAINT SVCS: PW PARKS CITY VEHICLE MAINT SVCS: INFO TECH CITY VEHICLE MAINT SVCS: PW LAND D CITY VEHICLE MAINT SVCS: PW FACS 501223 10/14/2021 021998 OLD TOWN TIRE AND SERVICE CITY VEHICLE MAINT SVCS: FIRE INC CITY VEHICLE MAINT SVCS: FIRE/TCC CITY VEHICLE MAINT SVCS: EM 501224 10/14/2021 012904 PRO ACTIVE FIRE DESIGN SEPT PLAN REVIEW SRVCS: FIRE AND, CONSULTING PREV 501225 10/14/2021 003591 RENES COMMERCIAL WEED SPRAYING: CITY CHANNELS MANAGEMENT 501226 10/14/2021 021981 ROBINSON, JESSICA REIMB: RFRSHMNTS: STAFF TRAINING 10/5 501227 10/14/2021 009213 SHERRY BERRY MUSIC JAZZ @ THE MERC 9/30/21 501228 10/14/2021 009746 SIGNS BY TOMORROW MILITARY FREEWAY BANNER: CMO 501229 10/14/2021 004209 TEMECULA SUNRISE ROTARY, JUL-SEP BUS BENCH FOUNDATION PLACEMENT-MAINT: PW 501230 10/14/2021 016311 TIERCE, NICHOLAS SEPT GRAPHIC DSGN SRVCS: THEATER 501231 10/14/2021 021580 TOWNSEND PUBLIC AFFAIRS OCT CONSULTING SRVCS: CITY INC CLERK Amount Paid Check Total 50,795.00 169.00 84.50 52.00 32.50 32.50 909.58 537.78 311.00 46.45 43.41 108.74 108.73 424.37 9,880.90 9,250.00 7.99 745.00 721.21 2,030.63 4,740.00 6,000.00 Grand total for EFT UNION BANK: 50,795.00 370.50 1,848.22 641.84 9,880.90 9,250.00 7.99 745.00 721.21 2,030.63 4,740.00 6,000.00 424,158.93 Page3 apChkLst Final Check List Page: 4 10/12/2021 2:41:39PM CITY OF TEMECULA 39 checks in this report. Grand Total All Checks: 424,158.93 Page:4 apChkLst 10/14/2021 3:17:20PM Final Check List CITY OF TEMECULA Page: 1 Bank: union UNION BANK Check # Date Vendor Description Amount Paid Check Total 11984 10/4/2021 000537 SO CALIF EDISON SEPT 700034047650 44270 MEADOWS 15.87 15.87 PKWY 11985 10/4/2021 000537 SO CALIF EDISON SEPT 700034500823 32932 LEENA WAY 16.03 16.03 11986 10/4/2021 000537 SO CALIF EDISON SEPT 700035621070 42335 MEADOWS 16.51 16.51 PKWY 11987 10/4/2021 000537 SO CALIF EDISON SEPT 700035691903 43487 17.75 17.75 BUTTERFIELD STG 11988 10/4/2021 000537 SO CALIF EDISON SEPT 700079543781 30153 TEMECULA 19.20 19.20 PKWY 11989 10/4/2021 000537 SO CALIF EDISON SEPT 700374361541 29429 TEMECULA 50.11 50.11 PKWY 11990 10/4/2021 000537 SO CALIF EDISON SEPT 700278695390 32329 OVERLAND 147.46 147.46 TRL 11991 10/4/2021 000537 SO CALIF EDISON SEPT 700619156906 32364 OVERLAND 3,423.23 3,423.23 TRL 11994 10/4/2021 001986 MUZAK LLC OCT DISH NETWORK 41952 6TH ST 59.16 59.16 11995 10/4/2021 001986 MUZAK LLC OCT DISH NETWORK 43230 BUS PARK 166.51 166.51 DR 11996 10/4/2021 001986 MUZAK LLC OCT DISH NETWORK STA 95 32131 175.38 175.38 11999 10/5/2021 000537 SO CALIF EDISON SEPT 700025366655 41955 4TH ST 13.05 13.05 12000 10/5/2021 000537 SO CALIF EDISON SEPT 700451136031 41702 MAIN ST 14.64 14.64 12001 10/5/2021 000537 SO CALIF EDISON SEPT 700404123666 41638 14.77 14.77 WINCHESTER RD 12002 10/5/2021 000537 SO CALIF EDISON SEPT 700230666549 28079 DIAZ RD 15.14 15.14 12003 10/5/2021 000537 SO CALIF EDISON SEPT 700230816695 28077 DIAZ RD 15.14 15.14 12004 10/5/2021 000537 SO CALIF EDISON SEPT 700390915502 27991 DIAZ RD 15.78 15.78 Page:1 apChkLst 10/14/2021 3:17:20PM Final Check List CITY OF TEMECULA Page: 2 Bank: union UNION BANK (Continued) Check # Date Vendor Description Amount Paid Check Total 12005 10/5/2021 000537 SO CALIF EDISON SEPT 700369097471 27407 DIAZ RD 16.30 16.30 12006 10/5/2021 000537 SO CALIF EDISON SEPT 700170354373 28402 MERCEDES 26.51 26.51 ST 12007 10/5/2021 000537 SO CALIF EDISON SEPT 700541167387 30027 FRONT ST 33.01 33.01 12008 10/5/2021 000537 SO CALIF EDISON SEPT 700169846034 41902 MAIN ST 154.17 154.17 12009 10/5/2021 000537 SO CALIF EDISON SEPT 700021560619 28300 MERCEDES 348.88 348.88 ST 12010 10/5/2021 000537 SO CALIF EDISON SEPT 700618295727 41952 6TH ST 772.26 772.26 12011 10/5/2021 000537 SO CALIF EDISON SEPT 700338442744 43210 BUS PARK 806.61 806.61 DR 12012 10/5/2021 000537 SO CALIF EDISON SEPT 700395923227 28314 MERCEDES 1,405.35 1,405.35 ST 12013 10/5/2021 000537 SO CALIF EDISON SEPT 700169903325 41904 MAIN ST 1,668.29 1,668.29 12014 10/5/2021 000537 SO CALIF EDISON SEPT 700024603688 41845 6TH ST 2,293.79 2,293.79 12015 10/5/2021 000537 SO CALIF EDISON SEPT 700168560580 28690 MERCEDES 2,566.93 2,566.93 ST 12016 10/5/2021 000537 SO CALIF EDISON SEPT 700350108713 43230 BUSINESS 3,756.46 3,756.46 PARK DR 12017 10/5/2021 000537 SO CALIF EDISON SEPT 700000050665 43200 BUS PARK 4,099.86 4,099.86 DR 12018 10/5/2021 000537 SO CALIF EDISON SEPT 700474429468 41000 MAIN ST 35,910.51 35,910.51 12023 10/6/2021 000537 SO CALIF EDISON SEPT 700240713022 41997 MARGARITA 14.76 14.76 RD 12024 10/6/2021 000537 SO CALIF EDISON SEPT 700593904368 46497 WOLF 18.64 18.64 CREEK DR 12025 10/6/2021 000537 SO CALIF EDISON SEPT 700593845259 31523 WOLF 19.78 19.78 VALLEY RD Paget apChkLst Final Check List Page: 3 10/14/2021 3:17:20PM CITY OF TEMECULA Bank: union UNION BANK Check # Date Vendor 12026 10/6/2021 000537 SO CALIF EDISON 12027 10/6/2021 000537 SO CALIF EDISON 12028 10/6/2021 000537 SO CALIF EDISON 12029 10/6/2021 000537 SO CALIF EDISON 12030 10/6/2021 000537 SO CALIF EDISON 12031 10/6/2021 000537 SO CALIF EDISON 12032 10/6/2021 000537 SO CALIF EDISON 12033 10/6/2021 000537 SO CALIF EDISON 12034 10/6/2021 000537 SO CALIF EDISON 12035 10/6/2021 000537 SO CALIF EDISON 12036 10/6/2021 010276 TIME WARNER CABLE 12037 10/6/2021 010276 TIME WARNER CABLE 12038 10/6/2021 010276 TIME WARNER CABLE 12039 10/6/2021 010276 TIME WARNER CABLE 12040 10/7/2021 001212 SO CALIF GAS COMPANY 12041 10/7/2021 001212 SO CALIF GAS COMPANY 12042 10/7/2021 001212 SO CALIF GAS COMPANY (Continued) Description Amount Paid Check Total SEPT 700116187149 44465 42.81 42.81 BUTTERFIELD STG SEPT 700271963590 42061 MAIN ST 44.92 44.92 SEPT 700047442340 30498 TEMECULA 282.52 282.52 PKWY SEPT 700622434290 29119 MARGARITA 503.40 503.40 RD SEPT 700014812146 41951 MORAGA 964.78 964.78 RD SEPT 700295805887 41375 MCCABE CT 1,032.56 1,032.56 SEPT 700492769845 28373 OLD TOWN 1,370.99 1,370.99 FRONT SEPT 700138949110 32211 WOLF 2,345.04 2,345.04 VALLEY RD SEPT 700562810212 32380 DEER 2,763.19 2,763.19 HOLLOW WAY SEPT 700169717813 28690 MERCEDES 3,343.19 3,343.19 ST OCTOBER INTERNET SVCS 41000 280.91 280.91 MAIN ST OCTOBER INTERNET SVCS 28816 598.63 598.63 PUJOL ST OCTOBER INTERNET SVCS 32131 S 250.66 250.66 LOOP RD OCTOBER INTERNET SVCS 41000 1,081.15 1,081.15 MAIN ST SEPT 101-525-0950-0 28816 PUJOL ST 14.79 14.79 SEPT 060-293-3315-7 28922 PUJOL ST 14.79 14.79 SEPT 026-671-2909-8 42051 MAIN ST 16.35 16.35 Page:3 apChkLst Final Check List Page: 4 10/14/2021 3:17:20PM CITY OF TEMECULA Bank: union UNION BANK Check # Date Vendor 12043 10/7/2021 001212 SO CALIF GAS COMPANY 12044 10/7/2021 001212 SO CALIF GAS COMPANY 12045 10/7/2021 001212 SO CALIF GAS COMPANY 12046 10/7/2021 001212 SO CALIF GAS COMPANY 12047 10/7/2021 001212 SO CALIF GAS COMPANY 12048 10/7/2021 001212 SO CALIF GAS COMPANY 12049 10/7/2021 001212 SO CALIF GAS COMPANY 12050 10/7/2021 014486 VERIZON WIRELESS 12052 10/12/2021 000537 SO CALIF EDISON 12053 10/12/2021 000537 SO CALIF EDISON 12054 10/12/2021 000537 SO CALIF EDISON 12055 10/12/2021 000537 SO CALIF EDISON 12056 10/12/2021 000537 SO CALIF EDISON 12057 10/12/2021 000537 SO CALIF EDISON 12058 10/12/2021 000537 SO CALIF EDISON 12059 10/12/2021 000537 SO CALIF EDISON (Continued) Description Amount Paid Check Total SEPT 133-040-7373-0 43210 BUSINESS 20.99 20.99 PARK SEPT 028-025-1468-3 41375 MCCABE 20.99 20.99 CT SEPT 181-383-8881-6 28314 22.56 22.56 MERCEDES SEPT 129-582-9784-3 43230 BUSINESS 58.22 58.22 PARK SEPT 021-725-0775-4 41845 6TH ST 76.83 76.83 SEPT 091-024-9300-5 30875 RANCHO 620.50 620.50 VISTA SEPT 129-535-4236-7 41000 MAIN ST 2,243.79 2,243.79 8/16-9/15 10,946.54 10,946.54 CELLULAR/BROADBAN D:CITYW I DE SEPT 700593944784 31738 WOLF 15.87 15.87 VALLEY RD SEPT 700402997759 45538 REDWOOD 16.06 16.06 RD SEPT 700171448958 28192 JEFFERSON 16.30 16.30 AVE SEPT 700505220908 45610 PECHANGA 32.55 32.55 PKWY SEPT 700454673905 40750 104.40 104.40 BUTTERFIELD STG SEPT 700404043945 45303 REDWOOD 128.47 128.47 RD SEPT 700039456210 46146 WOLF 223.20 223.20 CREEK DR SEPT 700335018442 45850 N WOLF 467.64 467.64 CREEK Page:4 apChkLst 10/14/2021 3:17:20PM Final Check List CITY OF TEMECULA Page: 5 Bank: union UNION BANK (Continued) Check # Date Vendor Description Amount Paid Check Total 12060 10/12/2021 000537 SO CALIF EDISON SEPT 700395478239 30017 RANCHO 1,248.50 1,248.50 CAL RD 12061 10/12/2021 000537 SO CALIF EDISON SEPT 700385358210 30600 PAUBA RD 16,070.98 16,070.98 12062 10/7/2021 005460 U S BANK INVESTMENT PURCHASE-XAPBV6: 999,000.00 999,000.00 FINANCE 12063 10/14/2021 005460 U S BANK INVESTMENT PURCHASE-XAPAM7: 998,500.00 998,500.00 FINANCE 12077 10/12/2021 018858 FRONTIER CALIFORNIA INC OCT INTERNET SVCS -THEATER 150.98 150.98 12078 10/12/2021 001212 SO CALIF GAS COMPANY SEPT 117-188-6393-6 32131 S LOOP RD 117.08 117.08 12079 10/12/2021 001212 SO CALIF GAS COMPANY SEPT 101-525-1560-6 27415 102.63 102.63 ENTERPRISE 12080 10/12/2021 001212 SO CALIF GAS COMPANY SEPT 098-255-9828-8 29119 24.03 24.03 MARGARITA RD 12081 10/14/2021 010349 CALIF DEPT OF CHILD SUPPORT PAYMENT 570.95 570.95 SUPPORT 12082 10/14/2021 017429 COBRAADVANTAGE INC, DBA FSA REIMBURSEMENT PAYMENT 21,464.69 21,464.69 THE ADVANTAGE GROUP 12083 10/14/2021 021301 1 C MA RETIREMENT -PLAN ICMA-401(A) RETIREMENT PLAN 1,134.62 1,134.62 106474 PAYMENT 12084 10/14/2021 000194 1 C M A RETIREMENT -PLAN ICMA-RC RETIREMENT TRUST 457 17,041.02 17,041.02 303355 PAYMENT 12085 10/14/2021 000444 INSTATAX (EDD) STATE TAX PAYMENT 29,949.16 29,949.16 12086 10/14/2021 000283 INSTATAX (IRS) FEDERAL TAX PAYMENT 96,328.71 96,328.71 12087 10/14/2021 001065 NATIONWIDE RETIREMENT NATIONWIDE RETIREMENT PAYMENT 13,520.36 13,520.36 SOLUTION 12088 10/14/2021 019088 NATIONWIDE RETIREMENT NATIONWIDE LOAN REPAYMENT 344.39 344.39 SOLUTION PAYMENT 12089 10/14/2021 000389 NATIONWIDE RETIREMENT OBRA- PROJECT RETIREMENT 3,117.34 3,117.34 SOLUTION PAYMENT Page:5 apChkLst 10/14/2021 3:17:20PM Final Check List CITY OF TEMECULA Bank: union UNION BANK (Continued) Check # Date Vendor Description 207052 10/14/2021 013387 ADAME LANDSCAPE INC, DBA SEPT SWEEPING SRVCS: PRKG SWEEPING UNLIMITED STRUCTURE 207053 10/14/2021 022696 ADAMS LANDSCAPING INC CAPPING MAINLINE VALVE: PARK & RIDE: PW 207054 10/14/2021 007282 AMAZON CAPITAL SERVICES MISC SUPPLIES: AQUATICS: TCSD INC MISC OFC SUPPLIES: HR MONITOR REPLACEMENT:COUNCIL CHP MISC SUPPLIES: ECO DEV MISC SMALL TOOLS/EQUIPMENT: HR MISC SMALL TOOLS & EQUIPMENT: ECC REC SUPPLIES: CRC: TCSD MISC OFC SUPPLIES: CITY CNCL OFC MISC SMALL TOOLS/EQUIPMENT: EOC MISC OFC SUPPLIES: TEM SHERIFF MISC SMALL TOOLS/EQUIPMENT: EOC REC SUPPLIES: CRC: TCSD 207055 10/14/2021 011304 AMEZCUA, MICHELLE EE COMPUTER PURCHASE PRGM 207056 10/14/2021 017149 B G P RECREATION INC TCSD INSTRUCTOR EARNINGS 207057 10/14/2021 007065 B&H PHOTO & ELECTRONICS CAMERAAND ACCESSORIES: TCSD CORP CAMERAAND ACCESSORIES: TCSD MISC AV EQUIPMENT: PEG SUPPLIES MISC AV EQUIPMENT: PEG SUPPLIES CAMERAAND ACCESSORIES: TCSD CAMERAAND ACCESSORIES: TCSD MISC AV EQUIPMENT: PEG SUPPLIES 207058 10/14/2021 011954 BAKER AND TAYLOR INC BOOK COLLECTIONS: LIBRARY BOOK COLLECTIONS: LIBRARY BOOK COLLECTIONS: LIBRARY BOOK COLLECTIONS: LIBRARY 207059 10/14/2021 022651 BRAND ASSASSINS Citywide Banner Program: Econ Dev 207060 10/14/2021 000152 CALIF PARKS AND MEMBERSHIP RENEWAL: PARKS: PW RECREATION SOC, C P R S 207061 10/14/2021 021054 CANTRELL,TINAJ TCSD INSTRUCTOR EARNINGS Amount Paid Page: 6 Check Total 540.00 540.00 200.00 200.00 628.62 111.29 538.25 104.76 33.70 185.45 470.60 58.68 64.15 92.64 90.66 6.80 2,385.60 2,000.00 2,000.00 9,564.80 9,564.80 616.60 5,960.24 969.35 1,726.52 205.54 248.11 -327.69 9,398.67 102.29 82.53 41.38 177.10 403.30 1,590.87 1,590.87 663.75 663.75 245.00 245.00 Page6 apChkLst 10/14/2021 3:17:20PM Final Check List CITY OF TEMECULA Page: 7 Bank: union UNION BANK (Continued) Check # Date Vendor Description Amount Paid Check Total 207062 10/14/2021 004462 CDW LLC, DBA CDW MICROSOFT SURFACE: PW 1,134.34 GOVERNMENT LLC MISC SMALL TOOLS & EQUIP: INFO TECI 622.44 MISC SMALL TOOLS & EQUIP: INFO TECI 147.03 1,903.81 207063 10/14/2021 021006 CLARIS INTERNATIONAL INC FILEMAKER LICENSING: PUBLIC 2,184.00 2,184.00 WORKS 207064 10/14/2021 019325 CROWELL, PAULA REIMB: MILEAGE: MISAC CONF 82.88 82.88 207065 10/14/2021 001233 DANS FEED AND SEED INC MISC SUPPLIES: STREET MAINT: PW 27.34 27.34 207066 10/14/2021 017432 EYEMED VISION CARE VISION PLAN PAYMENT 1,757.77 1,757.77 207067 10/14/2021 019469 FALCON ENGINEERING CNSTRCTN MGMT SVCS: SANTA 39,698.42 39,698.42 SERVICES GERTRUDIS CRK 207068 10/14/2021 021365 GEORGE HILLS COMPANY INC AUG CLAIM ADJUSTER SVCS: RISK 2,292.78 2,292.78 MGMT 207069 10/14/2021 003792 GRAINGER MISC SUPPLIES: PARKS: PW 1,196.21 MISC STAGE SUPPLIES: THEATER 264.32 1,460.53 207070 10/14/2021 000501 INTL INSTITUTE OF MUNICIPAL, MEMBERSHIP RENEWAL: JOHL, RANDI 215.00 215.00 CLERKS 207071 10/14/2021 021896 JP HANDMADE CORP, DBA MISC OFC SUPPLIES: ENVELOPES: 853.47 853.47 MINUTEMAN PRESS BUS LIC 207072 10/14/2021 019884 LEONIDA BUILDERS INC SANTA GERTRUDIS CRK PEDESTRIAN 204,396.30 204,396.30 EXT 207073 10/14/2021 003782 MAIN STREET SIGNS, DBA CITY STREET SIGNAGE: STREET 67.82 67.82 ATHACO INC MAINT: PW 207074 10/14/2021 021434 MATRIX TELECOM LLC DBA SEPT 800 SERVICES: CIVIC CENTER 69.72 69.72 LINGO 207076 10/14/2021 003076 MET LIFE INSURANCE DENTAL HMO PAYMENT 12,770.58 12,770.58 COMPANY 207077 10/14/2021 013443 MIDWEST TAPE LLC BOOKS ON TAPE: LIBRARY 43.49 43.49 207078 10/14/2021 017861 MYTHOS TECHNOLOGY INC OCT-DEC MONITORING SVCS: TVE2 450.00 450.00 Page:? apChkLst Final Check List Page: 8 10/14/2021 3:17:20PM CITY OF TEMECULA Bank: union UNION BANK (Continued) Check # Date Vendor Description 207079 10/14/2021 018099 NATIONAL SAFETY DOT Testing: HR COMPLIANCE INC 207080 10/14/2021 001323 NESTLE WATERS NORTH 8/23-9/22 WTR DLVRY SVC: AMERICA, DBA HARVESTON PRK READYREFRESH 207081 10/14/2021 003964 OFFICE DEPOT BUSINESS SVS SMALL TOOLS/EQUIPMENT: EM DIV SMALL TOOLS/EQUIPMENT: EM 207082 10/14/2021 018799 OLD TOWN PUB AND GRUB REFUND: CODE ENFORCEMENT CITATION 6808 207083 10/14/2021 019859 PGI - PACIFIC GRAPHICS INC. PRINTING SRVCS:THEATER 207084 10/14/2021 010338 POOL AND ELECTRICAL, VARIOUS SUPPLIES: AQUATICS PRODUCTS INC SPLASH PAD CHEMICALS & PARTS VARIOUS SUPPLIES: AQUATICS 207085 10/14/2021 005820 PRE -PAID LEGAL SERVICES PREPAID LEGAL SERVICES PAYMENT INC, DBA LEGALSHIELD 207086 10/14/2021 021026 QUESTICA LTD 12/12/21-12/11/22 SFTWARE SUBSCR:FIN 207087 10/14/2021 000947 RANCHO REPROGRAPHICS REPROGRAPHIC SRVC: CRC RENO, PW19-07 207088 10/14/2021 022537 REFRIGERATION SUPPLIES, HVAC SUPPLIES: THEATER DISTRIBUTOR HVAC SUPPLIES: CIVC CENTER 207089 10/14/2021 022494 REVZILLA MOTORSPORTS LLC, MOTOR GLOVES - TRAFFIC: TEM DBA REVZILLA.COM SHERIFF 207090 10/14/2021 000406 RIVERSIDE CO SHERIFFS 7/29-8/25 LAW ENFORCEMENT DEPT 207091 10/14/2021 001365 RIVERSIDE, COUNTY OF, RENEW PERMIT: CRC ENVIRONMENTAL HEALTH DEPT RENEW PERMIT: CRC 207092 10/14/2021 017549 ROSEN AND ROSEN MISC UNIFORMS: PW PARKS INDUSTRIES INC, DBA RAND R INDUSTRIES Amount Paid Check Total 89.95 89.95 41.05 41.05 55.22 110.67 165.89 250.00 250.00 1,917.00 1,917.00 435.87 382.59 129.17 947.63 222.25 222.25 37,448.85 37,448.85 232.71 232.71 104.23 64.21 168.44 414.59 414.59 2,495,987.88 2,495,987.88 734.00 900.00 1,634.00 2,257.12 2,257.12 Page:8 apChkLst 10/14/2021 3:17:20PM Final Check List CITY OF TEMECULA Page: 9 Bank: union UNION BANK (Continued) Check # Date Vendor Description Amount Paid Check Total 207093 10/14/2021 017699 SARNOWSKI SHAWNA M PHOTOGRAPHY SVCS: HUMAN 170.00 PRESTON SERVICES PHOTOGRAPHY SVCS:SPECIAL EVENT: 170.00 PHOTOGRAPHY SVCS: HUMAN SRVCS - 170.00 PHOTOGRAPHY SVCS: HUMAN SERVICE 170.00 680.00 207094 10/14/2021 017113 SCHOLASTIC LIBRARY MISC BOOKS: RHRTPL-TCSD 1,151.57 PUBLISHING, MISC BOOKS: RHRTPL-TCSD 32.11 1,183.68 207095 10/14/2021 000537 SO CALIF EDISON SEPT 700619554097 30051 RANCHO 16.90 VISTA RD SEPT 700116137841 VARIOUS LOCATION 24,960.90 24,977.80 207096 10/14/2021 000519 SOUTH COUNTY PEST SEPT PEST CONTROL SRVCS: PBSP 70.00 CONTROL INC SEPT PEST CONTROL SRVCS: WOLF CP 49.00 SEPT PEST CONTROL SRVCS: HARVEST 95.00 SEPT PEST CONTROL SRVCS: VAR. PAR 493.00 707.00 207097 10/14/2021 008337 STAPLES BUSINESS CREDIT MISC SUPPLIES: RHRTPL - TCSD 56.53 OFFICE SUPPLIES: CRC - TCSD 208.69 OFFICE SUPPLIES: TVM - TCSD 390.91 OFFICE SUPPLIES: PW CIP 105.87 OFFICE SUPPLIES: PW CIP 24.96 OFFICE SUPPLIES: THEATER 95.16 OFFICE SUPPLIES: CRC - TCSD 14.53 OFFICE SUPPLIES: THEATER 158.57 OFFICE SUPPLIES: THEATER 217.49 1,272.71 207098 10/14/2021 001547 TEAMSTERS LOCAL 911 UNION MEMBERSHIP DUES PAYMENT 4,948.22 4,948.22 207099 10/14/2021 019291 TLK ICE, INC., DBA:KONA ICE REFRESHMENTS: COLOR RUN 9/19/21 1,950.00 1,950.00 TEMECULA VAL 207100 10/14/2021 000161 TYLER TECHNOLOGIES, INC JUL ENERGOV TRAINING/SUPPORT: 17,482.50 17,482.50 INFO TECH 207101 10/14/2021 005460 U S BANK TRUSTEE ADMIN FEES: CFD 03-03 2,609.50 W.CRK TRUSTEE ADMIN FEES: CFD 03-06 HAR\j 2,609.50 TRUSTEE ADMIN FEES: CFD 01-2 HARVE 2,200.00 TRUSTEE ADMIN FEES: CFD 16-01 RORI 2,200.00 TRUSTEE ADMIN FEES: CFD 03-1 CROW 4,820.00 TRUSTEE ADMIN FEES: CFD 03-02 RORI 2,575.00 17,014.00 207102 10/14/2021 002702 USPS - POC, SEPT'21 POSTAGE METER DEPOSIT 1,561.37 1,561.37 ACCOUNT#8089685 207103 10/14/2021 018147 WADDLETON, JEFFREY L. MC SERVICES: COLOR RUN 700.00 700.00 Page9 apChkLst Final Check List Page: 10 10/14/2021 3:17:20PM CITY OF TEMECULA Bank: union UNION BANK Check # Date Vendor 207104 10/14/2021 007987 WALMART 207105 10/14/2021 008668 WES FLOWERS (Continued) Description Amount Paid Check Total MISC SUPPLIES: HEALTH FAIR/HUMAN 159.92 SVCS HELP CENTER SUPPLIES 134.17 294.09 SUNSHINE FUND 99.49 SUNSHINE FUND 99.49 198.98 Grand total for UNION BANK: 5,196,772.48 Page:10 apChkLst Final Check List Page: 11 10/14/2021 3:17:20PM CITY OF TEMECULA 137 checks in this report. Grand Total All Checks: 5,196,772.48 Page:11 apChkLst 10/19/2021 2:55:12PM Final Check List CITY OF TEMECULA Page: 1 Bank: eunion EFT UNION BANK Check # Date Vendor Description Amount Paid Check Total 501232 10/21/2021 000936 AMERICAN RED CROSS, STAFF/LIFEGUARDS CERTS: 80.89 80.89 HEALTH AND SAFETY SVCS AQUATICS 501233 10/21/2021 021400 AYERS ELECTRIC INC MISC ELECTRICAL WORK: CRC 800.00 MISC ELECTRICAL WORK: CIVIC CTR 600.00 MISC ELECTRICAL WORK: PARKING GAF 200.00 MISC ELECTRICAL WORK: PD STOREFR 200.00 1,800.00 501234 10/21/2021 004412 COMPLETE TENNIS CAMP, TCSD INSTRUCTOR EARNINGS 3,398.64 3,398.64 CTC TENNIS AKA KERRY LE 501235 10/21/2021 020436 CRONBERG, RICHARD N TCSD INSTRUCTOR EARNINGS 28.00 28.00 501236 10/21/2021 022506 DESIGN PATH STUDIO Permit Ready Accessory Dwelling Unit 5,737.50 5,737.50 501237 10/21/2021 020648 DG INVESTMENT HOLDINGS 2 MAINT & REPAIR SECURITY SYS: INFO 1,147.00 1,147.00 INC, CONVERGINT TECH TECHNOLOGIES 501238 10/21/2021 003945 DIAMOND ENVIRONMENTAL RESTROOM RENTAL: CITYWIDE 145.20 145.20 SRVCS CLEANUP 501239 10/21/2021 004192 DOWNS ENERGY FUEL FUEL FOR CITY VEHICLES: TCSD 568.31 FUEL FOR CITY VEHICLES: TRAFFIC: PN 359.18 FUEL FOR CITY VEHICLES: CIP: PW 117.40 FUEL FOR CITY VEHICLES: CODE & PLA 108.21 FUEL FOR CITY VEHICLES: EOC 80.42 FUEL FOR CITY VEHICLES: LAND DEV: F 76.31 FUEL FOR CITY VEHICLES: CODE ENFOI 52.93 FUEL FOR CITY VEHICLES: PARK MAINT 1,572.38 FUEL FOR CITY VEHICLES: STREET MAI 686.66 3,621.80 501240 10/21/2021 000177 GLENNIES OFFICE PRODUCTS MISC OFC SUPPLIES: PLANNING 195.68 INC MISC OFC SUPPLIES: PLANNING 53.18 MISC OFC SUPPLIES: CODE ENFORCEN 14.78 MISC OFC SUPPLIES: CODE ENFORCEN 11.52 275.16 501241 10/21/2021 012883 JACOB'S HOUSE INC EMPLOYEE CHARITY DONATIONS 40.00 40.00 PAYMENT 501242 10/21/2021 000482 LEIGHTON CONSULTING INC GEOTECH SVCS: JEFFERSON 5,500.00 5,500.00 BUECKING APTS 501243 10/21/2021 018675 MDG ASSOCIATES INC SEP CDBG-CV EMERGENCY RENTAL 2,546.00 ASSIST PGM SEP CDBG-CV EMERGENCY RENTAL AS 2,521.00 5,067.00 Page:1 apChkLst 10/19/2021 2:55:12PM Final Check List CITY OF TEMECULA Page: 2 Bank: eunion EFT UNION BANK (Continued) Check # Date Vendor Description Amount Paid Check Total 501244 10/21/2021 004043 MISSION ELECTRIC SUPPLY ELECTRICAL SUPPLIES: IWTCM 144.49 INC ELECTRICAL SUPPLIES: CIVIC CTR 101.24 ELECTRICAL SUPPLIES: CIVIC CTR 99.14 344.87 501245 10/21/2021 001868 MIYAMOTO JURKOSKY SUSAN, TCSD INSTRUCTOR EARNINGS 532.00 532.00 DBA MIYAMOTO MUSIC STUDIO 501246 10/21/2021 022599 NIEVES LANDSCAPE INC TREE PLANTING: RONALD REAGAN 100.00 100.00 PARK 501247 10/21/2021 021998 OLD TOWN TIRE AND SERVICE CITY VEHICLE MAINT SVCS: PW 1,410.71 INC PARKS CITY VEHICLE MAINT SVCS: PW PARKS 1,042.14 CITY VEHICLE MAINT SVCS: PW PARKS 571.49 CITY VEHICLE MAINT SVCS: PW TRAFFIi 394.51 CITY VEHICLE MAINT SVCS: PW TRAFFli 144.47 3,563.32 501248 10/21/2021 002800 PACIFIC STRIPING INC CITYWIDE PAINTING OF TRAFFIC 197,838.37 STRIPING LAYOUT NICOLE LANE: PW STREETS 1,383.50 199,221.87 501249 10/21/2021 021858 PLACEWORKS INC, DBA APR-AUG'21 PROF SRVCS: PLANNING 5,477.24 5,477.24 PLACEWORKS 501250 10/21/2021 003591 RENES COMMERCIAL SEP SHOPPING CART CLEANUP: CITY 1,774.00 MANAGEMENT R-O-WS SEP HOMELESS ENCAMPMENT CLEAN -I 1,725.00 3,499.00 501251 10/21/2021 004274 SAFE AND SECURE LOCKSMITH SRVCS: REDHAWK PARK 142.50 LOCKSMITH SRVC LOCKSMITH SRVCS: HARVESTON LAKE 26.81 LOCKSMITH SRVCS: CIVIC CENTER 25.12 LOCKSMITH SRVCS: CIVIC CENTER 25.12 219.55 501252 10/21/2021 009213 SHERRY BERRY MUSIC JAZZ @ THE MERC 10/14/21 525.00 JAZZ @ THE MERC 10/7 248.50 773.50 501253 10/21/2021 009746 SIGNS BY TOMORROW SIGNAGE: AOTW/TCSD 768.53 NEW SIGNAGE: CIVIC CENTER 288.47 1,057.00 501254 10/21/2021 000645 SMART AND FINAL INC MISC SUPPLIES: HIGH HOPES/HUMAN 380.61 380.61 SVCS 501255 10/21/2021 002366 STEAM SUPERIOR CARPET CARPET CLEANING: CIVIC CNTR 1ST 4,500.00 CLEANING FLOOR CARPET CLEANING: SENIOR CENTER 175.00 4,675.00 501256 10/21/2021 006145 STENO SOLUTIONS SEPT TRANSCRIPTION SVCS: TEM 84.24 84.24 TRANSCRIPTION, SRVCS INC SHERIFF 501257 10/21/2021 001546 STRAIGHT LINE GLASS AND REPLACE GLASS: HARVESTON COMM 464.55 464.55 MIRROR, COMPANY INC RM Paget apChkLst 10/19/2021 2:55:12PM Final Check List CITY OF TEMECULA Page: 3 Bank: eunion EFT UNION BANK (Continued) Check # Date Vendor Description Amount Paid Check Total 501258 10/21/2021 003849 TERRYBERRY COMPANY SERVICE AWARD: HR 195.16 SERVICE AWARD: HR 152.28 SERVICE AWARD: HR 94.90 SERVICE AWARD: HR 64.28 506.62 501259 10/21/2021 007766 UNDERGROUND SERVICE SEP UNDERGRND UTILITY LOCATOR 264.10 ALERT, OF SOUTHERN ALERTS: PW CALIFORNIA SEP DIG SAFE BIRD BILLABLE TCKTS: P% 94.30 358.40 501260 10/21/2021 008977 VALLEY EVENTS INC COLOR RUN EVENT SRVCS: 3,137.00 CRC-TCSD HEALTH FAIR RENTALS: MPSC-TCSD 9/2 977.50 4,114.50 501261 10/21/2021 003730 WEST COAST ARBORISTS INC 9/1-15 TREE MAINT: PARKS & MEDIANS 4,833.00 9/1-15 TREE MAINT: VILLAGES SLOPE 544.00 9/1-15 TREE MAINT: SIGNET SERIES 478.00 5,855.00 Grand total for EFT UNION BANK: 258,068.46 Page:3 apChkLst Final Check List Page: 4 10/19/2021 2:55:12PM CITY OF TEMECULA 30 checks in this report. Grand Total All Checks: 258,068.46 Page:4 apChkLst 10/21/2021 2:56:06PM Final Check List CITY OF TEMECULA Page: 1 Bank: union UNION BANK Check # Date Vendor Description Amount Paid Check Total 11958 9/30/2021 000246 PERS (EMPLOYEES' PERS RETIREMENT PAYMENT 118,795.59 118,795.59 RETIREMENT) 11993 10/15/2021 000262 RANCHO CALIF WATER VARIOUS SEPT WATER 3015553 DEER 65,602.50 65,602.50 DISTRICT HOLLOW 12051 10/15/2021 005037 AMERICAN ASPHALT SOUTH CITYWIDE SLURRY SEAL PGM 1,044,678.85 1,044,678.85 INC PW21-01 12064 10/4/2021 018098 ELITE CLAIMS MANAGEMENT FUNDS FOR WORKER COMP CLAIMS 20,000.00 20,000.00 INC 12090 10/7/2021 000245 PERS - HEALTH INSUR PERS HEALTH PAYMENT 147,482.32 PREMIUM PERS HEALTH PAYMENT 0.00 147,482.32 12091 10/19/2021 000246 PERS (EMPLOYEES' PERS RETIREMENT PAYMENT 119,218.15 119,218.15 RETIREMENT) 12092 10/13/2021 000537 SO CALIF EDISON SEPT 700581895061 29028 OLD TOWN 14.53 14.53 FRONT 12093 10/13/2021 000537 SO CALIF EDISON SEPT 700390905802 28301 RANCHO 30.65 30.65 CAL RD 12094 10/13/2021 000537 SO CALIF EDISON SEPT 700037888042 32005 MURRIETA 148.35 148.35 HOT 12095 10/13/2021 000537 SO CALIF EDISON SEPT 700116582930 44205 MAIN ST 152.07 152.07 12096 10/13/2021 000537 SO CALIF EDISON SEPT 700213755712 28816 PUJOL ST 1,133.74 1,133.74 12097 10/13/2021 000537 SO CALIF EDISON SEPT 700052349631 42081 MAIN ST 2,754.37 2,754.37 12098 10/13/2021 000537 SO CALIF EDISON SEPT 700173434428 42051 MAIN ST 9,079.64 9,079.64 12099 10/14/2021 005460 U S BANK INVESTMENT PURCHASE-XENAP5: 1,000,000.00 1,000,000.00 FINANCE 12101 10/18/2021 000537 SO CALIF EDISON SEPT 700418750458 31777 DE 16.62 16.62 PORTOLA RD 12102 10/18/2021 000537 SO CALIF EDISON SEPT 700619554097 30051 RANCHO 16.90 16.90 VISTA RD Page-1 apChkLst Final Check List Page: 2 10/21/2021 2:56:06PM CITY OF TEMECULA Bank: union UNION BANK (Continued) Check # Date Vendor Description 12103 10/18/2021 000537 SO CALIF EDISON SEPT 700251991189 45602 REDHAWK PKWY 12104 10/18/2021 000537 SO CALIF EDISON SEPT 700503663349 28916 PUJOL ST 12105 10/18/2021 000537 SO CALIF EDISON SEPT 700306036256 31454 TEMECULA PKWY 12106 10/18/2021 000537 SO CALIF EDISON SEPT 700572390172 46899 REDHAWK PKWY 12107 10/18/2021 000537 SO CALIF EDISON SEPT 700503770150 28922 PUJOL ST 12108 10/18/2021 000537 SO CALIF EDISON SEPT 700025717269 30875 RANCHO VISTA RD 12109 10/18/2021 000537 SO CALIF EDISON SEPT 600001509166 40356 N GENERAL KEARNY 12110 10/21/2021 000194 ICMARETIREMENT-PLAN ICMA-RC RETIREMENT TRUST457 303355 PAYMENT 12111 10/21/2021 000444 INSTATAX (EDD) STATE TAX PAYMENT 12112 10/21/2021 000283 INSTATAX (IRS) FEDERAL TAX PAYMENT 12113 10/19/2021 000537 SO CALIF EDISON AUG 600001004059 28000 LA SERENA WAY 102099 10/14/2021 022704 ANDARO, MOSES REFUND: DUPLICATE PAYMENT FOR INVOICE 207106 10/21/2021 003552 AFLAC PREMIUM HOLDING, AFLAC ACCIDENT INDEMNITY C/O BNB BANK LOCKBOX PAYMENT 207107 10/21/2021 015592 BAMM PROMOTIONAL Embroidery:uniforms: Bldg & Safety PRODUCTS INC 207108 10/21/2021 022651 BRAND ASSASSINS STATE OF THE CITY BACKDROPS 207109 10/21/2021 021851 CALIF NEWSPAPERS SEPT PUBLIC NTC ADS: CITY CLERK PARTNERSHIP, DBA SO CALIF NEWS GROUP Amount Paid Check Total 21.22 21.22 49.03 49.03 134.68 134.68 151.60 151.60 188.64 188.64 9,493.39 9,493.39 10,385.39 10,385.39 992.94 992.94 1,044.71 1,044.71 3,282.75 3,282.75 5,903.79 5,903.79 39.00 39.00 3,790.56 3,790.56 32.63 32.63 1,599.00 1,599.00 995.10 995.10 Paget apChkLst Final Check List Page: 3 10/21/2021 2:56:06PM CITY OF TEMECULA Bank: union UNION BANK (Continued) Check # Date Vendor Description 207110 10/21/2021 000152 CALIF PARKS AND MEMBERSHIP RENEWAL: TURNER, C. RECREATION SOC, C P R S 207111 10/21/2021 011922 CORELOGIC INC, DBA SEP PROP ID SFTWR: CODE CORELOGIC SOLUTIONS ENFORCEMENT 207112 10/21/2021 001264 COSTCO TEMECULA 491 SUPPLIES FOR QUALITY OF LIFE: PLANNING 207113 10/21/2021 022705 DANIELS, TIMOTHY REFUND: DUPLICATE BUSINESS LICENSE 207114 10/21/2021 012600 DAVID EVANS AND SEPT DSGN SVCS: DIAZ RD PROJ ASSOCIATES INC PW17-25 DSGN CONSULT SVCS: PICKLEBALL COI 207115 10/21/2021 021365 GEORGE HILLS COMPANY INC 10/8 CLAIMS RECOVERY SRVCS: RISK MGMT 207116 10/21/2021 003198 HOME DEPOT MISC HRDWR SUPPLIES: VARI FACILITIES 207117 10/21/2021 013286 INTRADO LIFE & SAFETY INC OCT ENTERPRISE 911 SVC: IT 207118 10/21/2021 004119 J T B SUPPLY COMPANY INC TRAFFIC SIGNAL EQUIP PRGM - CIP 207119 10/21/2021 021896 JP HANDMADE CORP, DBA MISC OFC SUPPLIES: ENVELOPES: MINUTEMAN PRESS CODE ENF LETTERHEAD ENVELOPES: CODE ENFC 207120 10/21/2021 014772 LOTA, RAYMOND A PHOTO BOOTH RENTALS: HALLOWEEN 207121 10/21/2021 016297 MID-AMERICAARTS ALLIANCE EXHIBIT RENTAL FEE - THRIFT STYLE: TCSD 207122 10/21/2021 021343 MILLER ARCHITECTURAL ARCHITECTURAL SVCS: MPSC CORP RENOVATION 207123 10/21/2021 000209 NUTRIEN AG SOLUTIONS INC, EQUIPMENT REPAIR: STREET MAINT: DBA CROP PRODUCTION PW SRVCS EQUIPMENT REPAIR: STREET MAINT: PV 207124 10/21/2021 006552 PAINTED EARTH VITICULTURE TILE KITS: HUMAN SRVCS-TCSD 207125 10/21/2021 003663 PECHANGA BAND OF SEPT PROF SRVCS: PARK & RIDE, LUISENO, MISSION INDIANS PW18-11 Amount Paid Check Total 145.00 145.00 301.00 301.00 98.72 98.72 148.00 148.00 3,513.90 1,108.50 4,622.40 3,764.77 3,764.77 109.49 109.49 300.00 300.00 5,585.35 5,585.35 111.02 374.74 485.76 730.00 730.00 3,150.00 3,150.00 6,710.88 6,710.88 152.51 121.55 274.06 494.81 494.81 3,773.52 3,773.52 Page:3 apChkLst Final Check List Page: 4 10/21/2021 2:56:06PM CITY OF TEMECULA Bank: union UNION BANK Check # Date Vendor 207126 10/21/2021 022537 REFRIGERATION SUPPLIES, DISTRIBUTOR 207127 10/21/2021 000278 SAN DIEGO UNION -TRIBUNE 207128 10/21/2021 017699 SARNOWSKI SHAWNAM PRESTON 207129 10/21/2021 000519 SOUTH COUNTY PEST CONTROL INC 207130 10/21/2021 000293 STADIUM PIZZA INC 207133 10/21/2021 007762 STANDARD INSURANCE COMPANY 207134 10/21/2021 012723 STANDARD INSURANCE COMPANY (Continued) Description HVAC SUPPLIES: TVE2 HVAC SUPPLIES: TVE2 HVAC SUPPLIES: TVE2 HVAC SUPPLIES: CIVC CENTER HVAC SUPPLIES: JRC HVAC SUPPLIES: TVE2 HVAC SUPPLIES: CRC HVAC SUPPLIES: CIVC CENTER SEPT PUBLIC NTC ADS: CITY CLERK PHOTOGRAPHY SRVCS: ARTS MAP GUIDE 9/24 PHOTOGRAPHY SRVCS: 1ST FRIDAY ME PHOTOGRAPHY SRVCS: HUMAN SRVCS PHOTOGRAPHY SRVCS: QUILT SHOW V SEPT PEST CONTROL SRVCS: WED CHPL OCT PEST CONTROL SRVCS: HISTORY I SEPT PEST CONTROL SRVCS: MPSC OCT PEST CONTROL SRVCS: TCC SEPT PEST CONTROL SRVCS: TCC SEPT PEST CONTROL SRVCS: CIVIC CE SEPT PEST CONTROL SRVCS: THEATER OCT PEST CONTROL SRVCS: PARKING l SEPT PEST CONTROL SRVCS: LIBRARY SEPT PEST CONTROL SRVCS: CRC OCT PEST CONTROL SRVCS: CRC SEPT PEST CONTROL SRVCS: JRC SEPT PEST CONTROL SRVCS: AQUATIC SEPT PEST CONTROL SRVCS: TVE2 SEPT PEST CONTROL SRVCS: DUCK PC OCT PEST CONTROL SRVCS: WOLF CRY SEPT PEST CONTROL SRVCS: SPLASH I SEPT PEST CONTROL SRVCS: T. MUSEL OCT PEST COTNROL SRVCS: HISTORY I SEPT PEST CONTROL SRVCS: WEST WI SEPT PEST CONTROL SRVCS: C. MUSEI REFRESHMENTS - HIGH HOPES EVENTS REFRESHMENTS - HIGH HOPES EVENT! BASIC LIFE INSURANCE PAYMENT VOLUNTARY SUPP LIFE INSURANCE PAYMENT Amount Paid Check Total 169.66 90.05 89.35 28.28 27.15 26.10 22.30 9.81 193.36 600.00 170.00 170.00 150.00 32.00 32.00 29.00 123.00 123.00 120.00 90.00 90.00 90.00 90.00 90.00 74.00 59.00 56.00 49.00 49.00 49.00 42.00 42.00 40.00 36.00 309.99 54.15 9,391.85 1,527.26 462.70 193.36 1,090.00 1,405.00 364.14 9,391.85 1,527.26 Page:4 apChkLst 10/21/2021 2:56:06PM Final Check List CITY OF TEMECULA Page: 5 Bank: union UNION BANK (Continued) Check # Date Vendor Description Amount Paid Check Total 207135 10/21/2021 009061 STURDIVANT, ANGELA P TCSD INSTRUCTOR EARNINGS 2,173.50 2,173.50 207136 10/21/2021 021096 TEMECULA VALLEY PONY REFUND: SEC DEPOSIT CC 2/19/20 200.00 200.00 207137 10/21/2021 020911 T-MOBILE USA, INC. GPS LOCATE SVCS-8/31-9/3/21 120.00 120.00 207138 10/21/2021 002110 UNITED RENTALNORTH LIFT PREV MAINT SRVCS: THEATER 423.00 AMERICA INC LIFT PREV MAINT SRVCS: CIVIC CENTEF 398.48 821.48 207139 10/21/2021 020963 UPTOWN TEMECULAAUTO AUG VEHICLE DETAILING SRVCS: FIRE 120.00 SPA LLC AUG VEHICLE DETAILING SRVCS: BLDG 16.00 AUG VEHICLE DETAILING SRVCS: PW F/ 12.00 AUG VEHICLE DETAILING SRVCS: CODE 8.00 AUG VEHICLE DETAILING SRVCS: TCSD 4.00 AUG VEHICLE DETAILING SRVCS: PW Cl 4.00 AUG VEHICLE DETAILING SRVCS: PW P/ 4.00 168.00 207140 10/21/2021 014850 VALLEY PRINTING SERVICES, PRINTING SRVCS: CITY 1,492.05 1,492.05 INC. NEWSLETTER/CMO 207141 10/21/2021 009101 VISION ONE INC, DBA SEPT SHOWARE TICKETING SRVCS: 3,988.80 3,988.80 ACCESSO THEATER 207142 10/21/2021 021010 VISIONARIES IMAGE CO LLC VAR VIDEOGRAPHY SRVCS: SOTC 4,508.50 4,508.50 207143 10/21/2021 018147 WADDLETON, JEFFREY L. TCSD INSTRUCTOR EARNINGS 847.00 847.00 207144 10/21/2021 000339 WEST PUBLISHING SEPT CLEAR SUBSCRIPTION: TEM 984.53 984.53 CORPORATION, SHERIFF DBA:THOMSON REUTERS 207145 10/21/2021 021148 WEX BANK 9/6-10/6 FUEL USAGE: POLICE 2,136.87 2,136.87 207146 10/21/2021 020193 WHITE CAP LP MAINT SUPPLIES: PW STREETS 1,161.91 MISC SUPPLIES: VARIOUS PARKS 662.68 MISC SUPPLIES: PW STREETS 130.90 1,955.49 Grand total for UNION BANK: 2,631,753.00 Page:5 apChkLst Final Check List Page: 6 10/21/2021 2:56:06PM CITY OF TEMECULA 67 checks in this report. Grand Total All Checks: 2,631,753.00 Page6 apChkLst 10/21 /2021 1:26:16 P M Final Check List CITY OF TEMECULA Bank: eunion EFT UNION BANK Check # Date Vendor Description 501262 10/25/2021 000944 MCCAIN TRAFFIC SUPPLY INC COMMUNICATION SYS UPGRADE: PW Amount Paid 26,817.75 Grand total for EFT UNION BANK: Page: 1 Check Total 26, 817.75 26, 817.75 Page-1 apChkLst Final Check List Page: 2 10/21/2021 1:26:16PM CITY OF TEMECULA checks in this report. Grand Total All Checks: 26,817.75 Paget Item No. 4 CITY OF TEMECULA AGENDA REPORT TO: City Council FROM: Aaron Adams, City Manager DATE: November 9, 2021 SUBJECT: Approve Recommendation for Community Service Funding Program for Fiscal Year 2021-22 (At the Request of Subcommittee Members Council Member Alexander and Council Member Schwank) PREPARED BY: Betsy Lowrey, Assistant to the City Manager RECOMMENDATION: That the City Council approve the recommendation to allocate a total of $100,000 to fund 23 out of 33 grant applications received from nonprofit organizations for the Fiscal Year 2020-21 Community Service Funding Program. BACKGROUND: The City Council appointed Council Member Jessica Alexander and Council Member Zak Schwank to the Fiscal Year 2021-22 Community Service Funding Ad Hoc Subcommittee to recommend grant fund allocations up to $5,000 per non-profit organization for programs that provide services to the citizens of Temecula. The Community Service Funding Program adopted Fiscal Year 2021-22 budget is $100,000. The Community Service Funding Program information was e-mailed to non-profit organizations in the Temecula Valley area including all community -based charities in the City's database. In addition, advertisements were sent to the local media. The application and guidelines were also posted on the City's website. A total of 33 applications from non-profit organizations were submitted to the City requesting a total of $151,800 in grant funding. The Ad Hoc Subcommittee, along with staff members, reviewed the requests for funding based on criteria previously adopted by the City Council to support non-profit organizations who offer community -wide services such as food, clothing, shelter, and medical care. At this time, the Ad Hoc Subcommittee recommends that 23 organizations receive grant funding ranging from $1,500 to $5,000 each, totaling $100,000 of the available $100,000 budget. FISCAL IMPACT: Funds are available in the Fiscal Year 2021-22 Community Service Funding line item 001.101.999.5267 in the amount of $100,000. ATTACHMENTS: 1. Fiscal Year 2021-22 Community Service Funding Program Ad Hoc Subcommittee Recommendation Spreadsheet 2. Fiscal Year 2021-22 Community Service Funding Program Applications COMMUNITY SERVICE FUNDING (CSF) GRANT PROGRAM Account No. 001-101-999-5267 ANNUAL CSF COUNCIL CSF CDBG _ SUB- 0*1 `� O N Q1 O N rH NN N N • NAME • ADDRESSO • ' ' • ' ' • • COMMITTEE N O N O N O rV O O N N O O O N N N O N •' • NOTE: Nonprofits located• C RECOM- 00 0 rn 0 o 0 00 0 rn o 0 0 00 rn o 0 0 0 �1 0 serve Temecula residents. MENDATIO N LL [V N LL N LL N (V LL LL N N N LL LL LL N 1 ALZHEIMER'S 9606 S. Santa Judith $ 5,000 CAREGIVER OUTREACH ABOUT FREE $0 Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't ASSOCIATION Monica Blvd., Martinez PROGRAMS & SERVICES. Classes, Apply Apply Apply Apply Apply Apply Apply Apply Apply Apply 2nd Floor support groups (2 in Temecula area), Beverly Hills, CA early -stage programming, and 24/7 90210 helpline. Funding will purchase media advertising, both online and in print in the City of Temecula (such as publications, newsletters, Temecula newspaper). 2 AMERICAN 1015 Amherst Antonio Y. $ 5,000 VETERANS 1ST RESPONDER GUITAR $5,000 5,000 4,784 5,000 Didn't Didn't Didn't Didn't Didn't Didn't Didn't PATRIOT MUSIC Ave. Villegas BUILDING WORKSHOP. Apply Apply Apply Apply Apply Apply Apply PROJECT Hemet, CA Teaches veterans and/or first 92544 responders how to build their own electric guitars. Funds will purchase guitar kits, shipping costs, marketing, instructor travel/training/food. No fees for participants; each will build and take home a completed electric guitar. 3 ANIMAL FRIENDS 33751 Mission Beth $ 5,000 SPAY/NEUTER VOUCHER PROGRAM. $0 Didn't 4,784 5,000 Didn't 1,500 Didn't Didn't Didn't Didn't Didn't OF THE VALLEYS Trail Road, Soltysiak Funding will help cover 95+ Apply Apply Apply Apply Apply Apply Apply Wildomar, CA spay/neuter surgeries, veterinarian 92595 costs, pet pharmaceuticals costs, post op care. Legend: "0" = Applied and Declined COMMUNITY SERVICE FUNDING (CSF) GRANT PROGRAM Account No. 001-101-999-5267 4 ASSISTANCE LEAGUE 5 BOY SCOUTS OF AMERICA CALIFORNIA INLAND EMPIRE COUNCIL INC. 28720 Via Montezuma, Temecula, CA 92590 PO BOX 893823 Temecula, CA 92589 Dorcus $ Shaktman Tina Roy , $ 5,000 OPERATION SCHOOL BELL -SH( Funding will purchase —143+ $: Famous Footwear gift cards pr to at risk TVUSD high school yc Students will use the gift cards purchase new shoes. 2,500 DAY CAMP/OUTDOOR ADVEN- Provides continuation of the w Cub Scout program through th summer for elementary aged y Funds will be used for prograrr supplies, youth recognition ite food, camp membership for Si with a financial need, and equi (shade structure, targets for ar and leader supplies). ANNUAL CSF COUNCIL CSF CDBG SUB � N N Q1 O N 0) O N cV • COMMITTEE M No o o 0 RECOM- 0Nb 0 0 0 0Nb I M 0 0 0 0Nb 0 0 0 0 MENDATIO N >- N >- N >- N N >- >- N >- N N N >- >- >- N } LL LL LL L.L LL LL LL LL LL LL )ES. $5,000 7,961 5,538 5,491 6,969.61 5,000 4,784 5,000 Didn't Didn't Didn't 35 Apply Apply Apply avided ,uth. to URE. $2,500 Didn't Didn't 0 Didn't Didn't Didn't Didn't Didn't Didn't Didn't eek-long Apply Apply Apply Apply Apply Apply Apply Apply Apply outh. -n s, ;outs pment chery, Legend: "0" = Applied and Declined 2 COMMUNITY SERVICE FUNDING (CSF) GRANT PROGRAM Account No. 001-101-999-5267 6 BOYS & GIRLS PO BOX 892349 CARLY $ 5,000 ULTIMATE STEM. Youth (ages 6-1 CLUB OF Temecula, CA Bennett- participate in web exploration, m SOUTHWEST 92589 Valle production, robotics, and coding. COUNTY Funds awarded will be used for S' program supplies and equipment as internet access fees, and technology including computers i accessories) to increase youth awareness about STEM opportun and future caeer paths. 7 CADENZA 31927 Corte Sandiwa $ 5,000 MUSICIAN DEVELOPMENT FUND. STRING Pollensa, Del Promote music of American coml ORCHESTRA Temecula, CA Rosario and local musicians. Funds will 92592 purchase instruments, musical accessories, sheet music, copyrigl licenses to rent and perform mus rental space of performance vent student travel expenses when do outreach community events. Prod helps provide quality music educ< to financially in -need students in Temecula. ANNUAL CSF COUNCIL CSF CDBG I SUB- N MO N MO fV N O COMMITTEE O O O O O O O O O 00 RECOM- 0 of 0 o 0 00 0 M 0 0 0 00 M o rH I 0 0 0 0 N MENDATIO >_ [V } N } N >_ N N � N N N N } L.L LL LL L.L LL LL L.L LL LL L.L 7) $5,000 5,000 4,784 5,000 1,500 Didn't Didn't 7,961 5,538 5,491 6,969.61 edia Apply Apply FEM (such ities II $0 Didn't 0 0 Didn't Didn't Didn't Didn't Didn't Didn't Didn't )osers Apply Apply Apply Apply Apply Apply Apply Apply it c, ies, ng ;ram ition Legend: "0" = Applied and Declined 3 COMMUNITY SERVICE FUNDING (CSF) GRANT PROGRAM Account No. 001-101-999-5267 8 CALIFORNIA VFW 8425 Carnoustie Kevin $ MOTORCYLE Ave, Hemet, CA Bussdieker CLUB INLAND 92545 EMPIRE 9 ICHARITY FOR CHARITY 27479 Ynez Road Temecula, CA 92591 Charity 1 $ Prestifilipp IN 5,000 HOME SAFETY INSPECTION FOR VETERANS/ACTIVE MILITARY FAMILI Funding will be spent on home safes inspections free of charge to veterai and active miltary and families, and funds will purchase needed battery smoke detectors, CO detectors, basi fire extinguisher (Class ABC) with ea mount & strap, and emergency kits Temecula only). 5,000 STARS OF THE VALLEY GOLF & GALA Funds will be used to host 1st golf tournament/fundraiser (to fulfill wishes of locals with life threatenin€ illnesses or traumatic injury). Funds will provide food for 50 volunteers, banners & signage at each hole, and printed material at each hole. ANNUAL CSF COUNCIL CSF CDBG I SUB- N 01 O N Ol O fV N O COMMITTEE O O O O O O O O O 00 RECOM- 0 of 0 o 0 00 0 M 0 0 0 00 d, o rH I 0 0 0 0 N MENDATIO } N } N } N >- N (V >- >- N N N (V >- >- >- } L.L LL L.L L.L LL L.L L.L LL LL L.L $5,000 Didn't Didn't Didn't 1,000 Didn't Didn't Didn't Didn't Didn't Didn't _S Apply Apply Apply Apply Apply Apply Apply Apply Apply Y is c 5y ;in $5,000 2,500 0 0 750 Didn't Didn't Didn't Didn't Didn't Didn't Apply Apply Apply Apply Apply Apply r Legend: "0" = Applied and Declined 4 COMMUNITY SERVICE FUNDING (CSF) GRANT PROGRAM Account No. 001-101-999-5267 10 CHOICE PROGRAM INC. (THE) 11 COMMUNITY MISSION OF HOPE 30847 Highland James $ 5,000 CHOICE PROGRAM. Provide Vista Circle, Cooley (elementary & middle school students) Temecula, CA community presentations, seminars, 92591 youth/parent workshops & school presentations. Developing future leaders, individual character, motivate youth to ahieve academic excellence, social responsibility, personal greatness, mental/physical wellbeing. Funding will be used for breakfast/luncheons, tee shirts, food, rental space, journals, hand sanitizers, & masks. 41760 Rider Way, Temecula, CA 92590 Allison $ 5,000 'HOLIDAY MEALS PROGRAM. Funds will Willits be used to purchase turkeys and hams from local retailers for CMOH clients (approx. 1000) during the three major holidays: Thanksgiving, Christmas, Easter. SUB- I COMMITTEE RECOM- MENDATIOIA $0 ANNUAL CSF COUNCIL CSF .01-I ON N �f V N O O O O O O 00 ri 0, c-I 0 N 00 c-I a� o c-I N 0 0 0 0 0 0 L}L L}L L}L L}L U_ L}L 1,000 959 0 Didn't Didn't Didn't Apply Apply Apply Didn't 4,784 5,000 1,000 Didn't 500 Apply Apply 00:e M O -1 N r-I r V r V N O O O O N N N N 00 a� o 0 0 0 0 L}L L}L L}L L}L Didn't Didn't Didn't Didn't Apply I ApIY I A pIY I Apply AD p�Y I 5,538I 5,491 16,969.61 Legend: "0" = Applied and Declined 5 COMMUNITY SERVICE FUNDING (CSF) GRANT PROGRAM Account No. 001-101-999-5267 CULTIVATING INCLUSION, INC. 13 1 HABITAT FOR HUMANITY INLAND VALLEY INC 31430 Loma Linda Rd. Temecula, CA 192592-1604 Mary Ann Tams 27475 Ynez Rd Mary Stein #390, Temecula, CA 92591 CULTIVATING INCLUSION. A job s location for adult transition progr for adults with special needs; pro is donated to food banks, CommL Mission of Hope and St. Vincent c Paul. Keeping farm fruitful and gr for clients of Care -Rite Vocationa Services, & TVUSD students. Func be used to purchase tools, water, & mulch, seeds & plants, pest co & weed abatement. $ 5,000 BRUSH WITH KINDNESS. Funding income Temecula resident with k no cost home repair/maintenana projects; minor home repairs and maintenance services with the gc preserving home affordability: landscaping, weed abatement, e� painting, fence work. ANNUAL CSF COUNCIL CSF CDBG I SUB- N MO N MO fV N O COMMITTEE O O O O O O O O O 00 RECOM- 0 of 0 o 0 00 0 M 0 0 0 00 I 0 M 0 o 0 rH 0 N 11 MENDATIO } N } N } N >_ N >_ (V >_ N >_ N >_ N >_ (V } L.L LL L.L L.L LL L.L L.L LL LL L.L to $5,000 Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't ams Apply Apply Apply Apply Apply Apply Apply Apply Apply Apply duce inity le yen Is will soil itrol low- $5,000 5,000 31,842 Didn't 4,784 5,000 1,000 Didn't Didn't Didn't ######## iw to Apply Apply Apply Apply al of terior Legend: "0" = Applied and Declined 6 COMMUNITY SERVICE FUNDING (CSF) GRANT PROGRAM Account No. 001-101-999-5267 14 HOSPICE OF THE 25240 Hancock Melanie $ 5,000 SENIOR ASSISTANCE PROGRAM. VALLEYS Ave #120, House Hospice care for senior citizens / +Murrieta, CA severely disabled adults in Temecula 92562 for end of life care. Grant funding w be used for services not covered by Medicare or other insurances such medication co -pays, incontinence supplies, fully electric beds, and overbed tables, and caregiver/bereaved family member! that reside in Temecula. 15 JACOB'S HOUSE 31525 Jedediah Martin INC Smith Road, Barrera- Temecula, CA Martinez 92592 $ 5,000 JACOB'S HOUSE HEALTHCARE HOSPITALITY HOME. Funds will supr operational costs for Temecula gues !eking refuge while caring for a lov ie in the hospital. Funds will suppc 3erational expenses that include: :ilities, facility improvements, !sidential supplies, system databas perational costs per room is 135/night and families stay for fre( ANNUAL CSF COUNCIL CSF CDBG I 01 SUB- rl O N 01 O N Ol O fV N 0 COMMITTEE 0 0 0 0 0 0 0 0 0 00 RECOM- 0 of 0 0 0 00 0 d, 0 0 o 00 d, 0 rH I o 0 0 0 N MENDATIO >- [V } N } N >- N N � N N N N } LL LL LL LL LL L.L LL LL LL LL $5,000 5,000 4,784 5,000 Didn't Didn't Didn't 5,583 5,538 5,491 Didn't i I I Apply Apply Apply Apply s $5,000 2,500 2,393 5,000 Didn't Didn't Didn't Didn't Didn't Didn't Didn't sort Apply Apply Apply Apply Apply Apply Apply is ed i rt es. Legend: "0" = Applied and Declined 7 COMMUNITY SERVICE FUNDING (CSF) GRANT PROGRAM Account No. 001-101-999-5267 16 MICHELLE'S 41669 PLACE WOM ENS Winchester Rd., BREAST CANCER Temecula, CA RESOURCE 92590 CENTER 17 NATIONAL PO BOX 1562, CHARITY LEAGUE Temecula, CA (NCL) MURRIETA- 92592 TEMECULA CHAPTER Kim Gerrish Jennifer Flanagan SUB- I COMMITTEE RECOM- MENDATIOIA $ 5,000 CANCER SUPPORT SERVICES. Providing $5,000 Temecula residents facing cancer with free resources including early detection, patient navigation. MP will spend funding on supplies for support group/class (such as art therapy, cooking classes, yoga, caregiver grief group), temporary financial assistance, transportation to medical appointments, and MRI & Lymphedema supplies not covered by insurance. $ 3,800 PHILANTHROPY SUPPORT. Jacob's House (plants, rocks, fertilizers, succulents; food & meal preparation & packaging); Backpacks for Change to provide to law enforcement and first responders backpacks filled with essentials on hand for children rescued from human trafficking (toiletry items, bags, tissue, small games and blankets); Rotary Club/Project Touch (blankets). $3,500 ANNUAL CSF 01 r-I Of 4 N O O O 00 ri rn c-I o N 0 0 0 LPL L}L L}L 5,000 4,784 5,000 Didn't 0 Didn't Apply Apply 0:e M O r1 N r-I N N N O O O O N N N N 00 d, o 0 0 0 0 L}L L}L L}L L}L Didn't Didn't Didn't Didn't Apply I A ply I A ply I Apply Didn't Didn't Didn't Didn't Apply I A ply I A ply I Apply Legend: "0" = Applied and Declined 8 COMMUNITY SERVICE FUNDING (CSF) GRANT PROGRAM Account No. 001-101-999-5267 18 NATIONAL PO Box 891381, Jennifer $ CHARITY LEAGUE Temecula CA Nguyen (NCL) TEMECULA 92598 CHAPTER RANCHO DAMACITAS / THESSALONIKA FAMILY SERVICES 38950 Mesa Rd, Femecula, CA 32952 / P.O. 3OX 890326, FEMECULA, CA a2589 5,000 PREVENTING PERIOD POVERTY - Funding will supply ROSE AGAIN FOUNDATION with 100 bags filled with 3 month of feminine needs supplies for Temecula foster girls. Funding will purchase totes, deodorants, tampons, feminine wipes, hand sanitizers, travel - sized facial tissue, feminine pads, panty liners, notecards, and period tracker sheets. EMPOWERMENT VILLAGE life skills program for single mothers in a five - home residential campus serving struggling single mothers and young children. Funding will be used to purchase program supplies, class supplies, food, and utility costs for the homes on campus. SUB- I COMMITTEE RECOM- MENDATIOIA $2,500 ANNUAL CSF COUNCIL CSF CDBG M O N ri CV CV N Ol r-I O N ri N M ri O N N O O O O O O O O O O 00 r-1 of -I o N 00 -1 d, 0 -1 CV 00 d, o r1 -i c-I N N O o O O O O O O O o I LPL L}L L.LL L.LL U_ L}L L.LL L}L L}L L.LL 5,000 0 4,800 Didn't Didn't Didn't Didn't Didn't Didn't Didn't Apply Apply Apply Apply Apply Apply Apply 5,000 4,784 5,000 Didn't Didn't Didn't Didn't Didn't Didn't Didn't Apply Apply Apply Apply Apply Apply Apply Legend: "0" = Applied and Declined 9 COMMUNITY SERVICE FUNDING (CSF) GRANT PROGRAM Account No. 001-101-999-5267 THERAPEUTIC HORSEMANSHIP PROGRAM 21 IROSE AGAIN FOUNDATION Bonsall, CA 92003 32039 Corte Sparkman, Temecula, CA 92592 Huber Kristen Hufford PROGRAM for Temecula disab low-income students and adult Temecula to receive physical/r support through equine -assist( activities. Funding would be ar 2/3 of the cost of lesson fees. - remaining 1/3 of the cost will k provided through donors, & fundraising campaigns/events; covers operational expenses b lesson fees. $ 5,000 KIDS SOAR PROGRAMS. Includ emergency placement gifting v foster child arrives to a new fo home including new clothing, basic needs, school supplies, sl needs, tutoring, and grocery gi ANNUAL CSF COUNCIL CSF CDBG I 01 SUB- rl O N 01 O N Ol O fV N O • COMMITTEE O O O O O I O O O O 00 RECOM- o M 0 o 0 00 0 rn 0 o o 00 I o rn 0 o 0 rH 0 N 11 MENDATIO } N } N } N N N N N N N } L.L LL L.L L.L LL LL L.L LL LL L.L ,SHIP $0 Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't ed or Apply Apply Apply Apply Apply Apply Apply Apply Apply Apply :s in rental �d plied to "he )e funding 2yond �s $5,000 5,000 4,784 5,000 3,500 2,500 750 Didn't Didn't Didn't Didn't ✓hen a Apply Apply Apply Apply 3ter hoes, )ecial ft cards. Legend: "0" = Applied and Declined 10 122 COMMUNITY SERVICE FUNDING (CSF) GRANT PROGRAM Account No. 001-101-999-5267 COMMUNITY DEVELOPMENT CENTER Temecula, CA 92592 23 'ROTARY CLUB OF PO BOX 64, TEMECULA Temecula, CA 1 92563 24 ISAFE FAMILY '28910 PUJOL JUSTICE CENTERS STREET ,TEMECULA, CA 92590 Cherise Manning Janelle Milburn women in Temecula to take control of their mental health. The funding will be used to secure the venue (rental$1,000) AV rental ($95), supplies & conference materials ($400) including pens, journals, resource booklets. $ 5,000 1 FOOD BASEKETS FOR LOW INCOME STUDENTS & SENIORS. Funds used will provide food baskets for low income seniors (served monthly) and 250 students/families identified by TVUSD served twice during the cold weather months of November and December. $ 5,000 SAFE EMERGENCY AND BASIC NEEDS is a stability program for individuals and families that have been impacted from violence. Grant funding will supply victims of abuse with basic needs such as shelter, clothing, food and transportation via gift cards and safety & crisis services. SL COMP REC MEND t $5, $ 5, ANNUAL CSF COUNCIL CSF CDBG I IB_ O N 01 O N Ol O N N AITTEE M 0 000 r-1 N1 _ c-I 0 N 00 c-I d, 0 c-I N 00 d, 0 rH .--I c-I N N 0 0 0 0 0 0 0 0 0 0 I ATIO LL LL LL LL LL LL LL LL LL LL 0 Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't Apply Apply Apply Apply Apply Apply Apply Apply Apply Apply D00 5,000 4,784 5,000 Didn't Didn't Didn't Didn't Didn't Didn't Didn't Apply Apply Apply Apply Apply Apply Apply D00 4,784 5,000 5,000 Didn't Didn't Didn't 5,583 5,538 5,491 6,969.61 Apply Apply Apply Legend: "0" = Applied and Declined 11 COMMUNITY SERVICE FUNDING (CSF) GRANT PROGRAM Account No. 001-101-999-5267 25 SIERRA CLUB, SANTA MARGARITA GROUP PO BOX 1708, Wildomar, CA 92595 26 SPECIAL 41880 KALMIA OLYMPICS SO CA STREET #155 INC (INLAND MURRIETA, CA EMPIRE) '92562 Caren Hanson Abbey Leffler $ 5,000 POLLINATOR GARDEN IN W CREEK PARK. Funding will b transform the area into an E and inspirational experience visitors with signs to show r plants and educate about r a water feature to attract p bench, and a pocket to holc information about installin€ plant gardens. NOTE: City \& group to possibly provide d, planting material for native demonstration plant garder NATIONAL GROUP REVIEWI APPLICATION $ 5,000 TEMECULA VALLEY GOLF PF Grant funds will be used to facility rental, green fees, cc uniforms, golf balls, and ad( equipment (bags, tees, club etc.). ANNUAL CSF COUNCIL CSF CDBG I 01 SUB- .� O N 01 O N Ol O fV N • COMMITTEE 00 RECOM- 0 rn 0 o 0 00 0 rn 0 o o 00 I 0 rn 0 o 0 rH 0 N MENDATIO } [V } N } N >- N >- (V � N N N (V } L.L LL LL L.L LL LL L.L LL LL L.L INCHESTER $2,500 Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't 2 used to Apply Apply Apply Apply Apply Apply Apply Apply Apply Apply educational for park iative ollinators, DIlinators, a native orking with ?sign and i. NOTE: NG ,OGRAM - $2,500 2,500 2,393 4,275 Didn't Didn't Didn't Didn't Didn't Didn't Didn't cover Apply Apply Apply Apply Apply Apply Apply )ach fitional golf s, gloves, Legend: "0" = Applied and Declined 12 COMMUNITY SERVICE FUNDING (CSF) GRANT PROGRAM Account No. 001-101-999-5267 27 TEMECULA MALLEY ART LEAG U E 28 ITEMECULA VALLEY GARDEN CLUB P.O. BOX 631,-MARILYN $ 5,000 FINE ART CLASSES. Grant funds TEMECULA, CA LATIMER used to equip and purchase art 92590 supplies, and venue rent, equipr repairs, for teaching art workshi Temecula student artists, and especially helping those student cannot afford supplies. PO BOX 1526 Judy $ 1,500 NATIVE PLANT DEMONSTRATIO Temecula, CA Sunderma GARDEN AT SAM HICKS MONUI` 92593-1526 / nn PARK. Funding will help buy gen 31492 CORTE information sign (—$1,200) 40 +y SALINAS shrubs that require little water/ TEMECULA, CA fertilizer/little maintenance (—$: 92592 and ID with info sign & QR code (—$400). RE: COST vs. REQUEST: will contribute toward costs ove requested $1,500 amount. NOT woming wim group to possibly I design and planting material for demonstration plant garden. ANNUAL CSF COUNCIL CSF CDBG I SUB- rl O N 01 O N O 1 O rV N O COMMITTEE O O O O O I O O O O 11� 00 RECOM- 0 M 0 o 0 00 0 rn 0 o 0 00 I 0 rn 0 o 0 rH 0 N MENDATIO } N } N } N >_ N >_ (V >_ N >_ N >_ N >_ (V } L.L LL L.L L.L LL L.L L.L LL LL L.L Nill be $0 0 959 Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't Apply Apply Apply Apply Apply Apply Apply Apply nent, )ps to s who $1,500 Didn't Didn't 0 Didn't Didn't Didn't Didn't Didn't Didn't Didn't /TENT Apply Apply Apply Apply Apply Apply Apply Apply Apply eral 10 ►60), TVGC r E: City )rovide native Legend: "0" = Applied and Declined 13 COMMUNITY SERVICE FUNDING (CSF) GRANT PROGRAM Account No. 001-101-999-5267 29 ITEMECULA VALLEY ROSE SOCIETY 30 ITEMECULA VALLEY VFW POST 4089 PO BOX 890367 Rebecca $ 5,000 PEACE FRIENDSHIP GARDEN AT ROSE Temecula, CA Weersing HAVEN HERITAGE GARDEN. Display 6 92589-0367 Peace Poles, one at each entrance, with 8 languages (spoken in Temecula) on each pole with a different message on each pole. Visit www.worldpeace.org to see peace poles and peace message. Will use the funds to purchase the poles, drainage pipe and pop-up drains, and shade rupture (such as Shade Pergola). r28075 DIAZ RD Brian $ 5,000 TEMECULA, CA Itschner 92590 VETERANS SERVICES OUTREACH. Help Veterans/Service Members/ Gold Star Families with rent, utilities, funeral arrangements and provide Thanksgiving turkeys and meals. 14 ANNUAL CSF COUNCIL CSF CDBG I SUB- o 0 0 0 0 o o 0 0 0 OMMITTEE N N N I N N N N N N N RECOM- 00 o of 0 o 0 00 d, 0 00 d, o � 0 0 0 0 0 0 0 1ENDATIO N LL [V N LL N N (V N N N (V U_ $0 Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't Apply Apply Apply Apply Apply Apply Apply Apply Apply Apply $5,000 Didn't 4,784 Didn't Didn't Didn't 5,000 Didn't Didn't Didn't Didn't Apply Apply Apply Apply Apply Apply Apply Apply Legend: "0" = Applied and Declined 14 COMMUNITY SERVICE FUNDING (CSF) GRANT PROGRAM Account No. 001-101-999-5267 31 THE 32 27262 VIA EMPOWERMENT INDUSTRIA CENTER TEMECULA, CA 92590 VLADA'S SEEDS OF LIFE 41725 Avenida Ortega, Temecula, CA 92592 Teresse $ 5,000 BREAKTHROUGH STUDENT & FAMILY Lewis ASSISTANCE PROGRAM. Evidenced based, comprehensive strengths and resilience building program for youth and families within Temecula. Grant funds will be used for participant fees, program supplies, Strength Program curriculum, and facility expenses; 90- minute wellness sessions for families. Program is anticipated to help 50 Temecula residents. Vlada $ 5,000 GROWING STRONG project provides Vladic free homemade meals & coaching to foster youths that have "aged" out of the system (former foster youth), underprivileged families & struggling single moms. Funds will purchase food/groceries, food preparation & storage supplies, tools, equipment & class materials to help approx. 300 Temecula residents. ANNUAL CSF COUNCIL CSF CDBG I 01 SUB- .� O N 01 O N Ol O N N 0 COMMITTEE 0 0 0 0 0 0 0 0 0 00 RECOM- 0 0, 0 0 0 00 0 0 0 0 00 o rH 0 0 0 0 N MENDATIO } N } N } N N N N N N (V } LL LL LL L.L LL LL LL LL LL LL $0 Didn't 0 5,000 Did Did Did Didn't Didn't Didn't Didn't Apply not not not Apply Apply Apply Apply apply apply apply $0 Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't Didn't Apply Apply Apply Apply Apply Apply Apply Apply Apply Apply Legend: "0" = Applied and Declined 15 COMMUNITY SERVICE FUNDING (CSF) GRANT PROGRAM Account No. 001-101-999-5267 33 WAVES PROJECT 42225 Barbara $ INC. Remington Ave. Rubin #A18, Temecula, CA 92590 I TOTAL 5,000 SCUBA TRAINING FOR WOUNDED VETERANS. Funding will provide training material, boat diving fees, boat transportation, parking, trained & certified dive professionals (instructors & assistants), meals & lodging for overnight & week-long training trips, SCUBA equipment & maintenance. 151.800 SUB- I COMMITTEE RECOM- 0 MENDATIO MOM $5,000 100,000 ANNUAL CSF r-1 ON N O O O 00 r-1 rn r-1 o N O N O N o N LLL L}L I L}L 5,0001 4,7841 5,000 COUNCIL CSF I F_ CDBG Ql O 1 r-I I Ol O 1-1 N r1 N N r1 rV N N O O O O I O I O O N N N N N N I N 00 Ql O 00 Ql O N O O O O O O O N N N N N N N I L}L L}L L}L L}L L}L L}L L}L Didn't Didn't Didn't Didn't Didn't Didn't Didn't Apply Apply Apply Apply Apply Apply Apply Legend: "0" = Applied and Declined 16 FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # il AMERICAN PATRIOT MUSIC PROJECT (formerly Phoenix Patriot Foundation) CITY OF TEM'ECUI[ A FISCAL YEAR 2020 - 2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 PROJECT/PROGRAM INFORMATION Amount Requested: $ 5000.00 MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: Veterans/First Responders Guitar Building Workshop Physical Address of Project/Program: TBD Temecula INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS Start Date: 6/23/202d End Date: 6/25/2024 If Grant is Awarded, Make Check Payable to: American Patriot MUSIC Project Mailing Address: Murrieta, CA 92562 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: American Patriot Music Project Website: americanpatriotmusic.org Number of Paid Staff: Year Organization Founded: 2019 1 Number of Volunteers: 35 Contact Name: Antonio Y Vlllegas Jr. Title/Position: Executive Director Contact Person's Email Address: tony@americanpatriotmusic.org Telephone: Geographic Area(s) the Organization Serves: Temecula, Murrieta & Southern California Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes 0 Date of Incorporation as a Nonprofit: 10/01/2019 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Number: Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: htt :lla sirs. ovla /eas/ 2. Attach State Entity Status Letter using this link: htt s:11WWW.ftb.ca. ov/online/self serve entity status letter/index.as 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info a o W(P charity found on this State Registry's Search Tool: htt /Irct.do°.ca, ov/Verification/Web/Sea s x f =Y CITY MANAGER'S City of Temecula Community Service Funding Grant APPLICATION ()FFICrPage 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No [K Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ❑ Yes [0 IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors 0 Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: To provide therapuetic music programs for injuries such as PTSD, MST, TBI or physical injuries to Veterans and/or First Responders. In the case of Veterans, related to delpoyment to a combat zone or actual combat, For First Responders injuries related to working conditions. FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑ Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY. GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP CSF 2019/2020 $4,784.00 Nov 2019 CSF 2018/2019 $ 5000.00 Jan 2019 $ $ $ $ City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. Veterans Guitar Building Workshop teaches Veterans and/or First Responders how to build their own electric guitars over a 3 day period. The skills learned include Carpentry, electronics, design, math applications and all elements required to complete the guitar. These skills in turn can be utilized in the community workplace. , which in turn increases the higher -ability. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. Guitar kits ($250.00 ea) for a 10 person project, the Kits and shipping costs= $700.00. Three instructors = $3,300.00 (4 day stay as they are traveling from Sinclair, Ohio and Lynwood, Wa). Food costs = $1020.00, we will continue to use the services of Creative Catering (local Temecula business) for food during the 4 day period. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. The skills that will be taught to each participant are skills that many times they did not realize they had. These new skillsets create new opportunities in their employment search. Further, the camaraderie that is formed by the participants creates an environment that allows for open discussions about the disabilities that they are working through. Estimate 10 Participants and as many volunteers. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. No fees for the participants, each will build and take home a completed electric guitar. Each (at no cost to the program) also receives a guitar case, a tuner & minin amp. APMP can provide guitar lessons (at no cost to the workshop grant). Expenses will cover the guitar kits, food, misc expenses (wood oils, paint, solder, etc.) and the trainer's expenses. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) Cash contributed to Project/Program by the Applicant Organization Other grants or funding already awarded for Project/Program, if any In -Kind match amount or volunteer credit hours estimated amount VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program (This amount is ineligible to be funded by City's Grant; however please include.) Equipment Expense For Project/Program Food Expense For Project/Program Marketing Expense For Project/Program Supplies Expense For Project/Program Facilities/Rent Expense For Project/Program Other Expense For Project/Program REVENUES f EXPENSES $ 5000.00 $1000.00 $p $ 2000.00 !i1 $3200.00 $1020.00 $200.00 $500.00 $Q $3300.00 TOTAL BUDGET FOR PROJECT/PROGRAM' $7000.00 I $8220.00 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 PREVIOUS* FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020, AS SHOWN BELOW. IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19/20 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2019-2020 (last L� year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and June 30.2020 December 31, 2020. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: Thursday, December 31, 2020. EXPENDITURE REPORT due on or before Friday, September 11, 202o Thursday, December 31, 2020 1. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF panization: Name of Project/Program: imount of Grant Fund Awarded: E Name of company E �, on Receipt/invoice Date (Mo/Day/Yr) a E on Receipt/invoice Must be dated on or between July 1, 2019 - December 31, 2020 EXPENDITURE TOTAL Month + Year Grant Received from City: Describe... Amount (1) what the expenditure was of (2) purpose of the expenditure Expenditure MUST support Project/Program description on Application + Award Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City City of Temecula Community Service Funding Grant APPLICATION Explain ... how the expenditure specifically benefitted Temecula residents If names/addresses of Temecula beneficiaries are available, please attach. Page 5 of 7 FISCAL YEAR (FY) 2020-2021 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant in FY 2020-2021 by the City of Temecula, then this information is not due until September 13, 2021 If your Organization is awarded a Community Service Funding Grant in Fiscal Year 2020-2021 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2020, and June 30, 2021. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2020-2021 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 13, 2021. EXPENDITURE REPORT due on or before September 13, 2021 5. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 6. Fill out this table (include additional copies if needed to explain all expenditures) 7. Attach Receipts/Invoices (in the same order as listed in this table) 8. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization:-______- Name of Project/Program: Amount of Grant Fund Awarded: $ Month + Year Grant Received from City: Describe... Explain ... Name of Company Date (Mo/pay/Yr) Amount (1) what the expenditure was how the expenditure E on Receipt/invoice on ReceipVlnvoice of (2) purpose of the expenditure specifically benefitted Must be dated on or Expenditure Temecul�l residents aZ between July 1, 2020 - June 30, 2021 MUST support Project/Program 1 description on Application + Award Letter If names/addresses of Temecula beneficiaries are available, ease attach, 1 $ 2 $ 3 $ 4 $ 5 $ 6 $ 7 $ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City City of Temecula Community Service Funding Grant APPLICATION Page 6 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: American Patriot Music Project MAILING ADDRESS: PHONE: Xp-� EMAIL: Cony@amerlcanpatriotmuslc.org Murrieta, CA 926=562 PRESIDENT / AUTHOR] SIGNATURE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: OFFICER: Antonio Y Villegas, Jr. Executive Dir Title DATE: 08/24/2020 (Month, Day, Year) Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 Stacey.Brown@TemeculaCA.gov (951) 694-6413 City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 Q HELPB Home > Tax Exempt Organization Search > American Patriot Music Project < Back to Search Results American Patriot Music Project EIN: I Temecula, CA, United States Publication 78 Data o MENU Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Page Last Reviewed or Updated. 6-Sept-2019 @If RS Our Agency About IRS P► Share 1 9 Print 930@inaIQ Know Your Rights Resolve an Issue Other Languages Related Sites Taxpayer Bill of Respond to a Espanol U.S. Treasury Rights Notice Q HELPB Home > Tax -Exempt organization Search > American Patriot Music Project <Back to Search Results American Patriot Music Project EIN: I Temecula, CA, United States Publication 78 Data o MENU Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Page Last Reviewed or Updated. 6-Sept-2019 QI RS Our Agency About I RS L?* Share $ Print 910@ina ra Know Your Rights Resolve an Issue Other Languages Related Sites Taxpayer Bill of Respond to a Espanol U.S. Treasury Rights Notice FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 2 ANIMAL FRIENDS OF THE VALLEYS CrrY OF'TEMECUTA FISCAL YEAR 2020 M 2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEP I EMBER 14, 2020 I PROJECT/PROGRAM INFORMATION Amount Requested: $ 5,000 Project/Program Title: World Spay MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Start Date: 02/23/2021 End Date: 02123/2021 Physical Address of Project/Program: INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Animal Friends of the Valleys Mailing Address: 33751 Mission Trail Rd. Wildomar, Ca. 92595 ORGANIZATION AND GEOGRAPHIC AREA SERVED I Name of Applicant Organization: Animal Friends of the Valleys Year Organization Founded: 1987 Website: animalfriendsofthevalleys.com Number of Paid Staff: 84 Number of Volunteers: 3345 Contact Name: Beth Soltysiak Title/Position: Dir. of Development Contact Person's Email Address:balh@animalrriandsoftMvalleys.com Telephone 951-805-6239 Geographic Area(s) the Organization Serves: Temecula, Murdela, Wildomar, Lake Elsinore, Canyon Lake, Menifee and surrounding rural county areas. Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Number: Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: http:llapps.irs rq_ov/a pa /eos/ 2. Attach State Entity Status Letter using this link: https /A&ww.ftb.ca.govfonlinelself serve entity s!Atus letter/lndex.asp 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htto://rct.dol.ca.govNerificationMel1/Search.asox?facility=Y City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No [#] Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ❑K Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee 0 , Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: Animal Friends of the Valleys is dedicated to promoting humane care of animals through education and proactive animal service programs. We are committed to preventing the suffering of animals and to help end pet overpopulation In the communities we serve. Through community education and Invpolvement AFV will strive to rind a loving and forever home far ell adoptable pets. FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑ Yes [I IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP Council member community grant Stew stewart AMOUNT I MONTH + YEAR I NAME OF CITY GRANT FUNDING RECEIVED` OR SPONSORSHIP $ 500 19/23/20191 animal medical fund Council member commuity grant MaryAnn Edwards 1 $ 500 spay/neuter grant CS F Grant $ 4,784.00 09/23/219 spay/neuter grant $ $ City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 . GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BYTHE CITYTO SUPPORTTHE PROJECT/PROGRAM AS DESCRIBED HERE. 1). Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. COMPLAINCE REPORT ON APPLICATION FOR DETAILS. World Spay/Neuter Day is on February 23, 2021. Every Year Animal Friends of the Valleys hosts Spay/Neuter Free Voucher days for those residents residing within our jurisdiction. These vouchers are good for free spay/neuter surgery at the AFV clinic. Animal Friends of the Valleys has a Spay/neuter day budget of $20,000. Once that is met vouchers are stopped given out. There are lines a block long for those residents needing financial assistance to alter their pets. Each city typically gives'money for those residents residing in each City proper after the $20,00 is allocated. The average cost to spay a pet is $100 and to neuter is $80.00. During this unprecedented time of COVID we are expecting the need to be even greater because of those facing financial hardships. Because of COVID most families will put off altering their pet because of the cost. A grant of $5,000 from the City of Temecula will help over 50 more families alter their pet which will keep at least 300 puppies from entering the shelter from Temecula. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. If awarded the $5,000 Animal Friends of the Valleys would allocate that money to Temecula residents only. All those applying for a free voucher have to show proof of residency with a current driver's license and a utility bill. Not only would that money offset the cost of altering their pet it also covers a free micro -chip. 85% of all animals that become lost without a micro -chip never find their way back home. It is so important to have your pet micro -chipped to prevent it from entering the shelter. It costs AFV $628 an hour to care, feed and house over 200 pets at the shelter. This number can be significantly reduced if the pets are altered and have a microchip. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. The additional $5,000 from the City of Temecula would go directly to Temecula residents. AFV has been actively working with each city to increase the number of families having the ability to Spay/Neuter their pets during World Spay/Neuter Day. The vouchers are given out on a first come basis and when we meet our projected budget we stop handing out the free vouchers. There are many more families from each city we would like to help. With Temecula's Community Service Grant AFV will be able to assist those extra 50 families exclusively from Temecula to have the ability to later and micro -chip their pet. During the annual Spay/Neuter Voucher Day held at the shelter located at 33751 Mission Trail Road Wildomar, Ca. there hundreds of animal owners waiting to get heir voucher. We turn away many from each city because the funding is limited. Your grant will help AFV expand its reach of making sure small puppies do not end up in the shelter. 4. SUMMARY STATEMENT: Summarize answers 1- 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. The funding will go directly to an estimated 50 families from Temecula to help offset the cost to Spay/Neuter and micro -chip their loving pet. Many families especially this year with the Pandemic will find it hard to allocate funds to Spay/neuter and micro -chip their pet. We are asking all cities to help on World Spay Day to assist their own residents. 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) Cash contributed to Project/Program by the Applicant Organization Other grants or funding already awarded for Project/Program, if any In -Kind match amount or volunteer credit hours estimated amount VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program (This amount is ineligible to be funded by City's Grant; however please include.) REVENUES I EXPENSES $5000 $ 20,000 $5000 $o $ 3225.00 Equipment Expense For Project/Program [$678.25 Food Expense For Project/Program $75.00 Marketing Expense For Project/Program $250.00 Supplies Expense For Project/Program $455.95 Facilities/Rent Expense For Project/Program $0 Other Expense For Project/Program $249.00 TOTAL BUDGET FOR PROJECT/PROGRAM $30,000 $4,933.15 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 SIGNATURE PAGE 1 The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. ■ Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: ff MAILING ADDRESS:00 �I M"1��U PHONE:(_) 641EMAIL: `r at 1 Vioqa, PRESIDENT / AUTHORIZED OFFICER: SIGNA IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Print Name +r^, Title n 1 DATE: 9/14( A-� (Month, Day, Year) Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 Stacey.Brown@TemeculaCA.gov (951) 694-6413 City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 INTERNAL REVENUE SERVICE DISTRICT DIRECTOR, 2 CUPANIA CIRCLE MOPTTEREY PARK, CA 91754 Date : JIIN [ 1003 LAKE ELSINORE ANIMAL FRIENDS PO BOX 1143 LAKE ELSINORE, CA 92-531-1143 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: Contact- JOANNA YAWNEY Contact Tele hone Number: Our Letter Dated: January 28, 1993 Addendum Applies: No This modifies our letter of the above date in which we stated that you would be treated as an organization that is not a private foundation until the expiration of your advance ruling period. Your exempt status under section 501(a) of the Internal Revenue Code as an organization described in section 5o1(c)(3) is still in effect. Based on th- information you submitted, we have determined that you are not a private foundation within the meaning of section 509(a) of the Code because you are an organization of the type described in section 509(a)�11) and 170(b)(1)(A)(vii Grantors and contributors may rely on i "'tlination unless the Internal Revenue Service publishes norjce p l+ contrary, However, if you lose your section 509(a)(1) status, a{g�� } 0 or contributor may not rely on this determination if he or she was ii�`•pa'rt responsible for, or was aware of, the act or failure to act, or the substantial or material change on the part the organization that resulted in your loss of such status, or if he or she acquired knowledge that the Internal Revenue Service had given notice that vcu would no longer be classified as a section 5o9(a)(1) organization. As of January 1, 1984, you are liable for taxes under the Federal Tnsurance Contributions Act (social security taxes) on remuneration of $l0o or more you pay to each of your employees during a calendar year. You art - not liable for the Lax imposed under the Federal Unemployment Tax. Act (FU1_L.' You are required to file Form 990 only rf your gross receipts each year are normally more than $25,04f1. For guidance in determining whether your gross recelPre are "normally" more than $25,00o, see the instructions for Form 990. If a return is t'equired, it must be filed by the 15th day of the fifth month after the end of your annual accounting period. A penalty of $10 a day is charged when a return is filed late, unless there is reasonable cause fodElaY r ,eMaxmum tl: penalty charged cannot exceed $5,000 cr 5 perce:ic. rat Your gross receipts for the ),ear, whichever is less. This pena].ey (uj,r a1c 6e charged if :x retrarn is not complete. so please be sure your return is _1jmjllex? be:ora gnu file it. If we haVe indicated in the heading of th-'s letter that an addendum ap);lies, the addendum enclosed is an integral (part of this letter. Letter 1050(DO/CG) ANIMAL FRIENDS OF THE VALLEY; WORLD SPAY DAY Tuesday, February 23, 2021 Join AFV as we Celebrate World Spay Day by providing Vouchers for FREE Spay or Neuter* valid at our Low Cost Spay/Neuter Clinic! Voucher distribution begins at Animal Friends of the Valleys shelter at 33751 Mission Trail in Wildomar from 8:00am to 12:00pm on 2/23/2021 Let's work together to keep our pets out of our shelters and in their forever loving homes! *Must reside within City limits of Canyon Lake, Lake Elsinore, Menifee, Murrieta, Temecula, or Wildomar. RESIDENTS OF UNINCORPORATED AREAS OF RIVERSIDE COUNTY WILL NOT QUALIFY FOR THIS PROMOTION. Proof of residency required (le: driver's license, utility bill, etc). Available to residents for personal pets only. DO NOT BRING YOUR PET TO THIS EVENT. Voucher will cover up to $100 for dogs and $60 for cats. Limit 2 per household. Vouchers are valid only at AFV's Low Cost Spay/Neuter Clinic located at 29001 Bastron Ave., Lake Elsinore, CA 92530. Vouchers are not transferable. Offer valid while supplies last. z ANIMAL FRIENDS OF THE VALLEYS 33751 Mission Trail Wildomar, CA 92595 Visit animalfriendsofthevalleys,comispa)l-neuter for more info about our spay/neuter services[ FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 3 ASSISTANCE LEAGUE OF TEMECULA CITY OF TEMECUI[ A FISCAL YEAR 2020 M 2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 Amount Requested: $ 5,000 PROJECT/PROGRAM INFORMATION MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: Operation School Bell - Shoes Start Date: 11 /20 End Date: 12/20 Physical Address of Project/Program: 28720 Via Montezuma, Temecula, CA 92590 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Assistance League of Temecula Valley Mailing Address: 28720 Via Montezuma Temecula, CA 92590 ORGANIZATION AND GEOGRAPHIC AREA SERVED Assistance League of Name of Applicant Organization: Temecula Valley Webslte: lnps://www.assistanGeleague.orght- n:aridF.- mil eyi Contact Name: Dorcas Shaktman Contact Person's Email Address: Year Organization Founded: 1989 Number of Paid Staff: NA Number of Volunteers: 170 Title/Position: Grants Chairman Telephone: Geographic Area(s) the Organization Serves: Southwest Riverside County Economic Development Region Geographic Area(s) the Project/Program Serves: City of Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ■❑ Date of Incorporation as a Nonprofit: No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Number: - Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows. 1. Attach IRS Deductibility Status using this link: http://apps.irs.gov/a leosl 2. Attach State Entity Status Letter using this link: httos://www.ftb,ca.gov/online/self sere entity status letter/index.asn 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info fgWym charity found on this State Registry's Search Tool: htt i rct.do.ca. ov/Verificationi�Veb/Search.as x?facilit =Y 2020 CITY MANAGED' City of Temecula Community Service Funding Grant APPLICATION OFFICEPage of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No 0 Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No 0 Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee 0 Board of Directors ❑■ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: Assistance League of Temecula Valley is committed to transforming the lives of families and in strengthening the communities that we serve. The vision and values of our member volunteers combine to develop and provide viable programs that address essential basic needs and help our families flourish. FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑ Yes [M IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP Operation School Bell $ 5,345 1/2018 CDBG Operation Foster Youth $ 5,000 2/2018 CSF Operation School Bell $ 7,961 11/2018 CDBG Operation SHADES $ 5,000 2/2019 CSF Operation SHADES $ 4,784 1/2020 CSF Operation School Bell $ 5,538 1/2020 CDBG City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. Assistance League of Temecula Valley's Operation School Bell program is committed to "changing lives" of students and families in our service area. If awarded, the Temecula grant funding will be used to provide new shoes to approximately 150 LCAP (Local Control and Accountability Plan) students in four Temecula Unified School District (TVUSD) high schools. Each identified student will be provided with a $35 gift card to be used at Famous Footwear retail stores. LCAP counselors work with assigned students, individually, to impact and improve student performance and outcomes, including increased graduation rates, requirement completion, improved attendance, as well as reduction in truancy and chronic absenteeism. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. If awarded, Assistance League will spend the grant funds for the purchase of Famous Footwear gift cards to to be provided to TVUSD LCAP students in helping with the commitment of "changing lives". Gift cards will be purchased directly from the Famous Footwear corporate office allowing Assistance League to take ad- vantage of the bulk discount offered through National Assistance League. Gift cards may only be used to buy shoes at Famous Footwear retail stores, ensuring that the purchases will be for shoes only. Having appropriate clothing and shoes, especially for high school students, is proven to boost the confidence and self-esteem of students and have a positive impact on school attendance and peer socialization. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. Grant funding will specifically benefit Temecula residents by "changing lives" of approximately 150 TVUSD LCAP students. The unique structure of the TVUSD LCAP counselor program supports the opportunity to focus support specifically where it is needed. LCAP students includes those with low grades and also focuses on at risk students, foster youth, socio-economically disadvantaged and English language learners. The LCAP counselor serves as a liaison between the students, parents, programs, staff and resources of the school. Assistance League volunteers are assigned to, work with each of the four TVUSD high school's LCAP counselors for student selection and distribution of gift cards. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: 150 Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 5 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. Grant funds will be used to purchase approximately 150, $35 gift cards from Famous Footwear to be provided to students (low-income, at -risk youth) identified by LCAP counselors at four high schools in the Temecula Valley Unified School District. Students will use the gift cards to purchase new shoes. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) i Cash contributed to Project/Program by the Applicant Organization Other grants or funding already awarded for Project/Program, if any In -Kind match amount or volunteer credit hours estimated amount VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM REVENUES I EXPENSES $ 5,000 $ 20,000 $ 1,000 Staffing Expense for Project/Program (In -kind) $ 1,000 (This amount is ineligible to be funded by City's Grant; however please include.) Equipment Expense For Project/Program $ Food Expense For Project/Program $ Marketing Expense For Project/Program $ Supplies Expense For Project/Program $ Facilities/Rent Expense For Project/Program $ Other Expense For Project/Program (Purchase of gift cards) $ 25,000 TOTAL BUDGET FOR PROJECT/PROGRAM $ 26,000 $ 26,000 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant in FY 2019-2020 by the City of Temecula, then this information is not due until Friday,-SeptemWr 11,-2020 Thursday, December 31 2020 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and Jane-34--2o2o-December 313 2020. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: F4day, sep{ember4 6-202 Thursday, December 31 2020 EXPENDITURE REPORT due on or before Fr-isay, saptember-�2o2o-Thursday. December 31, 2020 1. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitt—I frnrn this program: (approximate number of beneficiaries if you don't have a precise number): 175 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Assistance League of Temecula Valley Name of Project/Program: SHADES Amount of Grant Fund Awarded: $ 4,784 Month + Year Grant Received from City: 12/2019 c I Name of Company t- on Receipt/invoice a aZ 4imprint Date (Mo/Day/Yr) on Receipt/Invoice Must be dated on or between July 1, 2019 - December 31, 2020 11/4/2019 2 1 Amazon 1 11/17/2019 3 I Amazon I 10/15/2019 4 1 Omega Print 112/11/19 5 f Promenade at Temecula , 11/14/2019 7 Describe... Amount (1) what the expenditure was of (2) purpose of the expenditure Expenditure MUST support Project/Program description on Application + Award Letter $ 1,160.95 Classroom and student support supplies for 175 students. 432.00 $ Classroom book -"Why Didn't They Teach Me This In School" $ 1,239.20 $ 1,305.00 Classroom book -"Why Didn't They Teach Me This In School" 100 Personal Finance Conference workbooks -printing $ 1,500.00 60-$25 gift cards to be given to $ $ L EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ 5,637.15 (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City graduating students Explain ... how the expenditure specifically benefitted Temecula residents If namestaddresses of Temecula beneficiaries are available, Provided necessary supplies needed for successful class acilvities. Supplemental Financial Literacy textbook 'or students ongoing reference Supplemental Financial Literacy textbook for student's ongoing reference workbooks designed to with instruction Reward for students full day attendance and participation. SEP 1 12020 OFFICE City of Temecula Community Service Funding Grant Compliance Form 2019-2020 Extended SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME- Assistance League of Temecula Valley MAILING ADDRESS: 28720 Via Montezuma Temecula, CA 92590 PRESIDENT / AUTHORIZED OFFICER: Denise Lanier Print Nayne SIGNATURE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Dorcas Shaktman PHONE: EMAIL President Title DATE: 6 911,146 t�l (Month, Day, Year) Grants Chairman Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions:. Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 Stacey.Brown@TemeculaCA.gov (951) 694-6413 City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/9/2020 ESL ID: Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: _ Entity Name: ASSISTANCE LEAGUE OF TEMECULA VALLEY 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ❑X 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019) Q HELPB MENU Home > Tax Exempt Organization Search > Assistance League Of Temecula Valley <B arch Results Assistance league Of Temecula Valley EIN: Other Names , --, United States Publication 78 Data o Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Copies of Returns (990,990-EZ, 990-PF, 990-T) o Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits. Tax Year 2018 Form 990 Tax Year 2016 Form 990 Page Last Reviewed or Updated: 6-Sept-2019 & Share $ Print FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # BOYS & GIRLS CLUB OF SOUTHWEST COUNTY CITY OF TENMCULA FISCAL YEAR 2020 - 2021 COMMUNR'Y SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 1 4, 2020 I PROJECT/PROGRAM INFORMATION I Amount Requested: $ 5,000 MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: Ultimate STEM/Computer Science Start Date: 10/1/2020 End Date: 6/3=020 Physical Address of Project/Program: Boys & Girls Club Of Southwest County INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Boys & Girls Club of Southwest County Mailing Address: P.O. Box 892349 Temecula, CA 92589 i ORGANIZATION AND GEOGRAPIIIC AREA SERVED Name of Applicant Organization: BGC of Southwest County Year Organization Founded: 1990 Website: www.becswc.org Number of Paid Staff: 30 Number of Volunteers: 150 Contact Name: Shelly Anguiano Figueroa Title/Position: President & CEO Contact Person's Email Address: shellyf@becswc.org Telephone: 951.699.1526 x111 Geographic Area(s) the Organization Serves: Temecula, Murrieta, Lake Elsinore Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: 1990 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Number: - Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: hftp://apps.irs-gov/ar)l)/eosi 2. Attach State Entity Status Letter using this link: httpr :llwww hb.ca aov/online/self serve entity _status letterlindex ,a 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: h ://rct,do .ca. ovNerificationNVeb)Search.aVX2facili_ _ tvzY City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? NO ❑■ Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No 0 Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organizations: Executive Committee W Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION i Briefly describe the organization's mission/goals and objectives: To inspire, enable and support all youth to realize their full potential as successful, responsible and impactful members of the community. I FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑ Yes ® IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT MONTH + YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP Ultimate STEM Program $5,000 CSF 19-20 Before & After School Program $ 5,538 6/2019 CDBG 19-20 After School Transportation Program $ 5,000 12/2018 CSF Grant 18-19 Before & After School Program $ 7,961 9/2018 CDBG Grant 18-19 Before & After School Program $1,500 1/2018 CSF Grant 17-18 After School Program $ 5,000 12/2017 CSF Grant 17-18 City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE, SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. The Ultimate STEM/Computer Science Program will provide significant opportunities to advance STEM education and increase interest in STEM fields for youth. Technology and access to computers for youth is the foundation for this program. Through a variety of activities, youth will participate in web exploration, media production, robotics,coding and more. The program will teach youth the importance of the digital world and ignite their passion for technology. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. An additional eight (8) new computers will be purchased for the Clubhouse to allow for more youth to have access to technology, especially during the COVID-19 pandemic. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. Grant funding for this program will benefit youth members in Temecula by providing access to computers to complete homework and increase their knowledge and experience with technology. It will also help prepare youth for the 21 st Century and the work force. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program.- Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. Community Service Funds provided will be used to purchase eight (8) new computers for the Ultimate STEM/Computer Science Program; the additional computers will allow for more youth to participate in a variety of activities, including web exploration, media production, robotics,coding and more. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM REVENUES FEXPENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) $ 5,000 Cash contributed to Project/Program by the Applicant Organization $13,000 Other grants or funding already awarded for Project/Program, if any $ 5,000 In -Kind match amount orvolunteer credit hours estimated amount $ 0 VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program (This amount is ineligible to be funded by City's Grant; however please include.) $ 15,000 Equipment Expense For Project/Program Food Expense For Project/Program $ 5,000 $ 0 $ 0 Marketing Expense For Project/Program Supplies Expense For Project/Program $ 0 $ 0 Facilities/Rent Expense For Project/Program Other Expense For Project/Program $ 3,000 TOTAL BUDGET FOR PROJECT/PROGRAM $23,000 1$23,000 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date orthis application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Boys & Girls Club of Southwest County MAILING ADDRESS: P'0' Box 892349 PHONE: ( 951.699,1526 x111 EMAIL: shelyf@becswc.org Temecula, CA 92589 PRESIDENT/AUTHORIZED OFFICER: Shelly Anguiano Figueroa, President & CEO Print Name SIGNATURE: DATE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Print Name Title 9/10/2020 (Month, Day, Year) Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 Stacey.Brown@TemeculaCA.gov (951) 694-6413 City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 942657 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/10/2020 ESL ID: - Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: - Entity Name: BOYS & GIRLS CLUBS OF SOUTHWEST COUNTY ® 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ® 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. Q5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to. 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019) F3a S014 S,:,! .„ Entity Status letter Entity Search Summary The following Entity was found. Please click on the'Generate Letter' button to produce the Entity Status Letter for this entity. Entity ID: _ Entity Name: BOYS & GIRLS CLUBS OF SOUTHWEST COUNTY Address: PO BOX 892349 TEMECULA, CA M89-2349 Entity Status: REVIVED Exempt Status: EXEMPT Generate Letter Back Copyright ® 2020 State of Califomia I Privacy Notice 1/1 Q HELPO MENU= Home > TjX ExeMpLorgat!izatlon Search > Boys & Girls Club Of Southwest County <83ack to Search Resin st Boys & Girls Club Of Southwest County EIN: I , --, United States Other Names Publication 78 Data o Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Copies of Returns (990, 990- EZ, 990- P F, 990-T) o Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits. Tax Year 2018 Form 990 Tax Year 2017 Form 990 Tax Year 2016 Form 990 Page Last Reviewed or Updated. 6-Sept 1019 & Share Print FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # BOY SCOUTS OF AMERICA INLAND EMPIRE, CA TAHQUITZ DISTRICT CITY OF TEMECULA FISCAL YEAR 2020 - 2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 Amount Requested: $ Project/Program Title: PROJECT/PROGRAM INFORMATION $4200 Support Temecula Kids MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION 11 /01 /20 6/30/21 Start Date: End Date: Physical Address of Project/Program: Same INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Boy Scouts of America[Tahquitz District Mailing Address: Po Box 893823 Temecula, CA 92589 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization Website: www.ciecbsa.org Contact Name: Tina Roy California In. Emp Council Year Organization Founded: 1910 1 Number of Volunteers: 422 District Director Title/Position: 951-972-2201 Contact Person's Email Address: Telephone: Geographic Area(s) the Organization Serves:. Riverside and San Bernardino Counties Boy Scouts of America Number of Paid Staff: tina roy@scouting org Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ❑■ Date of Incorporation as a Nonprofit: 1910 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Number: Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: htt://a s.irs. ov/a /eos/ 2. Attach State Entity Status Letter using this link: httos://www.ftb.ca.gov/online/self serve entity status lettedindex.as 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htt ://rct.doo-ca. ovNerification/Web/Search.as x?flit ED SEP 0 3 2020 City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 CITY MANAGE; ;, Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No 0 Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ❑ Yes a IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: Eric Levine - Board Member This Application has been authorized by the organization's: Executive Committee ❑■ Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: The mission of the Boy Scouts of America is to prepare young people to make ethical and moral choices over their lifetimes by instilling in them the values of the Scout Oath and Law. FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES — :�= Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No a Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT MONTH + YEAR I NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT FUNDING RECEIVED OR SPONSORSHIP $ $ $ 4 $ City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. The Support Temecula kids program is for boys and girls, in grade K-12. The program is an online learning environment, with interactive games, workshops and events. These events keep kids connected, engaged and interacting with their peers in a "fun with purpose' environment. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. The funds will directly support Scouts here in Temecula whose families have been impacted with lower income and job loss due to COVID-19 by paying registration fees for online events such as virtual camp, merit badge classes, cub scout adventures loops and other related program materials for CAMP CIEC- see attached programs. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. The funds will directly support Scouts here in Temecula whose families have been impacted with lower income and job loss due to COVID-19 by paying registration fees. There are currently 622 Scouts in Temecula in packs, troops and crews. Over 50% have participated in our current programs over the last 4 months. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: �j I Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. The Support Temecula Kids program is designed to enhance and promote social interaction during this stay at home order. This program is providing a safe and proven quality learning environment keeping kids and families safe and connected during this pandemic. The progrE will support over 300 Scouts through a variety of Scouting events. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula $ Community Services Grant (Not to exceed $5,000) —T �� Op Cash contributed to Project/Program by the Applicant Organization $ Other grants or funding already awarded for Project/Program, if any $ In -Kind match amount or volunteer credit hours estimated amount $ $ el VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program (This amount is ineligible to be funded by City's Grant; however please include.) Equipment Expense For Project/Program $ $ Food Expense For Project/Program $ Marketing Expense For Project/Program $ Supplies Expense For Project/Program $ Facilities/Rent Expense For Project/Program $ Other Expense For Project/Program Y $ y��O TOTAL BUDGET FOR PROJECT/PROGRAM I $w $ lz — Citv of Temecula C:nmmiinity GPritino Fiindinn i-ron4 ADDI It- Anrw PREVIOUS* FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020. AS SHOWN BELOW. IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19120 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2019-2020 (last year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and - December 31, 2020. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received frorn the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: Thursday, December 31, 2020. EXPENDITURE REPORT due on or before Fey-f 4� 2020-Thursday, December 31, 2020 1. Demonstrate that the Community Service Funding Grant specifically beneftted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 2. Fill out this table (include additional Copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same Order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - C S F Organization: Name of P ect/P ro) rogram: Amount of Grant Fund Awarded: $ Month + Year Grant Received from City: Date Mo/Da Nr Describe... Explain ... e Name of Company on Recelpt/I vo ce Amount (1) what the expenditure was how the expenditure on Receipt/invoice Must be dated on or of (2) Purpose of the expenditure specifically benefitted between July 1, 2019 - Expenditure Telne. cola residents 9ef 0;•2828 MUST support Project/Program H names1eclttre3a° of Temecula Z December 31, 2020 description on Application + Award Letter benetidades we avallable, easy attach. 1 $ 2 $ 3 $ 4 $ 5 $ 6 $ 7 $ EXPENDITURE TOTAL Nate: Expenditure Total must be equal to $ (or greater then) the 'Amount of Grant Fund Awarded' (abov212Lovided by the Ci City of Temecula Community Service Funding Grant APPLICATION Page 5 of 7 FISCAL YEAR (FY) 2020-2021 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant in FY 2020-2021 by the City of Temecula, then this Information is not due until September 13, 2029 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2020-2021 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2020, and June 30, 2021. In addition, all grant funds must be substantiated with proper back-up documentation, Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved ,purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2020-2021 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receiptslinvoices, must be submitted to the City on or before due date: September 13, 2021. EXPENDITURE REPORT due on or before September 13, 2021 5. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 6. Fill out this table (include additional copies if needed to explain all expenditures) 7. Attach Receipts/invoices (in the same order as listed in this table) 8. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Managers Office - CSF Organization: Name of P ect/P roj rogram: Amount of Grant Fund Awarded: $ Month + Year Grant Received from City: Describe... Explain ... Name of Company Date (Mo/DayNr) Amount (1) what the expenditure was how the expenditure on Recelpt/Invoice on ReceipNlnvoice of (2) purpose of the expenditure specifically benefitted $ Must be dated on or Expenditure Lerr►ecula residents is between July 1, 2020 - MUST support Project/Program If° �fwaft of TemeWa Z June 30, 2021 description on Application + Award Letter0°' we Table, _T_ ettscn. 1 $ 2 $ 3 $ 4 $ 5 $ 6 $ 7 $ EXPENDITURE TOTAL Note, Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City City of Temecula Community Service Funding Grant APPLICATION Page 6 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. 0 Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. ■ The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Tahquitz District MAILING ADDRESS: PO Box 893823 Temecula 92592 PHONE: ( 951 ) 972-2201 EMAIL: tina.roy@scouting.org PRESIDENT / AUTHORIZED OFFICER: TUNA ROY SIGNATURE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: ame Print Name Title DATE: 07282020 (Month, Day, Year) Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 If you have any questions, please contact Betsy Lowrey at (951) 693-3959 or Stacey Brown at (951) 694-6413. City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 8/6/2020 ESL ID: Why You Received This letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: - Entity Name: CALIFORNIA INLAND EMPIRE COUNCIL, INC., BOY SCOUTS OF AMERICA a1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d, ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5. 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States T7Y/TDD: 800.822.6268 for persons with hearing or speech impairments FTS 4263A WEB (REV 12-2019) nt of the Treasu ra IRS 1poierrtal Revenue Stcnlce In reply refer to: CINCINNATI ON 45999-0038 Jan. 21 2020 LTR 416 7C 0 000000 00 00010850 BODC ss TE 90Y SCOUTS OF AMERICA 't S TE PHAN I E PHILL Boy Scouts of Amerks California Inland Empire Council 045 IRVING TX 75038-3008 EINlI- 026484 Employer identification numbers Group exemption numbers E"M Dear Taxpayers This is in response to your request dated Jan. 09, 2020, for Information about your tax-exempt status. Our records indicate we issued a determination letter to you in November 1965, and you're currently exempt under Internal Revenue Code (IRC) Section 501(c)(3). We also recognized the subordinates on the list you submitted as exempt from federal income tax under IRC Section 501(c)(3). For federal income tax purposes, donors can deduct contributions they make to you as provided in IRC Section 170. You're also qualified to receive tax deductible bequests, legacies, deviaos, transfers, or gifts under IRC Sections 2055, 2106 and 2522. Please refer to www.irs.gov/charities for information about filing requirements. Specifically, IRC Section 6033(j) provides that, if you don't file a required return or notice for three consecutive years, Your exempt status will be automatically revoked on the filing due date of the third required return or notice. In addition, each subordinate organization is subject to automatic revocation if it doesnit' file a required return or n6t'ice for three' consecutive years. Subordinate organisations can file required' returns or notices individually or as part of a group return. For tax forms, instructions, and publications, visit www.lrs.gov or call 1-800-TAX-FORN (1-800-829-3676). If you have questions, call 2-877-829-5500 between 8 a.m. and 5 p.m., local time, Monday through Friday (Alaska and Hawaii follow Pacific Time) . BOY SCOUTS OF AMERICA STEPHANIE PHILLIPS IRVING TX 75038-3008 Jan. 21, 2020 LTR 4167C 0 000000 00 00010851 Sincerely yours. King A. Billups, Operations Ma ne0er Accounts Mana0ement Operations i 0 BOY SCOUTS OF AMERICA® Home Contacts Scout Shop Calendar Search 1Coun�ilbersI iip Caping mProgram Training Advancement Resources Support Scouting Districts Monday Memoo Info Membership Commissioners Tools Internet Recharter Journey to Excellence Online Store My.Scouting.org Youth Protection Scouting Safely Photos September 1-4, 2020 Daily 3:00pm PDT September 1, 2020 September 1-4,2020 September 1-4, 2020 Flexible Class Schedule Daily 4:15pm PDT Daily 5:30pm PDT Camping Cooking Mammal Study Mining In Society REGISTRATION CLOSED REGISTRATION CLOSED REGISTRATION CLOSED REGISTRATION CLOSED September 8-11, 2020 September 8-11, 2020 Daily 3:00pm PDT Daily 4:15pm PDT American Heritage Citizenship "Community" 9 SPACES LEFT FULL CLASS September 14 & 21, 2020 September 15-18, 2020 Each Day 3:30pm PDT Daily 3:00pm PDT DWI Leatherwork Digital Technology LEATHER KIT INCLUDED September 15-18, 2020 September 15-18, 2020 September 22-24, 2020 September 22-25, 2020 Daily 4:15pm PDT Daily 5:30pm PDT Daily 3:OOpm PDT Daily 5:30pm PDT yl {` (*Trained) Crime Prevention Oceanography I.L.S.T Pulp & Paper FULL CLASS September 22-25, 2020 September 22-25, 2020 Daily 3:OOpm PDT Daily 5:30pm PDT Scouting Heritage Law October 6-9, 2020 Daily 3:OOpm PDT t. Emergency Preparedness October 13-16, 2020 Daily 4:15pm PDT Citizenship World October 6-9, 2020 Daily 4:15pm PDT a� Journalism October 13-16, 2020 Daily 5:30pm PDT 4 Entrepreneurship September 8, 2020 5:30pm PDT Sept 29 - Oct 2, 2020 Daily 3:OOpm PDT Camping October 6-9, 2020 Daily 5:30pm PDT 0 Textile Sept 29 - Oct 2, 2020 Daily 4:OOpm PDT Public Speaking October 13-16, 2020 Daily 3:OOpm PDT Chess Bobcat Badge September 1, 2020 5:30pm PDT no "Circles" September 9, 2020 4:30pm PDT : (0) 10:M "Coins" September 3, 2020 4:45pm PDT "Critter Care" September 24, 2020 4:45pm PDT "Claws" September 16, 2020 4:30pm PDT PO September 23, 2020 4:30pm PDT (�Isl "Germs Alive" "Finding Your Way" September 10, 2020 4:45pm PDT September 17, 2020 4:45pm PDT "Paws for Action" "Super Science" alft LIKE US ON 1U cebook. WebmuLec I eVYgcy-PollCy I Council Refund E!g jay, Sk �mbo 5cou�„Crttj 1230 Indiana Court • Redlands, CA 92374 1 (909) 793-2463 i3al ., Sc— Stare 1 4650 Arrow Highway Suite B1-3 • Montclair, CA 91763 1 (909) 625-4534 Copyright 2007-2020 • Boy Scouts of America, California Inland Empire Council #045 FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # �•J CADENZA STRING ORCHESTRA CITY OF TEXECUIFA FISCAL YEAR 2020 - 2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 PROJECT/PROGRAM INFORMATION Amount Requested: $_ 5,000, MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Pro ram Title: Musician development fund 9 Start Date: sent 202o End Date: Q •7 Physical Address of Project/Program: 9259 Temecula, CA INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Cadenza strip 0rcrhvstr,,i Mailing Address: Temecula, CA92592 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant grganization: Cadenza String Orchestra Year Organization Founded: 2oi8 Cadenza String Website; Number of Paid Staff: 2 Number of Volunteers; in Contact Name: Sandiwa del Rosario Title/Position: Director Contact Person's Email Address: Telephone. Geographic Area(s) the Organization Serves: Riverside County Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Geographic Area(s) the Organization Serves: , NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit:SePt 20, 2018 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Number: Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: htt //a sirs. ov/a /eos/ 2. Attach State Entity Status Letter using this link: hns,/Avww.ftb.cet.gov/onl!LieLself servegntity status letterfindex.asp 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info aIRMqcMuharity found on this State Registry's Search Tool: htt //rct.doi.ca. ovNerification/Web/Search.as x?facilit = Y SEP 1 12020 CITY MANAGER'S City of Temecula Community Service Funding Grant APPLICATION OFFIRge 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ® Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors X Members -at -Large ❑ f MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: Providing quality music education to local students through private lessons, workshops and performance opportunities. FINANCIAL STATEMENTS 1 Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ]) Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT MONTH + YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. Cadenza String Orchestra (CSO) provides quality and free music education to aspiring and financially in need local musicians. Students are also provided good playable instruments and accessories like bows, strings, etc. to also be able to give back to the community by playing at senior homes, local churches and assisting in other local non profit organizations. Last year, our orchestra won 1 st place at an international youth competition in Vienna, Austria representing the City of Temecula. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. Grant Funding will be spent on: instruments, instrumental accessories, meals, workshops for students, and travel expenses to further students' education, sheet music purchase and rental 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. The students who are residents of Temecula. The grant will help further and defray the cost of their studies. Through our free public performances, the community also benefits. We have helped countless Temecula residents, nonprofits and churches by sharing our music and also by helping them fundraise. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: 30 Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 10 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the projecttprogram and how the grant funds will be used. CSO provides quality music education and brings the community together through our free public performances. Accessories, meals, transportation and financial assistance to workshops are some of the things we provide. Doctors and professional musicians are also hired to help kids. Grant funds will help us acquire new equipment and continue our programs. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) $5000 Cash contributed to Project/Program by the Applicant Organization $ 3000 Other grants or funding already awarded for Project/Program, if any $ 109000 In -Kind match amount or volunteer credit hours estimated amount $30,000 VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program (This amount is ineligible to be funded by City's Grant, however please include.) $ 30 000 Equipment Expense For Project/Program $ 1 ,000 Food Expense For Project/Program $ 19500 Marketing Expense For Project/Program $ 500 Supplies Expense For Project/Program $ 500 Facilities/Rent Expense For Project/Program $ 11000 Other Expense For Project/Program $ 5500 TOTAL BUDGET FOR PROJECT/PROGRAM $ 4000 $40000 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 PREVIOUS* FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020, AS SHOWN BELOW. IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19120 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2019-2020 (last year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and June 39, 2028 December 31, 2020. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: I4._2020, Thursday, December 31, 2020. EXPENDITURE REPORT due on or before = ,,,� ;3 r,{,• ?I��(_) Thursday, December 31, 2020 1. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF N/A Organization: Name of Project/Program: Amount of Grant Fund Awarded: $ Month + Year Grant Received from City: Date (Mo/Day/Yr) Describe... Explain ... 1= Name of Company on Receiptlinvoice Amount (1) what the expenditure was how the expenditure on Receipt/invoice Must be dated on or of (2) purpose of the expenditure specifically benefitted = 9 E between July 1, 2019 - Expenditure Temecula residents z ' m December 31, 2020 MUST support Project/Program description on Application + Award Letter If names/addresses of Temecula blena� iaries are available, suecK 1 2 $ 3 $ 4 $ 5 $ 6 $ 7 $ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" aboveprovided by the City City of Temecula Community Service Funding Grant APPLICATION Page 5 of 7 FISCAL YEAR (FY) 2020-2021 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant in FY 2020-2021 by the City of Temecula, then this information is not due until September 13, 2021 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2020-2021 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2020, and June 30, 2021. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2020-2021 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 13, 2021. EXPENDITURE REPORT due on or before September 13, 2021 5. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 6. Fill out this table (include additional copies if needed to explain all expenditures) 7. Attach Receipts/Invoices (in the same order as listed in this table) 8. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: _ _ Name of Project/Program: Amount of Grant Fund Awarded: $ Month + Year Grant Received from City: ExplainName of Company Date (Mo/Day/Yr) Amount [Describe.,.. what te expenditure was how the expenditure on Receiptlinvoice on Recelpt/lnvoice of purpose of the expenditure specifically benefitted Must be dated on or Expenditure Temecula residents 2 a z between July 1, 2020 - 30, 2021 ST support Project/Program description on Application + Award Letter tt nartres/addresses of Temecula benefiJune fades are available, ease attach. please 1 $ 2 $ 3 $ 4 $ 5 $ 6 $ 7 $ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City City of Temecula Community Service Funding Grant APPLICATION Page 6 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Cadenza String Orchestra MAILING ADDRESS: TemeCUla CA 92592 PHON MAIL: PRESIDENT/AUTHORIZED OFFICER: Sandiwa del Rosario, Director SIGNATURE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: t Name Titie DATE: Sept.7,2020 (Month, Day, Year) Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 If you have any questions, please contact Betsy Lowrey at (951) 693-3959 or Stacey Brown at (951) 694-6413. City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 STATE OF CALIFORNIA FRANCHISE TAX BOARD a PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/6/2020 L�*34I93 Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: _ Entity Name: CADENZA STRING ORCHESTRA © 1. The entity is in good standing with the Franchise Tax Board, 2. The entity is not in good standing with the Franchise Tax Board. 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 . 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a-m_ to 5 p.m, weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTS 4263A WEB (REV 12-2019) INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 Date: MAY 2 0 2019 CADENZA STRING ORCHESTRA C/O SANDIWA DEL ROSARIO TEMECULA, CA 92592-0000 Dear Applicant: DEPARTMENT O? THE TREASURY' Employer Identification Number: DLN: Contact Person: CUSTOMER SERVICE ID# _ Contact Telephone Number: (877) 829-5500 Accounting Period Ending: May 31 Public Charity Status: 170 (b) (1) (A) (vi) Form 990/990-EZ/990-N Required: Yes Effective Date of Exemption: September 20, 2018 Contribution Deductibility: Yes Addendum Applies: No We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep.it for your records. Organizations exempt under IRC Section 501(c)(3) are further classified as either public charities or private foundations. We determined you're a public charity under the IRC Section listed at the top of this letter. If we indicated at the top of this letter that you're required to file Form 990/990-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked. If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter 04221-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. FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # N CHARITY FOR CHARITY CITY OF TEMECULA RECEIVED FISCAL YEAR 2020.2021 AUG 13 2020 COMMUNITY SERVICE FUNDING PROGRAM APPUeTAtMMER's (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 PROJECT/PROGRAM INFORMATION Amount Requested: $_'50DO. 00 MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: i 5�l-�C S DV) +V)-(- M p'N(e," Start Date: f { 21 End Date: 12 � 3 I Z I Physical Address of Project/Program: 2-14-1 C1 nez Roa cJ a g 2Sa I INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: C ha' -I +L� -{ter Ch a i Mailing Address: 2-I L41 Q y V)e Z (Z.oa I:J TEE-r,ec�-+la, CA g2S91 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization:Pr Cka Year Organization Founded: 2-00-1 Website:Char1'+g&►-ckari . oy— Number of Paid Staff: I Number of Volunteers: 25+' Contact Name: Chari-h.l `DY-C-5 rg- 1; pPp Title/Position: Fbund-erM Wcsi cl-uit Contact Person's Email AddressPion Telephone: g 51 -11`I 82-11 Geographic Area(s) the OrganizaPervePWe-rnec _.-4 I OL V a I ln:L� Geographic Area(s) the Project/Program Serves: T-e r-n ec.-.I I ct-- V al I tA.1 NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Geographic Area(s) the Organization Serves: Time-C,-A Ia- \f al Ie�q NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes V� Date of Incorporation as a Nonprofit: 2,C c��l No IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Number: Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: http://ems; irs.gov/aoo/eos/ 2. Attach State Entity Status Letter using this link: https:/Avww.ftb.ca.gov/online/self serve entity status letter/index.as 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htt://rct.doi.ca-ov/V'erification/Web/Search.as x?facilit -Y City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No 0 Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No 4 Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors 14 Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: Cha►-;}-� 4�)r Char(',+- IS CL local W'sHTUI-p 11►n9 Or9CLr,�ZU-�Dr -�ha+ -FLA WISh-r 5 -to Temew1a VaI IeLj resi'dtn+s o%-+ ► Spec -'a 1 ne-eds clue -tom 1 i (�e-I-h►�e0.�e►-+ r,o� i I!ness or-f,roLury-ia.-hZ iv-�iuV11 . FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑ Yes � IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP C F'C Ku r-4KC i 5 i nj Co nC�Lr }, -ry, t C >Twou n F � Servi Chap-; Iv1a a2�r,e �► T1-�cUnshpableS 2500 12I2o►g Alward Spar+sorsif p C-C:-- �.� ( MS) le J l'i City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM PROJECT the Temecula grant funding will be used to support. W CLk4 C7 -R I `+ ��r1 C� U rr i ti' 1 C�L.Lt� C L.i r Ir' wti - 1 i rr► F '�C,t'�" t C3 �'' S . `Pn t-. "'t I rN cl z v l 5 w i � 1 Icy. � s e d � � ra-�^ -}- w ► s H�e s -� � � c� � V � c! u a I s Lam► �-h i :r -)--k r � A--I'-e r+ �LA -ram Q-f-� C 1 +^, LA- rt� , ICe -W <S 'e. + 1rn d- v f CJ k'L0- l S U� o Cu'' C. 5 t.r 1 ; r� uo 1 i fie.. char, 9 t hg C, r c.,.,t ry-V S+c4 r, c-P- S QV-N d 9 i V-e. "-,P" l Io pc 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. f:�Ari dS 'W t, l l &C- u St d -1>W GUrGf S ln©4e l S+ay s, Q Y pe,Y k e r, C.-e S) b-e d moor-r� d'C c-� r-a+ i S -6V- Gt C- h 1 d, �l L- 2,c Pe r l-ter, C e I c- =" C am+ Q i -e,•, C e, 0-1 r I i ne, Cf,10� S i3Q e IC P e. r1-P-n C-e S 0,r d Am cu z o►-i pt'�CVNa S e S 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. A lee q u i 40 biz� G.. -Pose Chav-,+iG- i s �o toe- a�-v►-�n e c�.� 1 a va 1 Ie.� re s i cl-�-,-�-. W� Se.� V e.., Cs:;, Irn rv-% t 114. oul• ber,,e -A c i a v T -e S at�p— n Im i n C i'+e v S-e s �bsp i +cx,) , 1 D ca t '(--eS i Ck'-N+S 0%'n c:l Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: 40 Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. VV i s h-es c>,-% +he, nn cam!-r- i s a- PV-cx� rrC)- rrn 4- a+ -(Z+ t 1 I S s -tc> i nd ;'q i dV-L a l s w i �-h i►-fit++r� a �e i t l�rr S S or -Vv-alAry-' M-+; c ��- '�.{ pr©v r d ; > -, 4-V-rt vy-% h 01PP- . -Fl I +s % n c i u tJ-eS d e w-,cc'h,' c --, 2 yper 'i�n C e s� -{- h -mom � U�-rK b-ed+rvonn r-e.rY-i ocVel S Cx r-,ck ar%V c,-rl-,-et- w I S h e s------------ >` 5 City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) Cash contributed to Project/Program by the Applicant Organization Dither grants or funding already awarded for Project/Program, if any In -Kind match amount or volunteer credit hours estimated amount VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program (This amount is ineligible to be funded by City's Grant; however please include.) Equipment Expense For Project/Program Food Expense For Project/Program Marketing Expense For Project/Program Supplies Expense For Project/Program Facilities/Rent Expense For Project/Proeram Other Expense For Project/Program REVENUES I EXPENSES $rJWO TOTAL BUDGET FOR PROJECT/PROGRAM $ City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 PREVIOUS* FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020, AS SHOWN BELOW. IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19/20 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2019-2020 (last year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and jun,- = December 31, 2020. In addition, all grant funds musk be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: F4W%; iaer-m-242-= Thursday, December 31, 2020. 2. 3. 4_ EXPENDITURE REPORT due on or before Tway, s WmMm• Thursday, December 31, 2020 Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): Fill out this table (include additional copies if needed to explain all expenditures) Attach Receipts/Invoices (in the same order as listed in this table) Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: _ Name of Project/Program: Amount of Grant Fund Awarded: $ _ Month + Year Grant Received from City: Date (Mo/Day/Yr) Describe... Explain ... � Name of Company P Y on Receipt/Invoice Amount (1) what the expenditure was how the expenditure P E on Receipt/Invoice Must be dated on or of (2) Purpose of the expenditure specifically benefitted R between July 1, 2019 - Expenditure Temecula residents Q Z J June 10-, 20nN December 31, 2020 MUST support Project/Program description on Application + Award Letter If names/addresses of Temecula beneficiaries are available, .� $ lease attach. 7 $ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the Citv City of Temecula Community Service Funding Grant APPLICATION Page 5 of 7 FISCAL YEAR (FY) 2020-2021 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant in FY 2020-2021 by the City of Temecula, then this information is not due until September 13, 2021 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2020-2021 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2020, and June 30, 2021. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2020-2021 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 13, 2021. EXPENDITURE REPORT due on or before September 13, 2021 5. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 6. Fill out this table (include additional copies if needed to explain all expenditures) 7. Attach Receipts/Invoices (in the same order as listed in this table) 8. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Amount of Grant Fund Awarded: $ = Name of Company Date (Mo/Day/Yr) Amount E on Receipt/Invoice on Receipt/Invoice of E Must be dated on or Expenditure R Z between July 1, 2020 - June 30, 2021 21 Is 31 1$ Name of Project/Program: Month + Year Grant Received from City: Describe... (1) what the expenditure was (2) purpose of the expenditure MUST support Project/Program description on Application + Award EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City City of Temecula Community Service Funding Grant APPLICATION Explain ... how the expenditure specifically benefitted Temecula residents If names/addresses of Temecula beneficiaries are available, Page 6 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: 0,V)ar- 4-4 -R^ )r- Cko ri }'-L4 MAILING ADDRESS: 2-7L41 q \1 V1�e- Z V-0� PHONE: 1 ]�„'B2-11 EMAIL: T-erYl ecc.1 l a q Z.Sg I PRESIDENT / AUTHORIZED OFFICER: C� Q''' PY-C-3+f 4�- k PPQ i FbL-c r-td-e,+ 'n — Print Name Title SIGNATURE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: DATE: S) I t 12.0 (Month, Day, Year) Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 If you have any questions, please contact Betsy Lowrey at (951) 693-3959 or Stacey Brown at (951) 694-6413. City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 STATE OF CALIFORNIA A FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 8/11 /2020 ESL ID: Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: - Entity Name: CHARITY FOR CHARITY 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. 0 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 am. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019) INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 DEPARTMENT OF THE TREASURY Date : MAR 0 9 2009 CHARITY FOR CHARITY 31915 RANCHO CALIFORNIA RD STE 200 TEMECULA, CA 92591-0200 Dear Applicant: Employer Identification Number: DLN: Contact Person: CHRIS BROWN ID# _ 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: October 2, 2007 Contribution Deductibility: Yes Addendum Applies: No We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. Organizations exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations. We determined that you are a public charity under the Code section(s) listed in the heading of this letter. Please see enclosed Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, for some helpful information about your responsibilities as an exempt organization. Letter 947 (DO/CG) -2- CHARITY FOR CHARITY Enclosures: Publication 4221-PC Sincerely, 0 Ro ert Choi Director, Exempt Organizations Rulings and Agreements Letter 947 (DO/CG) ADAPTING TO CURRENT TIMES, ONE WISH .r DO YOU KNOW SOMEONE WITH A LIFE THREATENING ILLNESS OR TRAUMATIC INJURY? i NOMINATE THEM TODAY AT CHARITYFORCHARITY.ORO Charity for Charity The Unstoppables Motivational 5peaking Team Fulfilling wishes to individuals with life threatening illness or traumatic injury 501(c)(3www.charityforcharity.org 2018 California Non Profit of the Year z FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # C� THE CHOICE PROGRAM CITY OF TEMECULA REcelveo FISCAL YEAR 2020 - 2021 AUG 2 6 20, COMMUNITY SERVICE FUNDING PROGRAM APPLICA�'�20 (P/ease Print or Type) OFFNGF�,S DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 C Z _ PROJECT/PROGRAM INFORMATION Amount Requested: $ 5,000.00 Project/Program Title: MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Opportunities and Options:The Choice Program Physical Address of Project/Program: INCLUDE IF DIFFERENT THAN ORGANIZATI.ON'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Start Date: 12/01/2020 End Date: 11/30/2021 Options and Opportunities: The Choice Program Mailing Address: Temecula, CA 92591 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Opportunity and Options: The Choice Program Year Organization Founded. 2014 Website: www.cooleyfoundation.org Number of Paid Staff: 2 Number of Volunteers: 80 Contact Name: James Cooley Title/Position: CEO Contact Person's Email Address Telephone: Geographic Area(s) the Organization Serves: City Of Temecula Geographic Area(s) the Project/Program Serves: City of Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ❑■ Date of Incorporation as a Nonprofit: 2014 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Number: Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: httpalapps.irs.€ov/atap/eosl 2. Attach State Entity Status Letter using this link: hqp*:LAwm.fth.pa.gov/online/self serve entity, status letterlindex.asp 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http://rct.doi.ca.govNerificationMeb/Search.aspx?facility_rY City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No A Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No X Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee 0 Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: Our mission is to inspire and empower youth to build healthy relationships, develop their natural talents and abilities, and understand the importance of making a positive contribution to their community. Our goal is to create a community network that motivates academic, social, and civic responsibilty. Finally, our objective is to eliminate behaviors that are barriers to a positive and productive life. I FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. I CITY OF TEMECULA FUNDING — OTHER SOURCES I Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑ Yes 0 IF YES, PROVIDE INFORMATION IN TABLE BELOW: DAME OF PROGRAWPRO)ECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNTFUNDING MONTH + YEAR RECEIVED NAME OF CITY GRANT OR SPONSORSHIP JC Cooley Youth Leardership Program $ 959.00 January 20 CSF FY19/20 THE CHOICE PROGRAM $ 1,000 December 2018 CSF FY18/19 $ City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ■❑ Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No [W Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee 01 Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: Our mission is to inspire and'empower youth to build healthy relationships, develop their natural talents and abilities, and understand the importance of making a positive contribution to their community. Our goal is to create a community network that motivates academic, social, and civic responsibility. Finally, our objective is to eliminate behaviors that are barriers to a positive and productive life. FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No [0 Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT MONTH + YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. The Choice program is a community collaborative that mentors youth in the Temecula Independent School District, the Boys and Girls Club, and local faith -based organizations. Funding will support our youth mentoring/leadership initiative, and expand our youth and family outreach efforts. We will add presentations and educational sessions and continue our program curriculum that includes strengthening families, volunteerism, and educational travels. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. The Choice program will spend the awarded funds on monthly leadership inspirational breakfast, bi-monthly motivational seminars for elementary, middle, and high school students; food, tee shirts, rental space, hand sanitizers, and masks. These events and activities are central to our organization. As such, we plan to make adjustments that are consistent with Covid-19 guidelines to ensure the safety of our youth and families. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. Funding will specifically benefit Temecula residents by bringing youth and families together to participate in up -lifting and positive activities. Our community presentations and seminars give youth a platform to share and communicate their views and talents. Many families are too busy to sit and share a meal but the Choice program brings families together at the table while experiencing community, promoting self-esteem, embracing healthy life choices, and sharing ideas. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 0 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. The Choice program is requesting $5,000 to support our outreach efforts to more than 1,000 youth, cover the cost of inspirational breakfasts, tee-shirts, rental space, supplies, journals, and seminars. Any program adjustments will be based on local pandemic safety guidelines. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 Stacey Brown From: james cooley Sent: Friday, August 28, 2020 10:58 AM To: Stacey Brown Subject: Fwd: The Choice Program Grant document Attachments: TheChoiceProgramGrantSummary.docx Stacey, Here's the rewrite of 1 with more details of what the Grant money will be used for if awarded.. Very respectfully, James JC Cooley ---------- Forwarded message --------- From: MICHELLE COOLEY Date: Fri, Aug 28, 2020, 10:52 Subject: The Choice Program Grant document To: james cooley The funding will be used to assist The Choice Program in providing continuing mentorship within the Temecula communities and lifelong skills that will build character. This will also provide our youth in the Temecula community an opportunity to build strong leadership qualities by presenting in front of large audiences to become Future Leaders of Tomorrow. We also instill in our youth that everyone matters, and everyone has a destiny to fulfill. The Choice Program partners with the Boys & Girls Club, local Temecula churches and other organizations to involve our youth, families and community to work together to feed the hungry, assist at various nursing facilities, collect local trash to keep our community clean, but most importantly we take our students on field and mission trips (i.e. The Museum of Tolerance) to teach our youth to love not to hate and value every person. In addition, we provide lunch at several schools and assist with educating at risk youth such as group homes and foster care facilities to help build character. The bottom line is that the Choice Program focuses to encourage, build Future Leaders of Tomorrow, and instill a solid work ethic that you can achieve anything that you set your mind to. To -summarize, The Choice Program encourages our Youth to DREAM BIG, THINK BIG, AND BE BIG AT EVERYTHING THAT YOU DO! I 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECF/PROGRAM REVENUES EXPENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula $ Community Services Grant (Not to exceed $5,000) 5 000 Cash contributed to Project/Program by the Applicant Organization Other grants or funding already awarded for Project/Program, if any $ 207000 $ 0 In -Kind match amount or volunteer credit hours estimated amount $ 251000 VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program $ 3,000 (This amount is ineligible to be funded by City's Grant; however please include.) Equipment Expense For Project/Program i $ 7 000 Food Expense For Project/Program Marketing Expense For Project/Program $ 8r 000 $rJ 000 1 Supplies Expense For Project/Program $ 1 2v 000 1. Facilities/Rent Expense For Project/Program Other Expense For Project/Program $ 8, 000 $ 7, 000T TOTAL BUDGET FOR PROJECT/PROGRAM $ 50, 000 $ 50, 000� City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Opportunity and Options: The Choice Program MAILING ADDRESS: PHONE EMAIL. Temecula, CA 92591 PRESIDENT/AU RIZEDOFFICER: James Cooley CEO Print Name Title SIGNATURE: DATE: Z& (Mo(th, Day, ear) IF DIFFERENT THAN AB APPICATION PREPARED BY: Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 If you have any questions, please contact Betsy Lowrey at (951) 693-3959 or Stacey Brown at (951) 694-6413. City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 8/28/2020 ESL ID: Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: - Entity Name: OPTIONS & OPPORTUNITIES/THE CHOICE PROGRAM INC. 0 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. FZA 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: - 800.852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019) ' �j�? I]epartment of ate T=usu�• cf �I�—R- s Inte1,MII Itovenoo Sol, Vice OGDEN UT 84201-0029 OPTIONS OPPORTUNITIES -THE CHOICE PROGRAM INC 1� ULA CA 92541 ?53993 In reply refer to June 17, 2015 LTR 41686 0 0D0000 DD 00035577 BODC; TE Employer Identification dumber: Person to Contact: Ms Benjamin T-01", - _; e-e--T-el-eph•one ; umiber a 1-87 1-829-5300 -- Bear Taxpayer: This is in response to your May 20, 2015, request for information regarding your tax-exempt status. Our records indicate that you were recognized as exempt under section 5D1Cc)(3) of the Internal Revenue Code in a determination letter issued in October 2014. Our records also indicate that you are not a private foundation within the meaning of section 509Ca) of the Code because you are described irr Sect-ion(s) 509(a) (1) and 170(b) (1) (A) (vi) . Donors may deduct Gvntribut7cans to you as provided in section 170 of the Coder BsquestS, legacies: dGvises, grans"f�i S: Or gifts to you or for Your use are deductible for Federal estate and gift tax purposes i; they meet the atvolicable prov.isio,ns or sections 2055, 2106, and 2522 of the Code Please refer to our website winrtr.irs.goviea for information regarding filing requirements. Specifically, section 6033(i) of the code Provides that failure to file an annual information return for three consecutive years results in revocation of tax-exempt status as of the f iling -due Clete -of the third "ret-urn for oF`ganization5 -retguire'd_tO file. We will publish a list of organizations whose ta;c-exempt status was revoked under section 6U33CJ) of'.the Code on our website beginning in early 2011. 000000 QQ 00835578 OPTIONS OPPORTUNITIES -THE CHOICE PROG AM INC TEMEC CA 925g1 f you have any questions, call us at the telePhone number shown in the heading of this letter. Sincerer .yours, 7 Tamera P.ippenda Director, Exempt Droanizations FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # a I COMMUNITY MISSION OF HOPE aka RANCHO COMMUNITY REFORMED CHURCH CITY OF TEMECULA FISCAL YEAR 2020 M 2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 PROJECT/PROGRAM INFORMATION Amount Requested: $ 5,000 MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: Homeless Prevention Start Date: 7/30/20 End Date 6/30/21 Physical Address of Project/Program: TEMECULA CA 92590 INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: COMMUNITY MISSION OF HOPE Mailing Address: N TEMECULA CA 92590 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: COMMUNITY MISSION OF HOPE Year Organization Founded: 2009 WebSite:CMOH.NET Number of Paid Staff: 4 Contact Name: Maegan Bourlett Contact Person's Email Address: maegan.bourlett@cmoh.net Geographic Area(s) the Organization Serves: Temecula, Number of Volunteers: 98 Title/Position: Executive Director Telephone: Murrieta, Anza, Aguanga Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ❑■ Date of Incorporation as a Nonprofit: No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Number: RECEIVED Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: htt //a sirs. Dula . /eos/ SEp 14 2020 2. Attach State Entity Status Letter using this link: i*Ts.irtNww.ftd.ca. gvonline/self serve e : i ecas 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info abotdMm charity found on this State Registry's Search Tool: I�t1 1rc>?�c�.ca.vavl�terifcatianll leb�Searefh.asox?faei(ity— City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ❑■ Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No K Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑■ Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: We will empower our clients to become self-sufficient by providing food and resources for shelter, employment and healthcare through a collaborative, united network of community partners and volunteers. FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑ Yes ❑■ IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP Case Managment $ 5,538 CDBG Rental assistance $1,0001 2019 CSF/Maryanne Edwards Rental Assistace $ 5,000 June 2020 CS FA City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. The Housing Resource is designed to keep individuals and families off the street by providing case managment and funds and resources to keep them housed. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. The Community Mission of hope will spend the grand funds on clients rent, security deposit. We would screen each candidate. Requirments include having a 3-day pay or quit, an explanation of why rent was unable to be paid )loss of job, medical neeeds, etc), and proof they can succesfully sustain rent moving forward. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. Preventing homelessness to the individual or family. Benifitting the family, as well as the entire community. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program- Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. Funds will be used for rental assistance and/or security deposit to either prevent client from becoming homeless. Or help a homeless client enter into permanant housing. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant $ (Not to exceed $5,000) 5, 000 $ 25,000 Cash contributed to Project/Program by the Applicant Organization Other grants or funding already awarded for Project/Program, if any $ 7500 In -Kind match amount or volunteer credit hours estimated amount $ 0 VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program $10,000 (This amount is ineligible to be funded by City's Grant; however please include.) Equipment Expense For Project/Program $0 For Project/Program $0 LFoodpense g Expense For Project/Program $500 Supplies Expense For Project/Program $0 Facilities/Rent Expense For Project/Program $5 , 000 Other Expense For Project/Program $22,000(rent) TOTAL BUDGET FOR PROJECT/PROGRAM $37,500 $3 7,500 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 PREVIOUS* FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020, AS SHOWN BELOW. IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19/20 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2019-2020 (last year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and auRe_-ze-ae?o December 31, 2020. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: F y t: -: 1. Thursday, December 31, 2020. EXPENDITURE REPORT due on or before ursday, December 31, 2020 1. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: � � 5� Pmur4uk l D u-�� 'i�`� HL'fITame of Project/Program: 9I U JIlk ILl f /'�Tli 1 — LkIlG 50 2D Amount Grant Fund Awarded: `4 � y of $ l p Month + Year Grant Received from City: Name of Company p Y Date (Mo/DayNr) on Receipt/lnvoice Amount Describe... (1) what the expenditure was Explain ... u how the expenditure pbenefitted E in on Receipt/lnvoice Must be dated on or of 2 purpose of the expenditure () p p p specifically o E between July 1, 2019 - _3G-zQ2-3 Expenditure MUST support Project/Program Temecula residents names/addresses Temecula Z December 31, 2020 description on Application + Award Letter b it beneficiaries are available, ar available, lease attach. 1 V I -%A 'PromeilAk, '�j� ?.�i -- $ ��u +lit S Gx tYr ycwx 2 H dc'Ss r�vRu,�h�rr ,i11rC%9t,1 f �5�y'+ r 2 �vot� 115 & 31 I q ' $ ifs- ld y� Jgen i $ q3 P 4 &O1 All hG �p I �✓'i_ 1 91 $ // Jv — ,4K V ekle, 5 be-4 r- - -7/ a / OIL $130V r cfh �"aS lLLG 6 $ 7 $ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" above rovided by the Ci L Lo City of Temecula Community Service Funding Grant APPLICATION Page 5 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Community Mission of Hope MAILING ADDRESS: PHONE: EMAIL: Temecula, Ca 92590 maegan bourlett@cmoh net PRESIDENT/AUTHOR,,,, OFFICER: Scott Treadway President SIGNATURE: IF DIFFERENT -THAN ABOVE, APPICATION PREPARED BY: Print Name Title DATE: 8/24/2020 (Month, Day, Year) f ri t Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 Stacey. Brown@TemeculaCA.gov (951) 694-6413 City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 10 THE EMPOWERMENT CENTER CITY OF TEMECUI[A FISCAL YEAR 2020 M 2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 PROJECT/PROGRAM INFORMATION Amount Requested: $ 5000.00 MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: The Breakthrough Student & Family Assistance Prg. Start Date: Oct 2020 End Date: June 2021 Physical Address of Project/Program: 27262 Via Industria INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: The Empowerment Center Mailing Address: 27262 Via Industria Temecula, CA 92590 ORGANIZATION AND GEOGRAPHIC AREA SERVED The Empowerment Name of Applicant Organization: Center (TEC) Year Organization Founded: 2005 Website: www.theempowermentcenterinti.com Number of Paid Staff: 3 Number of Volunteers: 17 Contact Name. Teresse Lewis, LCSW Title/Position: Executive Director Contact Person's Email Address: tlewis@theempowermentcentedntl.eom Telephone: (951) 514-2939 x107 Geographic Area(s) the Organization Serves: Southwest County (Riverside) Geographic Area(s) the Project/Program Serves: Temecula, CA NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: Jan 2006 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Number: Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: http;//apps.irs.gov/app/eos/ 2. Attach State Entity Status Letter using this link: httos://www.ftb.ca.-(iov/online/self serve entity status Ietterlind x a 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htt ://rct.dd.ca. ovNerificationNVeh/Search.as x?facilit =Y City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ❑■ Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No * Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors ■0 Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: Our mission is to create pathways to resilience for youth & families through evidence -based programming for the whole family, strategic community partnerships, and professional development. FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? NO ❑■ Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT i MONTH + YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. The Breakthrough Student & Family Assistance Program is an evidence based, comprehensive, resilience building program for youth and families in Temecula. The foundation of this program begins with providing students and their families with a 120-minute strengths and resilience building family conference where the entire family unit meets with a trained social worker to identify the family's concerns, strengths, growth opportunities as well as risk, protective and stress factors. Subsequently, the entire family then actively participates in developing a comprehensive support plan that mitigates risk and builds on the family's strengths Once the support plan is developed, families are provided with the resource support necessary to implement the agreed upon plan objectives. Preventive and interventive resources provided to the family will include virtual parent support groups, small group interventions for students (K-12) and preventative trainings including parenting classes, strengths and character development workshops, and social and emotional skill building workshops. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. If awarded, The Empowerment Center will spend the money on program participants' fees for one -hundred and twenty (120) youth and families; at $20 per participant that equals $2400 total. Additionally, we are purchasing supplies for approximately $1600, and we anticipate facility expenses to cost approximately $1000. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. Grant funding will specifically benefit Temecula residents by providing the youth and families with a preventative and interventive program that mitigates the effects of grief, trauma, isolation, stress and instability youth and families are experiencing right now due to COVID-19, school closures, and subsequent job and income instability. The benefits to families are innumerable, but some will include a greater sense of connection to each other and the community, increased ability to problem solve and overcome barriers, increased awareness of family strengths, and strengthened social and emotional skills. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: 120 Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 14 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. The Breakthrough Student & Family Assistance Program is an evidence based, comprehensive, strengths and resilience building program for youth and families within Temecula. Grant funds will be used for program participants' fees ($2400), program supplies ($1600), and facilities expenses ($1000). City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET f LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula f $ 5, 000.00 Community Services Grant (Not to exceed $5,000) Cash contributed to Project/Program by the Applicant Organization $ 73,827.64 Other grants or funding already awarded for Project/Program, if any $23, 950.00 $16,408.36 In -Kind match amount or volunteer credit hours estimated amount VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program (This amount is ineligible to be funded by City's Grant; however please include.) $40,000.00 Equipment Expense For Project/Program $ 5,532.00 Food Expense For Project/Program Marketing Expense For Project/Program $1500.00 $ 7,250.00 Supplies Expense For Project/Program $ 5,400.00 Facilities/Rent Expense For Project/Program $ 49,704.00 Other Expense For Project/Program TOTAL BUDGET FOR PROJECT/PROGRAM $ 19,800.00 $119,186.00 $129,186.00 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 PREVIOUS* FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020, AS SHOWN BELOW. IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19/20 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2019-2020 (last year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and December 31, 2020. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: ,Z#day, SAPteMbeF �+ ten,.,,.. Thursday, December 31, 2020. EXPENDITURE REPORT due on or before r4; to.,.�, ,,a, �o:2a Thursday, December 31, 2020 1. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF No award to TEC in 2019/20: Not Applicable Organization: Name of Project/Program: Amount of Grant Fund Awarded: $ Month + Year Grant Received from City: Date (Mo/Day/Yr) Name of Company on Receipt/Invoice Amount Describe... (1) what the expenditure was Explain ... how the expenditure a on Recei tllnvoice (2) purpose of the expenditure specifically benefitted p Must be dated on or Of E between July 1, 2019 - Expenditure Temecula residents a Q z December 31, 2020 MUST support Project/Program description on Application + Award Letter If names/addresses of Temecula beneficiaries are available, lease attach. 1 $ 2 $ 3 $ 4 $ $ 5 6 $ 7 1$ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" aboveprovided by the City City of Temecula Community Service Funding Grant APPLICATION Page 5 of 7 FISCAL YEAR (FY) 2020-2021 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant in FY 2020-2021 by the City of Temecula, then this information is not due until September 13, 2021 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2020-2021 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2020, and June 30, 2021. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2020-2021 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 13, 2021. EXPENDITURE REPORT due on or before September 13, 2021 5. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 6. Fill out this table (include additional copies if needed to explain all expenditures) 7. Attach Receipts/Invoices (in the same order as listed in this table) 8. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Name of Project/Program: Amount of Grant Fund Awarded: $ Month + Year Grant Received from City: Describe... Explain ... Name of Company Date (Mo/DayNr) Amount (1) what the expenditure was how the expenditure E on Receipt/invoice on Receipt/invoice of (2) purpose of the expenditure specifically benefitted EMust be dated on or Expenditure Temecula residents Q 3 between July 1, 2020 - MUST support Project/Program If names/addresses of Temecula beneficiaries are available, June 30, 2021 description on Application + Award Letter please attach. 1 $ i $ 2 3 $ 4 $ 5 $ 6 $ 7 $ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City City of Temecula Community Service Funding Grant APPLICATION Page 6 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: The Empowerment Center MAILING ADDRESS: 27262 Via Industria Temecula, CA 92590 (951 ) 514-2939 x107 PHONE: J EMAIL: tlewis@theempowermentcenterintl.com PRESIDENT / AUTHORIZED OFFICER: Teresse Lewis, LCSW Print Narne Executive Director Title SIGNATURE: DATE: 09/13/2020 IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: (Month, Day, Year) Print: Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 Stacey.Brown@TemeculaCA.gov (951) 694-6413 City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 STATE OF CALIFORNIA FRANCHISE TAX BOARD B PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/13/2020 ESL ID: Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: - Entity Name: THE EMPOWERMENT CENTER X1. The entity is in good standing with the Franchise Tax Board. 2. The entity is not in good standing with the Franchise Tax Board. 0 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d El4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019) Q HELPO MENU Home > Tax Exempt Organization Search > The Empowerment Center < Back to Search Results The Empowerment Center EIN: 1.9 --, United States Other Names Publication 78 Data o Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Form 990-N (e-Postcard) o Organizations who have filed a 990-N (e-Postcard) annual electronic notice. Most small organizations that receive less than $50,000 fall into this category. Tax Year 2007 Form 990-N (e-Postcard) Copies of Returns (990, 990-EZ, 990-PF, 990-T) o Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits. Tax Year 2018 Form 990EZ i F_ I�lauik ILrvrnur3eav7cr In reply refer to: - DCDEN UT V4N11 1]1]�Y May 20, 2014 LTR 4163C a 000DDa GD 00031982 BODC: Tf THE EMPOWEFllil NY CENTER TIFFANY HAKI--W .. 27262 VIA Ih[)LJI-.kQTA TEh1ECULk rA SI2b9'1 -3751 f� 180'r, Employer 1riniitiFicatian Number: Parson to Contact: FIB, Wilms tali Free Telephone Nklmkiur: 0-Mfr-1329-5500 Dear Taxpayer! This is in response to V411ir Apr. Di, 1u14, request for inrormatian reyardinn your tax-exWmpr -.:�tntus. Dur rur_ords indicata :hat POLL were- recogni�,-i3d as exempt under seeLiopi ri0l(c)C33 of t:ha Internal Ravenue C0dQ to a deterninatiun letLar- :sued in January 71111G. Our retards nlsa indicaLe thAt ynu are not ,I Private fuundal.iult within tha meaning of section 51)9(a) nt the Code beuauj o you are desuribud in moction(s) 5[I9[:,1C1) and 170(h](11)[A)(vi). Tlonors may deduct cDntr•lhut-IDns to 3/uU 0R provided in tincklan 370 of the Code. Bkquests, ley2C_7Ps, deviseai, transfers] or yifts to you Dr +Or your are dc-ducLihir tar Feder•L-11 estate and gift tax purpo3es if they mraat the app11L;;4h1n provisions pl sections 2055, 21061. and 2522 of Ll,a Code. p14.nse refer- to our weDsite www.irti.govfeo far inf(wmation regarding filing requiremr4nts. Specjflr:;ally, secL1011 6033(j) of Lh(-. Code providr.k that faiLure to file aIt annual information reLurn for three cnro:ecutive yaars results .I.n revocation of tax-exem�71. z;kol.us as of Lht- filing due date of Ihl: thard reLurn tar orgar.i.-.iLiotna rariuirerl .a f s Le. vie w+ t.l Pub! ;li, ;ti ]i_.t Di ordL')In:ze;inns .YI&L7a F. tifiX-e, T:fAPt r,tat us arms revoked unrfar section 603'iCJ) of L11u (;Ode an our webs ite beginning in early May 28r 2014 LTR 4168C 0 000000 no 00081VA6 THE E1HP'UWFKN1-N1 KFN11-k T, TIFFANY BAKFR 27262 VIA INnuSTrr i A TEMECUI_A r_A Vrb9a-ar51 If yuu hmve RhY questions, please call u5 at the UJI(mhong number shown in the heaWna 01; thIs letter. Simcerely yoursp Tamera Ripperda Director, Exumpl Or ymm37,+ttons FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 11 FINE ARTS NETWORK THEATER CO. CrrY OF TEMECUTA FISCAL YEAR 2020.2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 PROJECT/PROGRAM INFORMATION Amount Requested: $ 5000.00 MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: Theater LIVE after COVID Physical Address of Project/Program: INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS Start Date: 12/1 /2( End Date: 7/31 /2' If Grant is Awarded, Make Check Payable to: Fine Arts Network Mailing Address: 41391 Kalmia St. #200 Murrieta, CA. 92562 ORGANIZATION AND GEOGRAPHIC AREA SERVED Fine Arts Network Name of Applicant Organization: Year Organization Founded: 1994 Website: www.fantheater.com Number of Paid Staff: 0 Number of Volunteers: 100-200 Contact Name: Brittany Campbell Title/Position: Artistic Director Contact Person's Email Address: Telephone: Geographic Area(s) the Organization Serves: Temecula -Corona, Hemet-Fallbrook Geographic Area(s) the Project/Program Serves: Temecula -Corona, Hemet-Fallbrook NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ■❑ Date of Incorporation as a Nonprofit: 10/6/94 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Number: Print out and attach to this application Verification from Federal (IRS) and State (FTI3) as follows: 1. YAttach IRS Deductibility Status using this link: htt ://a sirs. ov/a /eos/ 2. Attach State Entity Status Letter using this link: httos://www.ftb.r-a.-gov/online/self serve entity status letter/index.aso 3. ✓ Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http://rct.do',ca.cyov/VerificationNVeb/Search.aVx7failiY City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No F Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No* Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee Q Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives; Our mission is to provide education in the theater arts and performance opportunities for those with a passion to learn and to entertain. To provide to the community the highest caliber entertainment experience in a safe and encompassing environment. FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? NOR Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT MONTH + YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP I� City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/]PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECTIPROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. Our program "Theater Live after COVIDI9", will consist of gearing up and getting back - on stage. We know we will need to reach out to audience and performers with updayA information on any new standards, new shows, times, auditions, We also must reapo.v- for all new licensing, but cannot do this until we know when we will be back in the theaArv. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. The funding will be used for 3 purposes. 1) Launching a marketing campaign to ann0-u ,,e-P our new season and that live theater is back. 2) It will allow some funds to address cha*10 we may need to make due to COVID. 3) it will provide funding for deposits for the next, 4, that would normally not be necessary but for an entire year of non -performances. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. More than 50% of our audience is Temecula based. 50% of our actors currently live in Temecula. This grant will allow us serve our Temecula residents by being prepa-i"ed- to perform at the OTTCT by blasting our marketing and securing licensing rights. Local showsrbenefit, residents )and Temecula tourism. 8K-12K benefit. 150-200volunteec,S Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. This grant will kick-start our ability to let local residents and performers know that we are auditioning and setting a performance season. It will allow us to place deposits for the upcoming season, which must be done prior to announcements or ads. It will generate excitement that live theater is back. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM REVENUES i EXPENSES PENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) $ 5000 Cash contributed to Project/Program by the Applicant Organization $ 75000 Other grants or funding already awarded for Project/Program, if any In -Kind match amount or volunteer credit hours estimated amount VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM 1 $15000 Staffing Expense for Project/Program (This amount is ineligible to be funded by City's Grant; however please include.) $ 00 Equipment Expense For Project/Program $ 6500 Food Expense For Project/Program $ Marketing Expense For Project/Program Supplies Expense For Project/Program $7500 $1 1000 Facilities/Rent Expense For Project/Program $ 40000 $ 30000 Other Expense For Project/Program TOTAL BUDGET FOR PROJECT/PROGRAM $ 95,000 $ 95,000 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 PREVIOUS* FISCAL YEAR (F)O 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020. AS SHOWN BELOW. IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19120 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2019-2020 (last year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and Jun$ -as-. =a December 31, 2020. In addition, all grant funds must be substantiated with proper back-up documentation, Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date:Thursday, December 31, 2020. EXPENDITURE REPORT due on or before "aay, soak} Thursday, December 31, 2020 1. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly beWitted from this program: (approximate number of beneficiaries if you don't have a precise number); 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City anager's Office - CSF Organization: Name of Proj Program: Amount of Grant Fund Awarded: $ Month + ear Grant Received from City: Date (Mo/DayNr) scribe... # Explain ... c Name of Company P Y on Receipt/Invoice Amount (1) what the expenditure was how the expenditure p d E on Receipt/Invoice t/lnvoice p Must be dated on or of (2) purpose of the expenditure specifically benefitted P Y 8 between July 1, 2019 - Expe t e Temecula residents Z J i^:' '. December 31, 2020 MUST support ProjecUProgram description on Application + Award Letter If names/addresses of Temecula beneFlciaries are available, lease_ attach. 1 2 3 A9 $ 4 All 5 $ 6 $ $ 7 EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" alcoveprovided by the City City of Temecula Community Service Funding Grant APPLICATION Page 5 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. ■ Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula, • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Fine Arts Network Theater Co. MAILING ADDRESS: 41391 Kalmia St. PRESIDENT / AUTHORIZED OFFICER: Joe Arreola. Print Name PHONE: ( EMAIL SIGNATURE: IF DIFFERENT THAN ABOVE, BeverlyStephenson. APPICATION PREPARED BY: p President Title DATE: 9/10/2020 (Month, Day, Year) Founder/Exec. Board Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 Stacey.Brown@TemeculaCA.gov (951) 694-6413 City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 NOVSTATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-OW Entity Status Letter Date: 9/10/2020 ESL ID: - Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: - Entity Name: FINE ARTS NETWORK ® 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ® 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800,852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from OLAslde the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019) INTERNAL REVENUE SERVICE DISTRICT DIRECTOR 2 CUPANIA CIRCLE MONTEREY PARK, CA 91755-7406 Date: �CT �3gd FINE ARTS NETWORK C/O VIRGINIA K. COSTILOW 28410 FRONT STREET, SUITE 104 TEMECULA, CA 92590 Dear Applicant: DEPARTMENT OF THE TREASUIZY Employer Identification Number: Case Number: Contact Person: TERRY IZUMr Contact Tele hon umber: Accounting Period Ending: December 31 Foundation Status Classification: 509(a) (2) Advance Ruling Period Begins: July 27, 1994 Advance Ruling Period Ends: Dec. 31, 1998 Addendum Applies: No Based on information you supplied, and assuming your operations will be as stated in your application for recognition of exemption, we have determined you are exempt from federal income tax under section 501(a) of the Internal Revenue Code as an organization described in section 501(c)(3). Because you are a newly created organization, we are not now making a final determination of your foundation status under section 509(a) of the Code However, we have determined that you can reasonably expect to be a publicly supported organization described in section 509(a)(2). Accordingly, during an advance ruling period you will be treated as a publicly supported organization, and not as a private foundation. This advance ruling period begins and ends on the dates shown above. Within 90 days after the end of your advance ruling period, you must send us the information needed to determine whether you have met the require- ments of the applicable support test during the advance ruling period. If you establish that you have been a publicly supported organization, we will classi- fy you as a section 509(a)(1) or .909(a)(2) organization as long as you continue to meet the requirements of the applicable support test. If you do not meet the public support requirements during the advance ruling period, we will classify you as a private foundation for future periods. Also, if we classify you as a private -foundation, we will treat you as a private foundation from your beginning date for purposes of section 507(d) and 4940. Grantors and contributors may rely on our determination that you are not a private foundation until 90 days after the end of your advance ruling period. If you send us the required information within the 90 days, grantors and contributors may continue to rely on the advance determination until we make a final determination of your foundation status. If we publish a notice in the Internal Revenue Bulletin stating that we Letter 1045 (DO/CG) -2- FINE ARTS NETWORK will no longer treat you as a publicly supported organization, grantors and contributors may not rely on this determination after the date we publish the notice. In addition, if you lose your status as a publicly supported organi- zation, and a grantor or contributor was responsible for, or was aware of, the act or failure to act, that resulted in your loss of such status, that person may not rely on this determination from the date of the act or failure to act. Also, if a grantor or contributor learned that we had given notice that you would be removed from classification as a publicly supported organization, then that person may not rely on this determination as of the date he or she acquired such knowledge. If you change your sources of support, your purposes, character, or method of operation, please let us know so we can consider the effect of the change on your exempt status and foundation status. If you amend your organizational document or bylaws, please send us a copy of the amended document or bylaws. Also, let us know all changes in your name or address. As of January 1, 1984, you are liable for social securities taxes under the Federal Insurance Contributions Act on amounts of $100 or more you pay to each of your employees during a calendar year. You are not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA). Organizations that are not private foundations are not subject to the pri- vate foundation excise taxes under Chapter 42 of the Internal Revenue Code. However, you are not automatically exempt from other federal excise taxes. if you have any questions about excise, employment, or other federal taxes, please let us know. Donors may deduct contributions to you as provided in section 170 of the Internal Revenue Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. Donors may deduct contributions to you only to the extent that their contributions are gifts, with no consideration received. Ticket purchases and similar payments in conjunction with fundraising events may not necessarily qualify as deductible contributions, depending on the circumstances. Revenue Ruling 67-246, published in cumulative Bulletin 1967-2, on page 104, gives guidelines regarding when taxpayers may deduct payments for admission to, or other participation in,.fundraising activities for charity. You are not required to file Form 990, Return of Organization Exempt From Income Tax, if your gross receipts each year are normally $25,000 or less. If you receive a Form 990 package in the mail, simply attach the label provided, check the box in the heading to indicate that your annual gross receipts are normally $25,000 or less, and sign the return. If you are required to file a return you must file it by the 15th day of the fifth month after the end of your annual accounting period. We charge a penalty of $10 a day when a return is filed late, unless there is reasonable Letter 1045 (DO/CG) -3- FINE ARTS NETWORK cause for the delay. However, the maximum penalty we charge cannot exceed $5,000 or 5 percent of your gross receipts for the year, whichever is less. We may also charge this penalty if a return is not complete. So, please be sure your return is complete before you file it. You are not required to file federal income tax returns unless you are subject to the tax on unrelated business income under section 511 of the Code. If you are subject to this tax, you must file an income tax return on Form 990-T, Exempt Organization Business Income Tax Return. In this letter we are not determining whether any of your present or proposed activities are unre- lated trade or business as defined in section 513 of the Code. You need an employer identification number even if you have no employees. If an employer identification number was not entered on your application, we will assign a number to you and advise you of it. Please use that number on all returns you file and in all correspondence with the Internal Revenue Service. If we said in the heading of this letter that an addendum applies, the addendum enclosed is an integral part of this letter. Because this letter could help us resolve any questions about your exempt status and foundation status, you should keep it in your permanent records. If you have any questions, please contact the person whose name and telephone number are shown in the heading of this letter. Sincerely yours, . M Ri and R. Orosco District Director Letter 1045 (DO/CG) F T a 4 7 2 B M E 0 R s v 8 s I STATE OF CALIFORNIA FRANCHISE TAX BOARD P.O. BOX 942857 SACRAMENTO, CALIFORNIA 94257-4940 Date: 08/11/94 FINE ARTS NETWORK BEVERLY STEPHENSON MENIFEE CA 92584 Subject: ADDRESS VERIFICATION California Corporation No. Our department has been advised that this organization or corporation will be receiving returns or other doculnents from this office. Our records show the above address as the address to which forms will be mailed. If this address Is not correct, please complete and return this form promptly in the enclosed envelope. PLEASE TYPE OR PRINT FINE ARTS NETWORK CORPORATION NAME Virginia Costilow CARE OF NAME (If Applicable) 28410 Front Street, Suite 104 STREET Temecula CA 92590 CITY STATE ZIP NOTICE TO INCORPORATING ATTORNEY If you are the incorporating attorney, please provide us with the current address for the corporation. If you believe this would violate your attorney -client relationship, please forward this request to your client. If we cannot establish and maintain contact with the corporation, the corporation may suffer penalties for failing to comply with the law. TAXPAYER SERVICES TELEPHONE ASSISTANCE From January 2 through April 15, the best time to tail is from 7:00 a.m. to 10:00 a.m, and 6W p,rn. to 8:00 p.m. Monday -Friday, Service Is available from 8:00 a.m. to 5:00 p,m. the rest of the year, From within the United States From outslde the United States Call..... Call (not toll -free).... 1.800-852-5711 1.916-854.6500 For hearing Impaired with TDD, Call.... 1.800-822.6268 c COPY �= C w� Ca ifornia s. SECRETARY OF STATE'S OFFICE C,'ORPORATrm DIVISION L 0 "Y I, TONY MlLLE'R, Acting Secretary of State of the State of California, hereby certify: That the annexed transcript has been compared with the corporate record on file in this office, of which it purports to be a copy, and that same is full, true and correct. IN WITNESS WHEREOF, I execute this certificate and affix the Great Seal of the State of California this JUL 2 7 1994 /ic'ffng Se•croara of SWfe SEC/STATE FORM CE-107 (REV. 2J941 1�M 94 25170 FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 12 HABITAT FOR HUMANITY INLAND VALLEY CITY OF TEMECUI[ A FISCAL YEAR 2020.2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 I PROJECT/PROGRAM INFORMATION Amount Requested: $ 5,000 Project/Program Title: A Brush With Kindness MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Start Date: 7/1 /20 End Date: 6130/21 Physical Address of Project/Program: 41615 Winchester Road, Suite 214, Temecula, CA 92590 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Habitat for Humanity Inland Valley Mailing Address: 27475 Ynez Road, #390 Temecula, CA 92591 r ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Habitat for Humanity Inland Valley Year Organization Founded: 1991 Website: habitativ.org Number of Paid Staff: 40 Number of Volunteers: 750 Contact Name. Mary Stein Title/Position: Associate Director Contact Person's Email Address: mary c@habitatMOrg Telephone: 951-296-3362 ext 203 Geographic Area(s) the Organization Serves: Southwest Riverside County Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ❑■ Date of Incorporation as a Nonprofit: 2/21 /91 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Number: Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: http://apps,irs;qov/aooleosl 2. Attach State Entity Status Letter using this link: httos:/ANww.ft§.O.aovionlinerselt serve entity-statys letterfindwasa 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htto:Brct.do.ea.govNerificationlWeb/Search.aspx?facility=Y City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ❑■ Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No 0 Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors ❑■ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION I Briefly describe the organization's mission/goals and objectives: The mission of Habitat for Humanity Inland Valley, in partnership with God, is to facilitate the dream of homeownership, as well as improve living conditions for those in the community. FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement', and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. I CITY OF TEMECULA FUNDING — OTHER SOURCES i Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑ Yes ❑■ IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT 04 SPONSORSHIP AMOUNT MONTH + YEAR FUNDING RECEIVED NAME OF C17rY GRANT OR SPONSORSHIP A Brush With Kindness - Minor Repairs $ 4,784 February 2020 CSF A Brush With Kindness - Minor Repairs $ 5,000 April 2019 CSF Critical Home Repair Program $ 50,000 2020-2021 CDBG Critical Home Repair Program $ 40,000 2019-2020 CDBG City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. The A Brush with Kindness (ABWK) program is our minor home repair program providing low-income Temecula residents with low to no cost minor exterior home repairs and mantenance services with the goal of protecting and preserving home affordability. We serve any low-income Temecula resident in need. The majority of those seeking services are seniors. Typical repairs include weed abatement, exterior painting, fencework, accessibility and minor repairs. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. Funds will provide the basic materials, tools and supplies needed for minor repairs and maintenance projects such as: painting supplies and tools (dropclothes, rollers, brushes, liners, etc.), yardwork supplies (pruners, hedge trimmers, trash bags, rakes, etc.), green waste dump fees, trailer rental for hauling landscaping or site materials, lumber and volunteer supplies and expenses. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. This project is only available to qualified low-income Temecula residents and will help keep neighborhoods beautified and protect affordable housing while stabilizing residents. Many times simple repairs can cause struggling residents to quickly become financially unstable, but with ABWK, residents can gain some financial stability. Over 90% of those served are fixed -income seniors. Estimate 20-25 people served and 50 - 75 volunteers. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. A BRUSH WITH KINDNESS. Fund low-income Temecula resident(s) with home repair/maintenance projects; minor home repairs and maintenance services with the goal of preserving home affordability: landscaping, weed abatement, exterior painting, securing accessibility, and fence work. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) $5,000 Cash contributed to Project/Program by the Applicant Organization $ 7, 500 1. Other grants or funding already awarded for Project/Program, if any $ In -Kind match amount or volunteer credit hours estimated amount 1,59000 PVARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Expense for Project/Program (This amount is ineligible to be funded by City's Grant; however please include.) $5,000 Equipment Expense For Project/Program $11500 Food Expense For Project/Program $500 Marketing Expense For Project/Program $11500 Supplies Expense For Project/Program $5,000 Facilities/Rent Expense For Project/Program Other Expense For Project/Program $4 , 000 $ TOTAL BUDGET FOR PROJECT/PROGRAM 1$171500 $ 1 7, 500 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 PREVIOUS* FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020, AS SHOWN BELOW. IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19120 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2019-2020 (last year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, andDecember 31, 2020. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: Thursday, December 31, 2020. EXPENDITURE REPORT due on or before Friday, eptaF ! 4-Thursday, December 31, 2020 1. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Name of Project/Program: Amount of Grant Fund Awarded: $ Month + Year Grant Received from City: ' Date (Mo/Day/Yr) Describe... Explain ... Name of Company on Receipt/Invoice Amount (1) what the expenditure was how the expenditure E on Receipt/Invoice Must be dated on or of (2) purpose of the expenditure specifically benefitted u E between July 1, 2019 - Expenditure Temecula residents A = a Z duna 30.20WO December 31, 2020 MUST support Project/Program description on Application + Award Letter if names/addresses of Temecula beneficiaries are available, lease attach_ 2 $ !Jil f 5� mo 3 $ P E 4 $ 5 $ 6 $ $ 7 EXPENDITURE TOTAL I Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" above) provided by the City City of Temecula Community Service Funding Grant APPLICATION Page 5 of 7 FISCAL YEAR (FY) 2020-2021 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant In FY 2020-2021 by the City of Temecula, then this information is not due until September 13, 2021 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2020-2021 by the City of Temecula, all giant funds received must be expended anytime on or between July 1, 2020, and June 30, 2021. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2020-2021 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 13, 2021. EXPENDITURE REPORT due on or before September 13, 2021 5. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 6. Fill out this table (include additional copies if needed to explain all expenditures) 7. Attach Receipts/[nvoices (in the same order as listed in this table) 8. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Name of Project/Program: Amount of Grant Fund Awarded: $ Month + Year Grant Received from City: Describe... Explain ... e Name of Company Date (Mo/Day/Yr) Amount (1) what the expenditure was how the expenditure E on Recelpt/Invoice on Receipt/invoice of (2) purpose of the expenditure specifically benefitted Must be dated on or Expenditure Temecula residents 2 a Z between July 1, 2020 - June 30, 2021 MUST support Project/Program description on Application + Award Leiter If names/addresses of Temecula beneficiaries are available, - lease attach. 1 $ 2 $ Gv swb�l`f - 3 $ pr► �z-f� q 13 4 $ 5 $ 6 $ 7 $ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City City of Temecula Community Service Funding Grant APPLICATION Page 6 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: ` abitat for Humanity Inland valley MAILING ADDRESS: 274758 Ynez Road #390 Temecula, CA 92591 951-296-3362 ext 203 PHONE: () EMAIL: mary@habita6v.org PRESIDENT /AUTHORIZE.� mmy Marine, Executive Director Name SIGNATURE: Title DATE: 9/10/2020 (Month, Day, Year) IF DIFFERENTCATON PREPARED BY:Mary THAN ABOVE,11 APPICATiary Stein, Associate Director Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 Stacey.Brown@TemeculaCA.gov (951) 694-6413 City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/10/2020 ESL ID: Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter, Entity ID: _ Entity Name: HABITAT FOR HUMANITY INLAND VALLEY, INC. 0 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ❑X 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019) OR IRS [icprir{rneut of Ilia Trceaury infernal Revenue Service In reply refer to: OGDEN UT 84201-0029 Mar. 09 2015 LTR 4167C 0 000000 00 00040704 BODC: TE HABITAT FOR HUMANITY INTERNATIONAL INC �i HABITAT FOR HUMANITY INTRNL PARENT % EDWARD K QUIBELL - CFO/SR VP 121 HABITAT ST AMERICUS GA 31709-3423 052913 Employer Identification Number: Group Exemption Number: Person to Contact: Ms Benjamin Toll Free Telephone Number: 1-877-829-5500 Dear Taxpayer: This is in response to your Jan. 20, 2015, request for information about your tax-exempt status. Our records indicate that you were issued a determination letter in January 1987, and that you are currently exempt under section 501(c)(3) of the Internal Revenue Code. Based on the information supplied, we recognized the subordinates named on the list you submitted as exempt from Federal income tax under section 501(c)(3) of the Code. Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to you or for your use are deductible for Federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106 and 2522 of the Code. If you have any questions, please call us at the telephone number shown in the heading of this letter. Sincerely yours, f Tamera Ripperda Director, Exempt Organizations FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 13 HOSPICE OF THE VALLEYS CITY OF TEMECUILA FISCAL YEAR 2020.2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 PROJECT/PROGRAM INFORMATION AmountRequested: $5,000 $MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: Senior Assistance Program Start Date: 07/01/2020 End Date: 06/30/2021 Physical Address of Project/Program: Hospice of the Valleys INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Mailing Address: 25240 Hancock Avenue, Suite 120 Murrieta, CA 92562 ORGANIZATION AND GEOGRAPHIC AREA SERVED 1 Name of Applicant Organization: Hospice of the Valleys Year Organization Founded: 1982 Website: https:Hhospiceofthevalleys.org/ Number of Paid Staff: 63 Number of Volunteers: 50 Contact Name: Melanie House Contact Person's Email Address: mhouse@hovsc.org Title/Position: Development Coordinator Telephone: 951-200-7800 Geographic Area(s) the Organization Serves: SW Riverside County & Fallbrook Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Geographic Area(s) the Organization Serves: Aguanga, Canyon Lake, Fallbrook, Hemet, Homeland, Lake Elsinore, Menifee, Murrieta, Nuevo, Perris, Quail Valley, Romoland, San Jacinto, Sun City, Temecula, NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes © Date of Incorporation as a Nonprofit: June 1983 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Number: - Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: htt :lla s.irs.gov/apr)/eos/ 2. Attach State Entity Status Letter using this link: httpsJ1www.ftb.ca.ttov/anlinetself_serve _entity status_ lettedindex.aso 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htt :lirct.do�.ca. ov/VerificationlWeb/Search_as x?facilit =Y RECEIVED SEP 0 2020 City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 CITY MANAGER'S OFFICE Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ® Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ❑X Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors ® Members -at -Large ❑ I MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: Mission: We foster reverence for life, relief of suffering and campasslon in loss for the, terminally ill residents and their families in the communities we serve. Vision: We seek to embady the hospice philosophy in all we do including: the affirmation of life, promotion of self-determination, education, understanding, and acre tance.We dedicate ourselves to the values of compassionate care lovincl presence,and the sustenance of hope for those dealing with the many difficult challenges at the end of life. We believe that transformation and healing area part of the dying rocess and change ali who participate in this sacred experience. We advocate sensitivitV. attentiveness and respect of all persons as we honor each life entrusted to our care. We support a culture of teamwork and professional collaboration. We embrace the callinq to worts diligently to provide leadership as educators and advocates for the suffering and dVing in our community.We hold ourselves accountable for the valuable resources which we have been given and vow to use them res onsibl .We are committed to the highest standards of personal and professional ethics and integrity,and maintain the hi hest standards of excellence in the provision of care. We continue our professional growth through advanced training and accreditation certification. I FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES I Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑ Yes ❑x— IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANTOR SPONSORSHIP AMOUNT MONTH + YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP CDBG $ 5583.00 06/2019 Temecula CDBG $5491.00 06/2020 Temecula City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. The Senior Assistance Program is hospice care for senior citizens and severeIV disabled adults. Care includes personal visit by clinicians and volunteers as well as the provisions of medical supplies, medications and durable medical a ui ment. Our bereavement andspiritual services also fall under the Senior Assistance Program and includes care such as support topatients' families and loved ones for at least 13 months post loss; monthly mailings on coping with the loss of a loved one; phone calls as needed; access to week) §2pport.grougs in the City of Temecula; our Hos ice Hearts Program; and free to the public memorial events offered twice earl - typically takinq place in the City of Temecula. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. Grant funding will be used for services not covered by Medicare or other insurances such as medication co -pays, incontinence supplies, fully electric bed rentals and overbed tables. All items that make our patients more comfortable as well as assist their caregivers and family members. Funding will also go towards supplies for our Hospice Hearts Program. Hospice Hearts have become an invaluablegift we offer to our patients` families and - caregivers. When separated, the tiny inner heart can be placed with the loved one who has died as a reminder of their unbroken connection to those that remain behind. While the outer heart is cherished by the family to treasure a small token shared with their loved one who has passed Numerous families who have received the hospice hearts have told us how meaningful they are and how they have provided comfort. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. All funds received from this rant will directly benefit our patients and their families who reside in Temecula. Providing these supplies and medical equipment keep these patients comfortable at the end of life while lessening the burden of care for the patients'family members and caregivers. Additionally, carinq and serving the bereaved that reside in Temecula. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: 140 Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 50 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. Our program will benefit patients residing in Temecula and will be used to pay for uninsured equipments_ supplies, and medication that keep our patients comfortable at the end of life. Further, it will allow us to continue caring forpatients' families and caregivers after the loss of their loved one. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula $ 5,000 Community Services Grant (Not to exceed $5,000) Cash contributed to Project/Program by the Applicant Organization $ 39,509 Other grants or funding already awarded for Project/Program, if any $ 5,491 In -Kind match amount or volunteer credit hours estimated amount $ 0 VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM ! Staffing Expense for Project/Program $ (This amount is ineligible to be funded by City's Grant; however please include.) Equipment Expense For Project/Program $ Food Expense For Project/Program $ i Marketing Expense For Project/Program $ Supplies Expense For Project/Program $ 50,000 Facilities/Rent Expense For Project/Program $ Other Expense For Project/Program $ I— -- TOTAL BUDGET FOR PROJECT/PROGRAM --- $ 50,000 $ 50,000 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. ■ The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Hos ice of the Valleys MAILING ADDRESS: 25240 Hancock Ave. #120 PHONE: (951) 200-7800 Murrieta, CA 92562 EMAIL: Icvar@hovsc.org PRESIDENT/AUTHORIZED OFFICER: L nette Cvar Chief Financial Officer Print Name Title SIGNATURE: !/ DATE: (Month, Day, Year) IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Melanie House Development Coordinator Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 If you have any questions, please contact Betsy Lowrey at (951) 693-3959 or Stacey Brown at (951) 694-6413. City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 STATE OF CALIFORNIA C FRANCHISE TAX BOARD B PO BOX 942857 7 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 8/13/2020 ESL ID: Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: _ Entity Name: HOSPICE OF THE VALLEYS SC 0 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019) Q HELP$ MENU = Home > Tax Exempt Organization Search > Hospice Of The Valleys Sc < Bark to Search Results Hospice of The Valleys Sc EIN: I Murrieta, CA, United States Other Names Publication 78 Data o Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Copies of Returns (990, 990-EZ, 990-PF, 990-T) o ,Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits. Tax Year 2017 Form 990 Page Last Reviewed or Updated. 6-Sept-2019 EMIRS r* Share Print 910 @'10 no �� FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 14 INLAND FUTURES FOUNDATION CITY OF TEMECUTA FISCAL YEAR 2020 - 2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 PROJECT/PROGRAM INFORMATION Amount Requested: $ 5,000 MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: "Uncovered in the Archives" Start Date. 11/2018 End Date: Ongoing Physical Address of Project/Program: INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Inland Futures Foundation, f/b/o KVCR's "Uncovered in the Archives" Mailing Address: San Bernardino, CA 92408-0108 I ORGANIZATION AND GEOGRAPHIC AREA SERVED I KVCR: 1962 Name of Applicant Organization: Inland Futures Foundation Year Organization Founded: IFF: 2019 Webs ite: www•kvcr.org/uncovercdinthearclzives Number of Paid Staff: 20 Number of Volunteers: 20 Host/Co-Executive Producer, Contact Name: Brad Pomerance Title/Position: Uncovered in the Archives Contact Person's Email Address: bradgbigmistproductions.com Telephone: Geographic Area(s) the Organization Serves: The City of Temecula, the Temecula Vallev and Greater Inland California Geographic Area(s) the Project/Program Serves: The City of Temecula, the Temecula Valley and Greater Inland California NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. We look forward to working directly with the City of Temecula to discover fascinating stories about Temecula's history that we can "uncover the archives." NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: 7/18/2019 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Number: _0000- Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: http://aQps.irs.gov/app/eos/ 2. Attach State Entity Status Letter using this link: htt2s://www.ftb.ca.gov/onlinelself serve _entity status tetterlindex.as 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: hit .//rct.doi.ca, ov/Vehfication/Web/Search.as x7faGilit =Y The Inland Futures Foundation is the successor organization to the KVCR Educational Foundation. Given IFF's recent incorporation, it has yet to file a Form 990. As a result, we are attaching the first page of the KVCR Educational Foundation's most recent Form 990. If you would like the most recently -filed Audited Financials for the Inland Futures Foundation, we can provide those at your request. City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No 0 Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No [K] Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors 0 Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: In 1962, KVCR launched as the first PBS affiliate in Southern California. Today, KVCR serves the City of Temecula, the Temecula Valley and Greater Inland California. KVCR's mission is to serve as a beacon for cultural and educational media that informs and transforms the entire region. KVCR promotes and cultivates discovery and engagement with educational, entertaining and thought -provoking programs. KVCR aims to reflect the many cultures and interests that make the Temecula Valley and Inland California so unique and vibrant. KVCR works to nourish strong communities by celebrating the diverse, inclusive and resilient nature of the region. I FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No 0 Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT MONTH + YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. 365 days a year, 24 hours a day, KVCR serves as the PBS television station for the City of Temecula, the Temecula Valley and all of Greater Inland California. On the television program "Uncovered in the Archives," Host Brad Pomerance travels to various institutions throughout the region to unravel some of history's most extraordinary events - remembered and forgotten - all told through the hidden treasures that we uncover in the archives. After an award -winning successful first season, KVCR has ordered a second season of "Uncovered in the Archives," which airs in both daytime and primetime on a weekly basis. A generous grant from the City of Temecula will support the production Season 2 of "Uncovered," the only television program currently airing in the region dedicated to stories by and about Greater Inland California. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. Although KVCR broadcasts "Uncovered in the Archives," the producers of the program are required to raise all the necessary funds to cover the entire budget for the series. In Season 2, that budget totals $200,000. As show on Page 4, $75,000 of that $200,000 includes hard costs (costs which are not salaries). These costs include the purchase and/or rental of all filming equipments — cameras, lights, audio, monitors, power supplies and batteries, computers, media storage and more. Those costs also include personnel costs - food, transportation, lodging, wardrobe, make-up and more. Currently, "Uncovered in the Archives" is the only originally -produced program airing on KVCR that focuses exclusively on Greater Inland California, including Temecula and the Temecula Valley. Through the generous grant of the City of Temecula, the producers of "Uncovered" will be able to continuing producing this public television by and about this region, an area that is sorely overlooked by the overlapping larger media markets. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. The City of Temecula and its residents will benefit in three tangible ways: 1) The production team films on location, eats in restaurants, frequents businesses, pays parking fees and fills their gas tanks — all supporting economic growth in Temecula, 2) "Uncovered in the Archives" tells stories based exclusively in Temecula, the Temecula Valley and Inland California. Given this unflinching goal, viewers living in Temecula directly benefit through the sustained opportunity to watch consistent television programming that features stories about their hometowns, building civic pride in their communities, and 3) KVCR is carried not only in Riverside and San Bernardino Counties, but in significant portions of Inyo, Kern, Los Angeles, Orange, Santa Barbara and Ventura Counties. Viewers outside the region learn about even more places to visit in Temecula, the Temecula Valley and Greater Inland California, increasing potential tourism and other business opportunities to the area. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: 24,577/monthly Estimated number of VOLUNTEERS INVOLVED in this Project/Program:10-20 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. This grant will cover equipment purchases/rentals and other hard costs to produce the historically -driven television show "Uncovered in the Archives" - airing on Temecula's PBS station, KVCR. *** Accordingly to recent Nielsen Television data, approximately 700,000 households tune into KVCR on a monthly basis. Of those 700,000 households, 42.5% are found in Riverside and San Bernardino Counties or 297,000 Riverside and San Bernardino Counties households tune into KVCR on a monthly basis. The City of Temecula (with approximately 34,000 households) comprises 2.5% of the combined Riverside and San Bernardino Counties (1,358,000 households). By extrapolation, in City of Temecula, 7,425 households tune into KVCR on a monthly basis. The U.S. Census Bureau states that each Temecula household includes 3.31 individuals. By extrapolation, 24,577 individuals living in the City of Temecula are watching KVCR on a monthly basis. 5. Provide Project/Program budget details below. Season 2 of "Uncovered in the Archives" PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) $ 5,000 Cash contributed to Project/Program by the Applicant Organization $ Other grants or funding already awarded for Project/Program, if any $ 19,500 In -Kind match amount or volunteer credit hours estimated amount $ VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program (This amount is ineligible to be funded by City's Grant; however please include.) $ 125,000 Equipment Expense For Project/Program Food Expense For Project/Program i $ 25,000 $ 5,000 Marketing Expense For Project/Program $ 5,000 Supplies Expense For Project/Program $ 10,000 $ 25,000 Facilities/Rent Expense For Project/Program Other Expense For Project/Program $ 5,000 TOTAL BUDGET FOR PROJECT/PROGRAM $ 200,000 $ 200,000 After a successful 1 st Season of "Uncovered in the Archives," KVCR recently committed to a 2nd Season of the series. We have set a 2nd season budget for $200,000. On the heels of KVCR's announcement, the City of Riverside announced that it was extending its grant to "Uncovered," seeding the 2nd season budget with $19,500. As a result, we have begun fundraising for the 2nd season, which is the sole responsibility of the producers of "Uncovered in the Archives." We would be honored to call the City of Temecula a sponsor of Season 2 of our series. City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 PREVIOUS* FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020, AS SHOWN BELOW. IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19/20 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2019-2020 (last year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and :.:. n December 31, 2020. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: Thursday, December 31, 2020. i EXPENDITURE REPORT due on or before I=rkmy.--s�eplef, F1-�-n2o-Thursday, December 31, 2020 1. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Amount of Grant Fund Awarded: $ Name of Project/Program: Month + Year Grant Received from City: Describe... plain Date (Mo/Day/Yr) ... Name of Company p Y on Receipt/Invoice Amount (1) what the expenditure was how the expenditure P E on Receipt/invoice Must be dated on or of (2) purpose of the expenditure specifically benefitted between July 1, 2019 - Expenditure Temecula residents Q Z june 30, 2020 December 31, 2020 MUST support Project/Program description on Application + Award Letter If namesladdresses of Temecula beneficiaries are available, lease attach. 1 $ - 2 $ $ 3 4 $ 5 $ 6 $ 7 $ EXPENDITURE TOTAL Note: Expenditure Total must be equal to "Amount $ (or greater than) the of Grant Fund �. Awarded" (above)providedby the a City — — — — City of Temecula Community Service Funding Grant APPLICATION Page 5 of 7 FISCAL YEAR (FY) 2020-2021 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant in FY 2020-2021 by the City of Temecula, then this information is not due until September 13, 2021 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2020-2021 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2020, and June 30, 2021. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2020-2021 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 13, 2021. EXPENDITURE REPORT due on or before September 13, 2021 5. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 6. Fill out this table (include additional copies if needed to explain all expenditures) 7. Attach Receipts/Invoices (in the same order as listed in this table) 8. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: _ Name of Project/Program: Amount of Grant Fund Awarded: $ _ Month + Year Grant Received from City: d t� " E 4Z Name of Company Date (Mo/DayNr) Amount on Receipt/Invoice on Receipt/Invoice of Expenditure Must be dated on or between July 1, 2020 - June 30, 2021 4a H EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City Describe... (1) what the expenditure was (2) purpose of the expenditure MUST support Project/Program description on Application + Award Letter Explain ... how the expenditure specifically benefitted Temecula residents If names/addresses of Temecula beneficiaries are available, please attach. City of Temecula Community Service Funding Grant APPLICATION Page 6 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Inland Futures Foundation, f/b/o KVCR's "Uncovered in the Archives" MAILING ADDRESS: PHONE: EMAIL: brad@bigmistproductions.com San Bernardino, CA 92408-0108 PRESIDENT / AUTHORIZED OFFICER: Brad Pomerance Print Name SIGNATURE: JN� IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Print Name Host/Co-Exec. Producer, Uncovered in the Archives Title DATE: 9/ 13/2020 (Month, Day, Year) Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 Stacey.Brown@TemeculaCA.gov (951) 694-6413 City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/13/2020 ESL ID: Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: - Entity Name: INLAND FUTURES FOUNDATION OF THE SAN BERNARDINO COMMUNITY COLLEGE ❑X 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ❑X 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019) SDepartment of the Trca3ury Internal Revenue Service' In reply refer to: OGDEN UT 84201-0029 July 18, 2019 LTR 4168C 0 000000 00 00027156 BODC: TE INLAND FUTURES FOUNDATION OF THE SAN BERNARDINO COMMUNITY COLLEGE DISTRICT Ye MATTHEW K I SN BERNRDNO CA 92408-0108 019082 Employer ID number: Form 990 required: YES Dear Taxpayer: We're responding to your request dated May 22, 2019, about your tax-exempt status. We issued you a determination letter in SEPTEMBER 2015, recognizing you as tax-exempt under Internal Revenue Code (IRC) 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 170Cb)(1)CA)(iv). Donors can deduct contributions they make 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 and of your annual accounting period: - Form 990, Return of Organization Exempt From Income Tax - Form 990EZ, 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-EZ - Form 990-PF, Return of Private Foundation or Section 4947(a)(1) 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., ■ July 18, 2019 LTR 4168C 0 000000 00 00027157 INLAND FUTURES FOUNDATION OF THE SAN BERNARDINO COMMUNITY COLLEGE DISTRICT MATTHEW K ISAAC SN BERNRDNO CA 92408-0108 local time, Monday through Friday (Alaska and Hawaii follow Pacific time). Thank you for your cooperation. Sincerely yours, Stephen A. Martin Director, EO Rulings & Agreements rj E 0 0 K V C R T V 2 4 Aft ]3 R' The Heart of Southern California Wine Country 365 days a year, 24 hours a day, KVCR serves as the PBS television station for the City of Temecula, the Temecula Valley and Greater Inland California. KVCR's mission is to serve as a beacon for cultural and educational media in Inland California that informs and transforms the entire region. As the first PBS affiliate in Southern California, KVCR is going through a renaissance. As part of this resurgence, KVCR's goal is to expand its original programming slate, supporting television series by and for the Temecula Valley and Greater Inland California, whose communities are often underserved by overlapping, larger media markets. In furtherance of that goal, in 2018, KVCR ordered the historically -driven television series Uncovered in the Archives from Brad Pomerance and CJ Eastman. Both Brad and CJ are seasoned industry professionals, with a demonstrated commitment to television programming in Greater Inland California, having most recently worked for Charter Communications, now Spectrum, in the region for about a decade. On Uncovered in the Archives, Host Brad Pomerance travels throughout the Temecula Valley and Greater Inland California to unravel some of the region's most extraordinary historical events - known and unknown, remembered and forgotten - all told through the hidden treasures that we uncover in the archives. This 30-minute television program airs in daytime and primetime on a weekly basis on PBS -affiliate KVCR. Thanks to the invaluable support of sponsors from the public, private and non- profit sectors, Uncovered in the Archives recently concluded its first season. In recognition of this invaluable support, the Announcer audibly thanked all Season 1 sponsors at the beginning and end of each episode, while each and every sponsor's logo is prominently shown on the screen for the audience to visually see (an example of which is shown on the next page). During the first season of Uncovered in the Archives, we were humbled to receive some very positive feedback, a sampling of which we provide here. "I absolutely loved the program. It left me on the edge of my seat, anticipating what's coming next. Absolutely phenomenal. Encore!" "I was so impressed at your ability to move effortlessly from one location to another." - "The show was excellent. I was thoroughly impressed with how the program was orchestrated and edited. I really feel that `Uncovered in the Archives' will become a complete success with viewers." "I love this show. Such interesting information. I think Brad Pomerance is the next Huell Howser." Over its first season, Uncovered in the Archives was likewise honored to receive two highly -coveted awards for its work — from the Los Angeles Area Press Club and the Society of American Archivists. 2 During Season 1, Uncovered in the Archives proudly produced an episode in the Temecula Valley' at the Western Science Center, where Brad uncovered the groundbreaking discovery that led to the region's nickname, The Valley of the Mastodons - httl2s://www.pbs.org/video/4-y4lley-of-the-mastodons-hOudik/ By continuing production of Uncovered in the Archives into Season 2, the City of Temecula, the Temecula Valley, Riverside County and Greater Inland California will garner significant tangible benefits. - During production of Uncovered in the Archives, the crew of nearly ten people eat at multiple local restaurants. We fill our gas tanks in these communities. We pay parking fees on city streets. We make purchases at area businesses. We look forward to creating even more of this economic activi - by telling more stories, filming in more locations, eating at more restaurants, filling more gas tanks and frequenting more businesses in the City of Temecula and the Temecula. - The mission of Uncovered in the Archives is to tell stories based exclusively in Greater Inland California. Given this unflinching goal, viewers living in Temecula and the Temecula Valley directly benefit through the sustained opportunity to watch consistent television programming that features stories emanating from their own communities — building civic pride in these often - overlooked areas. ' "Uncovered in the Archives" Director Glenn Grant, shown behind the camera in the picture above, has lived and worked in the Temecula Valley for close to 20 years. He has produced significant video content for the City of Temecula and other Temecula Valley entities, including Hot Summer Nights, the Rod Run, Temecula Street Painting, the Temecula Valley Balloon and Wine Festival and Temecula Winterfest. 3 - KVCR is carried not only in Riverside and San Bernardino counties, but in significant portions of Inyo, Kern, Los Angeles, Orange, Santa Barbara and Ventura Counties. While KVCR and Uncovered in the Archives target its content especially for viewers in Greater Inland California, its programming is broadcast throughout these several Southern California counties. As a result, Temecula and the Temecula Valley doubly benefits — its residents enjoy self -grown programming highlighting their home region, while viewers living outside the area are presented with even more places to visit in the region, increasing tourism and other business and economic opportunities to the area. Under the KVCR business model, the production team from Uncovered in the Archives is required to raise the entire budget for the series. For Season 1, we received generous support from public, private and non-profit sources, including (in alphabetical order) the City of Claremont, the Coachella Valley Water District, the City of Hesperia, the City of La Quinta, Loma Linda University Health, the City of Riverside, the County of Riverside and the Grace Helen Spearman Charitable Foundation. As shown above, all sponsors receive on -air mentions with an accompanying logo at the beginning and end of each broadcast of every episode of the program during the sponsored period. Now that KVCR has most recently committed to a second season of Uncovered in the Archives, the producers have just begun to seek out sponsors for the 2nd season of the series, whose total budget has been set at $200,000. We recently learned that the City of Riverside generously renewed its grant to Uncovered in the Archives, providing $19,500 to be applied to episodes during Season 2 of the series. We would be honored to have the City of Temecula affirm its commitment to outstanding public television programming by supporting KVCR's Uncovered in the Archives, which will allow for the production of a whole new slate of episodes during the second season of the series. We sincerely thank the City of Temecula for its consideration. 4 c5a�zmon Ow Rizeap K V C R T V 2 4 [Ineov¢rQd in the c(4rchivQs offas a hQartg thanks to our S¢ason 1 Sponsors LOMA LINDA UNIVERSITY HEALTH �STR►� ,�'r� GRACE HELEN ���;;SPEARMAN o ?CHARITABLE �`tir�v�` FOUNDATION rCR I . 9 "Uneovurzd in the prmi¢rz K V C R 9 1 . 9 I� E N E131pi� Host/Co-Executive Producer Brad Pomerance F:AlDID C 9 t v 2 4 Co -Executive Producer G Eastman & Director Glenn Grant K V C R 9 ] . 9 E94PIP4E a MM wa O! Host/Co-Executive Producer Brad Pomerance & Director Glenn Grant BEHIND THE SCENES INSIDE THE ARCHIVES OF " aticoveizC'D itinie `Ntzo'I' v S" Coach¢118 Vall¢y Watjzr 'District Z9rchiv¢s Palm Dgzizrt, California IM Smil¢y Library-orchiv¢s Pscilands, California Mission Inn Munum 14rchives P,iv¢rsid¢, California gad Vash¢m tiolocaust Museum-9rchivszs krusal¢m, Israol Orangiz County lirchivQs clanta lina, California e5an Manu¢l band of Mission Indians lirchiv" e5an bizrnardino, California Munum of R.ivvrsid¢ lirehives R,iv¢rsid¢, California San bornardino ivounty Historical lirehiv" San $¢rnardino, California Palm Springs j9¢rial Tramway Z4rehivizs Palm Springs, California aA. r r`r /- 1 i- Local MQdia and ei�ct¢d Officiak fQatunz aLM h L v U �aho L tA = now W • • qn # C O N Z •n U CL W L c c O Vv v 7 �i E a,a a r 3 W L Z a E E � = a 0 a 0 Z W W a tC � L � N L t L L 00 CL O= H 3 ? :b t W C Q Rw IECN� a mpt�e acorn e►vs Empire KVCR's "Uncovered in the Archives" gives voice to Inland Empire arei'ett.,i,nirrcriot l7th 4a[.catidts:�F^ierii.�n:rren[Jc?�rrr!'n AtyorcJS�G"�Yw!..�; 3 7y,V N.c vie By Community News - January 28, 2020 Photo SBCCO: Bled Pomera , nW and cP murnv amdum o!'Uncovered in the Ardnive4-M a tour a/Me Mission !nn Museum wMr /Caren Raines, —.W Paintings lost and neglected in the catacombs of the Mission Inn are the subject of an award whaling episode of "Uncovered in the Archives," a documentary show aired on EMPIRE I KVCR. One of r3 episodes in the first season, it took third place for short documentaries in the rath National Arts V Entertainment Journalism Awards for the Los Angeles Press Club "We are proud to be honored among such a line group of journalists," said Brad Pomerance, who hosts and produces the series Eastman and Pomerance worked together at Charter Communications on a show called Loral Edition. 'They created and produced 13 episodes of "Uncovered in the Archives" for EMPIRE KVCR, by visiting the archives of museums, libraries and schools. This is the first season of the show. "Our very first episode came from an idea from Don Singer, a trustee on the board of the San Bernardino Community College District " Pomerance remembered. "It was about the first African American to live in greater Redlands, and I wouldn't have known about it, but for Don." The crew found and interviewed the great -great- grandchildren of Israel Beal. Another episode, not yet aired, centers around Dr. Lyra George from along with CJ Eastman and Glenn Grant for Empire EMPIRE Loma Linda University Health, who would go on horseback to KVCR, the public TV and radio station for the Inland Empire, deliver the babies of the San Manuel Band of Mission Indians in the operated by the San Bernardino Community College District. early igocs. Her cane at a time of great prejudice saved the lives of The honored episode tells the story of paintings by Henry Chapman mothers and babies. "When you watch the episode, it is dear why Ford of the California Missions, images credited with inspiring the the tribal members feel so tied to Loma Linda and Lyra George," Mission Revival architectural movement. Purchased for the Mission Pomeranee said Inn, they were damaged in a flood and left to rot until a housekeeper tried to throw them away. Citizens formed the Friends of the Mission Inn, as well as a Mission Inn Foundation, and they had the paintings carefully restored They now hang in the hotel's Spanish Gallery and in other spots around the hotel. "In taping the episode, seeing the before and after of the paintings was absolutely awe-inspiring," said Eastman, who works as the co. executive producer for the series. "The fact that they were covered in pigeon feces, and they could still bring them back to their original spectacular condition was truly amazing to me." He said he is proud to be working with EMPIRE I KVCR to give the Inland Empire a voice in the larger Southern California media market. He said he likes learning about people who should be more famous than they are. "These are compelling stories about very significant moments in history," Pomeranoe said. "I feel honored that I have the opportunity to tell these stories." Eastman echoed that sentiment. `"The hardest part is figuring what to leave out." Viewers can find "Uncovered in the Archives" on Empire KVCR of online. GIMandErrlpire.US KVCR TV Show Wins Los Angeles Press Club Award ar nw "N.". Iaowp' 73 I= SAN BERNARDINO, Calif. — Paintings lost and neglected In the catacombs of the Mission Inn are the subject of an award -winning episode of "Uncovered in the Arch Ives," a documentary show aired on EMPIRE I KVCR One of 13 episodes In the first season, it took third place for short documentaries In the 12th National Arts 6 Entertainment Journalism Awards for the Los Angeles Press Club "We are proud to be honored among such a fine group ofjoumallsts," said Brad Pomerance, who hosts and produces the series along with Q Eastman and Glenn Grant for Empire EMPIRE I KVCR, the public TV and radio station for the Inland Empire, operated by the San Bernardino Community College District. ThgAWQMd josodCtells the story of paintings by Henry Chapman Ford of the California Missions, images credited with inspiring the Mission Revival architectural movement. Purchased for the Mission Inn, they were damaged in a flood and left to rot until a housekeeper tried to throw them away, Citizens formed the Friends of the Mission Inn, as well as a Mission Inn Foundation, and they had the paintings carefully restored. They now hang in the hotel's Spanish Gallery and In other spots around the hotel 'in taping the episode, seeing the before and after of the paintings was absolutely awe - Inspiring' said Eastman, who works as the co -executive producer for the series 'The fact that they were covered in pigeon feces, and they Could still bring them back to their original spectacular condition was truly amazing to me' Eastman and Pomerance worked together at Charter Communications on a show called Local Edition. They created and produced 13 episodes of "Uncovered in the Archives" for EMPIRE I KVCR, by visiting the archives of museums, libraries and schools This is the first seainft of the show. 'Our very first episode came from an idea from Don Singer, a trustee on the board of the San Bernardino Community College District," Pomerance remembered 'it was about the first African American to live in greater Redlands, and I wouldn't have known about it, but for Don -"The crew found and interviewed the great, great grandchildren of Israel Beal Another episode. not yet aired, centers around Dr Lyra George from Loma Linda University Health, who would go on horseback to deliver the babies of the San Manuel Band of Mission Indians In the early 1900s. Her Cafe at a time of great prejudice saved the lives of mothers and babies 'When you watch the episode, It is clear why the tribal members feel so tied to Loma Linda and Lyra George." Pomerance said, He said he is proud to be working with EMPIRE I. KVCR to give the Inland Empire a voice In the larger Southern California media market He said he likes learning about people who should be more famous than they are. "These are compelling stories about very significant moments in history," Pomerance said 1 feel honored that I have the opportunity to tell these stories' Eastman echoed that sentiment "The hardest part is figuring what to leave out Y!['h'S[icafL4nsLLIa[atx[sfllnsRsck[hwls' an Em(}}tyt[}LC[l6tLtlq¢d! EMPIRE KVCR'S "UNCOVERED IN THE ARCHIVES" GIVES VOICE TO INLAND EMPIRE BY CALINEWS 3 DAYS AGO Paintings lost and neglected in the catacombs of the Mission Inn are the subject of an award -winning episode of "Uncovered in the Archives," a documentary show aired on EMPIRE I KVCR. One of 13 episodes in the first season, it took third place for short documentaries in the 12th National Arts & Entertainment Journalism Awards for the Los Angeles Press Club. "We are proud to be honored among such a fine group of journalists," said Brad Pomerance, who hosts and produces the series along with CJ Eastman and Glenn Grant for Empire EMPIRE I KVCR, the public TV and radio station for the Inland Empire, operated by the San Bernardino Community College District. The honored episode tells the story of paintings by Henry Chapman Ford of the California Missions, images credited with inspiring the Mission Revival architectural movement. Purchased for the Mission Inn, they were damaged in a flood and left to rot until a housekeeper tried to throw them away. Citizens formed the Friends of the Mission Inn, as well as a Mission Inn Foundation, and they had the paintings carefully restored. They now... FACL, INC. FINE ARY CONSERVATION LABORATORIES PBS Feature of Saving Historic Paintings of Missions Recognized by Los Angeles Press Club Special recognition from the Los Angeles Press Club was announced yesterday for the widely viewed PBS special documentary featuring the art conservation mystic arts of Fine Art Conservation Laboratories for saving the incredibly historic mission paintings by Henry Chapman Ford, now part of the art collection of the Mission Inn in Riverside, California. The paintings are considered by many scholars as a national treasure given their unique place in US and California history. The prestigious Los Angeles Press Club's 12th National A&E Journalism Awards have named as a finalist In "the category of "Documentary or Special Program, Short" KVCR's PBS Uncovered in the Archives. We are proud to be honored among such a fine group of Journalists. Below is the list of the finalists in this category, The episode for which Uncovered In the Archives received the nomination told the very Interesting story of the several efforts of saving of the 36 paintings from complete destruction and their painting restoration by art conservation professionals at Fine Art Conservation Laboratories over several years.. We are so grateful to all the participants in and supporters of this episode. Without everyone's excellent team effort and great attitude, this accolade would not have been possible. �y `-,,Wnd Fad p.WM %. ci- ups Ri.ialpns of CAf—lr ",e awed from 6.rt a, Uncovered In the Archives producers are Brad Pomerance, CJ Eastman and Glenn Grant The honored 20 minute episode Is featured in this blog post with the video at the end of the article — https:i�www,i'i1�saR I I :ph�—,-pLQgram-on rare-hisMr.&._qL-ap inUgs•of-missions•of•ca-rho +v,vtL r rail �r n�! ,frig -restoration riversrle gT Q1j5ion •innf Scott M. Haskins, Oriana Montemurro, Virginia Panizzon FACL Art Conservators VP W r"0M the MF \ \ ) $ / $ ) / 6 k m f } ° § \ u f » ± o 5 ° \ A / { } / '0 ƒ a / 2 - u . \ / i Q) § k k \ § - j } fu 'A/ . 2 ) \ f � 7 °§ / -0 ( 3 $ 2 / ; } § _ 0� / 0 �� E ) § } a ) \ A 0 \ k cu g � } § / R _ 0 O . � \ 0 / \ \ a % 0 ° 2 0 8 2 co a ` / i 2 - ( § > ■ 2 O }\§ , k \ U 7 / \ § / _ - § 0 { / \ 0 K \ a \ \ L 2 E + § c ; , ! ® 2 2 7 ■ O I ° [ > Qj ° j t 2 2 « @ Ill® ( — CD m = E / \ 7 _0 ,u f { co (D \ § % § ovi c \ a $ $ « } & £ 2 , E » f k E ` § < £ � ( § y Ln E E f % e k "n w ) \ \ C % j ® k \ § \ j J « 2 .g # @ # / g ) e ■ g § Q/ E ± E 2 ! k 2 \ / Q- $ Q a % \\\E _ u a W j \/\ \ ro \j Tram History Explored In PBS Series I KNews 94.3 & 144.1 e Tram History Explored In PBS Series SEP 26, 2019 @ 9:37AM i Co.. 3e. Photo From Pair, Springs aerial Tramway The history of the Palm Springs Aerial Tramway will be revealed in an episode of the popular Empire/KVCR PBS series "Uncovered In the Archives." Series host Brad Pomerance travels to Palm Springs to sift through the Tramway's archives to find out how how this world-renowned attraction was born. It's a 30-minute episode airing Sunday September 29th at 9:30 p-m, and again on October 4th and 9th. The Palm Springs Aerial Tramway remains closed through September 29th for its annual maintenance, but is scheduled to re -open on September 30th. Photo From Palm Springs Aerial Tramway Palm Springs Aerial Tramway featured on Empire/KVCR PBS program By Idyliwlld Town Crier - October 3, 2019 Palm Springs Aerial Tramway Contributed Historical records of the Palm Springs Aerial Tramway will soon be revealed in an episode of the popular Empire/KVCR PBS series "Uncovered in the Archives." Series host Brad Pomerance travels to Palm Springs to sift through the tramway's archives to learn how this world-renowned Southern California attraction came to be- The 30-minute episode premiered on Sept. 29, 2019 at 9:30 p.m. and will also air Oct. 4 and Oct. 9. According to Pomerance, `The Palm Springs Aerial Tramway holds so much history in Palm Springs that to have access to the archives of this iconic attraction was truly a treat for me." "Uncovered in the Archives" travels throughout greater Inland California to reveal some of the region's most extraordinary historical events and places — known and unknown, remembered and forgotten — all told through the hidden treasures that are discovered in the destinations visited. The series is produced for Empire KVCR/PBS by Big Mist Productions and the Endeavor Production Company, with C.J. Eastman serving as executive producer and Glenn Grant as creative director. About Palm Springs Aerial Tramway The Palm Springs Aerial Tramway is the world's largest rotating tram car. Opened in 1963, the tram's 80-passenger cars travel along the breathtaking cliffs of Chino Canyon from the Valley Station (elevation 2,643 ft.) to the Mountain Station (elevation 8,516 ft.) in approximately 10 minutes. For more information, please call 888-515 TRAM or 760-325- 1391, or visit us at www.pstramway.com- Also, download the free mobile tour now available in the App Store/Google. Morrie About All Cities + Calerirhr Galleries Traffic C`arneras Contarrt us HESPERIA. "Uncovered in the Archives" kooks at Hesperia's Early Days by 11 • November 23, 2019 • 0 Comments By Staff Reports (Hesperia)— The PBS series, "Uncovered in the Archives" recently focused on the history of Hesperia. Hosted by KVCR's Brad Pomerance, the 26-minute episode includes interviews with historian Gary "Griz" Drylie and long-time residents Jim Walker and George Stanford. It also includes a tale of how a performance of the song, "Headin' for Hesperia" on the Arthur Godfrey show sparked a boom in the desert town in the 1950s. To view the show, click on https-//www.pbs,orq/video/headin-for-hesperia- SAN BERNARDINO COUNTY News from Supervisor Robert A. Lovingood "Uncovered in the Archives" looks at Hesperia's early days The PBS series, "Uncovered in the Archives" recently focused on the history of Hesperia. Hosted by KVCR's Brad Pomerance, the 26-minute episode includes interviews with historian Gary "Grit' Drylie and long-time residents Jim Walker and George Stanford. It also includes a tale of how a performance of the song, "Headin' for Hesperia" on the Arthur Godfrey show sparked a boom in the desert town in the 1950s. To view the show, dick on https,A!A ww.gbs.orglvi eolheadin-for- hesperia-taevnu/ News from Councilman Kevin bash Uncovered In the AmMy2s Don't miss this upcoming episode! Good Morningl Thank you to the Lake Norconian Club Foundation for allowing me to reprint the following onnouncementl Really excifing after decade of lighting to get the truth out to finally see Norco's historic contributions to wheelchair basketball get told and particularly to have the once forgotten Rolling Devils get their just duel Don't miss this exciting eventl Kevin Bash (951 )768-8981 The Roiling Devils finally get their due. Tonight at 9pm on Channel 24 (Public Television KVCR) "Uncovered In the Archives" will tell the true story of how Wheelchair Basketball was pioneered in Norco at the old Naval Hospital. (Also October 11 and 161 This program is a huge win In that for decades Naval Historians denied this monumental event (and others( and belittled the efforts of our little town and the Lake Norconion Club Foundation. Magulded administrators went so far as to intimidate into silence at least one national Naval scholar and to disparage our research to both local and national preservation advocates. Well, the truth Is out after ten years of fighting with the State Historical Resources Commission unanimously nominating to expand the Lake Norconlan Club National Register Listing to Include the Naval accomplishments and buildings. Inexcusably, while we have a great relationship with local command, the National Naval "Historians" in Washington are inexcusably holding back the rightful listing. So, we continue to fight. KVCR Documentary Sunday October 6, 11, 16 The Real Story Of Wheelchair Basketball In Norco Is Finally Told Uncovered In the Archlves sun 10/0e119, 9:00PM FA 10111119, C311PI11 Wed 10116/19.11:30AM For More Inlonnatlon ClIck the Image Below Mad Pom Ma • IN Svnday, OdOIW 6th at r110P1A tole... An S.101.. ocn,oe dM oI V10" An H b a nvx onaodnol Vrxmaed of Ml NtM.q- 'Mein xp VMORI IM IIbbN OI W bMW rBalnlCdl ln,. Mad®n m..asonvaw cml , -41 4- CHL �� -� KVCR Public Television Uncovered in the Archives Airing Times: Sunday Oct. 6, 2019 at 9 PM Friday Oct. 11, 2019 at 6:30 PM Wednesday Oct. 16, 2019 at 11:30 AM 0 0 0 re►►►►►►u►►ity ArouO conversation PECTR,,.L.IM PIONEER ADVENTIST PHYSICIAN FEATURED IN DOCUSERIES - AND MORE NEWS SHORTS Written by: Pam Dietrich Publlshed: February 21, 2020 In this week's Adventist news round -up, pioneer physician Lyra George Is featured in the docuserles "Uncovered In the Archives, a Washington student is a finalist In a video contest, Antiguan Charles Wafter Stevens discusses his faith on his 100th birthday, and Forbes discusses how Adventists In Papua New Guinea may be the "saving grace" for some species of sharks and rays. Pioneer SDA Physidan Lyn George feadmd In Soutltam Catifomia Doeuseries. Uncovered In the Archives, a documentary series, featured physician Lyra George from Loma Linda University, who would go on horseback to deliver the babies of the San Manuel Bend of Mission Indians in the early 1900s. Her care at a time of great prejudice saved the lives of mothers and babies 'When you watch the episode, it is clear why the tribal members feel so tied to Loma Linde and Lyra George, said Brad Pomerance, who hosts and produces the series along with CJ Eastman and Glenn Grant for Empire EMPIRE I KVCR, the public TV and radio station for the Inland Empire, operated by the San Bernardino Community College District The series took third place for short documentaries in the 12th National Arts & Entertainment Journalism Awards for the Los Angeles Press Club. From Empire Network' " and from Medium.com, . About Archives • About SAA • Careers • Education • Publications • Advocacy • Membership 013ME30 AhoWArhives J. Franklin Jameson Archival Advocacy Award: Brad Pomerance and Q Eastman Brad Pomerance, host and co -executive producer of NVCR-TVs Uncovered in the Archives, and CJ Eastman, co -executive of Uncovered in the Archives, are 2020 recipients of the J. Franklin Jameson Archival Advocacy Award given by the Society of American Archivists (SAA). The award honors individuals, institution, or organization that promotes greater public awareness, appreciation, or support of archival activities or programs. Each week, viewers throughout southern California watch, Uncovered in the Archives, a thirty minute public television program on Empire I PBS. Brad Pomerance travels to archival repositories to describe some of the region's most extraordinary historical events, He features archival experts and treasures, and shoots footage behind the scenes in special collections, allowing the public to learn more about the archival profession. In every episode, the archives are a character in the program - The audience is made aware of the pivotal role that archivists play in maintaining our collective history. Given the success of the shows first season, plans have been laid for the program's second season, including potential expansion to other Public Broadcasting Service affiliates throughout the State of California and beyond. Uncovered in the Archives is and will continue to shine a bright light on how archives and archivists fortify the history of our communities, our cities, our states and our nation. Pomerance describes the documentary series as an opportunity to "unravel some of the region's most extraordinary historical events —known and unknown, remembered and forgotten —all told through the hidden treasures that we uncover in the archives." Harold T, Pinkett Student of up J, Franklin Jameson Archival Color Award: Carol Ng -He Advocacy Award: CIC's Humanities Research for the Public Good Program , Pnnle,. friendly version Login to past comments What Are Archives? Standards Archival Orga ni Ea ft ns Archival Consultants Resources Bibliography of American Archival History Facts & Figures NCw4�PilR ACll lllS Empire KVCR1'S:ncov.red in the Archiv4"rma Sae iety of Am cricen Archivist award B a •T•�•�—:� REDLANDs News Your Cornmunit}}. Your Nempaper. EWM PICK KVCR-TV hosts honored by archival society Jun 18, 2020 Updated 16 min ago CI Eastman and Brad Pomerance of "Uncovered in the Archives" have been honored by by the Society of American Archivists Brad Pomerance, host and co -executive producer of KVCR-TV's 'Uncovered in the Archives; and CI Eastman, the show's co -executive, are 2020 recipients of the 1. Franklin Jameson Archival Advocacy Award given by the Society of American Archivists. The award honors individuals, institution or organization that promotes greater public awareness, appreciation, or support of archival activities. Each week, viewers throughout Southern California can watch "Uncovered in the Archives," a 30-minute public television program on Empire I PBS. Pomerance travels to archival repositories to describe some of the region's most extraordinary historical events. He features archival experts and treasures, and shoots footage behind the scenes in special collections, allowing the public to learn more about the archival profession. Episode 1: Israel Beal, African -American Pioneer in Inland California ♦ Link: https-//www.pbs.oro-/video/the-colorcd-citizen-pklh7L� ♦ Featured Archives: ■ Family Archives of the Descendants of Israel Beal ■ Redlands High School ■ Redlands Area Historical Society ■ San Bernardino Historical and Pioneer Society ■ A.K. Smiley Library Episode 2: The Mission Inn Saves Henry Chapman Ford's California Mission Paintings ♦ Link: https://www.pbs.org/video/episode-2-henry-chapman-ford-paintings-fnuu3c/ ♦ Featured Archives: ■ Fine Art Conservation Laboratories ■ Mission Inn Foundation & Museum ■ Mission Inn Hotel & Spa Episode 3: Bringing Water into the California's Coachella Valley ♦ Link: https:/lwww.pbs.or&Lvideolepisgde-3-coachella-valley-an-oasis-in-the-desert-59dboal ♦ Featured Archives: ■ Coachella Valley Water District ■ Coachella Valley History Museum ■ Greater Palm Springs Conventions & Visitors Bureau ■ Historical Society of Palm Desert ■ Peter Rabbit Farms Episode 4: The Excavation'of the Valley of the Mastodons ♦ Link: https://www.pbs.orgividee/4-vallgy-of-the-mastodons-liOudikj ♦ Featured Archives: ■ Metropolitan Water District of Southern California ■ Paleontologist Kathleen Springer's Archive ■ Paleontologist Eric Scott's Archive ■ Western Science Center > Episode 4 Extra: Nazi Soldier Painted on Torah ♦ Featured Archive: 0 Yad Vashem World Holocaust Remembrance Center, Jerusalem, Israel Episode 5: The Development, Demise and Resurrection of the CA Ghost Town, Calico ♦ Link: https://www.pbs.org/video/tlie-silver-rgsli-of-calico-dkgr:il,- ♦ Featured Archives: ■ Family Archives of Pam Lambert and Ryan Isom ■ San Bernardino County Archives ■ San Bernardino County Museum Episode 6: The History of the Iconic Palm Springs Aerial Tramway ♦ Link: https://www,pbs.orOvideo/6-pal_ m-sn?•ini!s-aerial-tramway-mmxbjr/ ♦ Featured Archives: ■ California State Parks Archives ■ Family Archives of Jim Landells and Steve Nichols ■ Greater Palm Springs Conventions & Visitors Bureau ■ Palm Springs Aerial Tramway Archives Episode 7: The Invention of Wheelchair Basketball ♦ Link: htt s://www, bs.or video/wheelchair-basketball-72wiow/ ♦ Featured Archives: ■ California Rehabilitation Center ■ Alice Coehlo Family Archives ■ Lake Norconian Club Foundation ■ Elizabeth Kinzer O'Farrell Collection ■ Norco Councilman Kevin Bash Archives ■ John Winterholler Collection Episode S: The History of Riverside's Chinatowns ♦ Link: https://www.pbs.ol-p/video/riversides-cliiiiatowns-4cndd3l ♦ Featured Archives: ■ Chinese Historical Society of Southern California ■ Museum of Riverside ■ Riverside Public Library ■ Save Our Chinatown Foundation Episode 9: Headin' to Hesperia, How a Song Transformed a Town ♦ Link: httDS://www.pbs.org/video/headin-for-hesperia-taevnu/ ♦ Featured Archives: ■ Griz Drylie Historical Collection ■ City of Hesperia Archives ■ The Estate of F.X. McDonald ■ Family Archives of George Stanford and Jim Walker ■ Hesperia Unified School District Episode 10: The Construction of Benedict Castle ♦ Link:littps://www. b}�.s.org/videQlbenediet-castle-ouiftb/ ♦ Featured Archives: ■ Family Archive of Crystal Coleman, Thelma Perrin Davidson and Marian Semic ■ Mission Inn Museum & Foundation ■ City of Riverside ■ Teen Challenge ■ Vincate & Associates Historical Consultants Collection Episode 11: Henry Jekel Homes ♦ Link: https://www.pbs.orp-/video/I l-henry-iekel-homes- teQx ♦ Featured Archives: ■ City of Riverside ■ Family Archives of John & Nancy Brown, Thelma Perrin Davidson and Marian Semic ■ Vincate & Associates Historical Consultants Collection Episode 12: An Enduring Friendship: San Manuel Band of Mission Indians & Loma Linda University Health ♦ Link: htips-//www.pbs.orgivideo/12-lyra:geo%e-d97ggpi ♦ Featured Archives: ■ Loma Linda University Health ■ San Bernardino County Archives ■ San Manuel Band of Mission Indians Episode 13: The 100" Anniversary of Knott's Berry Farm • Currently In Production ♦ Probable Featured Archives: ■ Knott's Berry Farm ■ Orange County Archives EMT NRE ( PBS MW K V C R Fall, 2020 Re: Uncovered in the Archives Dear Friends, I am writing to ask for your support of the television series, Uncovered in the Archives, produced by Brad Pomerance and CJ Eastman. This letter also certifies that Empire PBS I KVCR intends to include the series in our broadcast schedule. KVCR is the second oldest public television station in California and the first PBS station in Southern California. Headquartered in San Bernardino, KVCR-TV also has two transmitters in the Palm Desert/Coachella Valley. KVCR's four multichannel broadcasts reach over 6 million homes throughout two of the largest counties in the country — Riverside and San Bernardino, covering an immense region of Inland Southern California. Including cable and satellite providers, KVCR reaches millions more homes throughout Los Angeles, Ventura and Orange counties. KVCR currently carries the first season of Uncovered in the Archives, is excited about the promise of a second season, and is committed to carrying it upon completion. Familiar with the producers' work, I find it highly produced, revealing, educational and entertaining. The experienced team of Pomerance and Eastman are nationally recognized professionals, committed to quality production. Their work covers a broad range of interesting subjects and is highly respected. Recent accolades include: The J. Franklin Jameson Archival Advocacy Award from The Society of American Archivists, awarded in 2020, and; The Los Angeles Press Club National Entertainment & Arts Awards, 3rd Place, Documentary, for Season 1 of the series in 2019. Pomerance and Eastman demonstrate an engaging passion for their craft and know how to communicate it on screen. And their proven track records ensure the consistent delivery of the highest quality content. See: https://www.obs.orgZvideo/first-look-ticeet/. Your support of this project will be rewarded by knowing that you are part of this amazing series, and that you are contributing to the important preservation, knowledge and appreciation of the valuable history and rich culture of a diverse region. Your support will help make a positive impact in our community and our lives. Especially in this COVID- imposed new normal, partnerships between organizations like yours are more important and valuable than ever before! I hope you will consider funding this exceptional program. Thank you for your interest and support of, Uncovered in the Archives Sincerely, Alfredo Cruz, Interim General Manager — Phone: San Sernardino, CA 92410 K V C R T V 2 4 FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # is JACOB'S HOUSE INC. CITY OF TEMECUI[A FISCAL YEAR 2020 - 2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 Amount Requested: $ 5,000 PROJECT/PROGRAM INFORMATION MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: Jacob's House Operations Start Date: 7/1 /19 End Date: 6/30/20 Physical Address of Project/Program: 31525 Jedediah Smith Rd., Temecula CA 92592 INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Jacob's House Mailing Address: 31525 Jedediah Smith Rd. Temecula CA 92592 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Jacob's House Inc. Year Organization Founded: 2007 Website: www•jacobs housetemecula.org Number of Paid Staff: 4 Number of Volunteers: 60 Contact Name: Martin Barrera-Martinez Title/Position: Operations Manager Contact Person's Email Address: martin@jacobshousetemecula.org Telephone: 951-452-2627 Geographic Area(s) the Organization Serves: Temecula Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ❑■ Date of Incorporation as a Nonprofit: 8/16/07 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Number: Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: http://api2s.irs.-gov/appIeosf 2. Attach State Entity Status Letter using this link: https://www.Rb.ca.gov/online/self serve entit status letterlindex.aso 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: ht�t _Ilrca.Ldoj.c_ ovNer€fication=eb/Search.aspx?facility=Y City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No * Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No* Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors * Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: Jacob's House is a'Refuge' for families displaced by a traumatic medical crisis in Southwest Riverside County. Families access shelter, meals, hope, comfort, & peaceful respite while caring for a loved one in critical/life-threatening care in a local Southwest County hospital. JH is a vital community resource providing emergency shelter; while providing physical, emotional, and spiritual support to families in crisis. FINANCIAL STATEMENTS I Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, maybe needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑ Yes ❑■ IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT 'MONTH + YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP Laundry room expansion $1768.84 Feb 2017 CSF rehabilitation project; upgrade laundry roomo $2500.00 Feb 2018 CSF operational expenses; office/residential supplies $2500.00 Feb 2019 CSF operational expenses; office/residential supplies $ 2395.00 Feb 2020 CSF $ $ City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. Jacob's House is the only emergency hospitality resource in all of Riverside County. Services are extended to family members in partnership with (5) hospitals: Rancho Springs, Inland Valley, Temecula Valley, Rady's, and Loma Linda. JH can serve up to 15 guests, or 4 families, in the 4 bedroom Temecula residence; equipped with kitchen, laundry room, Internet, cablefrV, playground, garden, chapel & more. Services are free of charge, saving families an average $70,000/ year in emergency expenses for lodging, meals, & transportation. JH currently provides 500 nights of emergency shelter to 250 family members in crisis each year. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. City grant funds will be spent on residential operations extended to families in medical crisis. Expenses may include: household supplies, groceries, ancillary services, utilities, repairs/maintenance, security, facility improvements, landscaping, office supplies etc. JH hospitality services are valued at $135/day. This year, JH will provide 500 nights of shelter at a total program cost of $67,500 City funds will sustain program services, and preserve the financial resources of 250 family members displaced by medical crisis in Temecula Valley. Each family sheltered by JH saves at least $1500 in medical related lodging, meals, and travel. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. 60+ Temecula Partners volunteer as JH House Attendants; coordinating Intake, Events, Outreach, Property Maintenance, & more. Volunteers include: TV Methodist Church, (NCL) Temecula & (NCL) Mumiets-Temecula, Wells Fargo, Eagle/Girl Scouts, Rock Church, Old Town Spicerrea Merchants, Abbott, Europa Winery, Rogers Group R/E, & Starbucks Meadow Parkway Business partners include: Rancho Family Medical, Pechanga, CR&R, Alta Pacific, Open Jar, & Temecula Valley Hospital. JH builds bridges between Healthcare, community, and family; helping Southwest County better serve the emergent needs of patients & families. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. Funding supports JH Operations for 250 Temecula guests seeking refuge while caring for a loved one in the hospital. Expenses include: kitchen supplies/groceries, utilities, internet/tv, repairs/maintenance, security systems, garden/landscaping, facility improvements, office & residential supplies. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) $ 5000 Cash contributed to Project/Program by the Applicant Organization $188500 Other grants or funding already awarded for Project/Program, if any s 17500 In -Kind match amount or volunteer credit hours estimated amount $ 17000 VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM I, Staffing Expense for Project/Program $ 96000 (This amount is ineligible to be funded by City's Grant; however please include.) Equipment Expense For Project/Program $ 2500 Food Expense For Project/Program $1500 Marketing Expense For Project/Program $ 7500 Supplies Expense For Project/Program $13500 Facilities/Rent Expense For Project/Program $ 42000 Other Expense For Project/Program $ 65000 $ 228000 TOTAL BUDGET FOR PROJECT/PROGRAM $ 228000 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 SIGNATURE PAGE The aPPkant adonowkKkes and agrees to the following: ■ IkOdOw t is subject to alf Community Service Funding Program requirements including submittal deadlines wW pall . ' Every COMITU rtRy Service Funding appiicabon is torisidered individualty and on its own rnerit. AVMV& WE be gir*rr to organizations and activities that directly benefit the residents of Temecula. * FeWtdM fs Imt rely affable to the recipient, and requires an award letter signature upon approval. Pie aiMaw time for diedcs to be processed. • The awardlireof Conway y Service Funding does not constitute an automatic annual allocation. • The recognition for amity Service Funding should accrw to the City of Temecula. ■ Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the furl were used appropriately. • Community Service Funding grants wA not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shaft provide a fult accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then Compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAML. Jacob's House Inc. 31525 Jededigh Smith fed 95-452-2627 MAIUNG ADDRESS: PHONE:_ EMAIL: Temecula CA 92592 PRESIDENT/AUTHORIZED OFFICER: Shawn Nelson, President Print Name SIGNATURE: DATE; nmrrn�e� sync ueemmewiaorg Title Septemberl4th, 2020 (Month, Day, Year) IF DIFI=ERENTTHAN ABOVE, APPICATION PREPARED BY: MartinBa.rrera`Ma'rtrneZ, Operations tanager Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14,2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 Stacey.Brown@TemeculaCA.gov (951) 694-6413 City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 nrm2ML REVENUE SERVICE P. O. BOX 2508 CINC'201AM, OH 45201 Date NOV 0 3 1008 JAMB I S HOUSE, INC. C/O 1QRTIN A WEISS ONE BETTERWORLD CIRCLE, TEMECULA, CA 92590 Dear Applicant: DEPARTMENT OF THE TREASURY L"loyer Identification Number: DLN: Contact Person: JOANNA YAWNEY ID# _ SUITE 300 Contact Telephone Number: (877) 829-5500 Accounting Period Eb!id7.ng: December 31 Public Charity status: 170 (b) (1) (A) (vi) Form 990 Required: Yes Effective Date of Exemption: August 16, 2007 Contribution Deductibility: Yes Addendum Applies: No We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are tempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding Your exempt status, you should keep it in your permanent records. Organizations exempt undef 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. Plec-se see enclosed Publication 4221-PC, Compliance Guide for 501(c)(3) public Charities, for some helpful information. about your responsibilities as an exenipt organisation. Letter 947 (DO/CG) -2- JAMII'S MUSE, INC. Snc1()sU=S: Publication 4221-PC Sincerely, I " �wf Ii 10 Z-5 Z�--ao 0 � Robert Choi Director, Exempt Organizations Ruling& and Agreements Letter 947 (DO/CG) FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 16 MICHELLE"S PLACE CITY OF TEMECUIFA FISCAL YEAR 2020 - 2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 Amount Requested: $ 5,000 PROJECT/PROGRAM INFORMATION MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: Cancer Support Services Start Date: dan„aryzoz, End Date: Physical Address of Project/Program. 41669 Winchester Rd, Temecula 92590 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Michelle's Place Mailing Address: 41669 Winchester Rd Temecula, CA 92590 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Michelle's Place Year Organization Founded: 2001 Website:wwW•michellesplace.org Number of Paid Staff: 10 Number of Volunteers: 132 Contact Name: Kim Gerrish Contact Person's Email Address. kim@michellesplace.org Title/Position: Executive Director Telephone: 951-699-5455 Geographic Area(s) the Organization Serves: Riverside County Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Q Date of Incorporation as a Nonprofit: 1 1/4/01 No IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: NEW -State Identification Number: - Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: I. Attach IRS Deductibility Status using this link: htt :/la sirs. ov/a 1eos/ RECEIVED 2. Attach State Entity Status Letter using this link: hit s:vww.flb.ca. ovlonlinelself serve entity status letterhndex.as 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info atapy uh CQQy found on this State Registry's Search Tool: htt :Nrct.do'. ov/Verification/Weh/Search R'S OFFICE City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ❑■ Yes ❑ IF YES, BRIEFLY DESCRIBE= Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No a Yes ❑ IF YES, PROVIDE COUNCIL MEMBERS NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's:� Executive Committee ❑ Board of Directors I Members -at -large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: Empowering individuals and families impacted by cancer through education and support services. FINANCIAL STATEMENTS Upon request, copies the organization's current budgel/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management, Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑ YesDE IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT MONTH + YEAR NAME OF C]TY GRANT E DEDBY THE CITY GRANTOR SPONSORSHIP AMOUNT FUNDING RECEIVES} OR SPONSORSHIP cer Center Expansion $ 50,000 5/2019 Matching Grant Council member Zak Schwank - Breast Health Asst $ �,000 6/201 (� CSF 5k Walk of Hope $ in kind 9/2019 Sponsorship Cancer Resource Center $ 4,784 11/2019 CSF City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTSIINVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. The Cancer Support Program provides free resources to cancer patients and their families. These resources include education on prevention and early detection, patient navigation services, temporary financial assistance, transportation, a variety of support groups and other support services for the entire family. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. Michelle's Place will use the funds to provide resources to families dealing with cancer. These resources include free wigs, prosthesis, wigs, hats, scarves, and support groups. We will utilize the funds to provide transporation to medical appts and temporary financial assistanct. We provide Free educational seminars on early detection, prevention, advances in cancer treatement, etc. We provide yoga, Reiki and expressive art. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. Michelle's Place is the only cancer resource center in the region and is located in Temecula. Residents can receive free transportation, financial assistance, wigs, hats, scarves, prosthesis, lymphedema sleeves and anthing else they may need to help them recover from cancer treatment. At least 32 Temecula residents will benefit from this project and more than 60 volunteers will participate. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. The Temecula Community Service Grant funding will provide Temecula residents facing cancer with potentially life saving diagnostic breast health services, naviation through the cancer journey, temporary financial assistance and education on early detection and prevention. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below, PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM REVENUES I EXPENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) $ 53000 Cash contributed to Project/Program by the Applicant Organization $ 45,000 Other grants or funding already awarded for Project/Program, if any t $ 72,350 $ In -Kind match amount or volunteer credit hours estimated amount VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program (This amount is ineligible to be funded by City's Grant; however please include.) $62,000 Equipment Expense For Project/Program $ Food Expense For Project/Program $ $250 Marketing Expense For Project/Program $ 1 A'-! 50 Supplies Expense For Project/Program Facilities/Rent Expense For Project/Program $ Other Expense For Project/Program $75,000 TOTAL BUDGET FOR PROJECT/PROGRAM $122.350 $138,700 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Michelle's Place Cancer Resource Center MAILING ADDRESS: kim@michellesplace.org PHONE: EMAIL: PRESIDENT/AUTHORIZED OFFICER: ' `Im `-'errlsh SIGNATURE; IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY_ Executive Director DATE: 09/14/2020 SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Betsy.Lowrey@TemecuIaCA.gov (951) 693-3959 Stacey, Brown@TemeculaCA.gov (951) 694-6413 City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 STATE OF CALIFORNIA FRANCHISE TAX BOARD F T B PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 10/6/2020 ESL ID: Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: - Entity Name: MICHELLE'S PLACE CANCER RESOURCE CENTER ❑X 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. X❑ 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019) Q HELPB MENU Home > Tax Exempt Organization 5earch > Michelles Place Breast Cancer Resource Center < Bac k to Search Resu Its Michelles Place Breast Cancer Resource Center EIN: I , --, United States Other Names Publication 78 Data Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Copies of Returns (990, 990-EZ, 990-PF, 990-T) 8 Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non -profits. Tax Year 2018 Form 990 Organization Name: Michelles Place Breast Cancer Resource Center EIN: Tax Period: 201812 Return ID: Filing Type: E Return Type: 990 Copy of Return: 2018 Form 990 Filing Page Last Reviewed or Updated. 6-Sept-2019 P► Share $ Print 910@ina ra Our Agency Know Your Rights Resolve an Issue Other Languages Related Sites About IRS Taxpayer Bill of Respond to a Espanol U.S. Treasury Rights Notice Work at IRS Ep�z Treasury Taxpayer Office of Appeals Inspector General Help Advocate Service for Tax Identity Theft Administration Contact Your Accessibility Protection PyccKMA Local Office USA.gov Civil Rights Report Phishing TiengViet Tax Stats, Facts & Figures Freedom of Tax Fraud & Information Act Abuse No Fear Act FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 17 NATIONAL CHARITY LEAGUE TEMECULA VALLEY CHAPTER CrrY OF TEMECUTA FISCAL YEAR 2020.2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 PROJECT/PROGRAM INFORMATION Amount Requested: $4,800 _ MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: Helping ljands-Mantling Hearts Start Date: June 1, 2020 End Date: March 1 2021 Physical Address of Project/Program: nja INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: National Charity League, Inc., Temecula Valley Chapter _ Mailing Address: PO Box 891381 Temecula CA 92589 ORGANIZATION AND GEOGRAPHIC AREA SERVED National Charity League, Inc. Local: 2013 Name of Applicant Organization: Temecula VaRgy Chapter Year Organization Founded: National: 1925 Website: Number of Paid Staff: 0 Number of Volunteers: Local: 207 Contact Name Stacy Clemens or Jeni Ko erek Title/Position: Grade Level Advisors Class of 2021 Stacy Contact Person's Email Address: Telephone: Geographic Area(s) the Organization Serves: Temecula Valley Geographic Area(s) the Project/Program Serves: Temecula Valley NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Empty Cradle distributes about 400 backpacks per year between San Diego and Riverside County Geographic Area(s) the Organization Serves: do itals. All of the backpacks from our project will go to Ranclio Springs and Loma Linda. With that in mind it is estimated that 75% of the backpacks from our project will go specificany to Temecula residents. Any grant money awarded will be applied to these backpacks. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes x❑ Date of Incorporation as a Nonprofit: February 2, 2015 No IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Number--now- Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: htt ://a sirs. ov/a /eos/ 2. Attach State Entity Status Letter using this link: htti2s://www.fttt-ra.aov/online/self serve entity %1�ttgpLex asP 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: hft ://rct.doi.ca. ov,NerificationAVeb/Search.a f c t 0 CITY MANAGER'S OFFICE City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ❑x Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ❑x Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors ❑x Members -at -Large ❑ I MISSION STATEMENT OF ORGANIZATION I Briefly describe the organization's mission/goals and objectives: To foster a mother -daughter relationship in a philanthropic organzation committed to community service, leadership development and cultural experiences. NCL Inc, Temecula Valley Chapter is a local chapter of a very organized national organization, both with boards and strict monitoring of our structure and budget management. We have served over 34,000 volunteer hours since 2013 - with 23 LOCAL non-profit organizations that directly serve the residents of Temecula Valley. I FINANCIAL STATEMENTS I Upon request, copies the organization's current budgettfinancial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? NO ❑ Yes 0 IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT MONTH + YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP We've Got Your Back $5,000 Nov. 2018 Community Service Funding Program City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. As Seniors, National Charity League, Temecula Valley Class of 2021 was challenged to complete a Community Service Senior Leadership Project. The purpose of this project is to have the senior class use the skills we have acquired over the last five years of NCL to create a project that will benefit the community and can be supported by our chapter. The Class of 2021 will use these funds to support the organization Empty Cradle by providing 200 Sibling Backpacks. Empty Cradle's mission is "To comfort the grief of an aching heart and ease the pain of an empty cradle." Since 1982, they have been working to support grieving families who have recently experienced the death of a baby through early pregnancy loss, stillbirth or infant death. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. If awarded the grant funding, the NCL Temecula Valley Class of 2021 will use the money to supply Empty Cradle with 200 sibling backpacks. Sibling backpacks help the children of grieving families by providing comfort and helping them understand the loss of their baby brother or sister. Each handmade drawstring backpack will include the children's book "We were Gonna Have a Baby, but We Had an Angel Instead," a stuffed teddy bear, a coloring book (our class is designing this and Empty Cradle is having it printed), a box of crayons and 2 sticker sheets. Our total budget is $6,400. 100% of any grant funding received will be spent on the needed backpacks and supplies providing 75% of the items required to suvj2ort Temecula residents through our project. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. If awarded the grant funding, we would use it to pay for the supplies and materials used to make the sibling backpack kits. Empty Cradle distributes about 400 backpacks per year between San Diego and Riverside County Hospitals. All of the backpacks from our project will go to Rancho Springs Hospital and Loma Linda Hospital. With that in mind, it is projected that 75% of the backpacks from our project will go specifically to Temecula residents. Our grant application reflects this percentage and any funding received will thus be directly benefiting Temecula residents. The remainder of our funding and supplies to complete our project will be provided by additional fundraising efforts and through donations by our NCL chapter volunteers. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: 200 children & their families Estimated number of VOLUNTEERS INVOLVED in this Project/Program: This class project of deoelope by13 the NCL seniors - a support o Their c apter. 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. Our Ticktocker Class of 2021 Senior Leadership Project: Helping Hands - Mending Hearts will provide 200 sibling backpacks to Empty Cradle with the majority of these backpacks in our project going to support Temecula residents, specifically for siblings struggling with the loss of their baby brother or sister. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below- PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) $4,800 Cash contributed to Project/Program by the Applicant Organization $1,000 Other grants or funding already awarded for Project/Program, if any $0 In -Kind match amount or volunteer credit hours estimated amount $400 VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program (This amount is ineligible to be funded by City's Grant; however please include.) $0 Equipment Expense For Project/Program $0 Food Expense For Project/Program $0 Marketing Expense For Project/Program $0 Supplies Expense For Project/Program $6,400 Facilities/Rent Expense For Project/Program $0 Other Expense For Project/Program $0 TOTAL BUDGET FOR PROJECT/PROGRAM $6,200 $6,400 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: rational Charity League, Inc. Temecula Valley Chapter MAILING ADDRESS: PO Box 891381 PHONE EMAI Temecula, CA 92589 PRESIDENT / AUTHORIZED OFFICER: Jackie Robertson President Print Name Title SIGNATURE: DATE: L�' (Month, Day, Year) IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Stacv Clemens Jeni Koperek and the Class of 2021 GLAs and Ticktockers Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 If you have any questions, please contact Betsy Lowrey at (951) 693-3959 or Stacey Brown at (951) 694-6413. City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 8/22/2020 ESL ID: Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: - Entity Name: NATIONAL CHARITY LEAGUE, INC., TEMECULA VALLEY CHAPTER 0 1. The entity is in good standing with the Franchise Tax Board. 2. The entity is not in good standing with the Franchise Tax Board. 0 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other govemmentaI agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019) INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 DEPARTMENT OF THE TREASURY Date: DEC 09 [.V NATIONAL CHARITY LEAGUE INC TEMECULA VALLEY CHAPTER C/O JULIET GROSSMAN PO BOX 891300 TEMECULA, CA 92589-1300 Dear Applicant: Employer Identification Number: DLN: Contact Person: MS. GAISER ID# _ Contact Telephone Number: (877) 829-5500 Accounting Period Ending: May 31 Public Charity Status: 509 (a) (2) Form 990 Required: Yes Effective Date of Exemption: June 3, 2013 Contribution Deductibility: Yes Addendum Applies: No We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. Organizations exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations. We determined that you are a public charity under the Code section(s) listed in the heading of this letter. Please see enclosed Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, for some helpful information about your responsibilities as an exempt organization. Letter 947 (DO/CG) NATIONAL CHARITY LEAGUE INC Enclosure: Publication 4221-PC Sincerely, 400 ;9�06 A 7 Director, ftempt Organizations Letter 947 (DO/CG) FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # OUR NICHOLAS FOUNDATION aka ONF FOR AUTISM INC CrrY OF TEMECUTA SEP 14 2020 FISCAL YFAR 2o2o . 2O2 i CITY MANAGER'S COMMUNIFTY SEMI E FUPMW4G PROGRAM APPi1CA (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 Amount Requested: $ 5,000 PROJECUPROGRAM INFORMATION MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION tire. u�DS Project/Program Title: Shredderz � ^tip Ste+ rN c StartDate: Now End Date: Physical Address of Project/Program: 31493 Rancho Pueblo Rd #205 Temecula, CA 9,1592' INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Our Nicholas Foundation Mailing Address: 31493 Rancho Pueblo Rd #205 Temecula, CA 92592 ORGANIZATION AND GEOGRAPHIC AREA SERVED on going Name of Applicant Organization: Our Nicholas Foundation Year Organization founded: 2005 Website: ournick.org Number of Paid Staff: 0 Number of Volunteers: 200 r-r'ntact Name: Mark Anselmo Title/Position: Founder Contact Person's Email Address: info@ournick.org Telephone: 951.303.8732 Geographic Area(s) the Organization Serves: TciTlecula Valley Geographic Area(s) the Project/Program Serves: City of Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROF". ST A__'rTT0 Is this organization incorporated as a nonprofit? Yes a Date of Incorporation as a Nonprofit: 2005 NO n IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING -cues i identification Number:now— State Identification Number: prmrt out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: http://a2ps.irs.gov/app/eos/ 2. Attach State Entity Status Letter using this link: htros-flwvim, fth inn Iin-/--If cfo+11c I.++nrri "ny a,sp 3. Attach first nacre oniv or most recer a wa .'S corm iu or anam Dr,nt out c, found on this State keaistrv's Search I ool: y, City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 E I`° nI73Iron or anv memaers ar the hoard of Directors of the organization been involved with mess transacums val;uea over 4i5QU inciudina anv business transactions. =menu or Inreresrs in rear oroDerty vomit a Temecula Citv Council Member durina U r..��i i,: monins-! No 0 Yes LJ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? NOW Yes U IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGAN;--.—N: This Application has been authorized by the organization's: Executive Com- mittee S Board of Directors ❑ Members -at -Large ❑ lrI]LaS i ON STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: Our mission is to provide resources for the local autism community including emplovment 0000rtunities and social skills FINANCIAL STATEMENTS U po►r req u est, copies the organ i zation's current budgetifinancial statements (balance statement and income statement), - a It avartarsle C€ IA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑ Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF AME OF CITY FUNDED 9VTIE THE PROGRAM/PROJECT GRANT OR SPONSORSHIP I AMOUNT I � ND NG RECEIVED I N OR SPONSORSHIP City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? NO ❑ Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ❑ Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑ Yes n IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT I MONTH + YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP Bowl with Nick, Kick with Nick $ 4,784 FY 2019/2020 CSF Subcommittee AFTER SCHOOL PROGRAMS $ 5,000 FY 2018/2019 CSF Subcommittee Autism and the Arts Institute $ 1,000 FY 2019/2020 CSF Council Discretionary Kick with Nick (1 k), Circus Vargas (2k) $ 3,000 FY 2018/2019 CSF Council Discretionary City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. Young adult work program that helps the special needs community with vocational skills. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. Funds would be used for commercial shredder equipment and employee uniforms 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. This will benefits young adults in the special needs community in Temcula by providing an employment opportunity. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program; Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. The funds from this grant will help offset the cost of buying professional shredding equipment and uniforms enabling ONF to provide an employement opportunity for young adults in Temecula's special needs comunity. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LIFE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) $ 5, 000 Cash contributed to Project/Program by the Applicant Organization $ 0 Other grants or funding already awarded for Project/Program, if any $ 0 In -Kind match amount or volunteer credit hours estimated amount $ o VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program (This amount is ineligible to be funded by City's Grant; however please include.) $0 Equipment Expense For Project/Program $72500 Food Expense For Project/Program $0 Marketing Expense For Project/Program $0 Supplies Expense For Project/Program $0 Facilities/Rent Expense For Project/Program $0 Other Expense For Project/Program $21500 TOTAL BUDGET FOR PROJECT/PROGRAM $ $10 , 000 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 PREVIOUS* FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020, AS SHOWN BELOW. IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19/20 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2019-2020 (last year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and 4ww_,a, �w December 31. 2020. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: f4da , se to;;; er =3,,non, Thursday, December 31, 2020. EXPENDITURE REPORT due on or before Friday, =i,i, _ H Thursday, December 31, 2020 1. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Name of Project/Program- Amount of Grant Fund Awarded: $ Month + Year Grant Received from City: Date (Mo/Day/Yr) Describe... Explain ... Name of Company on Receiptlinvoice Amount (1) what the expenditure was how the expenditure (2) purpose of the expenditure specifically benefitted E on Receipt/invoice Must be dated on or of a z between July 1, 2019 - Expenditure Temecula residents '"" 9 MUST support Project/Program If names/addresses of Temecula December 31, 2020 description on Application + Award Letter beneficiaries are available, Please attach. 1 $ 2 $ 3 $ 4 $ 5 $ 6 $ 7 $ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (abovej provided b the Cit City of Temecula Community Service Funding Grant APPLICATION Page 5 of 7 FISCAL YEAR (FY) 2020-2021 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant in FY 2020-2021 by the City of Temecula, then this information is not due until September 13, 2021 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2020-2021 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2020, and June 30, 2021. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2020-2021 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 13, 2021. EXPENDITURE REPORT due on or before September 13, 2021 5. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 6. Fill out this table (include additional copies if needed to explain all expenditures) 7. Attach Receipts/Invoices (in the same order as listed in this table) 8. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Name of Project/Program: Amount of Grant Fund Awarded: $ Month + Year Grant Received from City: Describe... Explain ... c Name of Company Date (Mo/Day/Yr) Amount (1) what the expenditure was how the expenditure E on Receipt/Invoice on Receipt/Invoice of (2) purpose of the expenditure specifically benefitted U E Must be dated on or Expenditure Temecula residents o a z between July 1, 2020 - MUST support Project/Program If names/addresses of Temecula beneficiaries are available, June 30, 2021 description on Application + Award Letter lease attach. 1 $ 2 $ 3 $ 4 $ 5 $ 6 $ 7 $ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City City of Temecula Community Service Funding Grant APPLICATION Page 6 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. ■ Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATIONNAME:Our Nicholas Foundation MAILING ADDRESS: 31493 Rancho Pueblo Rd #205 PHONE: (951).303.8732 EMAIL: info@ournick.org Temecula, CA 92592 PRESIDENT/AUTHORIZED OFFICER: Mark Anselmo Founder Print Name SIGNATURE: �A-L IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Title DATE: I2azz (Month, Day, Year) Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Betsy. Lowrey@TemecuIaCA.gov (951) 693-3959 Stacey.Brown@TemeculaCA.gov (951) 694-6413 City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 Date: OCT 3 12011 ONF FOR AUTISM INC C/O KATHRYN ANSELMO 31493 RANCHO PUEBLO RD STE 205 TEMECULA, CA 92592 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: DLN: Contact Person: SHAWNTEL R SANDERS ID# - 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: February 17, 2011 Contribution Deductibility: Yes Addendum Applies: No We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. Organizations exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations. we determined that you are a public charity under the Code section(s) listed in the heading of this letter. Please see enclosed Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, for some helpful information about your responsibilities as an exempt organization. Enclosure: Publication 4221-PC Sincerely, r L G, Lerner Director, Exempt Organizations Letter 947 (DO/CG) Form 990-N (e-Postcard) Organizations who have filed a 990-N (e-Postcard) annual electronic notice. Most small organizations that receive less than $50,000 fall into this category. Tax Year 2012 Form 990-N (e-Postcard) Tax Period: 2012 (01/01/2012 - 12/31/2012) EIN: Legal Marne (Doing Business as): Oilf Foi klti5rti lit[ Tax Year 2011 Form 990-N (e-Postcard) Tax Period: 2011 (01/01/2011 - 12/31/2011) EIN: Legal Name (Doing Business as): Onf For Autism Inc duals#ePostcard00 Mailing Address: Gross receipts not greater than: 31493 RANCHO PUEBLO RD $50,000 TEMECULA, CA 92592 United States Organization has terminated: No Principal Officer's Name and Address: MARK JANSELMO Website URL: www.ournicholasfound ation.org TEMECULA, CA 92592 United States Mailing Address: Gross receipts not greater than: 31493 RANCHO PUEBLO RD S50,000 TEMECULA, CA 92592 United States Organization has terminated: No Principal Officer's Name and Address: KATHRYN S ANSELMO Website URL: www.ournicholasfound ation.org ECULA, CA 92592 United States FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 19 RADY CHILDREN"S HOSPITAL CITY OF TEIVIECULA FISCAL YEAR 2020.2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 PROJECT/PROGRAM INFORMATION Amount Requested: $ 1,007 MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: Autism Friendly Tool Kits Start Date; 01/01/21 End Date: 06/30/21 Physical Address of Project/Program: 25170 Hancock Ave, Murrieta, CA 92562 INCLUDE IF DIFFERENT THAN ORGANIZATtON'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Rady Children's Hospital San Diego Mailing Address, 3020 Children's Way MC 5150 San Diego, CA 92123 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization; Rady Children's Hospital Year Organization Founded: 1954 Website: www.rchsd.org Number of Paid Staff: 5,214 Number of Volunteers: 500 Contact Name: Kristin Gist Contact Person's Email Address: kgist@rchsd.org Title/Position: Sr Director, Developmental Svc Telephone: 858-576-1700 x247715 Geographic Area(s) the Organization Serves: SW Riverside Co, Imperial Co, San Diego Co Geographic Area(s) the Project/Program Serves: Southwest Riverside County NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Geographic Area(s) the Organization Serves: SW Riverside Co, Imperial Co, San Diego Co NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ® Date of Incorporation as a Nonprofit: July 1997 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number State Identification Number; Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: http:r/aipps.irs.gov/apc/eosl 2. Attach State Entity Status Letter using this link: b-ttos:,I/www.ftb.c&qovlonlinEdself serve entity status letterlindex. 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your chanty found on this State Registry's Search Tool: htt :/Irct.doi.ca. ov/Verificati nNVebiSearch.gL x?facilit =Y RECEIVED City of Temecula Community Service Funding Grant APPLICATION S5VgA 2f �020 CITY MANAGER'S OFFICE Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property With a Temecula City Council Member during the past 12 months? No ® Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ® Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: Rady Children's is a nonprofit pediatric -care provider dedicated to excellence in care, research and teaching. Our mission is to restore, sustain and enhance the health and developmental potential of children through excellence in care, education, research and advocacy. FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? NO ❑ Yes ® IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT MONTH +YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP Alexa's PLAYC Autism Inclusion Preschool �0 Dec, 2019 Temecula Comm Service Fund 201 Is I City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTSIINVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. Children with an autism spectrum disorder (ASD) do not access primary health care at the same rates as their typically developing peers (Straus et at., 2019), in large part because a doctor's visit can be traumatizing if the providers don't know how to support the child's unique behavioral and communication needs. Children with sensory issues can be adverse to bright lights and unusual noises. Children who have difficulty communicating can become scared or frustrated when they can't tell you what they need. But it doesn't have to be this way. With some simple and inexpensive prevention efforts, every child can have a positive healthcare experience. This is what led Rady Children's to create the Autism Friendly Tool Kit. Tool kits include informations about what to expect during a visit, and age -appropriate items for a child, such as fidget toys, bubbles, visual schedules, and a timer. These materials provide for calming, distracting, occupying and de-escalating a child during the visit. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. A grant from the City of Temecula will allow us to create four Autism Friendly Tool Kits for use in primary care offices located in Temecula. Two tool kits will be distributed to the Children's Primary Care Medical Group (CPCMG) pediatric office at 27699 Jefferson, and one each will be provided to CPMG at 31170 Temecula Parkway and 44274 George Cushman Court. Funds will be used to purchase one storage bin for each location, sanitizing wipes, and a variety of sensory and communication items such as noise cancelling headphones, weighted lap pads, sunglasses, white board with markers, and sensory balls. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. Autism Friendly Tool Kits will be used in three Temecula -based pediatric practices (CPCMG Temecula Parkway, CPCMG Jefferson, and CPCMG Redhawk) that serve a combined 15,670 total children, an estimated 530 of whom are on the autism spectrum. These inexpensive tool kits benefit Temecula's children, their parents, and their medical providers by creating a positive healthcare experience. And the benefits of a single doctor's visit going more smoothly cascade far beyond that one child — other appointments will be more likely to start and end on time, and the waiting room environment will be more tranquil for all patients. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: 530 Estimated number of VOLUNTEERS INVOLVED in this Project/Program, 2-5 in partnership with the Professional Women's 'Boundta.ble 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. Autism Friendly Tool Kits use communication and sensory materials to help children with autism remain calm during medical visits. We will use grant funds to create tool kits for three primary rare offices, supporting children, their parents, and their medical providers in creating positive healthcare experiences. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM REVENUES I EXPENSES Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) $ 1007 Cash contributed to Project/Program by the Applicant Organization $ Other grants or funding already awarded for Project/Program, if any $ In -Kind match amount or volunteer credit hours estimated amount $ 313 VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program (This amount is ineligible to be funded by City's Grant; however please include.) $ 302 Equipment Expense For Project/Program $ Food Expense For Project/Program $ Marketing Expense For Project/Program $ Supplies Expense For Project/Program $ 1007 Facilities/Rent Expense For Project/Program $ Other Expense For Project/Program $ 11 TOTAL BUDGET FOR PROJECT/PROGRAM $ 1,320 $ 1,320 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 THIS PAGE INTENTIONALLY LEFT BLANK PER CITY OF TEMECULA DUE TO CHANGE IN REPORT DUE DATE PREVIOUS* FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020, AS SHOWN BELOW. IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19120 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2019-2020 (last year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and Jd w4o, ?= December 31, 2020. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: Thursday, December 31, 2020. EXPENDITURE REPORT due on or before ember 41, 2oaa-Thursday, December 31, 2020 1. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Name of Project/Program: Amount of Grant Fund Awarded: $ Month + Year Grant Received from City: Date (Mo/Day/Yr) Describe... Explain ... Name of Company on Receiptlinvoice Amount (1) what the expenditure was how the expenditure benefitted £ on Receiptlinvoice Musl be dared on or of (2) purpose of the expenditure specifically between July 1, 2019 - 30 2029 Expenditure MUST support Project/Program Temecula residents II n al7ernecule W z .Luna December 31, 2020 description on Application + Award Letter p pp beneficiaries ar av pleas cieries are available, lease attach. 1 $ 2 $ 3 $ 4 $ 5 $ 6 $ 7 $ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" aboveprovided by the Ci City of Temecula Community Service Funding Grant APPLICATION Page 5 of 7 THIS PAGE INTENTIONALLY LEFT BLANK PER CITY OF TEMECULA DUE TO CHANGE IN REPORT DUE DATE FISCAL YEAR (FY) 2020-2021 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant in FY 2020-2021 by the City of Temecula, then this information is not due until September 13, 2021 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2020-2021 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2020, and June 30, 2021, In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2020-2021 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 13, 2021. EXPENDITURE REPORT due on or before September 13, 2021 5. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 6. Fill out this table (include additional copies if needed to explain all expenditures) 7. Attach Receipts/Invoices (in the same order as listed in this table) 8. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Name of Project/Program: Amount of Grant Fund Awarded: $ Month + Year Grant Received from City: Describe... Explain ... -- Name of Company Date (Momaytyr) Amount (1) what the expenditure was how the expenditure on Receipt/Invoice on Receiptflnvoice of (2) purpose of the expenditure specifically benefitted $ E a Must be dated on or � between July 1, 2020 - Expenditure MUST support Project/Program Temecula residents Temecula nameslaes a z June 30, 2021 1 description on Application + Award Letter b beneficiaries are available, are available. it Please attach. 1 $ - - 2 $ 3 $ 4 $ 5 $ 6 $ 7 '$ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City City of Temecula Community Service Funding Grant APPLICATION Page 6 of 7 I SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements Including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on Its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. 4! Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Rady Children's Hospital San Diego MAILING ADDRESS: 3020 Children's Way MC515(�HONE: (858) 966-7715 EMAIL: sntumer@rchsd.org San Diego CA 92123 PRESIDENT / AUTHORIZED OFFICER: Nicholas Holmes, MD, MBA Sr Vice President & COO Print (flame Title 09 " I oilSIGNATURE: DATE; (Month, Day, Year) IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Shelley Turner Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 If you have any questions, please contact Betsy Lowrey at (951) 693-3959 or Stacey Brown at (951) E94-6413. City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 8/12/2020 ESL Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: - Entity Name: RADY CHILDREN'S HOSPITAL-SAN DIEGO ❑X 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ❑X 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5. 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019) Internal Revenue Service P.O. Box 2508 Cincinnati, OH 45201 Date: DEC 0 6 2007 RADY CHILDRENS HOSPITAL -- SAN DIEGO % DEANNA ALBA 3020 CHILDRENS WAY MSC 5098 SAN DIEGO CA - 92123-4223 Dear Sir or Madam: Department of the'rreasury Person to Contact: Vaida Sin Teton ID# k" Toll Free Telephone Number: 877-829-5500 Employer Identification Number: This is in response to the amendments to your organization's Articles of Incorporation filed with the state on August 18, 2006. We have updated our records to reflect the name change from CHILDRENS HOSPITAL- SAN DIEGO to RADY CHILDRENS HOSPITAL -- SAN DIEGO, as indicated above. Our records indicate that a determination letter was issued in July 1997 that recognized you as exempt from Fe4leral income tax. Our records further indicate 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 509(a)(1) and 170(b)(1)(A)(iii). Donors may deduct contributions to you as provided in section 170 of the Code. Bequests, legacies, devisE:s, transfers, or gifts to you or for your use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of sections 2055, 2106, and 2522 of the Code. If you have any questions, please call us at the telephone number shown in the heading of this letter. Sincerely, rl J• ��x 4�' Ci Westcott Ma alter, Exempt Organizations Determinations Details about Page 1 of 2 Q HELP© MENU Home > Tax Exempt Organization Search > Rady Childrens Hospital -San Diego < Back to Search Results Rady Childrens Hospital -San Diego EIN: I , --, United States Other Names Publication78 Data o Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Copies of Returns (990, 990-EZ, 990-PF, 990M-T) o Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non -profits. Tax Year 2017 Form 990 Tax Year 2017 Form 990T Tax Year 2016 Form 990T https:Happs. irs.gov/app/eos/displayAll.do?dispatchMethod=displayAllInfo&Id= l 152 898&... 8/ 12/2020 Details about Page 2 of 2 Tax Year 2016 Form 990 , Page Last Reviewed or Updated. 6-Sept-2019 MRS r# Share Print In 0Oino 0" Our Agency Know Your Rights Resolve an Issue Other Languages Related Sites About IRS Taxpayer Bill of Respond to a Espanol U.S. Treasury Rights Notice Work at IRS EP�z Treasury Taxpayer Office of Appeals Inspector General Help Advocate Service of -q01 for Tax Identity Theft Administration Contact Your Accessibility Protection PyccKv4H Local Office USA.gov Civil Rights Report Phishing TiengViet Tax Stats, Facts & Figures Freedom of Tax Fraud & Information Act Abuse No Fear Act Privacy Policy https://apps.irs.gov/app/eos/displayAll.do?dispatchMethod=displayAllInfo&Id=l 152898&... 8/ 12/2020 FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 20 ROSE AGAIN FOUNDATION CITY OF TFNECCUIIA FISCAL YEAR 2020.2021 CDMMUNr Y SERVICE FUNDING PROGRAM APPLICATION (Please Pant or Type) DUR ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 PROJECT/PROGRAM INFORMATION Amount Requested: $ 5,000. ProjecUProgram Title: aids Soar Programs MAXIMUM ALLOWABLE:'$5.000 PERORGANIZATION 07.01-20 06.30-21 Start [Date: --_-- End date: Physical Address of Project/Program- INCLUDE IF DIFFERENT THAN GRGANl7ATIGN'S MAILING ADDRESS If Grant is Awarded. Make Check Payable to: Rose Again Foundation Mailing Address: Temecula CA 92592 ORGANIZATION A" GEOGRAPHIC AREA SERVED Name of Applicant Organization: Rose Again Foundation 2013 APp 9 Year OrganizationI;oundest: i�vseAgainFoundation.org 1 1 00+ Contact Name: TitEelPosition; Website: Number of Paid Staff: Number of Volunteers: Rhonda Reinke G.F.Q. hW66 koseAgeinFoundal{on org Contact Person's Email Address: Telephone: Geographic Area(s) the Organization Serves: Temecula and Murrieta Geographic Area(s) the Project/Program Serves: Temecula and Murrieta NOTE: COMMUNITY SEWCE FUNDING GRANT PROGRAM FUNDING MUST BE ELf IVf�LY USED TO 5Et2►IE TEMECULA, NONPROFIT STATUS 03: tot. is this organization 'incorporated as a mnprofit?: 'Yes � ©ate of Incorporation as a Nonprot�t: A No IF No, THEN KSLIGIBLE TO RECEIVE Cr Y FUNDING Federal Identification Number, _., r Stilts Identification Number'. Print OW and attach to this -application Verification from Federal (IRS) and State (FTB) as -follows: I. Attach IRS Deductibility Status using this link: http:llap,Ds.irs,c1ovlaopleosl 2. Attach State Entity.Status Letter using this fink: n :toyww. v! n(pn ,If serve entity satins fitter!' de .a 12 3: Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: httg:l/rct.do .gov1VerircationANNe tSeargh.aspx?tgCil ty=Y City of Temecula CornRinity Service funding Grant APPLICATION Page t of 7 Has the organization or arty- members of the Boars! of Directors of the organization been Involved with any personal business transactions valued -over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during Ow past 92 months? NO 9 Yes Q 1F YES, SR*nY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No f Yes[] IF yEs-, PROVIDE COUNCIL MEMBERI NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization',s: Executive Committee Board of Directory Members -at -Large 0 MISSION STATEMENT OF ORGANIZATION Briefly describe the organizations mission/goals-and objectives: To h8lp sweet the, needs and enhance the fives of foster Children and emancipated foster youth in our community FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management, ❑o not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within 4he past two years, has your organization received for concurrently requesting) any ether sources Of funding from the City of Temecula? No o Yes jj IF lIES, PROVIDE: INFORMATION -IN TABLE B oW. NAME of PROGRAPA/PROJEwCT MvtrT�r � �A� i�RAAi OF CITY GttAMT FUNDED BY THE CM GRANT OR SPONSORSHIP AMOUNTRAW RE:CEWED 09 SPONSORSHIP Please see attachment "A" $ City of Terhewta Cofrrwity Service Fending Grant APPLICATION POP 2 of 7 GR.A.NT FUNDING PROJECT/PROGRAM DESCRIPTION WM: RECEIPTSONVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE Ci Y To SUPPORT THE PR]JECTIPROGRAM AS DESMSED HERE. SEE COMPLAINCE DEPORT ON APPLICATION FOR DETAItS. Briefly describe THE PROGRAM l PROJECT. the Temecula grant funding WM be used to support. Emergency Placement Gifting - when a, foster child arrives to a new, foster home New Shoes Program - provides now properly fitted shoes for school, activRies and work Tutor Me Program - Provides in home tutoring to help foster Tide catch up to their grade level Extra Curricular AcOvities . providing .a t+esffirye outlet for their trauma and lass And separation fmm €amity 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded), Also, include equipment or services to be purchased and why. Thee grant funding Yriil be used to provide the Kids Soar services listed above. We have found that- not just one, but a combination of our prograMs brings the quickest and greatest amount of healing for the faster bids. Funds will be used for new clothing, Shoes, basic Heads; school supplies, special needs, tutoring and extra Curricular activities and Camps. 3, if awarded, explain HOW the grant funding will specifically BENEFIT TEMECUTA RESIDENTS. *he Temecula foster children we serve are our neighbors. fty gO to school with our We -and grandkitls, they will grow up to be neighbors and Have families of their town. EACh Child has great potera Q but needs our support to learn, achieve, thrivd, and heat from their trauma, and the to and separation fMm family. These innocent victims need our support tr4 help become) happy productive Temecula residents. Estimated number of PEOPLE FROM TEMEW XPECT TO BENEFIT from this ProjectIProgram: 0L/ Estimated number of ► OLUNTEERS INVOLVED in this ProjecttProgram: q 0 f 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 60 words or less to describe the project/program and how the grant funds will be used. Funds will be used to provide new clothes, shoes, basic needs and special needs to Emergency Placement foster children when they first arrive. Followed up with in -home iutoring and financial assistance4or extra eurricular activities and City recreational programs and classes. G#yofTemecula unity Service Funding Grant APPLICATI Page 5. Provide Project/Prograrn budget details below_ PROJECT/PROGRAM BUDGE!' LINE ITEMS FOR PROJECT/PROGRAM VARIOUS TYPES OF R EVE N U ES/1 NCOME FOR THE PROIECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) Cash contributed to Project/Program by the Applicant Organization Other grants or funding already awarded for Project/Program, if any fn•Ifind match amount or volunteer credit hours estimated amount VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program (This amount is ineligible to be funded by City's Crant; however please include,) Equipment Expense For Project/Program Food Expense For Project/Program Marketing Expense For Project/Program Supplies Expense For Project/Program Facilities/Rent Expense For Project/Program Other Expense For Project/Program REVENUES .1 EXPENSES MUSS $ 1,500. TOTAL BURET FOR PROJECT/PROGRAM I s 36,000 108,000 38,000 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 PREVIOUS* FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO CO%AD-19, THIS Ot:A❑UNE HAS BEEN EXTENDED TO OECEMBER 31. 2020. AS SHOWN BELOW IF YO11iR ORGANIZATION WAS NOT AWARDED A CO MMUNtTY SERVICE FUNDING GRANT IN FY 19120 (LAST YEAR), THEN SKIP THIS PASTE, If your organization vlfe$ awarded a Community Service Fum ingi Grant in FY 20194020 Mast yerj by the City of Temecula. please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and December 31, 2020. In addition, all grant funds must be substantiated with proper bads -up documentation, Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up Information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receiptstinvoices, must be submitted to the City on or before due flats: Thursday, December 31, 2020. EXPENDITURE REPORT due on or before 'F,4ay.se.,4je;.1.1.72.=-Thursday, Detcember31, 2020 1. ❑ernonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly bertefitted from this program: (approximate number of beneficiaries if you don't have a precise number). 2, Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Recelptsllnvoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92599, Attn: City Manager's Office - CSF Organization: Name of Project/Program. Amount of graft Fund Awarded: $ Month + Year Grant Received from City: Date (moioaylYr) Describe... Explain Name of Company on Receipt/invoice Amoupt (1) what the expenditure was , flow the expenditure on Receiptlinvoice Must be dated on or of (2) purpose of the expenditure specifically benefitted betw"n July 1, 2019 - Expenditure I2MerM1j residents lu Er3f} 2i3?i MUST support ProjectiPrograrn If namesladdrewes of Temecuha dZ [}ocr�mher 31, 2Q28 description on Application + Award Leuor, tra+istaarles are avaEEAble, 1s0 IIiSach. EXPENDITURE TOTAL Note; Expenditure Total must be equal to (or greater than) the "Amount of Grant Fund Awarded" (above) Provided by the Qtv City of Temecula Community Se+vice Funding Grant APPLICATION Page 6 of 7 SIGNATURE PAGE Thwapplicant acknowledges and agrees to the.fo€lowing; ■ Recipient is subject to all Community Service Funding Program requirements including submittal_ deadffrtes and payment disbursements. * Every Community Service Funding application is considered individually and on its own _merit. s Awards will be given to organizations and activities that directly benefit the residents of Termcuia. i Funding is not immediately available to the recipient, and requires an award letter signature upon.approval. Please allow time for checks to be processed. a The awarding of Community Service Funding does not constitute an automatic annual allocation. the recognition for Community Service Funding should accrue to the City of Temecula. ■ Community Service funding must be spent as specified on_the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. Community Service Funding -grants will not be awarded or announced within the 60 days before an election In which:an awarding Council Member is on the ballot, The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. ■ if.awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information container[ in this Application is true to the best of our knowledge and belief. Rose Again Foundation ORGANIZATION NAME: NN►1RIN i ADDRESS: PfIC3NE- i ) EMAIL; Temecula, CA 92592 PRESIDENT % AUTHORIM OMCER: Kristen Hu!#ord N iir iI Name SINNATURE. L'- A+ Tau dl DATE: IF DIFFERENT THAKABOVE,-Rhonda Reinke ARPICATION PREPARED BY: President Title ©910412020 (M:art h, Day, Year) C. E..0. Print dazzle Vtle SUBMIT ORIGINAL APPLICATION BY MIQNDAY, SEPTEMBER 14, 202%, ` OS City of Temecula Community Service Funding Attrr: City Managees dice 41000 MAIN STREET TEM EC U LA, CA 92590 Questions: Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 Stacey,Brown@TemeculaCA.gov (951) 694-6413 City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 STATE OF Cv+ UFORNIA FRAWHISE TAX BOARD Ro Box 942657 SACPAMENT4 CA 94257.OW Entity SWU3 Lefte;' Date: f2020 ESL 11M Why You Received This latter Accordlhg to our records, the fotfowsng entity information is true and accurate as of the date of this letter. Entity t©: - Entity Name: ROSE AGAIN FOUNDATION LAJ 1 The entity is in good standing with the Franchise Tax Board. 11 2. The entity is not in good standing with the Franchise Tax Board. 3. The entity is currently exempt from tax under RevOnue and Taxation Code (R&TC) Section 23701 d. 4. We do not have current information about the entity. 5- The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in Ca4fornia, this information does not reflect the status or voidabilfty of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revlvor may have a time limitation or may limit the functions the revived entity can perform, or Moth (R&TC Section 23305b), Connect With Us Web: ftb.ca.9av Phone: 8M 852,5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916-M.6500 from outside the United States TTY/TM 800,622.6268 for persons with hearing or speech impairments FTS 4263A V49 (REV .42.204i) INTERNAL REVENUE SERVICE, DEPARTMENT OF THE TREASURY F. 0. NOX 25os drNCINNATi, OR 45201 Dates � �iA I13-f Ens to er identifiCAtiOn Number's DLN' ROSE AGAIN FOUNDATION Contact Ptraon: CIO NATALIE Rm sHADLE CUSTOMER SERVIcs _ Contact Telephone Number; TEMECULA, CA 92592 (877) 929-5500 ACcOuntiaq Parlod 9nding , June 30 Public' Charity Status 1.10(h) (1) (A) (vi) Form 990 Required - yes 91fective Date of Examptia"t July is, 2013 C*ntributicm Deductibility. - Yes Addendum Applies: No App1 we are pleaBed to inform you that upon review of your application for tax exempt Status we have determined that you are exempt ram Federal income tax under section sol (c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified o rec ive tax deductible bequests, devises, transfers or gifts under section 2055, 210 or 2522 of the Code. Because this letter could help resolve any questions regarding your exeWt mti sss, y � should keep it in your permanent records Organizations exempt under section 501(c)(3) of the Code are further class tied ass 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 better. Please see enclosed PUbl1Cati0U 4221-PC, Compliance Guide for 501 (c) 13) Public Charities, for some helpful information about your reaponsibilities as an exempt organization. 11aCLOSUCOt PubFlicat M 4221-X Sincerely, Director, Exempt Organizations Letter 947 Grant Attachment `.A" Grants Received to date as of July 2018 thru July 2020 Sources of Grant Funding or Economic Development Sponsorships from the Temec Council CSF - ME HAP.E.Y. Program" 05-21-20 $1, 00. * Housing Assistance Pogram For Emancipated (Foster) Youth - H.A.P.E.Y Program G ty CSF Kids Soar Programs 01-17-19 $ 5,000. Council OSF - MR Kids Saar Programs 01-24-19 $ 1,000. Council CSF - iVIN H.A.P.E.Y Program 06-20-19 $1,000. Council CSF - ME H.A.P.E.Y. Program 06-20-19 $ 750. Council CSF - JS H-A.P.E.Y Program 06-20-19 $ 750. Council CSF - ZS Kids Soar Programs 10-17-19 $ 1,000. Cfty 'IMF Kids Soar Programs 12-23-19 $ 4,784. until CSF - JC Kids Saar Programs 7-08-18 $ 2,250. Council CSF - ME Kids Soar Programs 7-05-18 $ 500, Council CSF - JS Kids Soar Programs 7-05-18 $ 250. CDBG Kids Soar Programs 8-21-18 $ 3,206. Thank you City of Temecula and Council Members for your continued support! GrantAt#achmerr 3 Sept12020 FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 21 ROTARY CLUB OF TEMECULA FOUNDATION CITY OF TEXECULl FISCAL YEAR 2020.2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER i 4, 2020 I PROJECT/PROGRAM INFORMATION Amount Requested: $ 5000 MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Tift Food baskets for low-income families Start Date: 7-1-2020 End Date: June 30-2021 Physical Address of Project/Program: INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to Mailing Address: Rotary Club of Temecula Foundation P.O. Box 64, Temecula, CA 92593 I ORGANIZATION AND GEOGRAPHIC AREA SERVED 1 Name of Applicant Organization: Rotary Club of Temecula Year Organization Founded: 1999 Website: www.temecularotary.net Number of Paid Staff: 1 Number of Volunteers: 100 Contact Name: Judy Zulfiqar Title/Position:President Contact Person's Email Address: elephone Geographic Area(s) the Organization Serves: Temecula Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Geographic Area(s) the Organization Serves Temecula NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes © Date of Incorporation as a Nonprofit: 5-4-1999 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Number: - Print out and attach to this application Verification from Federal (IRS) and State (FTB) as ffttyED 1. Attach IRS Deductibility Status using this link: http //a s.irs.govlapp/eos/ 2. Attach State Entity Status Letter using this link: httips://www.ftb.ca.gov/online/self serve enK aU Igundex.asp 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed inftNapWIRK O'ray found on this State Registry's Search Tool: bLttp.//rct.doi.ca.gov/VerificationANeb/Search.aspMtCE=Y City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No © Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No © Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors © Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: Rotary International motto is "service above self', as is the goal of the Rotary Club -Temecula Noon to serve (Program 1) serve low-income seniors, families and veterans with weekly food boxes; (Program 2) gift cards for new clothes and school supplies for students; and (Program 3) food baskets to low income families with turkeys, hams and gift cards to supplement food/gift baskets for student/families identified by Temecula Valley Unified School District, military families, veterans and senior citizens in Temecula. FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES I Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑ Yes ® IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT MONTH + YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP food baskets for low income seniors and families $ 4784 Jan 2020 CSF food baskets for low income seniors and families $ 5000 Jan 2019 CSF $ $ $ City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. Funding will be used to support the FOOD BASKETS FOR LOW INCOME FAMILIES program. This year due to the high unemployment rate, the supplemental food baskets and gift cards provided from Thanksgiving to Christmas will be needed more than ever. Students/Families will be identified by the Temecula Valley Unified School District. 90% of the funds needed for this program will be donated by fellow Rotarian members of the Temecula Noon club. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). RC OF Temecula will spend the grant funding purchasing turkeys and hams to add to the food baskets for low income families. A list of all low-income students and families is provided by the school administrative staff in the Temecula Valley Unified School District. Rotarians will donate all other non-perishable foods to the food boxes. Last year RC of Temecula delivered 250 food baskets/boxes to families identified by TVUSD for each holiday period. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. Grant funding specifically benefits low income students and their families as identified by school personnel within the TVUSD. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: 500 families Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 100 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. Food baskets for low income families. Funds will purchase turkeys, hams and gift cards to supplement food/gift baskets for students/ families identified by TVUSD, military families, veterans and seniors citizens in Temecula. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET -- LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES f I VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula $ Community Services Grant (Not to exceed $5,000) 5000 Cash contributed to Project/Program by the Applicant Organization $ 20000 Other grants or funding already awarded for Project/Program, if any $ 10000 �in-Kind match amount or volunteer credit hours estimated amount $ 25000 VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM I $ Staffing Expense for Project/Program (This amount is ineligible to be funded by City's Grant; however please include.) 0 I Equipment Expense For Project/Program $ Food Expense For Project/Program $ 35,000 $ Marketing Expense For Project/Program $ i Supplies Expense For Project/Program Facilities/Rent Expense For Project/Program $ Other Expense For Project/Program in kind volunteer hours $ 25000 $ 60,000 $ 60,000 TOTAL BUDGET FOR PROJECT/PROGRAM City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 PREVIOUS' FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020, AS SHOWN BELOW. IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19/20 (LAST YEAR, THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2019-2020 (last year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and Jmpe,44,-gwo December 31, 2020. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: rd'y, September , i 2o20. Thursday, December 31, 2020. EXPENDITURE REPORT due on or before €r y:-eptemWF-1a- D Thursday, December 31, 2020 1. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 990 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Rotary Club of Temecula Foundation Amount of Grant Fund Awarded: $ 4784 Name of Company E on Receipt/invoice r� <Z Winco Foods 2 Date (Mo/Day/Yr) on Receipt/Invoice Amount Must be dated on or of between July 1, 2019 - Expenditure June W,-202-0 December 31, 2020 11-26-2019 3 I Stater Bros. ' 121/23/19 'OTAL Note: Expenditure Total must be equal to (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City $ 4,963.12 $ 4963.12 Name of Project/Program Month + Year Grant Received from City: 1-20-20 Describe... (1) what the expenditure was (2) purpose of the expenditure MUST support Project/Program description on Application + Award 60 turkeys and 25 bags of 61 hams Explain ... how the expenditure specifically benefitted Temecula residents If names/addresses of Temecula beneficiaries are available, Dlease attach. low income families are indentifie by TVUSD staff and reside in low income families identified by TVUSD staff and reside in Temecula Valley City of Temecula Community Service Funding Grant APPLICATION Page 5 of 7 EA ww auto FOODS 711e f lt]' i°rirr f.a rrrk i www.wJncotnods.com 40135 Winchester Rd Temecula, CA 92591 Store 00DUO Cashier: 0onie M 11/26/19 07:10:34 x****xxx*BEGIN DUPLICATE RECEIPTw....,-,, Sure ##0056 Cashier: Uonie M 11/26/19 06:51:24 MAN WT67I.39 lb W 1.28 / TRKY,WINCO AOL lb 2911 55 @ 1.97 4,707.07 FS POTATO,54 BAG 333,9353610 MAN WT'217.22 1 b @ rrrr 108.35 FS .68 ! TURKEY.JENNIE 0 2910 lb 147.70 FS SUBTOTAL 4,963.12 TOTAL TAX .00 CHECK TOTAL TE Ma 4,963.12 4,963.12 CASH CHAW 00 NUMBER OF ITEMS 57 11/26/19 Oper 0 903345 Trx N 5 07:09:52 Term # 3 Store 00056 THANK YOU FOR SHOPPING AT WIND (951) 676-4595 *****x*****END DUPLICATE RECEIPT,**"*,,*** MANUAL 43.20 1b@ 1.49 / lb MEAT 59.15 F MANUAL 39.70 l 1Q 1.49 r' lb MEAT 61.39 F MANUAL 41.20 ILA 1.49 ! lb MEAT 64.82 F EP BPOS MANUAL 43.50 Ih@ MEAT MANUAL 42.30 I b� 1,49 i lb 5"a.03 F 1. �19 � lb . MEAT 64.07 F ma P k e t s MANUAL 43.00 Ib@ 1.49 / lb MEAT 68.09 F MANUAL 45.70 1 bg 1.49 .' 1 k, MEAT • 72.41 F Red Hawk MANUAL 48.60 Irj@ 1.49 ! lb (951) 303-1244 MEAT 70.92 F xxxxxxx MANAGER xxxxxxx MANUAL 47.60 11)@ MEAT 1,49 ! lb Bill Landgraf S t�r� # �3g MANUAL 42.10 11� 62,73 F 1.49 / lb MEAT 64.67 i= Cashier: Luis G MANUAL 43.40 lbp 1,49 � ib MEAT 6:3.52 F 06 e 31 = 2 7 MEAMANUAL 42.70 lb@ 1.49 / 1b MEAT 71.07 F 42,10 lb@ 62.73 F 1.49 / lb MANUAL 47.70 1b9 MEAT 1.49 ' lb AMANUAL 42.50 1W 1.49 i 1b 63'n�3 F MANUAL 43.10 1bQ 64.22 F 1.49 / lb MEAMANUAL 63 47 F MEAT 69.14 F MEAMANUAL 42.60 1b@ 1.49 j lb MANUAL 46.40 lb@ MEAT 1.49 / Ib 42.80 IbW 1.49 ! 11) 53'77 F MANUAL 47.00 ilk 70.03 F 1.49 / lb MEAMANUAL 60.20 F MEAT 71.97 F MANUAL 40.40 1ba MEAT 1.49 r lb MANUAL 48.30 I b@ MEAT 1.49 ,/ lb 46,80 1bg r 6,r, 73 F 1,49 IV, MANUAL 48.20 lb@ 71.82 F 1.49 / ib MkAMANUAL . 70.63 F MEAT 70,92 F MEAMANUAL 47.40 1b 1.49 .� lb MANUAL 47.60 1b9.: MEAT 1.49 / lb MANUAL 42. 20 1 W 62.88 F t A9 ! 1b MANUAL 47.10 lb@ 1.49 / lb 70.18 F HEAT 56.62 F MEAT 61. 24 F 35.00 11� MEAT 1. 49 .a` i b MANUAL 41.10 lb@ MEAT 1.49 / lb 43.50 1bg 6`1-62 F 1.09 MANUAL 46.10 lb@ 68.69 F 1.49 lb MERMANUAL 65.26 F MEAT 64.37 F MANUAL 43.80 113� MEAT 1.49 / Ih MANUAL 43.20 lb9 MEATMANUAL 1.49 i lb 41,90 1b@ 62.43 F 1.49 / 1b MANUAL 43,70 lb® 1.49 / lb 65.11 F MEAT 65.26 F MEAT 60.94 F MANUAL 43.80 lb@ 1.49 / lb MANUAL 40.90 1b@ 1.49 / lb MEAT 68.39 F MEAT 67.65 F 45A0 11)@ 1.49 / 1b MANUAL 45.40 lb@ 1.49 / lb MEAMANUAL 63.18 F MEAT 56.92 F MANUAL 42.40 1W 1,49 / 113 MANUAL 38.20 lb® 1.49 / lb MEAT 62.73 F MEAT 57.51 F MANUAL 42.10 lb@ MEAT 1.49 i Ib MANUAL 38.60 lb@ 1.49 / ih 55.43 F MEAT 63.47 F MANUAL 37.20 1139 1.49 / lb MANUAL 42.60 lb@ MEAT 1.49 / lb MEAT MANUAL 38.60 lbQ 57.51 F 1.49 1b MANUAL 40.60 lb@ 1.49 lb 60.49 F MEAT , 54.6a7 F MEAT 61.39 F MANUAL 43.40 I1%t 1.49 ! lb MANUAL 41.20 lb8 1.49 / Ib MEAT 62.88 F MEAT 65.86 F MANUAL 42.20 ll)@ 1.49 / lh MANUAL 44.20 Ib9 1.49 r lb MEAT 57.51 F MEAT 68.39 F MANUAL 38.60 lb@ MEAT 1.49 / 1b MANUAL 45.90 Ib® MEAT 1,49 / lb MANUAL 41.90 1W 62.43 F 1.49 / 1b MANUAL 41.80 lb9 1.49 / lb 62.28 F NO BAGS 11n MEAT 62.28 F ` b iuiAL 3,653.3G MANUAL 41.80 lb® 1.49 / lb TOTAL TAX .00 MEAT MANUAL 41.20 lb9 61.39 F 1.49 / lb TOTAL DUE 3.853.30 MEAT 64.22 F piscover TENDER 3,853.30 MANUAL 43.10 lb@ MEAT 1.49 / lb CASH CHANGE MANUAL 38.00 1b@ 56.62 F 1.49 / I .00 MEAT Number OF ITEMS 61 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. ® Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Rotary Club of Temecula Foundation MAILING ADDRESS: P.O. Box 64 Temecula, CA 92593 PRESIDENT / AUTHORIZED OFFICER: Judy Zulfiqar Print Name SIGNATURE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Print Name PHONE: EMAIL: President Title DATE:..? :�7 � J � O (Month, Day, Year) Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 If you have any questions, please contact Betsy Lowrey at (951) 693-3959 or Stacey Brown at (951) 694-6413. City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # SAFE FAMILY JUSTICE CENTERS CITY OF TF.MECUL/l FISCAL -YEAR 2020 - 2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 PROJECT/PROGRAM INFORMATION Amount Requested: $ 5000.00 MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: SAFE Emergency and Basic Needs Start Date: 07/1/20 End Date: 06/30/21 Physical Address of Project/Program: 28910 PUJOI Street, Temecula CA 92590 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: SAFE Family Justice Centers Mailing Address: 28910 Pujol Street Temecula CA 92590 I ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: SAFE Family Justice Centers Year Organization Founded: 1998 Website:www•safefamiliesca.org Number of Paid Staff: 11 Number of Volunteers: 20 Contact Name: Janelle Milburn Title/Position: Supervisor Contact Person's Email Address: tanellemilburn@safefamiliesca.org Telephone: Geographic Area(s) the Organization Serves: Temecula 951-587-3900 Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: 1998 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number:mom- State Identification Number: Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: http;//apps.irs.gov/app/eos/ 2. Attach State Entity Status Letter using this link: https://www.ftb.ca.gov/online/self serve entity st " dex.as 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your c aroty found on this State Registry's Search Tool: http://rct.doi.ca.gov/Verification/Web/Searr-h.as li 20 CITY MANAGER'S O Flc City of Temecula Community Service Funding Grant APPLICATION age Fof 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No Q Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No W Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors * Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: SAFE Family Justice Centers are committed to providing comprehensive co -located services that help protect families, seek justice, and promote SAFE futures for children, youth, and families who have been affected by violence. V FINANCIAL STATEMENTS I Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑ Yes 0 IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANTOR SPONSORSHIP AMOUNT MONTH + YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPON50RSHIP Domestic Violence services $ 5491.00 07/201/-2020 CDBG Domestic Violence services $5538.00 07/2018-2019 CDBG Emergency and basic needs $ 4784.00 07/2019-2020 CSF Creating SAFE families $ 5000.00 07/2018-2019 CSF City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. The SAFE Emergency and Basic Needs is a stability program for indivivals and families that have been impacted from violence. SAFE Family Justice Centers provide comprehensive services to adults and children following abuse. Services can include case management, therapy, housing, transporation, needs asessments and access to basic needs such as clothing, shelter and food. This grant will directly impact citizens of the City of Temecula. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. SAFE Family Justice Centers will use grants to supply victims of abuse with basic needs items such as shelter, clothing, food and transportation. Once needs assessments are complete with our victims advocates, the victiruvill receive gift cards to help meet their basic needs. This is to provide stabilization to the victims following abuse. This is critical in their success to promoting healing and becoming whole after their victimizations. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. Following violence, adults and children are often left displaced and without proper resources. SAFE Family Justice Centers will be able to provide services to victims that reside in the city of Temecula. Our mission is to reduce the effects of trauma to the citizens of Temecula. Providing victims with much needed resources such as food, clothing, shelter, gas and other basic needs are essential to their path of healing. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: 75 Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 15 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. Grant funds will assist SAFE Family Justice Centers to provide comprehensive services to Temecula citizens that have experienced violence and are in need of help with basic needs, safety and crisis services. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM REVENUES F EXPENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) $ 5000.00 Cash contributed to Project/Program by the Applicant Organization $ 500.00 Other grants or funding already awarded for Project/Program, if any $ In -Kind match amount or volunteer credit hours estimated amount $ VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program $ (This amount is ineligible to be funded by City's Grant; however please include.) Equipment Expense For Project/Program $ Food Expense For Project/Program $ Marketing Expense For Project/Program $ Supplies Expense For Project/Program $ Facilities/Rent Expense For Project/Program $ Other Expense For Project/Program $ TOTAL BUDGET FOR PROJECT/PROGRAM $5000.00 $ City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 PREVIOUS* FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020, AS SHOWN BELOW. IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19/20 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2019-2020 (last year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and December 31, 2020. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: 2o. Thursday, December 31, 2020. 2. 3. 4, EXPENDITURE REPORT due on or before F,+da -5 ptem#efaa-..-2c2o-Thursday, December 31, 2020 l Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): Fill out this table (include additional copies if needed to explain all expenditures) Attach Receipts/Invoices (in the same order as listed in this table) Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Amount of Grant Fund Awarded: $ Name of Project/Program: Month + Year Grant Received from City: Describe... Explain Date (Mo/Day/Yr) ... c Name of Company P Y on Receipt/Invoice Amount (1) what the expenditure was how the expenditure p on Receipt/Invoice Must be dated on or of (2) purpose of the expenditure specifically benefitted between July 1, 2019 - Expenditure Temecula residents :3m Ju30. 2020 MUST support Project/Program If names/addresses of Temecula Q Z December 31, 2020 _. description on Application + Award Letter beneficiaries are available, lease attach. 1 $ 2 $ 3 $ 4 $ 5 $ 6 $ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City City of Temecula Community Service Funding Grant APPLICATION Page 5 of 7 FISCAL YEAR (FY) 2020-2021 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant in FY 2020-2021 by the City of Temecula, then this information is not due until September 13, 2021 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2020-2021 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2020, and June 30, 2021. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2020-2021 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 13, 2021. EXPENDITURE REPORT due on or before September 13, 2021 5. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 6. Fill out this table (include additional copies if needed to explain all expenditures) 7. Attach Receipts/Invoices (in the same order as listed in this table) & Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Amount of Grant Fund Awarded: Name of Project/Program: Month + Year Grant Received from City: Describe... Name of Company Date (Mo/Day/Yr) Amount (1) what the expenditure was on Receipt/Invoice on Receipt/Invoice of (2) purpose of the expenditure Must be dated on or Expenditure between July 1, 2020 - MUST support Project/Program June 30, 2021 description on Application + Award Letter $ $ $ Explain ... how the expenditure specifically benefitted Temecula residents If names/addresses of Temecula beneficiaries are available, please attach. �l 4� $ 5 $ 6 $ 7 � $ EXPENDITURE TOTAL _ Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City City of Temecula Community Service Funding Grant APPLICATION Page 6 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. ■ Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. ■ Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as Incomplete. We hereby certify the information contained in this Application is true to the hest of our knowledge and belief. ORGANIZATION NAME: SAFE Family Justice Centers MAILING ADDRESS: 28910 Pujol Street PHONE: ,951,-587-3900 EMAIL Temecula CA 92590 PRESIDENT/AUTHORIZED OFFICER: Katie Gilbertson Executive Director SIGNATURE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Name Title DATE: 09/10/2020 (Month, Day, Year) Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 202B, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 Stacey.Brown@TemeculaCA.gov (951) 694-6413 City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/10/2020 ESL ID: Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: - Entity Name: SAFE FAMILY JUSTICE CENTERS 1. The entity is in good standing with the Franchise Tax Board. 2. The entity is not in good standing with the Franchise Tax Board. ❑X 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019) nCLry n1161•v — Home > Tax Exem"ggnftAtion Sear&h, > Safe Alternatives For Everyone Inc. <Back to Search Results Safe Alternatives For Everyone Inc. EIN: I Temecula, CA, United States Other Names Publication 78 Data 8 Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Copies of Returns (990, 990-EZ, 990-PF, 990-T) o Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits. Tax Year 2017 Form 990 Page Last Reviewed or Updated: 6-Sept 2019 If* Share $ Print `` r T U Q w� r--� 0 About IRS Work at IRS Help Contact Your Local Office Tax Stats, Facts & Figures Taxpayer Bill of Rights Taxpayer Advocate Service Accessibility Civil Rights Freedom of Information Act No Fear Act Privacy Policy Respond to a Notice Espanol Office of Appeals E'3Z Identity Theft iE�aj Protection PyCCKMA Report Phishing Tieng Viet Tax Fraud & Abuse U.S. Treasury Treasury Inspector General for Tax Administration USA.gov FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 23 SANTA ROSA PLATEAU NATURE EDUCATION FOUNDATION CITY OF TEMECULA FISCAL YEAR 2020 - 2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 PROJECT/PROGRAM INFORMATION Amount Requested: $ 2,500.00 MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: Nature Educ Distance Learning Video Protect Start Date: 1/10/21 End Date 12/31/21 Physical Address of Project/Program: 39400 Clinton Keith Road. Murrieta, CA 92562 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Santa Rosa Plateau Nature Education Foundation Mailing Address: P.O. Box 941 Murrieta Ca 92564 I ORGANIZATION AND GEOGRAPHIC AREA SERVED Santa Rosa Plateau Name of Applicant Organization: Nature Education Foundation YearOrganization Founded:2003 Website: srpnef.org Number of Paid Staff: 3 Number of Volunteers: 250 Contact Name: Ginger Greaves Title/Position: Exec. Director Contact Person's Email Address: execdirectorCa sronef.org —Telephone: 909-732-2209 Geographic Area(s) the Organization Serves Southwest Riverside Count !Temecula Valle Geographic Area(s) the Project/Program Serves: Temecula Valley Unified School District NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes H Date of Incorporation as a Nonprofit: 2003 NO IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Number: — Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: http://apps.irs.gov/ap /� eos/ 2. Attach State Entity Status Letter using this link: b-t-tos://www.ftb.ca.gov/ontine/self serve entity status letter/index.as 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htt ://ret.doi.ca. ovNerification/Web/Search.as x?facilit =Y City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No f J Yes❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No❑ Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee = Board of Directors ❑ Members -at -Large ❑ I MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: Mission: To educate and empower youth to appreciate, preserve and protect nature. Goals & Objectives: • Reconnect a generation of youth to nature who grown up in doors and isolated from the natural world. • Provide education, experiences and tools to guide a young citizen towards a life of environmental stewardship. I FINANCIAL STATEMENTS I CITY OF TEMECULA FUNDING — OTHER SOURCES I Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. Within the past two years, has your organizjMon rec d (or concurrently requesting) any other sources of funding from the City of Temecula? No `J Yes IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT MONTH + YEAR NAME OF CITY GRANT AMOUNT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP Environmental Education Pathway 31 Grade 12/18 CSF Grant $2,500 Environmental Education Pathway 3`d Grade 12/19 CSF Grant $2 132 SRP Fire Fund $3,500 (Individual Council June/July 2020 'Member Funds $ City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. Convert on -site field work activities for students and teachers to virtual, lesson plans, resources and interactivity platforms by developing, high quality static and live stream, standard -based nature education videos and webinars Will require purchase of video equipment, utilization of conferencing vendor(s) and video production support. As schools reopen, the on -site field work and experiences should gradually return. However, the development of the online and virtual resources will not be a short-term measure but will become permanently integrated as part of SRPNEF's long-term outreach programming to support environmental education in the Temecula Valley Unified School District and the region. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded) Also, include equipment or services to be purchased and why. Videographer $1,000 Writer/Editor 600 Ext Hard Drive 900 $2, 500 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. Videos will be made available to TVUSD teachers and classrooms to help them augment their environmental and science education requirements made more difficult with the current necessity for increased online and home schooling formats. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program. Estimated number of VOLUNTEERS INVOLVED in this Project/Program: TVUSD students in grades 3-6 will have access and will benefit. Approximately 15 volunteers will be involved in support of the video project. 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. Produce environmental and science education, standard -based videos for TVUSD classrooms in support of the current distance learning format due to COVID. Funds will be used to help cover the cost of professional videographer support to include editing and writing expertise, and to purchase external hard drives to support large video storage. CA o emecu a- - ommuni y Service un ing Urant APPLIGA3 ION — -image 3 of7-- 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) Cash contributed to Project/Program by the Applicant Organization Other grants or funding already awarded for Project/Program, if any In -Kind match amount or volunteer credit hours estimated amount VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program (This amount is ineligible to be funded by City's Grant; however please include.) Equipment Expense For Project/Program Food Expense For Project/Program Marketing Expense For Project/Program Supplies Expense For Project/Program REVENUES I EXPENSES $2,500 $1,500 $6,000 xtemal Hard ►rives (2) $ 1,800 $0 Facilities/Rent Expense For Project/Program Other Expense For Project/Program VideograpiEditor/Wri TOTAL BUDGET FOR PROJECT/PROGRAM $10,000 P, $8,200 $10,000 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 PREVIOUS* FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020, AS SHOWN BELOW IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19/20 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2019-2020 (last year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and June 30 2c2o December 31, 2020. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: r-fulay,- eptefnber I-1 -2=. Thursday, December 31, 2020. EXPENDITURE REPORT due on or before F-riay-,�rAber-1.1 2o2o-Thursday, December 31, 2020 1. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office -CSF Organization: Name of Project/Program: Amount of Grant Fund Awarded: $ Month + Year Grant Received from City: Date (Mo/Day/Yr) Describe... I Explain ... Name of Company on Receipt/invoice what expenditure was Amount (1�ht the p how the expenditure p on Receipt/Invoice Must be dated on or of (2) purpose of the expenditure 1 specifically benefitted E between July 1, 2019 - Expenditure j a z December 31, 2020 MUST support Project/Program war description on Application + Ad Letter If names/addresseslrsidents is beneficiaries are available, Dlease attach 1 $ 2 $- 3 $ $ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City City of Temecula Community Service Funding Grant APPLICATION Page 5 of 7 FISCAL YEAR (FY) 2020-2021 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant in FY 2020-2021 by the City of Temecula, then this information is not due until September 13, 2021 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2020-2021 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2020, and June 30, 2021. in addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2020-2021 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 13, 2021. i — EXPENDITURE REPORT due on or before September 13, 2021 5. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 6. Fill out this table (include additional copies if needed to explain all expenditures) 7. Attach Receipts/Invoices (in the same order as listed in this table) 8. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office -CSF Organization: Amount of Grant Fund Awarded: I Name of Company Date (Mo/Day/Yr) E on Receipt/invoice on Receiptlinvoice u E Must be dated on or between aE July 1, 2020 - June 30, 2021 VA 3 4 5 6 N Name of Project/Program: Month + Year Grant Received from City: Describe... Explain ... Amount �1) what the expenditure was how the expenditure of (2) purpose of the expenditure specifically benefitted Expenditure Temecula residents MUST support Project/Program If names/addresses of Temecula description on Application + Award Letter beneficiaries are available, lease atiaCh 41 �J $ �l EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City City of Temecula Community Service Funding Grant APPLICATION Page 6 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. + Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. e If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected asincomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Santa Rosa Plateau Nature Education Foundation MAILING ADDRESS: P. 0. Sox 941 Murrieta CA 9250 PHONE: (909-732-2 009 EMAIL: execdirector@srpnef.org PRESIDENT / AUTHORIZED OFFICER: Austin Linsley Title President Print Name DATE: 9/13/2020 SIGNATURE: (Month, Day, Year) IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Ginger Greaves Executive DireCfor Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 Stacey.Brown@TemeculaCA.gov (951) 694-6413 City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/11 /2020 ESL ID: - According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: - Entity Name: THE SANTA ROSA PLATEAU FOUNDATION 12 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. 2 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. The above information does not necessarily reflect: • The entity's status with any other agency of the State of California or other government agency. • If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or the entity did business in California at a time when it was not qualified or not registered to do business in California: o The status or voidability of any contracts made in California by the entity at a time when the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). o For entities revived under R&TC Section 23305b, any time limitations on the revivor or limitation of the functions that can be performed by the entity. Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 02-2019) Internal Revenue Service Director, EO Rulings & Agreements P.O. Box 2508 Cincinnati, OH 45201 Date: March 6, 2008 SANTA ROSA PLATEAU FOUNDATION PO BOX 941 MURRIETA, CA 92564 Acknowledgement of Your Request Department of the Treasury Employer Identification Number: Document Locator Number: Toll Free Number: 877-829-5500 We received your Form 8734, Support Schedule for Your Advance Ruling, or other information regarding your public support status. When communicating with us, please refer to the employer identification number and document locator number shown above. Your tax exempt status under section 501(c)(3) of the Internal Revenue Code remains in effect. What Happens Next? The information you submitted was entered into our computer system at our processing center in Covington, Kentucky, and has been sent to our Cincinnati office for initial review. We approve some cases based on this review. If this is the case, you will receive a letter stating that you are a publicly supported organization. If the review indicates that additional information or changes are necessary, your case will be assigned to an Exempt Organization Specialist in Cincinnati who will call or write you. We assign cases in the order we receive them If the additional information indicates that you meet one of the public support tests, you will receive a letter stating that you are a publicly supported organization. If the public support tests are not met, we will send you a letter re-classifying you as a private foundation. That letter will tell you why we believe you do not meet the public support tests, and will include a complete explanation of your appeal rights. When Can You Expect To Initially Hear From Us About Your Application? Normally, you may expect to hear from us within 120 days. If you do not, you may call our toll free number at 1-877-829-5500 Monday through Friday. Please have your identification numbers available so that we can identify your case. If you would rather write than call, please include a copy of this notice with your correspondence. Notice 3369 (cg) - (Rev. 12/2000) FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 24 SPECIAL OLYMPICS INLAND EMPIRE CITY OF TEMECULA FISCAL YEAR 2020-2021 (Please Print or Type) COMMUNITY SERVICE FUNDING PROGRAM APPLICATION DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 PROJECT/PROGRAM INFORMATION Amount Requested. $ 4,275 MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: Special Olympics COVID-19 response to sports training in the City of Temecula Start Date: October 2020 End Date: June 2021 Physical Address of Project/Program: Due to COVID-19 restrictions all programs are conducted remotely. INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Special OI m ics Southern California Inc. — Inland Empire Mailing Address: 41880 Kalmia Street #155 Murrieta CA 92562 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Special Olympics Southern California — Inland Empire Year Organization Founded_1969 Website: www,sosc.org/inlandempire _Number of Paid Staff: 3 Number of Volunteers: 1,124 Contact Name: Ms. Abbey Leffler Title/Position: Regional Director Contact Person's Email Address: aleffler@sosc.or Telephone: Geographic Area(s) the Organization Serves: San Bernardino & Riverside Counties Geographic Area(s) the Project/Program Serves: City of Temecula and surrounding communities NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. r NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes No IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Date of Incorporation as a Nonprofit: May 1996 Federal Identification Number: _ State Identification Number: _ Print out and attach to this application Verification from Federal (IRS) and State (FTB) aSWrCW9FD 1. Attach IRS Deductibility Status using this link: htti),,//apps.irs..gov/apr)/eos/ 2. Attach State Entity Status Letter using this SEP 1lAk?020 https://www.ftb.ca.gov/online/self serve entity status letter/index asp CITY MANAGER'S OFFICE City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http://rct.doi.ca.gov/VerificationMeb/Search.aspx?facility=Y Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ■ Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ■ Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee X Board of Directors X Members -at -Large X MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: The mission of Special Olympics Southern California (SOSC) — Inland Empire is to provide year-round sports training and athletic competition in a variety of Olympic -type sports for children and adults with intellectual disabilities, giving them the continuing opportunities to develop physical fitness, demonstrate courage, experience joy and participate in the sharing of gifts, skills and friendship with their families, other Special Olympics athletes and the community. FINANCIAL STATEMENT Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, maybe needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑ Yes 0 IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT FUNDED BY MONTH + YEAR NAME OF CITY GRANT THE CITY GRANT OR SPONSORSHIP AMOUNT FUNDING OR SPONSORSHIP RECEIVED Special Olympics sports programs in the City of Temecula $ 2,393 Dec 2019 CSF Special Olympics sports programs in the City of Temecula $ 2,500 Dec 2018 CSF Special Olympics sports programs in the City of Temecula $ 2,500 Dec 2017 CSF Special Olympics sports programs in the City of Temecula $ 2,268.84 Dec 2016 CSF City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 Special Olympics sports programs in the City of Temecula $ 2,500 Dec 2015 CSF Special Olympics sports programs in the City of Temecula 2,500 Dec 2014 1 CSF GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. Prior to COVID-19, our comprehensive year-round programming for children and adults with intellectual disabilities included: Community Sports Programs, Schools Programs,, Healthy Athletes, Athlete Leadership Program, and Team Wellness. During COVID-19, we adjusted our programming to help overcome increased isolation and sedentary lifestyles of our vulnerable athletes and their families, including: 1) A virtual sports season, the SOSC Healthy Lifestyle Challenge, which launched April 6 at www.sosc.org/hlc_Athletes engage virtually with their teammates, friends, coaches, and volunteers through online videos featuring daily physical fitness, nutrition, and hydration challenges. The videos are also live -streamed weekly for an added social component. Teams earn points with top performers earning prizes. One hundred percent of participating athletes increase their physical fitness activity level, which directly improves children's well-being and overall health. 2) Communication through email, phone, and social media to provide reassurance and emotional support for our athletes and to sustain the thousands of constituent relationships we established over the past five decades so that we can successfully sustain and resume our programming through and post-COVID-19. 3) Providing fitness kits to 171 Community Sports Program athletes who live in the City of Temecula and surrounding areas by October 2020. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. If awarded, Special Olympics Southern California — Inland Empire will spend grant funds on purchasing 171 fitness kits, each with a drawstring bag, (2) exercise bands (51b and 101b), jump rope, banded pedometer, 2.5" stress ball and fitness instruction materials. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. Grant funding will specifically benefit Temecula residents by providing a resource to support athletes while they are unable to participate in the programs in person. Many of our athletes in Temecula programs are over the age of 18 and may live alone. They do not have family to depend on for support, so Special Olympics is their family. Our staff and volunteers will continue to work hard and adapt to support and encourage our athletes no matter the challenge. Continuing virtual programs and providing fitness kits is crucial for maintaining physical activity and social/emotional connection for this vulnerable population now and in the future when we safely resume sports programs and competition. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: 171 Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 10 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. Special Olympics virtual programs and fitness kits will empower individuals with intellectual disabilities in the City of Temecula and surrounding areas to maintain physical activity and social/emotional connection. 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET 11 LINE ITEMS FOR PROJECT/PROGRAM I REVENUES 1 EXPENSES II VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula $ 4,275 Community Services Grant (Not to exceed $5,000) Cash contributed to Project/Program by the Applicant Organization $ 0 Other grants or funding already awarded for Project/Program, if any $ 0 In -Kind match amount or volunteer credit hours estimated amount $ 0 VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program _F (This amount is ineligible to be funded by City's Grant; however please include.) Equipment Expense For Project/Program Food Expense For Project/Program Marketing Expense For Project/Program Supplies Expense For Project/Program Facilities/Rent Expense For Project/Program Other Expense For Project/Program: Shipping/Postage TOTAL BUDGET FOR PROJECT/PROGRAM $ 4,275 $0 $ 2,565 $0 $0 $0 $0 $ 1,710 $ 4,275 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 PREVIOUS* FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020, AS SHOWN BELOW. IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19/20 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2019- 2020 (last year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and June 30, 2020 December 31, 2020. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: Fridayternbe�l0. Thursday, December 31, 2020. EXPENDITURE REPORT due on or before Friday, September 11, 202o Thursday, December 31, 2020 1. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number), 38 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF yanization: Special Olympics Southern California — Inland Empire me of Project/Program: Special Olympics sports programs in the City of Temecula fount of Grant Fund Awarded: $ 2,393 Month + Year Grant Received from City: Dec 2019 Name of Company a on Receiptlinvoice U c a E Y 2 az Date (Mo/Day/Yr) on Receiptlinvoice Must be dated on or between July 1, 2019 - clune 30, 2020 December 31, 2020 j Describe... i Amount (1) what the expenditure was of (2) purpose of the expenditure Expenditure MUST support Project/Program description on Application + Award Lette Special Olympics 10/1 /2019 $ 2,400 1 Southern California EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ 2,400 (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City SOSC Bowling Championship Games Registration Fees for Temecula Valley athletes Explain ... how the expenditure specifically benefitted Temecula residents If names/addresses of Temecula beneficiaries are available, please 7 Temecula residents attended the 2019 SOSC Bowling Championship at no cost. This included: accommodations, meals and expenses related to City of Temecula Community Service Funding Grant APPLICATION Page 5 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Special Olympics Southern California — Inland Empire MAILING ADDRESS: 41880 Kalmia Street, #155, Murrieta, CA 92562 PHONE: EMAIL: aleffler@sosc.org PRESIDENT / AUTHORIZED OFFICER: Mr. Bill Shumard President & CEO Print Name Title SIGNATURE: DATE: September 9 2020 (Month, Day, Year) IF DIFFERENT FROM ABOVE, APPICATION PREPARED BY: Ms. Abbey Leffler Regional Director Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 If you have any questions, please contact Betsy Lowrey at (951) 693-3959 or Stacey Brown at (951) 694-6413. City of Temecula Community Service Funding Grant APPLICATION Page 6 of 7 � � vi .nurvr�wir� FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/2/2020 ESL ID: Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: Entity Name: SPECIAL OLYMPICS SOUTHERN CALIFORNIA, INC. 0 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ❑X 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019) Q HELPB MENU= Home > Tax Exempt Organization search > Special Olympics Southern California Inc. <Back to Search Results Special Olympics Southern California Inc. EIN:-j , --, United States Other Names Publication 78 Data o Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Copies of Returns (990, 990-EZ, 990-PF, 990-T) e Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non -profits. Tax Year 2018 Form 990 Page Last Reviewed or Updated: 6-Sept-2019 f'IRS Our Agency AboutlRS Work at IRS Help Contact Your Local Office Tax Stats, Facts & Figures Know Your Rights Resolve an Issue Taxpayer Bill of Rights Respond to a Notice Taxpayer Advocate Service Office ofAppeaIs Accessibility Identity Theft Protection Civil Rights Report Phishing Freedom of Information Act Tax Fraud & Abuse f* Share Print C©@InO Other Languages Related Sites Espanol U.S. Treasury C'3Z Treasury Inspector General for Tax Administration USA.gov PyCCKLIO Tieng Vitt No Fear Act FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 25 TEMECULA EDUCATION FOUNDATION CITY OF TEMECULA Start Date: 6/14/21 Physical Address of Project/Program: Temecula Valley High School INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS End Date: 7/9/21 If Grant is Awarded, Make Check Payable to: Temecula Education Foundation Mailing Address: 31350 Rancho Vista Rd Temecula, CA 92592 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Temecula Education Foundation Year Organization Founded: 2007 Website: temeculaeducationfoundation.org Contact Name: Mark Katan FISCAL YEAR 2020.2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 Amount Requested: $ 5,000 PROJECT/PROGRAM INFORMATION MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: T.E.F. Summer school program Number of Paid Staff: 1 Number of Volunteers: 3 Title/Position: Executive Director Contact Person's Email Address Telephone: Geographic Area(s) the Organization Serves: City of Temecula Geographic Area(s) the Project/Program Serves: City of Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ❑ Date of Incorporation as a Nonprofit: 9/12/2007 NO ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FLUOUGIVED Federal Identification Number:olm- State Identification Number: SE 29 Print out and attach to this application Verification from Federal (IRS) and State (FTB) as fd1TCy, %NAGER,,- 1 Attach IRS Deductibility Status using this link: htt :Ha s.irs. ov/a /eosi OFFICE 2. Attach State Entity Status Letter using this link: DLtp-s-://www.ftb.ca.gov/online/self serve entity status letter/index.as 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htt :Ilrct.do".ca. ovNerifcationlVNeblSearch.as x?facilit =Y City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ■❑ Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ❑■ Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors ❑■ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: The Mission of the Temecula Education Foundation is to enhance educational opportunities in theTemecula Valley Unified School District (T.V.U.S.D.) by providing student enrichment programs and promoting community enggagement FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑ Yes FE-1 IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANT OR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP Taste of Temecula Valley $ 1000 August 2019 Mayor pro-tem Stewart City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. The Temecula Education Foundation has delivered an accelerated summer school program for the last 10 years. Our summer school program meets the needs of highly motivated students looking to free up their typical school year schedule so they can participate In the ARTS, MUSIC or SCIENCES.. In addition we offer free tuitions for approximately 10 % of attendees. We would like to increase this to 20 or 25% but do the high cost of instruction it becomes difficult. We have more at risk or students in need of help than what we can support. Working with TVUSD guidance counselors to select students in need of our services and we make educational dreams a reality. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. The grant funding we receive will go towards our tuition support fund to any TVUSD student that has a need, can apply and receive free tuition from us. The student we help have been homeless and first members of a family trying to attend college, families that receive free and reduced lunches at school, families who just need assistance so their children can succeed. Any amount would help, we don't want pursuits of Music, Arts and Sciences enrichment to be a financial burden on families. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. Our summer school program is available to all Temecula high school students both public and private we reach out to those approximately 22,000 students. Annually we have as many as 400 actually enrolling each year so it benefits them their families and hopefully those students graduate and come back to join us in the City of Temecula. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. The Temecula Education Foundation supports student success by providing assistance to expand the students experience in Music, Arts and Sciences we have raised and delivered $255,000 to the student's classrooms of TVUSD. We have done events, Taste of Temecula and others, while expensive to produce their profits fuel our existence. We have adjusted our event focus back to delivering quality enrichment to every student in Temecula. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM REVENUES I EXPENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) $ 51000 Cash contributed to Project/Program by the Applicant Organization $ Other grants or funding already awarded for Project/Program, if any--] $ 1,200 In -Kind match amount or volunteer credit hours estimated amount F$ VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program (This amount is ineligible to be funded by City's Grant; however please include.) Equipment Expense For Project/Program $ 45,000 $ Food Expense For Project/Program $ Marketing Expense For Project/Program Supplies Expense For Project/Program $ 400 $ 1 ,700 I- - Facilities/Rent Expense For Project/Program $5,500 Other Expense For Project/Program $ 200 l- TOTAL BUDGET FOR PROJECT/PROGRAM $ 6,200 $ 52,800 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 PREVIOUS* FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020, AS SHOWN BELOW. IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19/20 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2019-2020 (last year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and cape 3e,2e2e December 31, 2020. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: Thursday, December 31, 2020. EXPENDITURE REPORT due on or before Friday~-serteFnbsPa-l. f.. Thursday, December 31, 2020 1. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Name of Project/Program: Amount of Grant Fund Awarded: $ Month + Year Grant Received from City: FDescribe... Explain ... Date (Mo/Day/Yr) p Name of Company (1) what the expenditure was how the expenditure � p Y on Receipt/invoice Amount p E on Receipt/invoice Must be dated on or of (2) purpose of the expenditure specifically benefitted w between July 1, 2019 - Expenditure Temecula residents E iURe 30 2n9n MUST support Project/Program If names/addresses of Temecula a Z December 31, 2020 description on Application + Award Letter beneficiaries are available, a:€�asc attach 1 $ 41 1$ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund I Awarded" (above) provided by the City City of Temecula Community Service Funding Grant APPLICATION Page 5 of 7 FISCAL YEAR (FY) 2020-2021 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant in FY 2020-2021 by the City of Temecula, then this information is not due until September 13, 2021 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2020-2021 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2020, and June 30, 2021. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2020-2021 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 13, 2021. EXPENDITURE REPORT due on or before September 13, 2021 5. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 6. Fill out this table (include additional copies if needed to explain all expenditures) 7. Attach Receipts/Invoices (in the same order as listed in this table) 8. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Name of Project/Program: Amount of Grant Fund Awarded: $ Month + Year Grant Received from City: Describe... Explain ... Name of Company Date (Mo/DayNr) Amount (1) what the expenditure was how the expenditure td on Receipt/Invoice on Receipt/Invoice of (2) purpose of the expenditure specifically benefitted u E Must be dated on or Expenditure Temecula residents 9 - between July 1, 2020 - MUST support Project/Program If names/addresses of Temecula a z June 30, 2021 description on Application + Award Letter beneficiaries are available, lease attach 1 $ $ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City City of Temecula Community Service Funding Grant APPLICATION Page 6 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Temecula Education Foundation MAILING ADDRESS: 31350 Rancho Vista Rd PHONE: EMAIL: Temecula CA 92592 PRESIDENT/ AUTHORIZED OFFICER: Robert Mark Katan Executive Director Print Name SIGNATURE: DATE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Title August 31,2020 (Month, Day, Year) Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 Stacey.Brown@TemeculaCA.gov (951) 694-6413 City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 Form 990 Return of Organization Exempt From Income Tax Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations) Department of the Treasury ► Do not enter social security numbers on this form as it may be made public. Internal Revenue Service ► Go to wwwJrs.gov1Form990 for instructions and the latest information. A For the 2018 calendar year, or tax year beginning * 2018, and B Check if applicable: C Name of organization TEMFC ° A EDUCATION FOUNDATION ❑ Address change Doing business as ❑ Name change Number and street (or P.O. box if mail is not delivered to street address) ❑ Initial return 30520 RANCHO CA RD ❑ Final return/terminated City or town, state or province, country, and ZIP or foreign postal code ❑ Amended return TEMECULA, CA 92591 ❑ Application pending F Name and address of principal officer: DONNA SAN MIGUEL. TF.m rn 1 Tax-exempt status: in 501 c 3 ❑ 501(c) { } 4 [inseil J Website: ► N/A K Form of organization: X❑ corporation ❑ Trust ❑ Association ❑ Other ► Room/suite 107-152 OMB No. 1545-0047 �18- Open to Publio •- • 120 D Employer identification number E Telephone number G Gross receipts $ 241, 606. l Is this a group return for subordinates? ❑ Yes N No F,A CA 92591 H(b) Are all subordinates included? ❑ Yes ❑ No or ❑ 527 If "No," attach a list. (see instructions) H(c) Group exemption number ► L Year of formation: 2 0 0 31 M State of legal domicile: CA - 7Llitrrlary 1 Briefly describe the organization's mission or most significant activities: SUPPORT EDUCATION# L PROGRAMS IN THE TEMECULA VALLEY CQl<MITY m C---------------------------------• •---------------•---------------------------------------------------------------------------.____----------------------------,_---__ 2 Check this box Illif the organization discontinued its operations or disposed of more than 25% of its net assets. 0 3 Number of voting members of the governing body (Part VI, line 1 a) . . . . . . . . . 3 3 4 Number of independent voting members of the governing body (Part VI, line 1 b) 4 3 y 5 Total number of individuals employed in calendar year 2018 (Part V, line 2a) . . . . , 5 0 6 Total number of volunteers (estimate if necessary) . . . . . . . . . . . . . . 6 3 a 7a Total unrelated business revenue from Part VIII, column (C), line 12 . . . . . . . . 7a 0 b Net unrelated business taxable income from Form 990-T, line 38 7b 0. Prior Year Current Year Q 8 Contributions and grants (Part VI 11, line 1h) . . . . . . . . . 5,136. 1 459. v 9 Program service revenue (Part VIII, line 2g) . . . . . . . . . 81,155. 5,515. at 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) . . . . . 102. 185. 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) . . . 13,503. 194 543. 12 Total revenue -add lines 8 through 11 (must equal Part VIII, column (A), line 12) 99, 896. 201, 700. 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) . 24,221. 22,221. 14 Benefits paid to or for members (Part IX, column (A), line 4) . . . . . . y15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) 66 963. 90,482. Professional fundraising fees (Part IX, column (A), line 11e) . . . . . . 300 016a 0. x b Total fundraising expenses (Part IX, column (D), line 25) ► 8,309. w 17 _ Other expenses (Part IX, column (A), lines 11 a-11 d, 11 f-24e) . . . . . 13,285. 26,828. 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) 104,769. 139,531. 19 Revenue less expenses. Subtract line 18 from line 12 -4, 873. 62 169. o E Beginning of Current Year End of Year 20 Total assets (Part X, line 16) . . . . . . . . . . . 66,505. 129,025. 21 Total liabilities (Part X, line 26) . . . . , . . . 10,570. 10,921. 22 Net assets or fund balances. Subtract line 21 from line 20 55, 935, 118, 104. Signature Black Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge. } 11/15/2019 Sign Signature of officer Date Here DONNA SAN MIGUEL TREASURER Type or print name and title Paid Print/Type preparer's name Preparer's signature Date I Check ❑X if PTIN Preparer DANIEL S . VENNE self-employed Use Only Firm's name ► DAN'IEL S . VENNE CPA Firm's EIN ► Firm'saddress ► 41911 FIFTH STREET SUITE 300 TEMECULA CA 925901 Phoneno. May the IRS discuss this return with the preparer shown above? (see instructions) Yes ❑ No For Paperwork Reduction Act Notice, see the separate instructions. BAA REV 05120n9 PRO Form 990 (2018) STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/1 /2020 ESL ID: Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: - Entity Name: TEMECULA EDUCATION FOUNDATION 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. ❑ 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 . ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019) FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 26 TEMECULA VALLEY GARDEN CLUB CITY OF TEMECULA FISCAL YEAR 2020.2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please ,Print or Type) DUE ON OR BEFORE: MOND", SEPTEMBER 14, 2020 Amount Requested: $ 1,500 PROJECT/PROGRAM INFORMATION MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: Native Plant Demonstration Garden Start Date: 11 /15 End Date: 03/30 Physical Address of Project/Program: Temecula Park to be determined INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Temecula Valley Garden Club Mailing Address: P.O. Box 1526 Temecula, CA 92593-1526 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Temecula Valley Garden Club Year Organization Founded• 1984 Website: temeculavalleygardenclub.com Number of Paid Staff: 0 _ Number of Volunteers: 102 Contact Name: Judy Sundermann Title/Position: Contact Person's Email Address: ����Llephonen Geographic Area(s) the Organization Serves: Temecula Valley Community Service Chairperson Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROFIT STATUS Is this organization it ref es a nonprofit? Yes Date of as a Nonprofit: 2005 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number:EE=_ State Identification Number: Print out and attach to this application Verification from Federal (IRS) and State (FTB) as f I! w 1. Attach IRS Deductibility Status using this link: h t_P.�pHa s.ir_ 5.gov/app/eos/ ��c���Eo _ 2. Attach State Entity Status Letter using this link: httys://www.ftb.ca.gov/online/self serve en a i ndex.as 3. Attach first page only of most recent IRS Form 990 or attach printout of detailed info a out our charity found on this State Registry's Search Tool: htt ://rct.doii.ca. ov/Verification/Web/Searc�ITs N City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ❑■ Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ❑■ Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑■ Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: Temecula Valley Garden Club was established in 1984 for charitable and educational purposes. We encourage interest in gardening, promote horticultural best practices and conservation of natural resources, and aid civic organizations and the community through educational and beautification projects. FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑■ Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT AMOUNT MONTH +YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANTOR SPONSORSHIP FUNDING RECEIVED ORSPONSORSHIP City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. The Temecual Valley Garden Club will install and maintain a Native Plant Demonstration Garden in a Temecula Park. Native plants require little supplemental water, no fertilizer and require significantly little maintenance. Native plants support a diversity of wildlife including birds and polinators. By seeing the plants in different seasons visitors will see how they may fit in their garden. Plants will be identified. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. When the grant is approved, the Community Service Committe will meet with the City representative to determine the loca- tion of the garden. The Commttee will complete a design for the area and submit a list of materials to be purchased. Upon approval, the plants will be ordered and planted by the Committee. Additions to the site could include a water source, mulch and rocks or boulders. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS, The Native Plant Demonstration Garden will benefit Temecula residents because they will enjoy the beauty of the native plants and learn about plants that will thrive in their gardens. As residents add native plants to their gardens they will conserve water and help wildlife. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: l., ®° 0 + Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. With California's ongoing drought and need for water conservation the Temecula Valley Garden Club has focused on creating natural habitats. The Native Plant Demonstration Garden would educate and encourage our community to preserve the natural flora and fauna for now and for years to come. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM I REVENUES I EXPENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula $ Community Services Grant (Not to exceed $5,000) 1 1 500 Cash contributed to Project/Program by the Applicant Organization $ Other grants or funding already awarded for Project/Program, if any $ In -Kind match amount or volunteer credit hours estimated amount $ 1 , 500 VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program $1500 (This amount is ineligible to be funded by City's Grant; however please include.) Equipment Expense For Project/Program Food Expense For Project/Program $ $ Marketing Expense For Project/Program $ Supplies Expense For Project/Program s1,500 Facilities/Rent Expense For Project/Program Other Expense For Project/Program $ $ TOTAL BUDGET FOR PROJECT/PROGRAM I s3,000 s3,000 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 PREVIOUS* FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020, AS SHOWN BELOW. IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19/20 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2019-2020 (last year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and Jn e- , i December 31, 2020. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: Friday, SeptembeF o2� Thursday, December 31, 2020. - __7EXPENDITURE REPORT due on or before F--Fiday. sepko�1-22�Thursday, December 31, 2020 1. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Name of Project/Program: Amount of Grant Fund Awarded: $ Month + Year Grant Received from City: Date (Mo/Day/Yr) Describe... Explain ... Name of Company on Receipt/Invoice Amount (1) what the expenditure was how the expenditure E on Receipt/Invoice Must be dated on or of (2) purpose of the expenditure specifically benefitted A between July 1, 2019 - Expenditure Temecula residents = J.,, o ' 2-0 December 31, 2020 MUST support ProjectlProgram description on Application + Award Letter If names/addresses of Temecula beneficiaries are available, Please allach, 2$ f4 $ - — —F - 3 $ - 5 $ 6 $ 7 1 $ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the Cfty City of Temecula Community Service Funding Grant APPLICATION Page 5 of 7 FISCAL YEAR (FY) 2020-2021 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant in FY 2020-2021 by the City of Temecula, then this information is not due until September 13, 2021 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2020-2021 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2020, and June 30, 2021. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that. Fiscal Year 2020-2021 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 13, 2021. EXPENDITURE REPORT due on or before September 13, 2021 5. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 6. Fill out this table (include additional copies if needed to explain all expenditures) 7. Attach Receipts/Invoices (in the same order as listed in this table) 8. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Amount of Grant Fund Awarded: $ Name of Company Date (MolDay/Yr) Amount E on Receipt/invoice on Receipt/invoice of EMust be dated on or Expenditure Z between July 1, 2020 - June 30, 2021 EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City Name of ProjectlProgram: Month + Year Grant Received from City: Describe... (1) what the expenditure was (2) purpose of the expenditure MUST support ProjectlProgram description on Application + Award Letter Explain ... how the expenditure specifically benefitted Temecula residents If namesladdresses of Temecula beneficiaries are available, City of Temecula Community Service Funding Grant APPLICATION Page 6 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot, • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Temecula Valley Garden Club MAILING ADDRESS: PO Box 1526 PHONE:R-IM--m EMAIL: Temecula, CA 92593-1526 PRESIDENT/AUTHORIZED OFFICER: Sarajane M. Kirby Co -President Print Name Title SIGNATURE. DATE:O9/14/2020 (Month, Day, Year) IF DIFFERENT THAN ABOVE, Judy Sundermann, CommunityService Chairperson APPICATION PREPARED BY: eryP Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 Stacey.Brown@TemeculaCA.gov (951) 694-6413 City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 STATE OF CALIFORNIA � FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/13/2020 ESL ID: Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: - Entity Name: TEMECULA VALLEY GARDEN CLUB 1. The entity is in good standing with the Franchise Tax Board. © 2. The entity is not in good standing with the Franchise Tax Board. 0 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019) FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 27 TEMECULA VALLEY MUSEUM, INC. RECEIVED SEP 14 2020 CITY MANAGER'S OFFICE CITY OF TEMECULA FISCAL. YEAR 2020 - 2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MOND", SEPTEMBER 14, 2020 PROJECT/PROGRAM INFORMATION Amount Requested: $ I MAXIMUM ALLOWABLE: $6,000 PER ORGANIZATION Project/Program Title 10D11 4di--����p Start Date End Date`'�xj Physical Address of Project/Program 3[- 5 .5r. INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable I Mailing Address: �iVl�au , ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Year Organization Founded:l"—L— Websit ! Nuum�ae'r ofia d �Staf : Number of Volunteers: Contact Name �'`-� �FT.� Title/Position: 1- � Contact Person's Email Adclres Welephonelonnow— Geographic Area(s) the Organization Serves: ��(,{1�I JJL..,r� �,J l.fiS� Geographic Area(s) the Project/Program Serves: NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes �' Date of Incorporation as a Nonprofit: ft No IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number State Identification Numbe Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: http://api2s.irs. ov/a /eos/ 2. Attach State Entity Status Letter using this link: htt s://www fib ca. nv1nnllne/sslf serve entdy status +�s►erlin�dex asp 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http.//rct.dr,[,ca.ycv/Verifir:Aticn/Uyeb/5earch asox facility=Y Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ❑ Yes % IF YES, BRIEFLY DESCRIBE: �..a�. .car e-V I'S F L Is a Temecula City Council Member a member of the Board of Directors or an Officer o organization? No-%. Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organizations: Executive Committee ❑ Board of Directors', Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: TVM, • LVMXj WN-04 lti �a��� Vi4C�(��.�'N,.ai�S��A►1 Ci�rlrf D� t� tt�,4 C��t1��-�.l�lr�!`t� �'- 4 [ir' TC '4'i't1 4Tc ow - r CoWk Ol't ``��— ' �t � ZGr� i`�L 1 C tMS'r �3-�1 MfCt_Uk4 .�4LWNA" 1b1Wtaem C -rt 0 N'AANb FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW: FUNDED YTHEOCITY GRANTOR SPONSORSHIP AMOUNT FUNDING RECE VED+ N OR SPONSORSHIP GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS, 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. -r%Ill' i't4c'. 15 1h�5 t Er� Oou TZ'1 L.P -.-Ltd �1� i`�/ �-- Ns "(HETV�c-�WVA, W%'Dip rr,4c� rA-XVz, T1€E V IP-IL `'C~C QRg 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. IJA (�,� "t• ti l JCL- ` .7�C ��} i4 V � 1 A)67 Ct��- - 3. if awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. fE i �A !✓ice'() W 1-1;;� fl�r t ' [OUP,L -e� D tC.C. tom" it+t Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the prgjec#lprogram and how the grant funds will be used. C 5�1J arw, . € ct � /v . r e-�z -rt IR k":r _ �cc T 5. Provide Project/Program budget details below PROJECT/PROGRAM BUDGET —LINE ITEMS FOR PROJECT/PROGRAM VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) Cash contributed to Project/Program by the Applicant Organization Other grants or funding already awarded for Project/Program, if any In -Kind match amount or volunteer credit hours estimated amount VARIOUS TYPES OF EXPENSES FOR THE .SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program (This amount is ineligible to be funded by City's Grant; however please include.) Equipment Expense For Project/Program Food Expense For Project/Program Marketing Expense For Project/Program Supplies Expense For Project/Program Facilities/Rent Expense For Project/Program Other Expense For Project/Program REVENUES l EXPENSES TOTAL BUDGET FOR PROJECT/PROGRAM $3.,coo i $ PREVIOUS* FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020, AS SHOWN BELOW. IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19120 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2019-2020 (last year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and June,-i4, ai m December 31, 2020, In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: Thursday, December 31, 2020. 1. 2. 3. 4. EXPENDITURE REPORT due on or before f=riday. selxem,)er 1-i, 2o2o-Thursday, December 31, 2020 Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): Fill out this table (include additional copies if needed to explain all expenditures) Attach Receipts/Invoices (in the same order as listed in this table) Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Amount of Grant Fund Awarded: $ Name of Project/Program: Month + Year Grant Received from City: Date (Mo/Day/Yr) Describe... Explain ... d Name of Company on Receipt/invoice Amount (1) what the expenditure was how the expenditure E on Receipt/invoice Must be dated on or of (2) purpose of the expenditure specifically benefitted U E between July 1, 2019 - Expenditure Temecula residents az June 30. 202-0 MUST support Project/Program If names/addresses of Temecula December 31, 2020 description on Application + Award Letter, beneficiaries are available, lease attach KI 6 $ 7 $ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the Citu FISCAL YEAR (FY) 2020-2021 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant in FY 2020-2021 by the City of Temecula, then this information is not due until September 13, 2021 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2020-2021 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2020, and June 30, 2021. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2020-2021 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 13, 2021. 6. 7. 8. EXPENDITURE REPORT due on or before September 13, 2021 Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number). Fill out this table (include additional copies if needed to explain all expenditures) Attach Receipts/Invoices (in the same order as listed in this table) Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Amount of Grant Fund Awarded: $ Name of Project/Program: Month + Year Grant Received from City: Describe... Name of Company Date (Mo/Day/Yr) Amount (1) what the expenditure was E on Receipt/Invoice on Receipt/Invoice of (2) purpose of the expenditure 0 E Must be dated on or Expenditure az between July 1, 2020 - MUST support Project/Program June 30, 2021 description on Application + Award Letter 1 $ 14I I I$ I I EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City Explain ... how the expenditure specifically benefitted Temecula residents If names/addresses or Temecula beneficiaries are available. SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. ■ Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. ® Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: r" c-ot�frAC MAILING ADDRESS: , []. PHONE: EMAIL PRESIDENT/AUTHORIZED OFFICER �'-r -* SIGNATURE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: llwli Pal rr,E� DATE L (MoI11h, 1),IF YI-..If). SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 Stacey.Brown@TemeculaCA.gov (951) 694-6413 STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 10/16/2020 ESL ID: Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: - Entity Name: TEMECULA VALLEY MUSEUM ❑X 1. The entity is in good standing with the Franchise Tax Board. El2. The entity is not in good standing with the Franchise Tax Board. El3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 . ❑ 4. We do not have current information about the entity. El5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD. 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019) Q HELPO MENU = Home > Tax Exempt Oranizati n Search > Temecula Valley Museum <Back to Search Results Temecula Malley Museum EIN: I , --, United States Other Names Publication 78 Data o Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Copies of Returns (990, 990-EZ, 990-PF, 990-T) o Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non -profits. Tax Year 2018 Form 990EZ Tax Year 2017 Form 990EZ FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 28 TEMECULA VALLEY RURAL LIFESTYLES, INC. CITY OF TEMECUTA FISCAL YEAR 2020.2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 I PROJECT/PROGRAM INFORMATION I Amount Requested: $ 5000.00 MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: Temecula Valley Trails Implementation Physical Address of Project/Program: INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS Start Date: Jan 2021 End Date: June 2021 If Grant is Awarded, Make Check Payable to: Temecula Valley Rural Lifestyles, Inc. Mailing Address: 43980 Mahlon Vail Circle #3002 Temecula CA 92592 I ORGANIZATION AND GEOGRAPHIC AREA SERVED I Name of Applicant Organization: Temecula Valley Rural Lifestyles, Inc. 2014 Pp 9 Year Organization Founded: Website: none Contact Name: Gil Pankonin Contact Person's Email Address: Number of Paid Staff: 0 Number of Volunteers: Geographic Area(s) the Organization Serves: Temecula, Title/Position: President ITelephone: Temecula Valley and Wine Country Geographic Area(s) the Project/Program Serves. Temecula, Temecula Valley and Wine Country NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ■❑ Date of Incorporation as a Nonprofit: No IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number State Identification Number: Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: http.//apps.irs.gov/aooleosi 2. Attach State Entity Status Letter using this link: b_tl2s://www.ftb.ca._qovionlinelself serve enti @Qrhndex.as 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: hlW:I/ret.do'.ca.gov/VerificationNVeb/SearchQgNiffiiIR02� CITY MANAGER'S OFFICE City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No * Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No 0 Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors FNI Members -at -Large ❑ NIISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: WWI mission is W; 1 Pres—almainlaina cvnnedad n°IW°rk°f ddmg trails lh—gh-Teeala Velley(or Una benefl pffha local mmmundy. 2) M,vs eaeamenla and land for those lndn, 3) cooperate with other organizations to expand the trails 4) raise public awareness of trail system requirements, including educational materials I FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. P CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑ Yes* IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT MONTH + YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP 2020 Rose Parade $ 5000 Summer 2019 °mlc bevel°pmenl Funding Program for Spsdel Evanf City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. TVRL and Riverside County have identified 3 priority trail segments for collaborate on for implentation. This grant will enable us to make progress on these priorities The initial segment has a total budget of $75,000 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. TVRL will work with Riverside County to survey the priority trails, secure easements, grade the trail and install borders where necessary for the safety of trail users. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. Recreational trail use benefits the community by allowing users to enjoy the outdoors through safe activity. This is especially vital now, during the current pandemic, for both physical ad mental health. All residents will benefit. Approximately 20 volunteers will likely be involved Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. The funds will be used to construct priority segments of the Wine Country Trail map, for the benefit of all Temecula residents. Having a safe place to exercise outdoors can truly add to the benefits of living in Temecula. The grant would pay for the first phase. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PR.OJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) $ 5000 Cash contributed to Project/Program by the Applicant Organization $ 2500 Other grants or funding already awarded for Project/Program, if any $ 1 0000 In -Kind match amount or volunteer credit hours estimated amount $ 200 hrs VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program (This amount is ineligible to be funded by City's Grant; however please include.) $0 Equipment Expense For Project/Program $0 Food Expense For Project/Program $0 Marketing Expense For Project/Program $0 Supplies Expense For Project/Program $50000 Facilities/Rent Expense For Project/Program $ Other Expense For Project/Program $20000 TOTAL BUDGET FOR PROJECT/PROGRAM $17500 $ 7 0 0 0 0, City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 PREVIOUS* FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020, AS SHOWN BELOW IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19/20 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2019-2020 (last year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between .July 1, 2019, and Jun&-3a,-=o December 31, 2020. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receiptslinvoices, must be submitted to the City on or before due date: Cs;aoop;� "�� +, L24, Thursday, December 31, 2020. EXPENDITURE REPORT due on or before Friday, s ..+e4,r,n. + � -Thursday, December 31, 2020 1. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number). 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Name of Project/Program: Amount of Grant Fund Awarded: $ Month + Year Grant Received from City: Date (Mo/Day/Yr) Describe... Explain ... Name of Company on Receipt/Invoice Amount (1) what the expenditure was how the expenditure E on Receipt/Invoice Must be dated on or of (2) purpose of the expenditure specifically benefitted o between July 1, 2019 - Expenditure Temecula residents a Z December 31, 2020 MUST support Project/Program description on Application + Award Letter If names/addresses of Temecula beneficiaries are available, lease attach 1 $ 2 $ 3 $ $ 4 5 $ 6 $ 7 $ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" above rovided by the City City of Temecula Community Service Funding Grant APPLICATION Page 5 of 7 FISCAL YEAR (FY) 2020-2021 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant in FY 2020-2021 by the City of Temecula, then this information is not due until September 13, 2021 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2020-2021 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2020, and June 30, 2021. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2020-2021 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 13, 2021. EXPENDITURE REPORT due on or before September 13, 2021 5. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 6. Fill out this table (include additional copies if needed to explain all expenditures) 7. Attach Receipts/Invoices (in the same order as listed in this table) 8. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Name of Project/Program: Amount of Grant Fund Awarded: Month + Year Grant Received from City: Describe... Explain ... Name of Company Date (Mo/Day/Yr) Amount (1) what the expenditure was how the expenditure on Receipt/invoice on Receipt/invoice of (2) purpose of the expenditure specifically benefitted EMust be dated on or Expenditure Temecula residents o a z between July 1, 2020 - June 30, 2021 MUST support Project/Program description on Application + Award Letter If names/addresses of Temecula beneficiaries are available, leasr attach 1 $ 2 $ 3 $ 4 $ 5 $ 6 $ 7 $ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City City of Temecula Community Service Funding Grant APPLICATION Page 6 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Temecula Valley Rural Lifestyles, Inc. 43980 Mahlon Vail Circle #3002 MAILING ADDRESS: Temecula CA 92592 PHONE: "—"—=EMAILI PRESIDENT/AUTHORIZED OFFICER: Gil Pankonin, President Print Hama SIGNATURE: IF DIFFERENT THAN ABOVE, Lorraine Harrington Director APPICATION PREPARED BY: Title DATE:. 4 1120 (Month, Day, Year) Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY.. SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 Stacey.Brown@TemeculaCA.gov (951) 694-6413 City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 Date: DE(',1 Zola TEMECULA VALLEY RURAL LIFESTYLES INC 43980 MAHLON VAIL RD STE 3D02 TEMECULA, CA 92592-0000 Dear Applicant: DEPARTMENT OF THE TREASURY Emplo er Identification Number: DLN: Contact Person: CUSTOMER SERVICE ID# _ Contact Telephone Number: (877) 829-5500 Accounting Period Ending: August 31 Public Charity Status: 170(b) (1) (A) (vi) Form 990/990-EZ/990-N Required: Yes Effective Date of Exemption: September 05, 2014 Contribution Deductibility: Yes Addendum Applies: No We're pleased to tell you we determined you're exempt from federal income tax under internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This Letter could help resolve questions on your exempt status. Please keep it for your records, Organizations exempt under, IRC Section 501(c)(3) are further classified as either public charities or private foundations. We determined you're a public charity under the IRC Section listed at the top of this letter. If we indicated at the top of this letter that you're required to file Form 990/990-EZ/990-N, our records show you're required to file an annual information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked. If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter 114221-PC" in the search bar to view Publication 4221.-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Letter 5436 STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/8/2020 ESL ID: Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: _ Entity Name: TEMECULA VALLEY RURAL LIFESTYLES, INC. 0 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. © 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019) California Secretary of State x Secretary =. X w t Electronic Filing y of State State of California Corporation - Statement of Information Entity Name: TEMECULA VALLEY RURAL LIFESTYLES, INC. Entity (File) Number: File Date: Entity Type: Jurisdiction: Document ID: Detailed Filing Information 1. Entity Name: 2. Business Addresses: a. Street Address of Principal Office in California: b. Mailing Address: 3, Officers: 05/13/2020 Corporation CALIFORNIA TEMECULA VALLEY RURAL LIFESTYLES, INC. 43980 mahon vail rd., #3002 temecula, California 92592 United States of America 43980 mahon vail rd., #3002 temecula, California 92592 United States of America a. Chief Executive Officer: gil pakonin 43980 mahon vail rd., #3002 temecula, California 92592 United States of America b. Secretary: kerri graham p 43980 mahon vail rd., #3002 c temecula, California 92592 United States of America E v O 0 Use bizfile.sos.ca.gov for online filings, searches, business records, and resources. n4 rty r California Secretary of State Electronic Filing Officers (Cont'd): c. Chief Financial Officer: 4. Agent for Service of Process: margaret rich 43980 mahon vail rd., #3002 temecula, California 92592 United States of America gil pakonin 43980 mahon vail rd., #3002 temecula, California 92592 United States of America By signing this document, I certify that the information is true and correct and that I am authorized by California law to sign. Electronic Signature: M rich Use bizfile. sos. ca.gov for online filings, searches, business records, and resources. 70, N E U O 0 FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 29 THESSOLIKA FAMILY aka RANCHO DAMACITAS CITY OF TEMECUiA FISCAL YEAR 2020.2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 Amount Requested: $ 5,000 PROJECT/PROGRAM INFORMATION I MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: Empowerment Vulage / Project Independence Start Date: 7/1 /20 End Date: 6/30/21 Physical Address of Project/Program: Temecula, CA 92592-8753 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Rancho Damacitas Mailing Address: Temecula, CA 92592-8753 I ORGANIZATION AND GEOGRAPHIC AREA SERVED I Name of Applicant Organization: Thessalonika Family Services Year Organization Founded: 1983 Website www.4kidsfirst.org Number of Paid Staff. 6 Number of Volunteers: 150 Contact Name: Cal Winslow Title/Position: Chief Executive Officer Contact Person's Email Address. cal@4kids#irst.org Telephone Geographic Area(s) the Organization Serves: Temecula Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA, Geographic Area(s) the Organization Serves Temecula, CA 92592-8753 NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes IN Date of Incorporation as a Nonprofit: 1983 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Nurnber:� Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: hfRJlag2s.iM=v/aPP/eos/ 2. Attach State Entity Status Letter using this link: hUps,iiwww,Rb.,gA-qovtonline/sgtf-5grve enlity status letterlimkX.51S 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: httrsAmI.doi.ca,go NerifcalionfWeb/Search.asnx?facility=l' RECEIVCL City of Temecula Community Service Funding Grant APPLICATION SE'P Pa§e�0;4 '.1 naAMAGER" Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No 7 Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No O Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee Q Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: The mission of Rancho Damacitas is to break the generational cycle of child abuse and poverty through programs offering stable homes, opportunities for growth, and hope to at -risk children, struggling single mothers, and young adults formerly living in foster care. To accomplish this mission, our programs are designed to teach approximately 45 young adults and formerly homeless single mothers and the skills they need to be successful while providing them with support and guidance as they seek to reach their educational, financial and personal goals, I FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑ Yes ® IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT MONTH +YEAR FUNDING RECEIVED NAME OF CITY" GRANT OR SPONSORSHIP Empowerment Village $4.784.6 11/2019 Temecula City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM/ PROJECT the Temecula grant funding will be used to support. Recognizing a significant gap in stable housing and comprehensive life skill support services available to children aging out of the foster care system and to young low-income single mothers with children at -risk of entering the foster care system, Rancho Damacitas opened Project Independence, a stand-alone residential home and support program for emancipated 18-year-old youth transitioning out of foster care and into adulthood in 2012, followed by Empowerment Village, a five -home residential campus serving struggling single mothers with young children in 2017. Together, these programs address a myriad of unmet needs including supportive housing, educational achievement, employment, long-term financial stability among others, for the at -risk populations we serve. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why, Rancho Damacitas is requesting $5,000 in grant funds to offset costs associated with program expenses for these impactful initiatives. The programs' annual budget exceeds $580,000 each year and is funded entirely through philanthropic contributions. As such, grant funds will be utilized to purchase program supplies as well as cover housing and transportation expenses associated with helping program participants get to and from school and/or work and other critical appointments while they are saving to purchase their own vehicles. Lastly, a small portion of funding will be used to cover utility costs for the homes on our campus. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. In our community there is no other organization providing the depth or similar scope of service to our target population —emancipated foster youth, and low-income single mothers, many of whom are domestic violence survivors and former foster youth. Our commitment to the health and well-being of children and families remains the cornerstone of our programs and services. Our purpose Is to be the light in a world of darkness for those we serve, providing them a hand -up, not a hand-out. Through our housing and support services Rancho Damacitas utilizes an innovative and Immersive service delivery model designed to teach at -risk young adults and single mothers the skills they need to be successful. While with us they obtain support and guidance as they reach their personal educational, financial and personal goals --actively working to make positive changes in their lives and their community. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: 45 Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 150 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. In direct alignment with the City of Temecula's Community Service Funding priorities, our programs deliver vital safety -net services to help the community's most vulnerable achieve long-term stability and success. As such, our programs focus on critical safety -net issues including homelessness, food security, health care, education, child abuse prevention, and employment. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) $5,000 Cash contributed to Project/Program by the Applicant Organization $176,400 Other grants or funding already awarded for Project/Program, if any $20,000 In -Kind match amount or volunteer credit hours estimated amount $17,244 VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program (This amount Is Ineligible to be funded by City s Grant; however please include.) $207,798 $0 Equipment Expense For Project/Program Food Expense For Project/Program $1,440 Marketing Expense For Project/Program $0 Supplies Expense For Project/Program $2,000 Facilities/Rent Expense For Project/Program $3,070 Other Expense For Project/Program $67,265 TOTAL BUDGET FOR PROJECT/PROGRAM $218,644 $281,573 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. The recognition for Community Service Funding should accrue to the City of Temecula. Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. ® If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Rancho DarnacltaS MAILING ADDRESS: PHONE: EMAIL: cal@4kidsfirst.org Temecula, CA 92592-8753 PRESIDENT /AUTHORIZE9,OFFICE I Winslow, Chief Executive Officer SIGNATURE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Print Name Print Name Title DATE: b2;fl tM ntl, Day ,'ea,, Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 If you have any questions, please contact Betsy Lowrey at (951) 693-3959 or Stacey Brown at (951) 694-6413. City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 INTERNAL REVENUE SERVICE District Director C/o MCCaslin Industrial Park Monterey Park, CA 91754 Attn:EOG-4 Department of the Trensury r' AUr, 2 r, 1993 Date: AUG 2 a i683 i j Employer Identifica='ion llurnuEk.F Thessalonika Family Services, Inc, P.O. Box 890326 Case Number: Temecula, CA 92589-0326 - Contact Person: R. Howard Contact Telephone Number Our Letter Dated: May 7, 1908 Caveat Applies: No 0ear Applicant: This modifies our letter of the above dote in which we star,rd that You would be treated ea an organization which is not a orivat foundation until the expiration of your 60 month termination of private foundation statue period under section 507(b)(1)(8). Based on the information you submitted, we have determined that you are not a private foundation within the meaning of secr,ar, 509(a) of the Internal Revenue Code, because you are an organiza- tiara of the type described in section 170(b)(1)(A)(v1), Your exempt status as an organization described in secticn 501(c)(3) of the Internal Revenue Code is still in effect. Grantors and contributors may rely on this determination unr,i tha Internal Revenue Service publishes notice to the contrary. However,, a grantor or a contributor may not rely on this determination if he or she was in part responsible for, or awarr, cf, the neL or failure to act that resulted in your loss of section 50 O (1) status, or ac4uired Knowledge that the Internal Revenue Service had given notice that you would be removed from Lray!iifreatlon as a section 509(a)(1) organization, If we indicated in the heading of this letter that an addendum applies, the iaddendum enclosed is an integral part of tnirs letter, Because this letter could help resolve sny quostior+s ❑bc,u!: your provate foundation status, please koeo it in your perr„nnent records, I If you have any queetione, please contact the person whose name and telephone number are shown above, Sincerely yours, • Mic el Ouinn District Director LAC, ; �•. , TG o-rY�a 7 1D5a(CG) STATE OF CALIFORNIA �b FRANCHISE TAX BOARD iGl PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/2/2020 ESL ID: - Why You Received This letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: - Entity Name: THESSALONIKA FAMILY SERVICES ® 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. n3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d, ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to 5 p.m, weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019) FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 30 TOWARD MAXIMUM INDEPENDENCE CITY OF TEMECULA FISCAL YEAR 2020.2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 PROJECT/PROGRAM INFORMATION Amount Requested: $ $5,000 MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: iPads for Individuals with Disabilities Start Date: 11 /20 End Date: 1 1 /20 Physical Address of Project/Program: 41707 Winshester Rd. Suite 206 Temecula CA 92590 INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Toward Maximum Independence Mailing Address: 4740 Murphy Canyon Rd. Suite 300 San Diego, CA 92123 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Toward Maximum Independence Year Organization Founded: 1981 Website: tmi-inc.org Number of Paid Staff: 400 Number of Volunteers: 2 Contact Name: Ginger Cohen Title/Position: Media Communications & Corporate Relations Specialist Contact Person's Email Address: gingerc@tmi-inc.org Telephone: Geographic Area(s) the Organization Serves: San Diego, Riverside and Imperial Counties Geographic Area(s) the Project/Program Serves. Temecula NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes K Date of Incorporation as a Nonprofit: 7-28-86 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: MENU_State Identification Number: Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follows: 1. Attach IRS Deductibility Status using this link: htt ://a sirs. ov/a /eos/ 2. Attach State Entity Status Letter using this link: httpsa vww.ftb,ca. ov/onlinelself serve entity.status ietterlindex.as 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http://rct. dog. ca.govlVerificationlWeb/Search.asAx?facility Y City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No I Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No [K Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee 1# Board of Directors ❑ Members -at -Large ❑ I MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: To provide personalized services to those who require support, enabling them to make informed choices regarding how they live, work and function productively and independently in the community R.a .: having a valued pl— and raa among a netvvoM of family, Mende, wik guea and rwighb , Choirs! having autonomy in de Wn m king bo in small every day m ilm and Imge, life derini g i— Conn e-- heving IM opp�ni y la p Hr Nncliowl — m 13 TMI has been transforming the lives of children and adults with developmental disabilities since 1981 I FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. I CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ■❑ Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW: NOF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNTAME MONTH + YEAR FUNDING RECEIVED NAME OF CITY GRANT OR SPONSORSHIP City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. TMI would purchase 16 ipads ($316 each) for families in need who don't currently have a device to receive remote services. Families without internet could access services via a hot spot. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. Purchase 16 ipads for families in need who have a family member with an intellectual or developmental disability in need of remote services. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. The ipads will be for 16 families living in the Temecula area. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. Purchase 16 ipads for individuals with I/DD to receive remote services for instruction, engagement and community involvement. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) $ 5 7 000 Cash contributed to Project/Program by the Applicant Organization $ Other grants or funding already awarded for Project/Program, if any $ In -Kind match amount or volunteer credit hours estimated amount $ VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program $ (This amount is ineligible to be funded by City's Grant; however please include.) Equipment Expense For Project/Program $ Food Expense For Project/Program $ Marketing Expense For Project/Program $ Supplies Expense For Project/Program $ Facilities/Rent Expense For Project/Program $ $ Other Expense For Project/Program TOTAL BUDGET FOR PROJECT/PROGRAM $ 5,000 1$5,000 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 PREVIOUS' FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020, AS SHOWN BELOW. *IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19/20 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2019-2020 (last year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and :a: December 31, 2020. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: FmNj. r14,29 o Thursday, December 31, 2020. EXPENDITURE REPORT due on or before €4day-&mAembw--4-2e2o-Thursday, December 31, 2020 1 Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Amount of Grant Fund Awarded: Date (Mo/Day/Yr) Name of Company on Receipt/invoice Amount E on Receipt/invoice Must be dated on or of between July 1, 2019 - Expenditure a. Junes Q Z December 31, 2020 Name of Project/Program: Month + Year Grant Received from City: i Describe... Explain ... (1) what the expenditure was how the expenditure (2) purpose of the expenditure specifically benefitted Temecula residents MUST support Project/Program If names/addresses of Temecula tlon on Application + Award Letter beneficiaries are available, description PP „iR„s. ,roach EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" above)_orovided by the City City of Temecula Community Service Funding Grant APPLICATION Page 5 of 7 FISCAL YEAR (FY) 2020-2021 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant in FY 2020-2021 by the City of Temecula, then this information is not due until September 13, 2021 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2020-2021 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2020, and June 30, 2021. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2020-2021 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 13, 2021. EXPENDITURE REPORT due on or before September 13, 2021 5. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 6. Fill out this table (include additional copies if needed to explain all expenditures) 7. Attach Receipts/Invoices (in the same order as listed in this table) 8. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: r Name of Project/Program: Amount of Grant Fund Awarded: $ Month + Year Grant Received from City: T Describe... Explain ... V Name of Company Date (Mo/DayNr) Amount (1) what the expenditure was how the expenditure E � on Receipt/Invoice on Receipt/Invoice of (2) purpose of the expenditure specifically benefitted t u E Must be dated on or Expenditure Temecula residents B = Z between July 1, 2020 - MUST support ProjectlProgram If namesladdresses of Temecula beneficiaries are available, June 30, 2021 description on Application + Award Letter please attach. 1 $ $ $ 2 3 4 $ 5 $ 6 $ 7 $ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City City of Temecula Community Service Funding Grant APPLICATION Page 6 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizatiorls and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. * The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Toward Maximum Independence MAILING ADDRESS: 4740 Murphy Canyon Rd. PHONE: EMAIL: gingerc@tmi-inc.org _ Suite #300, San Diego, CA 92123 PRESIDENT/AUTHORIZED OFFICER: Ginger Cohen, Media Comm "rint Name 5 — - 6: � �-- --� - SIGNATURE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: & Corp. Relations DATE: 9/14/20 % on'th, Cray, Year, SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 Stacey. Brown@TemeculaCA.gov (951) 694-6413 City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 31 VETERANS SUPPORT NETWOORK CITY OF TEMECULI FISCAL YEAR 2020.2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 Amount Requested: $ 1500 PROJECT/PROGRAM INFORMATION MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: Winter Wonderland (Drive -In) Start Date: 11/1/2020 End Date: 12/31/2020 Physical Address of Project/Program: CHS 27215 Nicolas Rd Temecula CA 92591 INCLUDE IF DIFFERENT THAN ORGANIZATION'S MAILING ADDRESS If Grant is Awarded, Make Check Payable to: Veterans Supplemental Support Network Mailing Address: 41593 Winchester Rd Ste 200 Temecula CA 92590 ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: Veterans Supplemental Support Network Year Organization Founded: 2009 Website: vetsupportnet.org Number of Paid Staff: 0 -Number of Volunteers: 142 Contact Name: Marcellus Benton Title/Position: Director Contact Person's Email Address: mbenton@vetsupportnet.org Telephone: _ Geographic Area(s) the Organization Serves: Riverside County (Southwest Region) Geographic Area(s) the Project/Program Serves: Riverside County (Southwest Region) NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes ■❑ Date of Incorporation as a Nonprofit: 9/11/2013 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Number: Print out and attach to this application Verification from Federal (IRS) and State (FT" f *4020 1. Attach IRS Deductibility Status using this link: http://ai2vs.irs.gov/apy/eos/ CITY. MANAGER'S 2. Attach State Entity Status Letter using this link: htt ://www.ftb.ca. oyz nline/self serve e HMOs letter/in ex.as 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: http://rct.doi.ca.gov/VerificationlWeb/Search.asaX7facility=Y City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No X Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ■❑ Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors *■ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: End and prevent suicide, hardship, hunger and homelessness among military and veteran familes. Objectives is to provide resource connections through events and supportive services to any veteran, service member and thier dependents FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑■ Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PROJECT FUNDED BY THE CITY GRANT OR SPONSORSHIP AMOUNT MONTH + YEAR FUNDING RECEIVED NAME OF CITY. GRANT OR SPONSORSHIP City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. For the past ten years Veterans Supplemental Support Network (VSSN) has fed and met the immediate need of over 10,000 military and veteran community residents especially during the holidays. Holidays are especially important as suicide and depression rates soar. VSSN will use the City of Temecula's funding to support its local resource, holiday gift baskets and toy give away, Winter Wonderland drive-thru event. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. The funding will be used towards the rental and purchase of equipment such as generators, blow-up figures, tables, chairs, canopies, stanchions, cones, tape, and linen at a special reduced rate from our annual vendors. These items are essential in creating a highly organized, safe, festive event with cheer and the distribution of toys and holiday baskets to over 10,000 local community members. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. Now more than ever struggling military and veteran families need the support from our community with a sprinkle of joy and hope. The City of Temecula will have the opportunity to join several businesses, community and church groups, and the Temecula Valley Unified School District in reducing the hardship and spreading joy to our local veteran and military community. This event has historically served over 10,000 community members along with over 300 volunteers who help from toy drives to distribution. We invite the City of Temecula to continue transforming the community into a happier and brighter place to call home. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. Be a part of something special and show support to your local veteran and military families. The 11th Annual Winter Wonderland starts giving holiday baskets from Nov 11-Dec 25th. VSSN's drive-in distribution event is slated for 12/1812020, here you will see your funding in action with equipment used to support the distribution of items to thousands of Temecula Residents. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) $1500 Cash contributed to Project/Program by the Applicant Organization Other grants or funding already awarded for Project/Program, if any $ 2500 $ 500 In -Kind match amount or volunteer credit hours estimated amount $ 4000 VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program (This amount is ineligible to be funded by City's Grant; however please include.) $0.00 Equipment Expense For Project/Program $2500 Food Expense For Project/Program [Marketing Expense For Project/Program $3000 $500 Supplies Expense For Project/Program $1 800 Facilities/Rent Expense For Project/Program $0.00 $700 Other Expense For Project/Program TOTAL BUDGET FOR PROJECT/PROGRAM $8500 $8500 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 PREVIOUS* FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020, AS SHOWN BELOW. IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19/20 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarded a Community Service Funding Grant in FY 2019-2020 (last year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and December 31, 2020. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: €44ay embw-�,1 . Thursday, December 31, 2020. EXPENDITURE REPORT due on or before r y, pt ,be.F:4 2o-Thursday, December 31, 2020 1. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/Invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Amount of Grant Fund Awarded: $ Name of Project/Program: Month + Year Grant Received from City: Date (Mo/Day/Yr) Describe... c Name of Company on Receipt/invoice I Amount (1) what the expenditure was 0 on Receipt/invoice Must be dated on or of (2) purpose of the expenditure E between July 1, 2019 - Expenditure a = ono 14,4 2� MUST support Project/Program December 31, 2020 description on Application + Award Letter EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund AwvardedCabove) provided by the Cit Explain ... how the expenditure specifically benefitted Temecula residents If names/addresses of Temecula beneficiaries are available, Please avacr _ City of Temecula Community Service Funding Grant APPLICATION Page 5 of 7 FISCAL YEAR (FY) 2020-2021 COMPLIANCE REPORT If your organization is awarded a Community Service Funding Grant in FY 2020-2021 by the City of Temecula, then this information is not due until September 13, 2021 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2020-2021 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2020, and June 30, 2021. In addition,. all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be requ [red to refund the amount of funds. To substantiate that Fiscal Year 2020-2021 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receipts/invoices, must be submitted to the City on or before due date: September 13, 2021. EXPENDITURE REPORT due on or before September 13, 2021 5. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 6. Fill out this table (include additional copies if needed to explain all expenditures) 7. Attach Receipts/Invoices (in the same order as listed in this table) 8. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Name of Project/Program: Amount of Grant Fund Awarded: $ _ Month + Year Grant Received from City: Describe... Explain ... Name of Company Date (Mo/oayNr) Receipt/Invoice Amount (1) what the expenditure was (2) of the expenditure how the expenditure benefitted on on Receipt/Invoice of purpose specifically Must be dated on or Expenditure Temecula residents between July 1, 2020 - Q Z MUST support Project/Program IF names/addresses of Temecula beneficiaries are available, June 30, 2021 - _. description on Application + Award Letter ease attach. 1 $ 2 $ 3 $ 4 $ 5 $ 6 $ 7 $ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City City of Temecula Community Service Funding Grant APPLICATION Page 6 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. ■ Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: Veterans Supplemental Support Network MAILING ADDRESS: 41593 Winchester Rd St 200 PHONE: EMAIL: mbenton@vetsupponnet.org Temecula CA 92590 PRESIDENT/AUTHORIZED OFFICER: Marcellus Benton Director Print Name Title SIGNATURE: DATE: 09/14/2020 (Month, Day, Year) IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Betsy.Lowrey@TemeculaCA.gov (951) 693-3959 Stacey.Brown@TemeculaCA.gov (951) 694-6413 City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 Q HELPB MENU Home > Tax Exempt Organization Search > Veterans Supplemental Support Network < Back to Search Results Veterans Supplemental Support Network EIN: I , --, United States Other Names Determination Letter o A favorable determination letter is issued by the IRS if an organization meets the requirements for tax-exempt status under the Code section the organization applied. Determination Letter: Determination er Publication 78 Data o Organizations eligible to receive tax-deductible charitable contributions. Users may rely on this list in determining deductibility of their contributions. On Publication 78 Data List: Yes Deductibility Code: PC Copies of Returns (990, 990-EZ, 990-PF, 990-T) o Electronic copies (images) of Forms 990, 990-EZ, 990-PF or 990-T returns filed with the IRS by charities and non- profits. Tax Year 2018 Form 990EZ Tax Year 2017 Form 990EZ Tax Year 2016 Form 990EZ Page Last Reviewed or Updated: 6-Sept-2019 I IDS Our Agency About IRS Work at IRS Help Contact Your Local Office Tax Stats, Facts & Figures Know Your Rights Resolve an Issue r► Share $ Print Oino�� Other Languages Related Sites Taxpayer Bill of Respond to a Notice Espanol U.S. Treasury Rights Office of Appeals EP3z Treasury Inspector Taxpayer Advocate General for Tax Service Identity Theft Administration Protection Accessibility PyccKMA USA.gov Report Phishing Civil Rights Tieng Viet Tax Fraud & Abuse Freedom of Information Act No Fear Act Privacy Policy 9/14/2020 SearchResults =,"M E P3 _, M0- 0- 1�16R Ei?;; .'�,._A.-Ii +i5 _cg•'tUi2CE ''z')�R;+i�1S Cf;i P.r7 SERVICE DISRUPTION - Site will be unavailable intermittently From Wednesday September 16th, 2020 10:30 PM. to Thursday September 17th 2:00 AM. Click on the Organization Name for details about the registration or report record. The maximum number of records shown per page Is Sol If there are multiple pages of th, results, the cltckable page numbers wNl he displayed at the bottom, if you get too many results or do not find the organizatton for which you are searching, dick the'Seart button and change the search criteria. It is best to search by something that is as unique to the organization as passible such as State Charity Registration plumber, FEIN, c Corporate Number, or an unusual portion of their name. To see all registration and report records associated with an organization, avoid searching by State Charity Registrz Number as that is record-specinc. Search Again rct.doi.ca.gov/Verification/Web/SearchResults.aspx 1/1 INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 Date: S E P 112013 VETERANS SUPPLEMENTAL SUPPORT NETWORK MURRIETA, CA 92562 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: DLN: Contact Person: JERRY FIERRO ID# - Contact Telephone Number: Accounting Period Ending: December 31 Public Charity Status: vi Form 990 Required: Yes Effective Date of Exemption: April 2, 2013 Contribution Deductibility: Yes Addendum Applies: No We are pleased to inform you that upon review of your application for tax exempt status we have determined that you are exempt from Federal income tax under section 501(c)(3) of the Internal Revenue Code. Contributions to you are deductible under section 170 of the Code. You are also qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Code. Because this letter could help resolve any questions regarding your exempt status, you should keep it in your permanent records. Organizations exempt under section 501(c)(3) of the Code are further classified as either public charities or private foundations. We determined that you are a public charity under .rhe.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, 4j'. t aL'." Director, Exempt Organizations Letter 947 (DO/CG) FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 32 THE WINE ROLLERS CITY OF TE1IMCULA SEP 0 3 2020 FISCAL YEAR 2020 M 2021 CITY MANAGER'S COMMUNITY SERVICE FUNDING PROGRAM APPLICA 6% (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 PROJECT/PROGRAM INFORMATION Amount Requested: $ 2500 The Empowerment Initiative I, I In INCLUDE IF DIFFERENT THAN ORGANIZATION'S If Grant is Awarded, Make Check Payable to: MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Start Date: November 1, 202oEnd Date: March 31, 2021 The Wine Town Rollers Mailing Address: 27475 Ynez Rd #315 Temecula, Ca. 92591 ORGANIZATION AND GEOGRAPHIC AREA SERVED I Name of Applicant Organization: The Wine Town Rollers Year Organization Founded: 2012 M '/' /- Website: www.TheWineTownRollers.com Number of Paid Staff: 0 Number of Volunteers: 35 Contact Name: Taryn Ranoa Title/Position: Director of Sponsorship & Fundraising Contact Person's Email Address: sponsorships@Mnetownrollers.com Telephone: Geographic Area(s) the Organization Serves: Temecula Geographic Area(s) the Project/Program Serves: Temecula NOTE: COMMUNITY SERVICEFUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. Geographic Area(s) the Organization Serves: Temecula NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: 07/16/2018 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Number: Print out and attach to this application Verification from Federal (IRS) and State (FT13) as follows: i. Attach IRS Deductibility Status using this link: htto://apps.irs.gov/app/eosl 2. Attach State Entity Status Letter using this link: b-ttp-s-.-Ztw-ww.ftb.ra.gov/onlinelself serve entily status letter/index.as 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about your charity found on this State Registry's Search Tool: htt ://rct.do4.ca. ovNedficationNVeb/Search.as x?facilit =Y City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No ® Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No ® Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organization's: Executive Committee ❑ Board of Directors ® Members -at -Large ❑ NIISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: Wine Town Rollers' mission is to embrace inclusiveness, strength, athleticism, and the focused pursuit of individual and league wide success for adults and youths through roller derby and it's communities. We continually strive to build upon ourselves as individuals so we can dominate the roller derby world as a strong, self sufficient and united team. We join forces with a variety of non -profits throughout the year, so we are always looking farther than ourselves. Our purpose is to empower women (and children) to become the best versia hpliave in rl FINANCIAL STATEMENTS Upon request, copies the organization's current budget/financial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ® Yes ❑ IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAM/PRo1ECi AMOUNT MONTH + YEAR NAME OF CITY GRANT FUNDED BY THE CITY GRANTOR SPONSORSHIP FUNDING RECEIVED OR SPONSORSHIP City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESC111 P FION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. The Wine Town Rollers is a Roller Derby league that meets 6 times a week for 3 hour practices and once a month for games (bouts) against other cities_ Our practices are absolutely vital for growth and learning. Each of our practices usually have approximately 30 different (dues paying) members who practice strategies and team building exercises_ We have created a project called, The Empowerment Initiative, which is a program that each member must graduate from, while repeatedly utilizing skills even beyond graduation, The program enables all members to work on self-esteem while building charisma and self-worth through the spout of roller derby. The Wine Town Rollers continually embrace ongoing efforts to build independence (through each "jammer' {gassing opponents to gain points), as well as, developing team comradery by whipping team mates to the finish line. By incorporating a variety of techniques and game plans in every play, members successfully flourish together as a team,as well as, as individuals. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. Once awarded the grant money, We will be able to pay for the rental of the track, medical boxes, replenishment of all necessary equipment (tape, chalk, updated software, pens, sharpies, score sheets, zip ties, batteries, clipboards (etc.), the rental of the storage unit that houses all of the tools necessary for playing roller derby (computer, generator, software, speaker, microphone, large screen TV, American flag), uniforms necessary for a united front, all medical practitioners required for safety, snacks and food to keep up morale and simple decorations for every bout.. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. We are the Wine Town Rollers!! We are a roller derby league of 150 Temecula based women and children who represent Temecula in every fiber of our being. We reach a multitude of residents as fans and players alike. We travel throughout the nation striving to continually make a name for Temecula in the world of sports. Likewise, we offer also fun classes (like Rollercize) that the general public can always be a part of and join in making healthy life choices. We are all residents of Temecula and demonstrate our dedication and pride at every practice and event. We are mothers, grandmothers, sisters, daughters and overall pillars in our society. We range in age from 7 years old to 67 years old and we benefit from roller derby in multiple ways. Roller Derby benefits us in our physical, emotional and mental day to day health. Roller Derby is not just a sport, it's a way of life that allows our members to profit on a much grander scale. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: 200 Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 150 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the project/program and how the grant funds will be used. The Empowerment Initiative is a roller derby league event that we host throughout the year. This program helps to build self esteem and overall self worth in Temecula's women and children. Grant funds will go toward uniforms, storage unit rental, track rental, operational expenses and snacks. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINE ITEMS FOR PROJECT/PROGRAM VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) Cash contributed to Project/Program by the Applicant Organization Other grants or funding already awarded for Project/Program, if any In -Kind match amount or volunteer credit hours estimated amount VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program (This amount is ineligible to be funded by City's Grant; however please include.) Equipment Expense For Project/Program Food Expense For Project/Program Marketing Expense For Project/Program Supplies Expense For Project/Program Facilities/Rent Expense For Project/Program Other Expense For Project/Program REVENUES 1 EXPENSES $ 2500 $ 700 $0 5U TOTAL BUDGET FOR PROJECT/PROGRAM I $ $0 $ 750 $ 400 $1500 $350 $ 450 $ 3350 $ 6800 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 PREVIOUS* FISCAL YEAR (FY) 2019-2020 COMPLIANCE REPORT DUE TO COVID-19, THIS DEADLINE HAS BEEN EXTENDED TO DECEMBER 31, 2020, AS SHOWN BELOW_ *IF YOUR ORGANIZATION WAS NOT AWARDED A COMMUNITY SERVICE FUNDING GRANT IN FY 19120 (LAST YEAR), THEN SKIP THIS PAGE. If your organization was awarder{ a Community Service Funding Grant in FY 2019-2020 (last year) by the City of Temecula, please submit this information. If your organization is awarded a Community Service Funding Grant in Fiscal Year 2019-2020 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2019, and June-30;-2a2o December 31, 2020. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds- To substantiate that Fiscal Year 2019-2020 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receiptsfinvoices, must be submitted to the City on or before due date: F;iday,_1;eptembe;-1a,2020. Thursday, December 31, 2020. EXPENDITURE REPORT due on or before FFiday-Sf1 eptembe1;-2wo-Thursday, December 31, 2020 1. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefrtted from this program: (approximate number of beneficiaries if you don't have a precise number): 2. Fill out this table (include additional copies if needed to explain all expenditures) 3. Attach Receipts/invoices (in the same order as listed in this table) 4. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Name of Project/Program: Amount of Grant Fund Awarded: $ Month + Year Grant Received from City: Date (Mo/Day/yr) Describe... Explain ... Name of Company on Receiptllnvoice Amount (1) what the expenditure was how the expenditure E on Receipt/Invoice Must be dated on or of (2) Purpose of the expenditure specifically benefitted between July 1, 2019 - Expenditure Temecula residents QZ amine 30. 2020 MUST support Pro*UProgram If namestaddresses of Temecula December 31, 2020 description on Application + Award Letter beneficiaries are available, ease attach. — 1 $ 2 $ — 3 $ 4 $ 5 $ 6 $ 7 � $ EXPENDITURE TOTAL Note: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the Citv City of Temecula Community Service Funding Grant APPLICATION Page 5 of 7 FISCAL YEAR (FY) 2020-2021 COMPLIANCE REPORT ff your organization is awarded a Community Service Funding Grant in FY 2020-2021 by the City of Temecula, then this information is not due until September 13, 2021 If your organization is awarded a Community Service Funding Grant in Fiscal Year 2020-2021 by the City of Temecula, all grant funds received must be expended anytime on or between July 1, 2020, and June 30, 2021. In addition, all grant funds must be substantiated with proper back-up documentation. Failure to provide proper documentation may jeopardize any future funding. City of Temecula reserves the right to conduct an audit and/or require additional back-up information to substantiate how funds received from the City were spent. If the funds are not spent in accordance with the approved purpose stated on the Application, the organization will be required to refund the amount of funds. To substantiate that Fiscal Year 2020-2021 funds received from the City were spent appropriately, proper back-up documentation including the table below with accompanying receiptslinvoices, must be submitted to the City on or before due date: September 13, 2021. EXPENDITURE REPORT due on or before September 13, 2021 5. Demonstrate that the Community Service Funding Grant specifically benefitted Temecula residents by providing the number of beneficiaries living in 92590, 92591 and 92592 that directly benefitted from this program: (approximate number of beneficiaries if you don't have a precise number): 6. Fill out this table (include additional copies if needed to explain all expenditures) 7. Attach Receipts/Invoices (in the same order as listed in this table) 8. Send to: City of Temecula, 41000 Main St., Temecula, CA 92590, Attn: City Manager's Office - CSF Organization: Amount of Grant Fund Awarded: $ o Name of Company Date (Mo/DayNr) Amount E ® on Receipt/invoice on Receiptlinvoice of r Must be dated on or Expenditure aE between July 1, 2020 - June 30, 2021 $ EXPENDITURE TOTAL (Vote: Expenditure Total must be equal to $ (or greater than) the "Amount of Grant Fund Awarded" (above) provided by the City Name of Project/Program: Month + Year Grant Received from City: Describe... Explain ... (1) what the expenditure was how the expenditure (2) purpose of the expenditure specifically benefitted Temecula residents MUST support Project/Program H names/addresses of Temecula description on A pti Application +Award Letter beneficiaries are available, please attach. City of Temecula Community Service Funding Grant APPLICATION Page 6 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: ■ Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. • Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: The Wine Town Rollers MAILING ADDRESS: 27475 Ynez Rd #315 Temecula, Ca. 92591 PRESIDENT / AUTHORIZED SIGNATURE: PHONE: EMAIL: sponsorships@winetownrollers.com Inga Reeves Print Name President Title DATE: - I (Month, Day, Year) IF DIFFERENT THAN ABOVE, Tary n Ranoa Director of Sponsorships & Fundraising APPICATION PREPARED BY: Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 If you have any questions, please contact Betsy Lowrey at (951) 693-3959 or Stacey Brown at (951) 694-6413. City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 8/11 /2020 ESL ID: Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: - Entity Name: WINE TOWN ROLLERS 0 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/FDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019) e INTERNAL REVENUE SERVICE P. O. BOX 2508 CINCINNATI, OH 45201 Date: M 06 2018 WINE TOWN ROLLERS 27475 YNEZ ROAD 315 TEMECULA, CA 92591 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: DIN: Contact Person: STEPHANIE L JONES TAYLOR ID# - Contact Telephone Number: Accounting Period Ending: December 31 Public Charity Status: 509 (a) (2) Form 990/990-EZ/990-N Required: Yes Effective Date of Exemption: August 11, 2015 Contribution Deductibility: Yes Addendum Applies: No We're pleased to tell you we determined you're exempt from federal income tax under Internal Revenue Code (IRC) Section 501(c)(3). Donors can deduct contributions they make to you under IRC Section 170. You're also qualified to receive tax deductible bequests, devises, transfers or gifts under Section 2055, 2106, or 2522. This letter could help resolve questions on your exempt status. Please keep it for your records. Organizations exempt under IRC Section 501(c)(3) are further classified as either public charities or private foundations. We determined you're a public charity under the IRC Section listed at the top of this letter. If we indicated at the top of this letter that you're required to file Form 990/990-EZ/990--N, our'records show you're- required to -file an -annual information return (Form 990 or Form 990-EZ) or electronic notice (Form 990-N, the e-Postcard). If you don't file a required return or notice for three consecutive years, your exempt status will be automatically revoked. If we indicated at the top of this letter that an addendum applies, the enclosed addendum is an integral part of this letter. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter 04221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c)(3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. Letter 947 0 -2- WINE TOWN ROLLERS Sincerely, Director, Exempt Organizations Rulings and Agreements Letter 947 FY 2020/2021 COMMUNITY SERVICE FUNDING GRANT APPLICATION # 33 WAVES PROJECT (WOUNDED AMERICAN VETERANS EXPERIENCE SCUBA) CITY OF TEMECULA FISCAL YEAR 2020.2021 COMMUNITY SERVICE FUNDING PROGRAM APPLICATION (Please Print or Type) DUE ON OR BEFORE: MONDAY, SEPTEMBER 14, 2020 Amount Requested: $ 5000 PROJECT/PROGRAM INFORMATION MAXIMUM ALLOWABLE: $5,000 PER ORGANIZATION Project/Program Title: SCUBA Diving Therapy for Wounded Veterans Start Date: 9-1-2020 End Date: 6-30-2021 Physical Address of Project/Program: INCLUDE IF DIFFERENT THAN ORGANIZATION's MAILING ADDRESS If Grant is Awarded, Make Check Payable to: WAVES Project, Inc. Mailing Address: 42225 Remington Ave #A-18 Temecula, CA 92590 I ORGANIZATION AND GEOGRAPHIC AREA SERVED Name of Applicant Organization: WAVES Project, Inc Year Organization Founded: 2013 Website: wavesproject.org Number of Paid Staff: 4 Contact Name. Barbara Rubin Number of Volunteers: 48 Title/Position: Treasurer Contact Person's Email Address: barbara@wavesproject.com Telephone: 951-308-0049 Ext 103 Geographic Area(s) the Organization Serves: Southern California, Greater Houston -TX, South Florida Geographic Area(s) the Project/Program Serves: Temecula Valley NOTE: COMMUNITY SERVICE FUNDING GRANT PROGRAM FUNDING MUST BE EXCLUSIVELY USED TO SERVE TEMECULA. NONPROFIT STATUS Is this organization incorporated as a nonprofit? Yes Date of Incorporation as a Nonprofit: 9-2013 No ❑ IF NO, THEN INELIGIBLE TO RECEIVE CITY FUNDING Federal Identification Number: State Identification Number: Print out and attach to this application Verification from Federal (IRS) and State (FTB) as follftEEiVED 1. Attach IRS Deductibility Status using this link: htt ://a sirs. ov/a /eosl 2. Attach State Entity Status Letter using this link: httos://www.fth.ca,ciov/online/self serve entitrc•etett� I tten exasp i--r-xtLtr... 3. Attach first page only of most recent IRS Form 990 or attach print out of detailed info about our charity found on this State Registry's Search Tool: htt :/Irct.doq.ca. ov/VerificationAVeb/Search as x A =YR c City of Temecula Community Service Funding Grant APPLICATION Page 1 of 7 Has the organization or any members of the Board of Directors of the organization been involved with any personal business transactions valued over $500 including any business transactions, negotiations, investments, or interests in real property with a Temecula City Council Member during the past 12 months? No X Yes ❑ IF YES, BRIEFLY DESCRIBE: Is a Temecula City Council Member a member of the Board of Directors or an Officer of the organization? No [K Yes ❑ IF YES, PROVIDE COUNCIL MEMBER'S NAME AND TITLE WITHIN THE ORGANIZATION: This Application has been authorized by the organizations: Executive Committee I■ Board of Directors ❑ Members -at -Large ❑ MISSION STATEMENT OF ORGANIZATION Briefly describe the organization's mission/goals and objectives: We offer the SCUBA Diving experience to wounded American veterans using the therapeutic value of water to aid in relieving symptoms of service connected injuries Our motto is: RECOVER - Through Adventure DISCOVER - Our Underwater World REBUILD - Families & Relationships FINANCIAL STATEMENTS f Upon request, copies the organization's current budgettfinancial statements (balance statement and income statement), and if available CPA's audit, may be needed to demonstrate sound financial management. Do not submit now. j CITY OF TEMECULA FUNDING — OTHER SOURCES Within the past two years, has your organization received (or concurrently requesting) any other sources of funding from the City of Temecula? No ❑ Yes* IF YES, PROVIDE INFORMATION IN TABLE BELOW: NAME OF PROGRAMjPROJECT FUN 0ED BY THE CITY GRANT OR SP[NSORSHIP AMOUNT MONTH + YEAR FUNDING RECEIVEDJ NAME OF CITY GRANT OR SPONSORSHIP Mission Oriented Diving $4784.00 11/2019 Community Service Funding SCUBA Training for Wounded Veterans $ 5000.00 12/2018 Community Service Funding $ $ $ $ City of Temecula Community Service Funding Grant APPLICATION Page 2 of 7 GRANT FUNDING PROJECT/PROGRAM DESCRIPTION NOTE: RECEIPTS/INVOICES WILL BE REQUIRED TO BE SUBMITTED TO THE CITY TO DEMONSTRATE THE ORGANIZATION USED GRANT FUNDING AWARDED BY THE CITY TO SUPPORT THE PROJECT/PROGRAM AS DESCRIBED HERE. SEE COMPLAINCE REPORT ON APPLICATION FOR DETAILS. 1. Briefly describe THE PROGRAM / PROJECT the Temecula grant funding will be used to support. SCUBA Diving for Wounded Veterans continues the work we do with disabled veterans living in Temecula. There are currently 38 Temecula residents who are enrolled in our programs which use SCUBA Diving as therapy for veterans with disabilities including PTSD, amputations, paralysis and anxiety disorders. 2. Describe HOW YOUR ORGANIZATION WILL BE SPEND the grant funding (if awarded). Also, include equipment or services to be purchased and why. Grant funding will be used to provide ground and boat transportation to dive sites, training materials both online and printed, SCUBA instructors and Dive Master fees to conduct the training and supervise dives, SCUBA equipment rentals and maintenance, purchases of specialized SCUBA equipment, parking at boat docks, Hotel rooms at overnight dive sites, meals while traveling, tools,UV protection rash guards for extended sun exposure. 3. If awarded, explain HOW the grant funding will specifically BENEFIT TEMECULA RESIDENTS. 18 Temecula residents have completed some of our programs, with 15 waiting to begin. The goal is to continue training and offer dive excursions for each of them on a regular basis. The maximum benefit is achieved when veterans are regularly engaged in some kind of diving and training. There are two Temecula residents who will complete their SCUBA Instructor training in 2021 to begin teaching the program to new participants. In addition; approximately 48 volunteers of which 5 are Temecula Residents give a great deal of time to assist with the project. Estimated number of PEOPLE FROM TEMECULA EXPECTED TO BENEFIT from this Project/Program: Estimated number of VOLUNTEERS INVOLVED in this Project/Program: 4. SUMMARY STATEMENT: Summarize answers 1 - 3 (above) in 50 words or less to describe the projecttprogram and how the grant funds will be used. Waves Project SCUBA Diving therapy for wounded veterans includes ground and boat transportation to dive sites, overnight lodging to conduct week-long service projects with the National Park service. All Diving Equipment required for each veteran and their dive buddy, certified dive professionals provide basic and advanced training and safety supervision. City of Temecula Community Service Funding Grant APPLICATION Page 3 of 7 5. Provide Project/Program budget details below. PROJECT/PROGRAM BUDGET LINT; ITEMS FOR PROJECT/PROGRAM REVENUES EXPENSES VARIOUS TYPES OF REVENUES/INCOME FOR THE PROJECT/PROGRAM Amount of money requested from the City of Temecula Community Services Grant (Not to exceed $5,000) $ 5000 Cash contributed to Project/Program by the Applicant Organization $ 4371 Other grants or funding already awarded for Project/Program, if any $ 1 2700 In -Kind match amount or volunteer credit hours estimated amount $ 2938 (108@27.20) VARIOUS TYPES OF EXPENSES FOR THE SPECIFIC PROJECT/PROGRAM Staffing Expense for Project/Program $ 3600 (This amount is ineligible to be funded by City's Grant; however please include.) Equipment Expense For Project/Program $ 8436 Food Expense For Project/Program $ 350 Marketing Expense For Project/Program $ 200 $ 462.5 Supplies Expense For Project/Program Facilities/Rent Expense For Project/Program $ 641 1 Other Expense For Project/Program $ 261 1 .5 TOTAL BUDGET FOR PROJECT/PROGRAM $ 7$22,071 City of Temecula Community Service Funding Grant APPLICATION Page 4 of 7 SIGNATURE PAGE The applicant acknowledges and agrees to the following: • Recipient is subject to all Community Service Funding Program requirements including submittal deadlines and payment disbursements. • Every Community Service Funding application is considered individually and on its own merit. • Awards will be given to organizations and activities that directly benefit the residents of Temecula. • Funding is not immediately available to the recipient, and requires an award letter signature upon approval. Please allow time for checks to be processed. • The awarding of Community Service Funding does not constitute an automatic annual allocation. • The recognition for Community Service Funding should accrue to the City of Temecula. • Community Service Funding must be spent as specified on the Application and records may be requested by the City of Temecula to ensure the funds were used appropriately. ■ Community Service Funding grants will not be awarded or announced within the 60 days before an election in which an awarding Council Member is on the ballot. • The recipient shall provide a full accounting with documentation on the use of awarded funds. The recipient shall return to the City any funds not spent or documented per the signed agreement. • If awarded a Community Service Funding Grant by the City of Temecula last year, then compliance receipts must be submitted on or before this application's due date or this application may be rejected as incomplete. We hereby certify the information contained in this Application is true to the best of our knowledge and belief. ORGANIZATION NAME: WAVES Project, Inc. 42225 Remington Ave #A18 951-308-0049 Ext 103 MAILING ADDRESS: PHONE: ) EMAIL: Temecula, CA 92590 PRESIDENT/AUTHORIZED OFFICER: Barbara Rubin Treasurer SIGNATURE: IF DIFFERENT THAN ABOVE, APPICATION PREPARED BY: Print Name barbara@wavesproject.com Title DATE: 09/10/2020 (Month, Day, Year) Print Name Title SUBMIT ORIGINAL APPLICATION BY MONDAY, SEPTEMBER 14, 2020, TO: City of Temecula Community Service Funding Attn: City Manager's Office 41000 MAIN STREET TEMECULA, CA 92590 Questions: Betsy. Lowrey@TemeculaCA.gov (951) 693-3959 Stacey.Brown@TemeculaCA.gov (951) 694-6413 City of Temecula Community Service Funding Grant APPLICATION Page 7 of 7 INTERNAL REVENUE SERVICE P. 0. BOX 2508 CINCINNATI, OH 45201 Date: J U L 212014 WAVES PROJECT INC TEMECULA, CA 92590 Dear Applicant: DEPARTMENT OF THE TREASURY Employer Identification Number: DLN: Contact Person: CUSTOMER SERVICE ID# _ Contact Telephone Number: (877) 829-5500 Accounting Period Ending: September 30 Effective Date of. Exemption: September 25,2013 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. Based on the information you submitted with your application, we have determined you are likely to qualify as a private operating foundation described in section 4942(j)(3) of the Code. Accordingly, you are treated as a private operating foundation for your first year. After that, you will be treated as a private operating foundation as long as you continue to meet the requirements of section 4942(j)(3). You are required to file Form 990-PF annually. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter 114221-PF" in the search bar to view Publication 4221-PF, Compliance Guide for 501(c)(3) Private Foundations, which describes your recordkeeping, reporting, and disclosure requirements. Sincerely, 7a—m- - mm' / Fe ,;a� Director, Exempt Organizations Letter 1075 STATE OF CALIFORNIA FRANCHISE TAX BOARD PO BOX 942857 SACRAMENTO CA 94257-0540 Entity Status Letter Date: 9/9/2020 ESL ID: Why You Received This Letter According to our records, the following entity information is true and accurate as of the date of this letter. Entity ID: - Entity Name: WAVES PROJECT, INC. 1. The entity is in good standing with the Franchise Tax Board. ❑ 2. The entity is not in good standing with the Franchise Tax Board. 0 3. The entity is currently exempt from tax under Revenue and Taxation Code (R&TC) Section 23701 d. ❑ 4. We do not have current information about the entity. ❑ 5. The entity was administratively dissolved/cancelled on through the Franchise Tax Board Administrative Dissolution process. Important Information This information does not necessarily reflect the entity's current legal or administrative status with any other agency of the state of California or other governmental agency or body. If the entity's powers, rights, and privileges were suspended or forfeited at any time in the past, or if the entity did business in California at a time when it was not qualified or not registered to do business in California, this information does not reflect the status or voidability of contracts made by the entity in California during the period the entity was suspended or forfeited (R&TC Sections 23304.1, 23304.5, 23305a, 23305.1). The entity certificate of revivor may have a time limitation or may limit the functions the revived entity can perform, or both (R&TC Section 23305b). Connect With Us Web: ftb.ca.gov Phone: 800.852.5711 from 7 a.m. to 5 p.m. weekdays, except state holidays 916.845.6500 from outside the United States TTY/TDD: 800.822.6268 for persons with hearing or speech impairments FTB 4263A WEB (REV 12-2019) Item No. 5 CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Patrick Thomas, Director of Public Works/City Engineer DATE: November 9, 2021 SUBJECT: Authorize City Manager to Execute the License Agreement Between the City of Temecula and Steve Y. Kim Living Trust for the Use of Property for Public Parking Purposes PREPARED BY: Patrick Thomas, Director of Public Works/City Engineer RECOMMENDATION: That the City Council authorize the City Manager to execute the license agreement between the City of Temecula and Steve Y. Kim and Hwa Seel Lee, Co -Trustees of the Steve Y. Kim Living Trust for the use of property for public parking purposes. BACKGROUND: On August 10, 2021, the City Council received an update on previous City Council direction regarding parking in Old Town. The presentation included an overview of the current parking environment in Old Town as well as potential parking strategies for the future. Staff also met with the Old Town Steering Subcommittee (Councilmembers Schwank and Alexander) on July 12, 2021 to discuss short-term solutions for parking in Old Town and a revised Old Town Parking Study. At the Subcommittee meeting, staff presented a concept plan for a temporary parking lot in Old Town on vacant property at the northeast corner of Old Town Front Street and First Street. The proposed temporary parking lot is estimated to yield approximately 150 parking spaces (see Exhibit B in attached License Agreement). The vacant property was recently acquired by the Steve Y. Kim Living Trust, and the new owner (Steve Y. Kim) is willing to enter into the subject License Agreement allowing the property to be used for temporary public parking. Currently, the property owner has submitted an application for development of a resort hotel and conference center on the vacant property. The License Agreement allows the Owner to terminate the agreement upon issuance of a grading permit, and also allows either party to terminate the agreement with 60 days written notice for any reason. FISCAL IMPACT: The License Agreement does not require payment of rent. It is anticipated the cost of improvements to the property will be approximately $20,000 to include compacted base material, asphalt paving for ADA spaces, striping and temporary lighting. Funding is available in the current CIP budget for the project costs. ATTACHMENTS: License Agreement LICENSE AGREEMENT BETWEEN CITY OF TEMECULA AND STEVE Y. KIM AND HWA SEEL LEE, CO -TRUSTEES OF THE STEVE Y. KIM LIVING TRUST, FOR THE USE OF PROPERTY FOR PUBLIC PARKING PURPOSES (APNs 922-072-010, -011, -0139 -016, -018, -021, and -023) This License Agreement Between the City of Temecula and Steve Y. Kim and Hwa Seel Lee, Co -Trustees of the Steve Y. Kim Living Trust dated January 12, 1988 for the use of Property for Public Parking Purposes (APNs 922-072-010, -011, -013, -016, -018, -021, and - 023) ("Agreement") is entered into between the City of Temecula, a municipal corporation ("City") and Steve Y. Kim and Hwa Seel Lee, Co -Trustees of the Steve Y. Kim Living Trust dated January 12, 1988 (collectively "Owner") as of , 2021 ("Effective Date"). The City and Owner are referred to below collectively as the "Parties". In consideration of the mutual promises contained herein, the Parties agree as follows: 1. Recitals. This Agreement is made with respect to the following facts and for the following purposes, which each of the Parties hereto acknowledge as true and correct: A. Steve Y. Kim and Hwa Seel Lee, Co -Trustees of the Steve Y. Kim Living Trust is the record owner of seven vacant parcels generally located northeasterly of the intersection of Front Street and First Street in the City of Temecula described more particularly below and referred to in this Agreement collectively as "Subject Properties". The Subject Properties are described below and roughly depicted on Exhibit "A" attached hereto and incorporated herein by this reference: (i) An approximate .1592-acre parcel identified as Riverside County Tax Assessor's Parcel Number ("APN") 922-072-010; (ii) An approximate .1673-acre parcel identified as APN 922-072-011; (iii) An approximate .1622-acre parcel identified as APN 922-072-013; (iv) An approximate .1680-acre parcel identified as APN 922-072-016; (v) An approximate .3376-acre parcel identified as APN 922-072-018; (vi) An approximate .1306-acre parcel identified as APN 922-072-021; and (vii) An approximate .1633-acre parcel identified as APN 922-072-023. B. Owner represents and warrants that Owner is the record fee owner of the Subject Properties and no other person or entity has the right to possession or use of the Subject Properties. C. Owner desires to authorize the City to use the Subject Properties for public use and the City desires to use the Subject Properties for public use, namely public parking purposes and all uses necessary or convenient thereto, subject to the terms and conditions set forth in this Agreement. 11086-0111 \2564935v2.doc D. The City and Owner desire to enter into this Agreement to provide the terms and conditions upon which the City will use of the Subject Properties for public parking purposes. 2. Right to Use Subject Properties for Public Parking Purposes. Owner hereby grants to City a license to possess and use the Subject Properties described above in Section I.A. and depicted roughly on Exhibit "A" hereto for public parking purposes in accordance with and subject to the terms and conditions of this Agreement. Owner agrees and acknowledges that Owner has reviewed and approved the draft concept plan for the public parking proposed for the Subject Properties attached hereto as Exhibit "B" and incorporated herein by this reference. 3. No Rent. In consideration of the benefits to the public of using the Subject Properties for public parking until such time as Owner determines to use the Subject Properties for another use, City will not pay any rent to Owner for use of the Subject Properties in accordance with the terms of this Agreement. 4. Term of this License. A. Duration. The term of this Agreement will commence on the Effective Date and end on December 31, 2022 ("Termination Date"), subject to the early termination provisions set forth in Sections 4.0 and D. hereto. B. Extension of term of License. The original term of the Agreement set forth in Section 4.A. can be extended by mutual written agreement of the City Manager and Owner. C. Right to Terminate Agreement. Either party may terminate this Agreement for any reason, with or without cause, by providing sixty (60) days prior written notice of termination to the other party ("Early Termination Date"). D. Owner may Terminate Agreement upon issuance of Grading Permit. Owner may terminate this agreement upon issuance of Grading Permit for the Subject Properties by providing thirty (30) days prior written notice of termination to City. Owner may elect to accept Subject Properties in as -is conditions or request the Subject Properties be returned to as close to the conditions of Subject Properties on Effective Date of this Agreement, according to Section S.G. 5. Responsibilities of City. A. City and the public are authorized to use the Subject Properties for public parking purposes ("Permitted Uses") consistent with the draft concept plan attached as Exhibit "B" hereto. B. City will grade the Subject Properties and place a decomposed granite (DG) base or similar material and stripe the parking stalls in a manner similar to the parking lots located in front of the City of Temecula City Hall. The City may also add some asphalt concrete (AC) paving to accommodate ADA parking spaces and temporary solar powered lights on poles. C. City shall be responsible for the costs of utilities, if any, in connection with the City's use of the Subject Properties for the Permitted Uses during the term of this Agreement. -2- 11086-0111\2564935v2.doc D. City shall maintain the Subject Properties in a clean and neat condition, clean and clear of refuse and obstructions, and will dispose of all garbage, trash, and rubbish. E. City shall not dump, place or store hazardous materials or toxic waste on the Subject Properties. F. If City damages the Subject Properties, City shall be responsible for restoring the Subject Properties to as close to the condition of said Subject Properties on the Effective Date of this Agreement. G. Within thirty (30) days of the Termination Date or Early Termination Date, the City shall return the Subject Properties to as close to the condition of said Subject Properties on the Effective Date of this Agreement, subject to reasonable wear and tear unless Owner informs City in writing that it wishes to maintain the surface improvements constructed by City on the Subject Properties. In said case, the Subject Properties will be left in the condition in which they existed on the Termination Date or Early Termination Date. 6. Indemnification. City agrees to defend, indemnify, protect and hold harmless Owner from and against any and all claims, demands, losses, defense costs or expenses, including reasonable attorney fees, or liability of any kind or nature which Owner may sustain or incur or which may be imposed upon Owner for injury to or death of persons, or damage to the Subject Properties arising out of City's negligent or wrongful acts or omissions arising out of or in any way related to City's use or occupancy of the Subject Properties for the Permitted Uses in accordance with this Agreement. 7. Owner's Reservation of Right of Entry. Owner shall have the right to enter the Subject Properties at all times during the period covered by this Agreement in order to ensure compliance with the terms of this Agreement. 8. Acknowledgements; Disclaimer of Warranties. A. City acknowledges that City has had the opportunity to inspect the Subject Properties and is accepting the use and possession of the Subject Properties "AS -IS" under the terms of this Agreement for the Permitted Uses. B. In executing and delivering this Agreement, except for Owner's representation to City that Owner is the record Owner of the Subject Properties and no other person or entity has the right to possession or use of the Subject Properties, City has not relied on any representation or warranty of Owner with respect to the condition or fitness of the Subject Properties for the City's Permitted Uses under the terms of this Agreement. 9. Liens. City shall not directly or indirectly create or permit to be created or to remain on the Subject Properties any mortgage, lien, or encumbrance in connection with the City's use of the Subject Properties for the Permitted Uses. City shall defend, indemnify and hold Owner harmless, pursuant to Section 7 (Indemnification) from any liens that may attach to the Subject Properties from the City's use of the Subject Properties for the Permitted Uses under the terms of this Agreement. -3- 11086-0111\2564935v2.doc 10. Notice of Transfer or Sale. If Owner determines to sell or transfer its interest in any portion of the Subject Properties during the term of this License Agreement, Owner agrees to provide written notice to any potential purchaser of the existence of this Agreement and to provide written notice to City of the sale or transfer of any portion of the Subject Properties. 11. Notice. Any notices that either party may desire to give to the other party under this Agreement must be in writing and may be given either by (i) personal service, (ii) delivery by a reputable document delivery service, such as but not limited to, FedEx, that provides a receipt showing date and time of delivery, or (iii) mailing in the United States Mail, certified mail, postage prepaid, addressed to the address of the party as set forth below or at any other address as that party may later designate by written notice to the other party. Notice shall be effective upon delivery to the addresses specified below or on the third business day following deposit with the document delivery service or United States Mail as provided above. City: CITY OF TEMECULA 41000 Main Street Temecula, California 92590 Attention: City Manager With a copy to: Richards, Watson & Gershon 350 South Grand Avenue, 37th Floor Los Angeles, California 90071 Attention: Peter M. Thorson, City Attorney Owner: Steve Y. Kim and Hwa Seel Lee, Co -Trustees of the Steve Y. Kim Living Trust 12. Interpretation. Each of the Parties had the full opportunity to participate in the drafting of this Agreement and, therefore, the Agreement shall not be interpreted against any party on the ground that the party drafted the Agreement or caused it to be prepared. 13. Governing Law. The Parties understand and agree that the laws of the State of California will govern the rights, obligations, duties, and liabilities of the Parties to this Agreement and the interpretation of this Agreement. Any litigation concerning this Agreement shall be filed in the Riverside County Superior Court. 14. Entire Agreement. This Agreement is the entire agreement and understanding between the Parties with respect to the subject matter of this Agreement and this Agreement supersedes any representations, or previous agreements, either oral or in writing, between the Parties hereto with respect to the subject matter of this Agreement. Any modifications of or amendments to this Agreement will be effective only if said modification or amendment is in writing and signed by the Parties hereto. 15. Authority to Execute Agreement. The person executing this Agreement on behalf of Owner warrants and represents to the City that this Agreement has been duly approved by Owner -4- 11086-0111 \2564935v2.doc and that all applicable notices and procedures were complied with and that the party signing on behalf of Owner is duly authorized by the Owner to execute this Agreement on behalf of the Owner and has been duly authorized to do so and that the consent of any other party is not required. In concurrence and witness whereof, the Parties hereto have caused this Agreement to be executed the day and year first above written. CITY OF TEMECULA, a municipal corporation Aaron Adams City Manager Attest: Randi Johl, City Clerk Approved as to form: Peter M. Thorson City Attorney OWNER Steve Y. Kim and Hwa Seel Lee, Co - Trustees of the Steve Y. Kim Living Trust dated January 12, 1988 C By. Steve Y. Kim, Co -Trustee of the Steve Y. Kim Living Trust dated January 12, 1988 By: Hwa Seel Lee, Co -Trustees of the Steve Y. Kim Living Trust dated January 12, 1988 -5- 11086-0111\2564935v2.doc Exhibit "A" Depiction of Subject Properties 1llLCRYOF First street f' mic varlCing Tea Ecv a Asueement I\- 922043027 1922043016 922043010 922043026 922360002 `)22072020 922072005 922072007 .922072021 922072019 922072022 9220720/6 922 072013 922072011 92.207201.0 922072023 922075001 922073026 LeWnd F P-16 SbeH Nam ■ ■ ,"Im ® CONIMP Cmr"F. i..; C9 aR Tammla ammo ty UW FM SWINOWY ARM 1ALM, RUWWW"Y' 8W.CAd JWAW'AEPoAL ■amem paws Faaimes Pau f�. 9220 yen � f �2f21000��1 'h�#_196a_'hY� �k�tela�..Nidl� STAine Thh m� h e �r 9�� f t7am mg6M�0 sly sY I! tr�e7ea�¢ mbr. Deal OLe/YMe Gemmoam ago l.hl appemm NftmWnmWoroWmtftamuFdc.cwmmLoratmffWm Eflml TMIB MY IaNOTTO BE WED FOR NAMATION Exhibit "B" Draft Concept Plan of Proposed Parking Improvements Item No. 6 CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Patrick Thomas, Director of Public Works/City Engineer DATE: November 9, 2021 SUBJECT: Authorize the City Manager to Execute the Memorandum of Understanding Between the City of Temecula and RTA Rancho Highlands, LLC Pertaining to the Ynez Road Improvements PREPARED BY: Anissa Sharp, Office Specialist II Ron Moreno, Principal Civil Engineer RECOMMENDATION: That the City Council authorize the City Manager to execute the Memorandum of Understanding between the City of Temecula and RTA Rancho Highlands, LLC pertaining to the Ynez Road Improvements. BACKGROUND: On October 28, 2020 the City of Temecula Community Development Department approved ministerially Planning Application Number PA19-1448, a Development Plan for a 270 unit multi -family community built by RTA Rancho Highlands, LLC, a Delaware limited liability company ("Developer"). The project will be located on 12.32 acres adjacent to the Temecula Duck Pond on the north side of Ynez Road. The community is planned to consist of 270 housing units (including 55 affordable units), leasing offices, a clubhouse, fitness center, pool, spa, barbeque areas, tot lot and dog park. Pursuant to the project Conditions of Approval the Developer is required to submit Street Improvement Plans to the Public Works Department improving the east side of Ynez Road from Tierra Vista Road to the southernly project boundary. Completion of the Ynez Road Improvements are required prior to the last Certificate of Occupancy. Discussions between the Developer and The City of Temecula ("City") have explored the benefit to the City of expanding the Ynez Road Improvements to include an additional 1,000 linear feet on the east side of Ynez Road. The Expanded Ynez Road Improvements would include street improvements, paving, curb and gutter, sidewalk, drainage facilities and raised landscaped median consistent with the median in the Ynez Road Improvements. The Memorandum of Understanding ("MOU") between the Developer and City set forth the obligations of both parties with respect to the design, environmental, permits and costs in connection with the Ynez Road Improvements and analysis of the feasibility of the Expanded Ynez Road Improvements. FISCAL IMPACT: Funding for this project is included in the Ynez Road Improvements — Phase 1 project in FY 2022-26 CIP Budget. ATTACHMENTS: Memorandum of Understanding (Ynez Road Improvements) MEMORANDUM OF UNDERSTANDING (YNEZ ROAD IMPROVEMENTS) This Memorandum of Understanding ("MOU") is made and entered into as of , 2021 ("Effective Date") by and between the City of Temecula, a municipal corporation ("City") and RTA RANCHO HIGHLANDS, LLC, a Delaware limited liability company ("Developer"). The City and Developer are referred to below collectively as the "Parties". In consideration of the mutual covenants and agreements contained herein and for other valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the Parties agree as follows: 1. Recitals. This MOU is made with respect to the following facts and for the following purposes, which each of the Parties hereto acknowledge as true and correct: A. On October 28, 2020, the City of Temecula Community Development Department approved ministerially Planning Application No. PA19-1448, a Development Plan for a 270 unit multi -family community built on 12.32 acres identified as Riverside County Tax Assessor's Parcel Numbers 944-330-004, 944-330-005, and 944-330-007 ("Project") in accordance with Section 17.21.030 of Chapter 17.21 of the Temecula Municipal Code. The Project, which is located adjacent to the Temecula Duck Pond approximately 775 feet southeast of Rancho California Road on the north side of Ynez Road, includes 270 housing units (including 55 affordable units), leasing offices, a clubhouse, fitness center, pool, spa, barbecue areas, tot lot, and dog park. B. The approval for the Project is effective until October 28, 2023. Pursuant to Section 17.21.030 of the Temecula Municipal Code, construction of the Project shall have occurred within three years of the date of approval or the approval shall become null and void, and such projects utilizing the Affordable Housing Overlay are not provided extensions. C. The approval of the Project was subject to several conditions of approval ("Conditions of Approval") designed to implement the standards and requirements set forth in Chapter 17.21 of the Municipal Code and designed to ensure the Project complies with all applicable State and local requirements. D. Pursuant to Condition 72 of the Conditions of Approval, Developer is required to obtain written clearances/permits from applicable agencies such as the San Diego Regional Water Quality Board (401 certification), U.S. Army Corps of Engineers (404 permit), California Department of Fish and Wildlife (Section 1602 Agreement), RCFC&WCD and other affected agencies as deemed necessary by Public Works (collectively, "Resources Agencies"). E. Pursuant to Condition 91 of the Conditions of Approval, Developer is required to submit to Public Works for approval street improvement plans in accordance with the City's General Plan/Circulation Element and corresponding City standards. Said street improvement designs must provide adequate right of way and pavement transitions in accordance with Caltrans' standards to join existing street improvements. Under Condition 91, Developer is required to improve the north side of Ynez Road from Tierra Vista Road to the easterly project boundary (Principal Arterial (6 lanes divided) Standard No. 100 - 110' R/W) ("Ynez Road Improvements"), -1- 11086-0004\2532171 vIdoc which Ynez Road Improvements include installation of half -width street improvements, paving, curb and gutter, sidewalk, street lights, drainage facilities, signing and striping, utilities (including but not limited to water and sewer), and striped median consistent with the median in the Ynez Road Improvements. Condition No. 97 of the Conditions of Approval requires that Developer complete the final Ynez Road Improvements prior to the last Certificate of Occupancy. F. The Parties have discussed the benefit to the City of expanding the scope of the design, environmental, planning and permit processing in connection with the Ynez Road Improvements to include an approximate additional eight hundred (800) linear feet of street improvements on the north side of Ynez Road from the easterly boundary of the Project to Rancho Vista, which area includes Ynez Road from easterly project boundary to Rancho Vista ("Expanded Ynez Improvements"). The Expanded Ynez Improvements include street improvements, paving, curb and gutter, sidewalk, street lights, drainage facilities, signing and striping, utilities (including but not limited to water and sewer), and striped median, consistent with the median in the Ynez Road Improvements. G. A map roughly depicting the Ynez Road Improvements and the Expanded Ynez Improvements (collectively "Ynez Improvements") is attached as Exhibit A hereto and is incorporated herein by this reference. H. In accordance with Condition No. 96 of the Conditions of Approval, the Parties desire to enter into this MOU to set forth the obligations of the Parties with respect to the design, environmental planning and processing, permits, and costs in connection with the Expanded Ynez Improvements and analysis of the feasibility of said Expanded Ynez Improvements. 2. Feasibility Review. Within 6 months of executions of this MOU, Developer shall prepare and deliver to the City the following documents: (a) preliminary engineering, design and environmental planning, and regulatory document strategy to determine the estimated extent of improvements, regulatory processing and environmental mitigation associated with the Expanded Ynez Improvements; (b) a schedule containing a quantities estimate of the Expanded Ynez Improvements; and (c) a cost estimate in coordination with the City to estimate the total cost of the Ynez Improvements, showing the two road segments separately as well as combined (collectively, the "Feasibility Documents"). A. The Parties agree that the total cost of the Feasibility Documents shall not exceed $100,000 (One Hundred Thousand Dollars), which cost shall be paid by Developer and reimbursed to Developer by City. B. If the City determines, in its sole discretion, that the City elects to construct the Ynez Improvements, the City shall, within forty-five (45) days following receipt of the Feasibility Documents ("Feasibility Period"), notify Developer, in writing, of City's determination to proceed ("Feasibility Notice"). The City's failure to deliver the Feasibility Notice prior to the expiration of the Feasibility Period shall conclusively be deemed City's election not to construct the Ynez Improvements. C. In the event City elects or is deemed to elect to not construct the Ynez Improvements, (i) this MOU shall terminate and (ii) the City shall reimburse Developer any -2- 11086-0004\2532171 vIdoe remaining balance of the costs incurred or paid by Developer, in connection with the Feasibility Documents, up to $100,000, within thirty (30) calendar days of receipt of invoice from Developer. Upon termination of this Agreement as provided in this Section 2, neither Parry shall have any further rights or liabilities under this Agreement. D. Any such termination of this Agreement, however, does not relieve Developer from its obligation to construct the Ynez Road Improvements in accordance with the Conditions 91, 95, and 97 of the Conditions of Approval for the Project. 3. Processing. Provided that City has timely delivered the Feasibility Notice of its election to construct the Ynez Improvements pursuant to Section 2 above, Developer will direct TK Consulting, Inc. ("Developer's Agent") to manage the design, environmental, regulatory processing, planning and permit processing of the Expanded Ynez Improvements as follows (collectively "Processing"): A. Developer shall cause Developer's Agent to direct and manage revised design plans for the Ynez Road Improvements as well as plans for the Expanded Ynez Improvements. B. Developer shall cause Developer's Agent to manage the preparation and processing of all environmental plans, reports and submittal documents for the Expanded Ynez Improvements required for processing and obtaining any applicable environmental approvals and permits required for construction. C. Developer shall cause Developer's Agent to prepare and submit any application/request for permits that the applicable Resources Agencies may require for the Expanded Ynez Improvements, on behalf of City as lead agency. D. Developer shall cause Developer's Agent to obtain proposals from and negotiate contracts with consultants for the Expanded Ynez Improvements subject to City review and approval and as described below: (1) Amended street improvements for the Ynez Road Improvements to allow transition for the Expanded Ynez Improvements. Creation of construction plan set for Ynez Improvements following environmental permitting (2) Street improvements and construction easements that include the limits of the Expanded Ynez Improvements; (3) Drainage improvement design and studies; (4) Dry utility design; (5) Environmental planning and processing of regulatory permits; (6) Additional technical studies as needed such as soils reports and traffic analysis; and -3- 11086-0004\2532171 vIdoc (7) Project management and processing of consultant plans and environmental permits; (8) Support during construction permitting and support during construction of improvements as needed by City. 4. Expanded Ynez Improvements Costs. The City shall within thirty (30) calendar days of receipt of monthly invoices from Developer, reimburse Developer for all costs incurred or paid by Developer in connection with the Processing of the Expanded Ynez Improvements, including any fees and permits, mitigation, or other related costs incurred or paid by Developer in connection with the Expanded Ynez Improvements. The estimated costs for the Feasibility Documents for the Expanded Ynez Improvements are set forth in Schedule 1 ("Estimated Costs for Feasibility Documents") attached hereto and incorporated herein by this reference. 5. Construction of the Ynez Road Improvements and Payment by Developer of Development Impact Fee. City's construction of the Ynez Road Improvements take the place of Developer's requirement to construct the Ynez Road Improvements under Conditions 91, 95, and 97 of the Conditions of Approval. Payment by Developer of Development Impact Fee associated with Ynez Road Improvements as described in Section 5, shall satisfy Developer's requirement to construct the Ynez Road Improvements under Conditions 91, 95, and 97 of the Conditions of Approval and releases Developer of all obligations for Ynez Improvements.. A. Developer shall pay to the City a Development Impact Fee (as hereinafter defined) as Developer's fair share of the costs incurred by City to construct the Ynez Improvements. As used herein, the Development Impact Fee shall mean the estimated costs for the construction of the Ynez Road Improvements based on the engineer's estimate for the Ynez Improvements, which engineer's estimate shall not be delayed or cause a delay for Developer. The estimated cost shall include only the improvements along the Developer's property frontage, set forth in "Schedule 2" ("Cost Estimate for Ynez Road Improvements") attached herein, and shall not require prevailing wage. The Development Impact Fee shall equal the engineer's estimate on Schedule 2, which shall include a 20% contingency. B. Developer shall construct interim improvements generally consistent with the onsite and offsite grading plans along the Developer's property frontage, but more specifically depicted in "Schedule 3" ("Depiction of Interim Improvements") attached herein. These improvements shall provide the City a rough graded and compacted area in the location of the ultimate Ynez Road Improvements, north of the existing AC berm. Developer shall also provide erosion control measures in this same area. 6. No Changes to Conditions of Approval for Project. Except as expressly provided herein, this MOU does not change any of the Conditions of Approval for the Project and nothing herein changes the approvals or conditions of approval for the Project. 7. Notices. All notices and demands will be given in writing by certified or registered mail, postage prepaid, and return receipt requested, or by overnight carrier. Notices will be considered given upon the earlier of (a) two business days following deposit in the United States mail, postage prepaid, certified or registered, return receipt requested, or (b) one business day following deposit 52 11086-0004\2532171 vIdoc with an overnight carrier service. The parties will address such notices as provided below or as may be amended by written notice: CITY: City of Temecula 41000 Main Street Temecula, California 92590 Attention: Aaron Adams, City Manager COPY TO: Richards, Watson & Gershon 350 South Grand Avenue, 37th Floor Los Angeles, California 90071 Attention: Peter M. Thorson, City Attorney DEVELOPER: RTA Rancho Highlands LLC 2082 Michelson Drive, 4th Floor Irvine, California 92612 Attention: Michael B. Earl COPY TO: TK Consulting, Inc. 2082 Michelson Drive, 4th Floor Irvine, California 92612 Attention: Tim Kihm Email: tkihm(artacq.com COPY TO: Nancy Dubonnet, Esq. Nancy Dubonnet APC, a Professional Law Corporation 2082 Michelson Drive, Suite 450 Irvine CA 92612 nancy(a),dubonnet.law 8. Miscellaneous. A. Amendments. Any amendments to this MOU will be effective only when duly executed by the Parties. B. Applicable Law. This MOU will be construed and interpreted under, governed, and enforced according to the laws of the State of California. C. Successors and Assigns. This MOU will be binding upon and inure to the benefit of the heirs, executors, administrators, successors, and assigns of the Parties hereto. D. Counterparts and Facsimile and Electronic Signatures. This MOU may be executed simultaneously in one or more counterparts, each of which will be deemed an original, but all of which together will constitute one and the same instrument. For purposes of this MOU, facsimile and electronic signatures will be deemed to be original signatures. -5- 11086-0004\2532171 v3.doe E. Remedies Not Exclusive and Waivers. No remedy conferred by any of the specific provisions of this MOU is intended to be exclusive of any other remedy and each and every remedy will be cumulative and will be in addition to every other remedy given hereunder or now or hereafter existing at law or in equity or by statute or otherwise. The election of any one or more remedies will not constitute a waiver of the right to pursue other available remedies. F. Interpretation and Construction. Each party has reviewed this MOU and each has had the opportunity to have its respective counsel and advisors review and revise this MOU and that any rule of construction to the effect that ambiguities are to be resolved against the drafting party will not apply in the interpretation of this MOU or any amendments or exhibits thereto. In this MOU the neuter gender includes the feminine and masculine, and singular number includes the plural, and the words "person" and "party" include corporation, partnership, firm, trust, or association wherever the context so requires. The Recitals and captions of the Sections and Subsections of this MOU are for convenience and reference only, and the words contained therein will in no way be held to explain, modify, amplify, or aid in the interpretation, construction, or meaning of the provisions of this MOU. G. Severability. If any part, term, or provision of this MOU is held by a court of competent jurisdiction to be illegal or in conflict with any law, the validity of the remaining provisions will not be affected, and the rights and obligations of the parties will be construed and enforced as if this MOU did not contain the particular part, term, or provision held to be invalid. [SIGNATURES ON NEXT PAGE] 10 11086-0004\2532171 vIdoe IN WITNESS WHEREOF, the undersigned have executed this MOU as of the Effective Date. RTA RANCHO HIGHLANDS, LLC, a Delaware limited liability company By: Name: Title: [SIGNATURES ON NEXT PAGE] -7- 11086-0004\2532171 vIdoc CITY OF TEMECULA, a municipal corporation By: Aaron Adams, City Manager ATTEST: Randi Johl, City Clerk Approved as to Form: Peter M. Thorson, City Attorney in 11086-0004\2532171 vIdoe EXHIBIT A Rough Depiction of Ynez Road Improvements & Expanded Ynez Improvements Project Frontage Ynez Road Improvements "EXHIBIT A" Ynez Road Expansion to Rancho Vista Road. APN: 944-330-007 EXISTING AC BERM J me - D .. 4 a EX. R/W 50' I i RAISED MED/AN EXISTING YNEZ ROAD SECT/ON N.TS SCALE.• 1 "=150' 44' APN: 944-290-016 EXISTING ENVIRONMENTAL JURISDICTIONS EXISTING R/W 1023' YNEZ ROAD APN:944-290-017 EXISTING ENVIRONMENTAL JURISDICTIONS U EX. LEGEND: R/W — STREET IMPROVEMENTS (SIDEWALK, CURB AND GUTTER, PAVEMENT & RAISED MEDIAN) — — — — EXISTING AC BERM (APPROXIMATE LOCATION) 0 — EXISTING TREE (APPROXIMATE LOCATION) 0 — EXISTING VAULT (APPROXIMATE LOCATION) — EXISTING TRAFFIC SIGNAL (APPROXIMATE LOCATION) Mar 11, 2021 AC/AB SIDEWALK PROACTIVE ENGINEERING ///////////// Project Frontage CONSULTANTS WEST CURB & GUTTER 25109 JEFFERSON AVE. SUITE 200 SCHEDULE 1 Estimated Costs for Feasibility Documents SCHEDULE 1 Estimated Costs for the Processing of the Expanded Ynez Improvements Consultant Discipline/Scope Timing DD Amount Biological /Cultural/Scope of Work Helix Task 1. General Bio. Survey and Jurisdictional Assessment 45 days $8,600.00 Amir Morales Task 3 Gen Bill Resources Assessment MSHCP Task 8 Management Meetings Civil Engineering Work/Scope of Work 1. Ynez Road Exp. & Design Concepts 1.1 Street & Grading Design Concepts 1.2 Earthwork Quantity take off PEC George Lenfestey 2. Topographical Survey & Mapping $36,200.00 Gilbert Almendarez 2.1. Research and Record Boundary 2.2 Aerial Topo 2.3 CDFW Jurisdictional Survey 3. Meetings Coordination Exhibits & Support 3.1 PM, Meetings, Drainage/Scope of Work 1. JLC Engineering HEC-RAS Analysis 60 days $9,000.00 Joe Castaneda 2.Conceptual Drainage & Water Quality Plan 3. Meetings & Coordination Morrow Engineering Kevin Dry Utilities/Scope of Work 30 days $1,250.00 Morrow Charter Communication Relocation Work Gouvis Eletrical Electric plan for Street Lights $0.00 Soils/ Scope of Work LGC Valley Geo Tech Slope Stability due diligence letter addressing geologic and 30 days $1,665.00 Randy Wagner geotechnical conditions & requirements. TK Consulting Project Management 90 days $13,500.00 SUBTOTAL $70,215.00 Contingency JAII Consultants 1 20% $14,043.00 TOTAL $84,258.00 SCHEDULE 2 Cost Estimate for Ynez Road Improvements PUBLIC WORKS DEPARTMENT OFF -SITE CONSTRUCTION SECURITY WORKSHEET (Updated As Of July 1, 2021) PARCEL/TRACT MAP: Rancho Highlands - Ynez Rd Improvements DATE: 10/20/2021 IMPROVEMENTS FAITHFUL PERFORMANCE SECURITY [100% of Estimated Costs] LABOR & MATERIAL SECURITY [50% of Estimated Costs] Street / Storm Drain (City Maintained) $ 298,000.00 $ 149,000.00 LD - CO/LD - CO Flood Control (RCFCD Maintained) $ - $ - LD - co Traffic (Signing & Striping / Signal) $ 120,500.00 $ 60,250.00 LD - CO/LD - co Water (LD - CO) $ 4,500.00 $ 2,250.00 Sewer (LD - CO) $ - $ - Erosion & Sediment Control $ - $ - Sub -Total (for fee calculation) $ 423,000.00 $ 211,500.00 Median/Pkwy Softscape (City Maintained) $ 4,000.00 $ 2,000.00 Total (for bonding purposes) $ 427,000.00 $ 213,500.00 DESIGN ENGINEERS OPINION OF CONSTRUCTION SECURITY The construction items and their quantities as shown on the attached worksheet are accurate for the construction of the improvements required or implied to fulfill the Conditions of Approval for this project. The mathematical extensions, using the Citv's unit costs, are accurate for determining bond amounts and fees. _ 10/20/2021 Engineer's Signature George Lenfestey Engineer's Name (Typed or printed) 45920 RCE # Civil Engineer's Stamp QROFESS/�,^ o Z L ; No. 45920 < m Exp. 12/31/22 J�9 civic �P �� CA \F� Date 12/31/22 Expiration Date ***PLEASE READ INSTRUCTIONS BELOW*** l . Quantities are to be taken from improvement plans. Use the unit costs as provided on the "City of Temecula Improvement Requirement Worksheet." 2. Show bond amounts to the nearest $500.00 (Rounded Up) 3. For construction items not covered by "City of Temecula Improvement Requirement Worksheet," Design Engineer is to provide his opinion of construction cost and use that cost. If the City's unit costs are determined to be too low in the opinion of the Design Engineer, the higher cost as provided by the Design Engineer should be used. 4. Estimates for water and sewer are for bonding purposes only. Plan check fees for water and sewer will be paid to the provider. City will collect inspection fee for water only using the normal fee calculation. NA01.178.000 Rancho Highlands - Temecula\Documents\Cost Estimates\Ynez Road Cost Estimate - MOU.xls] SCHEDULE3 Depiction of Interim Improvements SCHEDULE 3 udh lh l I I l lei i , LEGEND: INTERIM GRADING : TOP ®OF PROPOSED 2:1 SLOPE TO EXISTING AC BERM a YNEZ ROAD,�� YNEZ ROAD 1_ 50' L AN -- 4w EX. R/W -- ±16' VARIES I EXISTING I AC BERM - - - - - ----- ---- --� _ ? 7 ---- --- �-III_,-_�: EXISTINGPAVEMENT-1 GRADING BY AC PAVEMENT DEVELOPER EXISTING GROUND SECTION A -A N.T.S. Item No. 7 CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Patrick Thomas, Director of Public Works/City Engineer DATE: November 9, 2021 SUBJECT: Approve Agreement with Mariposa Tree Management, Inc., for Citywide Tree Trimming Maintenance Services for Fiscal Year 2021-2022 PREPARED BY: Julie Tarrant, Principal Management Analyst Stacey Biddle, Management Assistant RECOMMENDATION: That the City Council approve an agreement with Mariposa Tree Management, Inc., for citywide tree trimming maintenance services for Fiscal Year 2021-2022, in the amount of $500,000. BACKGROUND: On June 15, 2021, the Public Works Department Maintenance Division posted on the City of Temecula's online bidding service, PlanetBids, a Request for Proposal (RFP) No. 257 for Citywide Tree Trimming and Maintenance Services. The Public Works Department received six (6) electronic proposals. Selected panel members reviewed each proponent's submittal and after a thorough review and rating process, the top three were selected to conduct an oral interview with the panel members. Upon completion of the oral interview process, it was determined that Mariposa Tree Management, Inc. was the highest ranked firm and most qualified to provide Citywide Tree Trimming Maintenance Services. On September 14, 2021, following announcement of the proposed award of contract to Mariposa Tree Management Inc., the City received a letter from West Coast Arborists, Inc., protesting the award, citing claims as they pertained to Mariposa's qualifications, experience and safety record. The bid protest was reviewed by the Finance Director, in accordance with Municipal Code Section 3.32.060, and further consulted with the City Attorney to determine the validity of the protest. On September 27, 2021, a formal letter was provided to West Coast Arborists, Inc., with the Finance Director's findings that Mariposa met all of the requirements included in the RFP, and denying their protest. Subsequently, on September 29, 2021, West Coast Arborists, Inc., filed an appeal of the Finance Director's decision. As a result, the matter was further reviewed by the City Manager in accordance with the Municipal Code Section 3.32.060. On October 20, 2021, a formal letter was provided to West Coast Arborists, Inc., stating that the City Manager agreed with the prior findings of the Finance Director and legal counsel; and the protest was without merit and therefore denied. The decision of the City Manager is final and conclusive and shall not be subject to further appeal. Staff recommends approval of the Agreement with Mariposa Tree Management, Inc. for tree trimming maintenance services for FY2021-22, with an option to extend for four (4) additional one (1) year terms through to June 30, 2026. FISCAL IMPACT: Adequate funds are available in the Annual Operating Budget Fiscal Year 2021-2022. ATTACHMENTS: Agreement - Mariposa Tree Management, Inc. AGREEMENT FOR MINOR MAINTENANCE SERVICES BETWEEN CITY OF TEMECULA AND MARIPOSA TREE MANAGEMENT, INC. CITYWIDE TREE TRIMMING MAINTENANCE SERVICES THIS AGREEMENT is made and effective as of November 9, 2021, between the City of Temecula, a municipal corporation (hereinafter referred to as "City"), and Mariposa Tree Management, Inc., a Corporation, (hereinafter referred to as "Contractor"). In consideration of the mutual covenants and conditions set forth herein, the parties agree as follows: 1. TERM This Agreement shall commence on November 9, 2021, and shall remain and continue in effect until tasks described herein are completed, but in no event later than June 30, 2022, unless sooner terminated pursuant to the provisions of this Agreement. The City may, upon mutual agreement, extend the contract for four (4) additional one (1) year term(s). In no event shall the contract be extended beyond June 30, 2026. 2. SCOPE OF WORK Contractor shall perform all of the work described in the Scope of Work, attached hereto and incorporated herein as Exhibit A. ("Work"), and shall provide and furnish all the labor, materials, necessary tools, expendable equipment, and all utility and transportation services required for the Work. All of said Work to be performed and materials to be furnished for the Work shall be in strict accordance with the specifications set forth in the Scope of Work, Exhibit A. 3. PAYMENT a. The City agrees to pay Contractor monthly, in accordance with the payment rates and terms and the schedule of payment as set forth in Exhibit B, Payment Rates and Schedule, attached hereto and incorporated herein by this reference as though set forth in full, based upon actual time spent on the above tasks. Any terms in Exhibit B, other than the payment rates and schedule of payment, are null and void. This amount shall not exceed Five Hundred Thousand Dollars ($500,000) for the total term of this agreement unless additional payment is approved as provided in this Agreement. b. Contractor shall not be compensated for any services rendered in connection with its performance of this Agreement which are in addition to those set forth herein, unless such additional services are authorized in advance and in writing by the City Manager. Contractor shall be compensated for any additional services in the amounts and in the manner as agreed to by City Manager and Contractor at the time City's written authorization is given to Contractor for the performance of said services. C. Contractor will submit invoices monthly for actual services performed. Invoices shall be submitted between the first and fifteenth business day of each month, for services provided in the previous month. Payment shall be made within thirty (30) days of receipt of each invoice as to all non -disputed fees. If the City disputes any of Contractor's fees, it shall give written notice to Contractor within thirty (30) days of receipt of an invoice of any disputed fees set forth on the invoice. For all reimbursements authorized by this Agreement, Contractor 08/06/2021 shall provide receipts on all reimbursable expenses in excess of fifty dollars ($50) in such form as approved by the Director of Finance. 4. PERFORMANCE Contractor shall faithfully and competently exercise the ordinary skill and competence of members of their profession. Contractor shall employ all generally accepted standards and practices utilized by persons engaged in providing similar services as are required of Contractor hereunder in meeting its obligations under this Agreement. 5. CITY APPROVAL All labor, materials, tools, equipment, and services shall be furnished and work performed and completed subject to the approval of City or its authorized representatives. 6. WAIVER OF CLAIMS On or before making final request for payment under Paragraph 3 above, Contractor shall submit to City, in writing, all claims for compensation under or arising out of this Agreement. The acceptance by Contractor of the final payment shall constitute a waiver of all claims against City under or arising out of this Agreement, except those previously made in writing and request for payment. Contractor shall be required to execute an affidavit, release and indemnify Agreement with each claim for payment. 7. PREVAILING WAGES Pursuant to the provisions of Section 1773 of the Labor Code of the State of California, the City Council has obtained the general prevailing rate of per diem wages and the general rate for holiday and overtime work in this locality for each craft, classification, or type of workman needed to execute this Agreement from the Director of the Department of Industrial Relations. Copies may be obtained from the California Department of Industrial Relations Internet website at http://www,dir.ca.gov. Contractor shall provide a copy of prevailing wage rates to any staff or sub -contractor hired, and shall pay the adopted prevailing wage rates as a minimum. Contractor shall comply with the provisions of Sections 1720, 1725.5, 1771.1(a), 1773.8, 1775, 1776, 1777.5, 1777.6, and 1813 of the Labor Code. Pursuant to the provisions of 1775 of the Labor Code, Contractor shall forfeit to the City, as a penalty, the sum of $200.00 for each calendar day, or portion thereof, for each laborer, worker, or mechanic employed, paid less than the stipulated prevailing rates for any work done under this Agreement, by him or by any subcontractor under him, in violation of the provisions of the Agreement. This project, work, or service will be subject to compliance monitoring and enforcement by the Department of Industrial Relations (DIR) pursuant to Labor Code Section 1771.4. 8. REGISTRATION WITH THE DEPARTMENT OF INDUSTRIAL RELATIONS Registration with the Department of Industrial Relations (DIR) is mandatory as a condition for bidding, providing certain services, and working on a public works project as specified in Labor Code Section 1771.1(a). Contractor and any subcontractors must be registered with the Department of Industrial Relations to be qualified to bid, or provide a proposal and/or time and material quote or be listed in a bid, proposal or quote, subject to the requirements of Public Contract Code Section 4104; or engage in the performance of any contract that is subject to Labor Code Section 1720 et seq., unless currently registered and qualified to perform public work 08/06/2021 pursuant to Labor Code Section 1725.5. Contractor and subcontractors will be required to provide proof of registration with the DIR. For more information regarding registration with the Department of Industrial Relations, refer to http:/Iwww.dir.ca.gov/Public-Works/PublicWorks.html 9. SUSPENSION OR TERMINATION OF AGREEMENT WITHOUT CAUSE a. The City may at any time, for any reason, with or without cause, suspend or terminate this Agreement, or any portion hereof, by serving upon the Contractor at least ten (10) days prior written notice. Upon receipt of said notice, the Contractor shall immediately cease all work under this Agreement, unless the notice provides otherwise. If the City suspends or terminates a portion of this Agreement such suspension or termination shall not make void or invalidate the remainder of this Agreement. b. In the event this Agreement is terminated pursuant to this Section, the City shall pay to Contractor the actual value of the work performed up to the time of termination, provided that the work performed is of value to the City. Upon termination of the Agreement pursuant to this Section, the Contractor will submit an invoice to the City, pursuant to Section entitled "PAYMENT" herein. 10. DEFAULT OF CONTRACTOR a. The Contractor's failure to comply with the provisions of this Agreement shall constitute a default. In the event that Contractor is in default for cause under the terms of this Agreement, City shall have no obligation or duty to continue compensating Contractor for any work performed after the date of default and can terminate this Agreement immediately by written notice to the Contractor. If such failure by the Contractor to make progress in the performance of work hereunder arises out of causes beyond the Contractor's control, and without fault or negligence of the Contractor, it shall not be considered a default. b. If the City Manager or his delegate determines that the Contractor is in default in the performance of any of the terms or conditions of this Agreement, it shall serve the Contractor with written notice of the default. The Contractor shall have ten (10) days after service upon it of said notice in which to cure the default by rendering a satisfactory performance. In the event that the Contractor fails to cure its default within such period of time, the City shall have the right, notwithstanding any other provision of this Agreement, to terminate this Agreement without further notice and without prejudice to any other remedy to which it may be entitled at law, in equity or under this Agreement. 11. INDEMNIFICATION The Contractor agrees to defend, indemnify, protect and hold harmless the City of Temecula, Temecula Community Services District, and/or the Successor Agency to the Temecula Redevelopment Agency, its officers, officials, employees and volunteers from and against any and all claims, demands, losses, defense costs or expenses, including attorney fees and expert witness fees, or liability of any kind or nature which the City of Temecula, Temecula Community Services District, and/or the Successor Agency to the Temecula Redevelopment Agency, its officers, agents, employees or volunteers may sustain or incur or which may be imposed upon them for injury to or death of persons, or damage to property arising out of Contractor's negligent or wrongful acts or omissions arising out of or in any way related to the performance or non- performance of this Agreement, excepting only liability arising out of the negligence of the City of Temecula, Temecula Community Services District, and/or the Successor Agency to the Temecula Redevelopment Agency. 08/06/2021 12. INSURANCE REQUIREMENTS Contractor shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property, which may arise from or in connection with the performance of the work hereunder by the Contractor, its agents, representatives, or employees. a. Minimum Sco a of Insurance. Coverage shall be at least as broad as: 1) Insurance Services Office Commercial General Liability Form No. CG 00 01 11 85 or 88. 2) Insurance Services Office Business Auto Coverage form CA 00 01 06 92 covering Automobile Liability, code 1 (any auto). If the Contractor owns no automobiles, a non -owned auto endorsement to the General Liability policy described above is acceptable. 3) Worker's Compensation insurance as required by the State of California and Employer's Liability Insurance. If the Contractor has no employees while performing under this Agreement, worker's compensation insurance is not required, but Contractor shall execute a declaration that it has no employees. b. Minimum Limits of Insurance. Contractor shall maintain limits no less than: 1) General Liability: Two Million ($2,000,000) per occurrence for bodily injury, personal injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. 2) Automobile Liability: One Million ($1,000,000) per accident for bodily injury and property damage. 3) Worker's Compensation as required by the State of California; Employer's Liability: One million dollars ($1,000,000) per accident for bodily injury or disease. C. Deductibles and Self -Insured Retentions. Any deductibles or self -insured retentions shall not exceed Twenty Five Thousand Dollars and No Cents ($25,000). d. Other Insurance Provisions. The general liability and automobile liability policies are to contain, or be endorsed to contain, the following provisions: 1) The City of Temecula, the Temecula Community Services District, the Successor Agency to the Temecula Redevelopment Agency, their officers, officials, employees and volunteers are to be covered as insured's, as respects: liability arising out of activities performed by or on behalf of the Contractor; products and completed operations of the Contractor; premises owned, occupied or used by the Contractor; or automobiles owned, leased, hired or borrowed by the Contractor. The coverage shall contain no special limitations on the scope of protection afforded to the City of Temecula, the Temecula Community Services District, and the Successor Agency to the Temecula Redevelopment Agency, their officers, officials, employees or volunteers. 2) For any claims related to this project, the Contractor's insurance coverage shall be primary insurance as respects the City of Temecula, the Temecula Community Services District, the Successor Agency to the Temecula Redevelopment Agency, their officers, officials, employees and volunteers. Any insurance or self -insured maintained by the City of Temecula, Temecula Community Services District, and/or the Successor Agency to the Temecula Redevelopment Agency, its officers, officials, employees or volunteers shall be excess of the Contractor's insurance and shall not contribute with it. 08/06/2021 3) Any failure to comply with reporting or other provisions of the policies including breaches of warranties shall not affect coverage provided to the City of Temecula, the Temecula Community Services District, the Successor Agency to the Temecula Redevelopment Agency, their officers, officials, employees or volunteers. 4) The Contractor's insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability. 5) Each insurance policy required by this agreement shall be endorsed to state: should the policy be canceled before the expiration date the issuing insurer will endeavor to mail thirty (30) days' prior written notice to the City. 6) If insurance coverage is canceled or, reduced in coverage or in limits the Contractor shall within two (2) business days of notice from insurer phone, fax, and/or notify the City via certified mail, return receipt requested of the changes to or cancellation of the policy. e. Acceptability of Insurers. Insurance is to be placed with insurers with a current A. M. Best rating of A -:VI I or better, unless otherwise acceptable to the City. Self-insurance shall not be considered to comply with these insurance requirements. f. Verification of Coverage. Contractor shall furnish the City with original endorsements effecting coverage required by this clause. The endorsements are to be signed by a person authorized by that insurer to bind coverage on its behalf. The endorsements are to be on forms provided by the City. All endorsements are to be received and approved by the City before work commences. As an alternative to the City 's forms, the Contractor's insurer may provide complete, certified copies of all required insurance policies, including endorsements affecting the coverage required by these specifications. g. By executing this Agreement, Contractor hereby certifies: I am aware of the provision of Section 3700 of the Labor Code which requires every employer to be insured against liability for Workman's Compensation or undertake self- insurance in accordance with the provisions of that Code, and I will comply with such provisions before commencing the performance of the work of this Contract. 13. TIME OF THE ESSENCE Time is of the essence in this Agreement. 14. INDEPENDENT CONTRACTOR a. Contractor is and shall at all times remain as to the City a wholly independent contractor. The personnel performing the services under this Agreement on behalf of Contractor shall at all times be under Contractor's exclusive direction and control. Neither City nor any of its officers, employees, agents, or volunteers shall have control over the conduct of Contractor or any of Contractor's officers, employees, or agents except as set forth in this Agreement. Contractor shall not at any time or in any manner represent that it or any of its officers, employees or agents are in any manner officers, employees or agents of the City. Contractor shall not incur or have the power to incur any debt, obligation or liability whatever against City, or bind City in any manner. r�x�r�iy�z�y�i b. No employee benefits shall be available to Contractor in connection with the performance of this Agreement. Except for the fees paid to Contractor as provided in the Agreement, City shall not pay salaries, wages, or other compensation to Contractor for performing services hereunder for City. City shall not be liable for compensation or indemnification to Contractor for injury or sickness arising out of performing services hereunder. 15. LEGAL RESPONSIBILITIES The Contractor shall keep itself informed of all local, State and Federal ordinances, laws and regulations which in any manner affect those employed by it or in any way affect the performance of its service pursuant to this Agreement. The Contractor shall at all times observe and comply with all such ordinances, laws and regulations. The City, and its officers and employees, shall not be liable at law or in equity occasioned by failure of the Contractor to comply with this section. 16. CONTRACTOR'S INDEPENDENT INVESTIGATION No plea of ignorance of conditions that exist or that may hereafter exist or of conditions of difficulties that may be encountered in the execution of the work under this Agreement, as a result of failure to make the necessary independent examinations and investigations, and no plea of reliance on initial investigations or reports prepared by City for purposes of letting this Agreement out to proposal will be accepted as an excuse for any failure or omission on the part of the Contractor to fulfill in every detail all requirements of this Agreement. Nor will such reasons be accepted as a basis for any claims whatsoever for extra compensation or for an extension of time. 17. CONTRACTOR'S AFFIDA' After the completion of the Work contemplated by this Agreement, Contractor shall file an affidavit with the City Manager stating that all workmen and persons employed, all firms supplying materials, and all subcontractors on the Work have been paid in full, and that there are no claims outstanding against the project for either labor or materials, except certain items, if any, to be set forth in an affidavit covering disputed claims or items in connection with a Stop Notice which has been filed under the provisions of the laws of the State of California. 18. PROHIBITED INTEREST No officer, or employee of the City of Temecula that has participated in the development of this agreement or its approval shall have any financial interest, direct or indirect, in this Agreement, the proceeds thereof, the Contractor, or Contractor's sub -contractors for this project, during his/her tenure or for one year thereafter. The Contractor hereby warrants and represents to the City that no officer or employee of the City of Temecula that has participated in the development of this agreement or its approval has any interest, whether contractual, non - contractual, financial or otherwise, in this transaction, the proceeds thereof, or in the business of the Contractor or Contractor's sub -contractors on this project. Contractor further agrees to notify the City in the event any such interest is discovered whether or not such interest is prohibited by law or this Agreement. 08/06/2021 19. BOOKS AND RECORDS Contractor's books, records, and plans or such part thereof as may be engaged in the performance of this Agreement, shall at all reasonable times be subject to inspection and audit by any authorized representative of the City. 20. UTILITY LOCATION City acknowledges its responsibilities with respect to locating utility facilities pursuant to California Government Code Section 4215. 21. REGIONAL NOTIFICATION CENTERS Contractor agrees to contact the appropriate regional notification center in accordance with Government Code Section 4215. 22. DISCRIMINATION Contractor represents that it has not, and agrees that it will not, discriminate in its employment practices on the basis of race, creed, religion, national origin, color, sex, age, or handicap. 23. WRITTEN NOTICE Any notices which either party may desire to give to the other party under this Agreement must be in writing and may be given either by (i) personal service, (ii) delivery by a reputable document delivery service, such as but not limited to, Federal Express, that provides a receipt showing date and time of delivery, or (iii) mailing in the United States Mail, certified mail, postage prepaid, return receipt requested, addressed to the address of the party as set forth below or at any other address as that party may later designate by Notice. Notice shall be effective upon delivery to the addresses specified below or on the third business day following deposit with the document delivery service or United States Mail as provided above. Mailing Address: City of Temecula Attn: City Manager 41000 Main Street Temecula, CA 92590 To Contractor: Mariposa Tree Management, Inc. Attn: Brandon Williamson 6232 Santos Diaz Street Irwindale, CA 91702 24. ASSIGNMENT The Contractor shall not assign the performance of this Agreement, nor any part thereof, nor any monies due hereunder, without prior written consent of the City. Upon termination of this Agreement, Contractor's sole compensation shall be payment for actual services performed up to, and including, the date of termination or as may be otherwise agreed to in writing between the City Council and the Contractor. 08/06/2021 25. LICENSES At all times during the term of this Agreement, Contractor shall have in full force and effect, all licenses required of it by law for the performance of the services described in this Agreement. 26. GOVERNING LAW The City and Contractor understand and agree that the laws of the State of California shall govern the rights, obligations, duties and liabilities of the parties to this Agreement and also govern the interpretation of this Agreement. Any litigation concerning this Agreement shall take place in the municipal, superior, or federal district court with geographic jurisdiction over the City of Temecula. In the event such litigation is filed by one party against the other to enforce its rights under this Agreement, the prevailing party, as determined by the Court's judgment, shall be entitled to reasonable attorney fees and litigation expenses for the relief granted. 27. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties relating to the obligations of the parties described in this Agreement. All prior or contemporaneous agreements, understandings, representations and statements, oral or written, are merged into this Agreement and shall be of no further force or effect. Each party is entering into this Agreement based solely upon the representations set forth herein and upon each party's own independent investigation of any and all facts such party deems material. 28. LABOR AND MATERIAL BONDS Within ten (10) business days from the City Manager approval of this Agreement, Contractor shall provide the City with a Labor and Materials Bond to secure payment to any contractor, sub -contractor persons renting equipment, or furnishing labor or materials for the work required to be constructed or installed pursuant to this Agreement in the additional amount of the Agreement. The bond shall be in substantially the form attached as Exhibit C, incorporated herein by this reference, and approved by the City Attorney. The surety shall be a surety admitted in the State of California and approved by the City. 29. PERFORMANCE BOND Contractor shall execute and provide to City concurrently with this Agreement a Performance Bond in the amount of the total, not -to -exceed compensation indicated in this Agreement, and in a form provided or approved by the City in Exhibit D. No payment will be made to Contractor until it has been received and approved by the City. 30. AUTHORITY TO EXECUTE THIS AGREEMENT The person or persons executing this Agreement on behalf of Contractor warrants and represents that he or she has the authority to execute this Agreement on behalf of the Contractor and has the authority to bind Contractor to the performance of its obligations hereunder. The City Manager is authorized to enter into an amendment on behalf of the City to make the following non -substantive modifications to the agreement: (a) name changes; (b) extension of time; (c) non -monetary changes in scope of work; (d) agreement termination. 08/06/2021 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed the day and year first above written. CITY OF TEMECULA By: Maryann Edwards, Mayor ATTEST: MARIPOSA TREE MANAGEMENT, INC. (Two Signatures of corporate officers required unless corporate documents authorize only one person to sign the agreement on behalf of the corporation.) l By: Terry Noriega, President By: By: b- Randi Johl, City Clerk Dennis Jones, a etary & Vice President of Operations APPROVED AS TO FORM: By: Peter M. Thorson, City Attorney CONTRACTOR Mariposa Tree Management, Inc. Attn: Brandon Williamson 6232 Santos Diaz Street Irwindale, CA 91702 Ph. 626-960-0196 Brandon.williamson@mariposa-ca.com City Purchasing Mgr. Initials and Date, z� zl 08/06/2021 EXHIBIT "A" SCOPE OF WORK Contractor recognizes and agrees that this Agreement is for the purpose of establishing a contractual relationship between the City of Temecula and the Contractor, for citywide tree trimming maintenance services at the various locations upon real and personal property of the City. Work will include maintenance services, and emergency call -out. The procedure for assigning work is set forth as follows: 1. The City Manager or his designee shall submit to Contractor a written "Request for Work". The Request for Work shall include a description of the work to be completed, the time for completion of the work, and the plans and specifications, if any, work. 2. Within five (5) business days of the date of the Request for Work, Contractor shall respond in writing to the Request for Work and advise the City Manager whether it can perform the work and specify the cost of material which will be required and the estimated cost of labor and equipment necessary to complete the work in accordance with the labor and equipment rates set forth in Exhibit "B" to this Agreement. 3. In the event emergency work is required, the City Manager may transmit the Request for Work orally to the Contractor. As soon as practical following the emergency, the Contractor and Director shall in good faith confirm in writing the scope of the emergency work undertaken. 4. Upon acceptance of the Contractor's response by the City Manager, the Contractor shall proceed with the work. The performance of the work shall be pursuant to the terms of this Agreement. 10 III7111-I 11041 EXHIBIT "B" PAYMENT RATES AND SCHEDULE ITEM DESCRIPTION NO. uOM FEE / PRICE TREE TRIMMING 1. Street Tree Trimming (Clearance Trim) Each $58 00 2. Street Tree Aesthetic Trimming Each $68 00 3. Park / Slope Tree Aesthetic Trimming (Aerial Unit) Each $93.00 4. Park I Slope Tree Aesthetic Trimming (Climbing) Each $235.00 5. Palm Tree Trimming Each $68 00 6. Complete Tree and Stump Removal Diameter Inch $39.00 7. Complete Tree Removal Only Diameter Inch $29.00 8. Stump Removal Only Diameter Inch $16.00 9. Root Pruning with Root Barrier (10 feet length x 18 inches Each depth — deep root or equivalent) $165.00 10. Root Pruning without Root Barrier Each 1$195.00 TREE PLANTING 11. 15 Gallon with Root Barrier Each $180.00 12_ 15 Gallon without Root Barrier Each $160.00 13. 24 Inch Box with Root Barrier Each $375.00 14. 24 Inch Box without Root Barrier Each $355.00 15. Tree Watering Per Day $700.00 16. Crew Rental (3 men, aerial unit, dump truck and chipper) Per Hour $261.00 17. Crew Rental (2 men, aerial unit, dump truck and chipper) Per Hour 1$174.00 IE 08/06/2021 EXHIBIT "B" (continued) ---------------- 18_ Crew Rental (1 man) Per Hour $87 00 19. Emergency Work Call -Out (3 men, Including all neoessary Per Hour equipment, disposal fees, and zero material mark-up $321.00 ----------------- 20. Tree Inventory Data Collection Including GPS Data and Each " $3.00 Documentation of Tree ------------ Date: 06/11 /2021 1 ti Signature of A hor" Officer Dennis Jones, Secretary & Vice President of Operations Print Name of Authorized Officer 12 08/06/2021 Item No. 8 CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Patrick Thomas, Director of Public Works/City Engineer DATE: November 9, 2021 SUBJECT: Approve Agreement for Construction Support Services with STC Traffic, Inc., for Fiber Optic Communication System Upgrade, PW 18-05 PREPARED BY: Nick Minicilli, Senior Civil Engineer Julie Tarrant, Principal Management Analyst RECOMMENDATION: That the City Council: 1. Approve an agreement for construction support services with STC Traffic, Inc., in the amount of $154,670, for the Fiber Optic Communication System Upgrade, PW 18-05; and 2. Authorize the City Manager to approve extra work authorization not -to -exceed the contingency amount of $15,467, which is equal to 10% of the contract amount. BACKGROUND: In April 2015, the Caltrans Division of Local Assistance announced the Cycle 7 Call for Projects for the Highway Safety Improvement Program (HSIP). On July 28, 2015, the City Council approved Resolution 15-43 approving the filing of the project application for Highway Safety Improvement Program (HSIP) Cycle 7 funds. The Public Works Department - Traffic Division submitted a project application, and on December 2, 2015, the city was awarded HSIP Cycle 7 funding for the Fiber Optic Communication System Upgrade Project in the amount of $1,208,200. On April 5, 2018, the Public Works Department -Traffic Division posted on the City of Temecula's online bidding service, Planet Bids, a Request for Proposal (RFP) No. 223 for Professional Engineering and Construction Support Services for the Fiber Optic Communication System Upgrade. A total of four (4) proposals were received by the submittal deadline of April 25, 2018. Selected panel members reviewed each proponent's submittal and after a thorough review and evaluation, and rating process, STC Traffic, Inc., was the highest ranked firm and determined to be the best qualified firm with the most cost-effective proposal. Staff finalized the terms of the proposal and negotiated a not -to -exceed fee of $257,670 for the overall scope of work. On June 26, 2018, City Council approved an agreement for Consultant Services for the engineering design services for the preparation of Plans, Specifications, and Estimates (PS & E), for $103,000, plus a contingency of $10,300 for a total agreement of $113,300. The remaining Construction Support tasks, identified as Tasks 7-10 in RFP 223, were to be covered under separate agreement upon completion of the PS & E phase of work, and Caltrans obligation of the HSIP funds and authorization to proceed. STC Traffic, Inc., as the engineer of record, will provide Construction Support services including, construction oversight, RFI's, technical assistance, labor compliance, system configuration and signal timing coordination. STC Traffic, Inc., is a full -service Traffic Engineering, Planning, and ITS firm with extensive experience in designing and implementing innovative and effective traffic signal communication systems. STC Traffic, Inc., has designed and provided construction support for similar projects throughout Southern California. Staff recommends the approval of the agreement with STC Traffic Inc., in the amount of $154,670 to perform Construction Support Services for the Fiber Optic Communication System Upgrade project. FISCAL IMPACT: The Fiber Optic Communication System Upgrade project is identified in the City's Capital Improvement Program (CIP) Budget for Fiscal Years 2022-2026. It is funded with Highway Safety Improvement Program (HSIP) funds and Measure S. Adequate funds are available in the project account for the contract amount of $154,670, plus the $15,467 contingency, for a total encumbrance of $170,137. ATTACHMENTS: Agreement for Construction Support Services AGREEMENT FOR CONSULTANT SERVICES BETWEEN CITY OF TEMECULA AND STC TRAFFIC, INC. FIBER OPTIC COMMUNICATION SYSTEM UPGRADE, PW18-05 HIGHWAY SAFETY IMPROVEMENT PROGRAM (HSIP) CYCLE 7 FEDERAL PROJECT NO. HSIP7-08-020 CONSTRUCTION SUPPORT SERVICES THIS AGREEMENT is made and effective as November 9, 2021, between the City of Temecula, a municipal corporation (hereinafter referred to as "City"), and STC Traffic, Inc., a Corporation Inc. (hereinafter referred to as "Consultant"). In consideration of the mutual covenants and conditions set forth herein, the parties agree as follows: TERM This Agreement shall commence November 9, 2021 and shall remain and continue in effect until tasks described herein are completed, but in no event later than June 30, 2022, unless sooner terminated pursuant to the provisions of this Agreement. 2. SERVICES Consultant shall perform the services and tasks described and set forth in Exhibit A, attached hereto and incorporated herein as though set forth in full. Consultant shall complete the tasks according to the schedule of performance which is also set forth in Exhibit A. 3. PERFORMANCE Consultant shall faithfully and competently exercise the ordinary skill and competence of members of their profession. Consultant shall employ all generally accepted standards and practices utilized by persons engaged in providing similar services as are required of Consultant hereunder in meeting its obligations under this Agreement. 4. PAYMENT a. The City agrees to pay Consultant monthly, in accordance with the payment rates and terms and the schedule of payment as set forth in Exhibit B, Payment Rates and Schedule, attached hereto and incorporated herein by this reference as though set forth in full, based upon actual time spent on the above tasks. Any terms in Exhibit B, other than the payment rates and schedule of payment, are null and void. This amount shall not exceed One Hundred Fifty -Four Thousand Six Hundred Seventy Dollars and Zero Cents ($154,670.00) for the total term of the agreement unless additional payment is approved as provided in this agreement. b. Consultant shall not be compensated for any services rendered in connection with its performance of this Agreement which are in addition to those set forth herein, unless such additional services are authorized in advance and in writing by the City Council. Consultant shall be compensated for any additional services in the amounts and in the manner as agreed to by City Council and Consultant at the time City's written authorization is given to Consultant for the performance of said services. 08/09/2021 C. Consultant will submit invoices monthly for actual services performed. Invoices shall be submitted between the first and fifteenth business day of each month, for services provided in the previous month. Payment shall be made within thirty (30) days of receipt of each invoice as to all non -disputed fees. If the City disputes any of Consultant's fees, it shall give written notice to Consultant within thirty (30) days of receipt of an invoice of any disputed fees set forth on the invoice. For all reimbursements authorized by this Agreement, Consultant shall provide receipts on all reimbursable expenses in excess of Fifty Dollars ($50) in such form as approved by the Director of Finance. 5. PREVAILING WAGES Pursuant to the provisions of Section 1773 of the Labor Code of the State of California, the City Council has obtained the general prevailing rate of per diem wages and the general rate for holiday and overtime work in this locality for each craft, classification, or type of workman needed to execute this Agreement from the Director of the Department of Industrial Relations. Copies may be obtained from the California Department of Industrial Relations Internet website at http://www,dir.ca.gov. Consultant shall provide a copy of prevailing wage rates to any staff or sub -Consultant hired, and shall pay the adopted prevailing wage rates as a minimum. Consultant shall comply with the provisions of Sections 1720, 1725.5, 1771.1(a), 1773.8, 1775, 1776, 1777.5, 1777.6, and 1813 of the Labor Code. Pursuant to the provisions of 1775 of the Labor Code, Consultant shall forfeit to the City, as a penalty, the sum of $200.00 for each calendar day, or portion thereof, for each laborer, worker, or mechanic employed, paid less than the stipulated prevailing rates for any work done under this Agreement, by him or by any subconsultant under him, in violation of the provisions of the Agreement. This project, work, or service will be subject to compliance monitoring and enforcement by the Department of Industrial Relations (DIR) pursuant to Labor Code Section 1771.4. 6. REGISTRATION WITH THE DEPARTMENT OF INDUSTRIAL RELAT Registration with the Department of Industrial Relations (DIR) is mandatory as a condition for bidding, providing certain services, and working on a public works project as specified in Labor Code Section 1771.1(a). Consultant and any subcontractors must be registered with the Department of Industrial Relations to be qualified to bid, or provide a proposal and/or time and material quote or be listed in a bid, proposal or quote, subject to the requirements of Public Contract Code Section 4104; or engage in the performance of any contract that is subject to Labor Code Section 1720 et seq., unless currently registered and qualified to perform public work pursuant to Labor Code Section 1725.5. Consultant and subcontractors will be required to provide proof of registration with the DIR. For more information regarding registration with the Department of Industrial Relations, refer to http://www.dir.ca.clov/Public-Works/Publ!cWorks.htmi 7. SUSPENSION OR TERMINATION OF AGREEMENT WITHOUT CAUSE a. The City may at any time, for any reason, with or without cause, suspend or terminate this Agreement, or any portion hereof, by serving upon the Consultant at least ten (10) days prior written notice. Upon receipt of said notice, the Consultant shall immediately cease all work under this Agreement, unless the notice provides otherwise. If the City suspends or terminates a portion of this Agreement such suspension or termination shall not make void or invalidate the remainder of this Agreement. b. In the event this Agreement is terminated pursuant to this Section, the City shall pay to Consultant the actual value of the work performed up to the time of termination, provided that the work performed is of value to the City. Upon termination of the Agreement pursuant to this Section, the Consultant will submit an invoice to the City, pursuant to Section entitled "PAYMENT" herein. 8. DEFAULT OF CONSULTANT a. The Consultant's failure to comply with the provisions of this Agreement shall constitute a default. In the event that Consultant is in default for cause under the terms of this Agreement, City shall have no obligation or duty to continue compensating Consultant for any work performed after the date of default and can terminate this Agreement immediately by written notice to the Consultant. If such failure by the Consultant to make progress in the performance of work hereunder arises out of causes beyond the Consultant's control, and without fault or negligence of the Consultant, it shall not be considered a default. b. If the City Manager or his delegate determines that the Consultant is in default in the performance of any of the terms or conditions of this Agreement, it shall serve the Consultant with written notice of the default. The Consultant shall have ten (10) days after service upon it of said notice in which to cure the default by rendering a satisfactory performance. In the event that the Consultant fails to cure its default within such period of time, the City shall have the right, notwithstanding any other provision of this Agreement, to terminate this Agreement without further notice and without prejudice to any other remedy to which it may be entitled at law, in equity or under this Agreement. 9. OWNERSHIP OF DOCUMENTS a. Consultant shall maintain complete and accurate records with respect to sales, costs, expenses, receipts and other such information required by City that relate to the performance of services under this Agreement. Consultant shall maintain adequate records of services provided in sufficient detail to permit an evaluation of services. All such records shall be maintained in accordance with generally accepted accounting principles and shall be clearly identified and readily accessible. Consultant shall provide free access to the representatives of City or its designees at reasonable times to such books and records, shall give City the right to examine and audit said books and records, shall permit City to make transcripts there from as necessary, and shall allow inspection of all work, data, documents, proceedings and activities related to this Agreement. Such records, together with supporting documents, shall be maintained for a period of three (3) years after receipt of final payment. b. Upon completion of, or in the event of termination or suspension of this Agreement, all original documents, designs, drawings, maps, models, computer files containing data generated for the work, surveys, notes, and other documents prepared in the course of providing the services to be performed pursuant to this Agreement shall become the sole property of the City and may be used, reused or otherwise disposed of by the City without the permission of the Consultant. With respect to computer files containing data generated for the work, Consultant shall make available to the City, upon reasonable written request by the City, the necessary computer software and hardware for purposes of accessing, compiling, transferring and printing computer files. 10. INDEMNIFICATION The Consultant agrees to defend, indemnify, protect and hold harmless the City of Temecula, Temecula Community Services District, and/or the Successor Agency to the Temecula Redevelopment Agency, its officers, officials, employees and volunteers from and against any O8109/2021 and all claims, demands, losses, defense costs or expenses, including attorney fees and expert witness fees, or liability of any kind or nature which the City of Temecula, Temecula Community Services District, and/or the Successor Agency to the Temecula Redevelopment Agency, its officers, agents, employees or volunteers may sustain or incur or which may be imposed upon them for injury to or death of persons, or damage to property arising out of Consultant's negligent or wrongful acts or omissions arising out of or in any way related to the performance or non- performance of this Agreement, excepting only liability arising out of the negligence of the City of Temecula, Temecula Community Services District, and/or the Successor Agency to the Temecula Redevelopment Agency. 11. INSURANCE REQUIREMENTS a. Consultant shall procure and maintain for the duration of the contract insurance against claims for injuries to persons or damages to property, which may arise from or in connection with the performance of the work hereunder by the Consultant, its agents, representatives, or employees. Minimum Scope of Insurance. Coverage shall be at least as broad as: 1) Insurance Services Office Commercial General Liability form No. CG 00 01 11 85 or 88. 2) Insurance Services Office Business Auto Coverage form CA 00 01 06 92 covering Automobile Liability, code 1 (any auto). If the Consultant owns no automobiles, a non -owned auto endorsement to the General Liability policy described above is acceptable. 3) Worker's Compensation insurance as required by the State of California and Employer's Liability Insurance. If the Consultant has no employees while performing under this Agreement, worker's compensation insurance is not required, but Consultant shall execute a declaration that it has no employees. 4) Professional Liability Insurance shall be written on a policy form providing professional liability for the Consultant's profession. Limits of Insurance. Consultant shall maintain limits no less than: 1) General Liability: One Million ($1,000,000) per occurrence for bodily injury, personal injury and property damage. If Commercial General Liability Insurance or other form with a general aggregate limit is used, either the general aggregate limit shall apply separately to this project/location or the general aggregate limit shall be twice the required occurrence limit. 2) Automobile Liability One Million ($1,000,000) accident for bodily injury and property damage. 3) Worker's Compensation as required by the State of California; Employer's Liability: One Million Dollars ($1,000,000) per accident for bodily injury or disease. 4) Professional Liability Coverage: One Million Dollars ($1,000,000) per claim and in aggregate. d. Deductibles and Self -Insured Retentions. Any deductibles or self -insured retentions shall not exceed Twenty Five Thousand Dollars and No Cents ($25,000). e. Other Insurance Provisions. The general liability and automobile liability policies are to contain, or be endorsed to contain, the following provisions: 08/09/2021 1) The City of Temecula, the Temecula Community Services District, the Successor Agency to the Temecula Redevelopment Agency, their officers, officials, employees and volunteers are to be covered as insured's, as respects: liability arising out of activities performed by or on behalf of the Consultant; products and completed operations of the Consultant; premises owned, occupied or used by the Consultant; or automobiles owned, leased, hired or borrowed by the Consultant. The coverage shall contain no special limitations on the scope of protection afforded to the City of Temecula, the Temecula Community Services District, the Successor Agency to the Temecula Redevelopment Agency, their officers, officials, employees or volunteers. 2) For any claims related to this project, the Consultant's insurance coverage shall be primary insurance as respects the City of Temecula, the Temecula Community Services District, the Successor Agency to the Temecula Redevelopment Agency, their officers, officials, employees and volunteers. Any insurance or self -insured maintained by the City of Temecula, Temecula Community Services District, and/or the Successor Agency to the Temecula Redevelopment Agency, its officers, officials, employees or volunteers shall be excess of the Consultant's insurance and shall not contribute with it. 3) Any failure to comply with reporting or other provisions of the policies including breaches of warranties shall not affect coverage provided to the City of Temecula, the Temecula Community Services District, and the Successor Agency to the Successor Agency to the Temecula Redevelopment Agency, their officers, officials, employees or volunteers. 4) The Consultant's insurance shall apply separately to each insured against whom claim is made or suit is brought, except with respect to the limits of the insurer's liability. 5) Each insurance policy required by this agreement shall be endorsed to state in substantial conformance to the following: If the policy will be canceled before the expiration date the insurer will notify in writing to the City of such cancellation not less than thirty (30) days' prior to the cancellation effective date. 6) If insurance coverage is canceled or, reduced in coverage or in limits the Consultant shall within two (2) business days of notice from insurer phone, fax, and/or notify the City via certified mail, return receipt requested of the changes to or cancellation of the policy. f. Acceptability of Insurers. Insurance is to be placed with insurers with a current A.M. Best rating of A-:VII or better, unless otherwise acceptable to the City. Self-insurance shall not be considered to comply with these insurance requirements. g. Verification of Coverage. Consultant shall furnish the City with original endorsements effecting coverage required by this clause. The endorsements are to be signed by a person authorized by that insurer to bind coverage on its behalf. The endorsements are to be on forms provided by the City. All endorsements are to be received and approved by the City before work commences. As an alternative to the City's forms, the Consultant's insurer may provide complete, certified copies of all required insurance policies, including endorsements affecting the coverage required by these specifications. 12. INDEPENDENT CONTRACTOR a. Consultant is and shall at all times remain as to the City a wholly independent contractor. The personnel performing the services under this Agreement on behalf of Consultant shall at all times be under Consultant's exclusive direction and control. Neither City 08/09/2021 nor any of its officers, employees, agents, or volunteers shall have control over the conduct of Consultant or any of Consultant's officers, employees, or agents except as set forth in this Agreement. Consultant shall not at any time or in any manner represent that it or any of its officers, employees or agents are in any manner officers, employees or agents of the City. Consultant shall not incur or have the power to incur any debt, obligation or liability whatever against City, or bind City in any manner. b. No employee benefits shall be available to Consultant in connection with the performance of this Agreement. Except for the fees paid to Consultant as provided in the Agreement, City shall not pay salaries, wages, or other compensation to Consultant for performing services hereunder for City. City shall not be liable for compensation or indemnification to Consultant for injury or sickness arising out of performing services hereunder. 13. LEGAL RESPONSIBILITIES The Consultant shall keep itself informed of all local, State and Federal ordinances, laws and regulations which in any manner affect those employed by it or in any way affect the performance of its service pursuant to this Agreement. The Consultant shall at all times observe and comply with all such ordinances, laws and regulations. The City, and its officers and employees, shall not be liable at law or in equity occasioned by failure of the Consultant to comply with this section. 14. RELEASE OF INFORMATION a. All information gained by Consultant in performance of this Agreement shall be considered confidential and shall not be released by Consultant without City's prior written authorization. Consultant, its officers, employees, agents or subcontractors, shall not without written authorization from the City Manager or unless requested by the City Attorney, voluntarily provide declarations, letters of support, testimony at depositions, response to interrogatories or other information concerning the work performed under this Agreement or relating to any project or property located within the City. Response to a subpoena or court order shall not be considered "voluntary" provided Consultant gives City notice of such court order or subpoena. b. Consultant shall promptly notify City should Consultant, its officers, employees, agents or subcontractors be served with any summons, complaint, subpoena, notice of deposition, request for documents, interrogatories, request for admissions or other discovery request, court order or subpoena from any party regarding this Agreement and the work performed there under or with respect to any project or property located within the City. City retains the right, but has no obligation, to represent Consultant and/or be present at any deposition, hearing or similar proceeding. Consultant agrees to cooperate fully with City and to provide City with the opportunity to review any response to discovery requests provided by Consultant. However, City's right to review any such response does not imply or mean the right by City to control, direct, or rewrite said response. 15. NOTICES Any notices which either party may desire to give to the other party under this Agreement must be in writing and may be given either by (i) personal service, (ii) delivery by a reputable document delivery service, such as but not limited to, Federal Express, that provides a receipt showing date and time of delivery, or (iii) mailing in the United States Mail, certified mail, postage prepaid, return receipt requested, addressed to the address of the party as set forth below or at any other address as that party may later designate by Notice. Notice shall be effective upon 08/09/2021 delivery to the addresses specified below or on the third business day following deposit with the document delivery service or United States Mail as provided above. Mailing Address: City of Temecula Attn: City Manager 41000 Main Street Temecula, CA 92590 To Consultant: STC Traffic, Inc. Jason Stack 5865 Avenida Encirfas, Suite 142B Carlsbad, California 92008 16. ASSIGNMENT The Consultant shall not assign the performance of this Agreement, nor any part thereof, nor any monies due hereunder, without prior written consent of the City. Upon termination of this Agreement, Consultant's sole compensation shall be payment for actual services performed up to, and including, the date of termination or as may be otherwise agreed to in writing between the City Council and the Consultant. 17. LICENSES At all times during the term of this Agreement, Consultant shall have in full force and effect, all licenses required of it by law for the performance of the services described in this Agreement. 18. GOVERNING LAW The City and Consultant understand and agree that the laws of the State of California shall govern the rights, obligations, duties and liabilities of the parties to this Agreement and also govern the interpretation of this Agreement. Any litigation concerning this Agreement shall take place in the municipal, superior, or federal district court with geographic jurisdiction over the City of Temecula. In the event such litigation is filed by one party against the other to enforce its rights under this Agreement, the prevailing party, as determined by the Court's judgment, shall be entitled to reasonable attorney fees and litigation expenses for the relief granted. 19. PROHIBITED INTEREST No officer, or employee of the City of Temecula that has participated in the development of this agreement or its approval shall have any financial interest, direct or indirect, in this Agreement, the proceeds thereof, the Consultant, or Consultant's sub -contractors for this project, during his/her tenure or for one year thereafter. The Consultant hereby warrants and represents to the City that no officer or employee of the City of Temecula that has participated in the development of this agreement or its approval has any interest, whether contractual, non - contractual, financial or otherwise, in this transaction, the proceeds thereof, or in the business of the Consultant or Consultant's sub -contractors on this project. Consultant further agrees to notify the City in the event any such interest is discovered whether or not such interest is prohibited by law or this Agreement. 20. ENTIRE AGREEMENT This Agreement contains the entire understanding between the parties relating to the obligations of the parties described in this Agreement. All prior or contemporaneous agreements, 08/09/2021 understandings, representations and statements, oral or written, are merged into this Agreement and shall be of no further force or effect. Each party is entering into this Agreement based solely upon the representations set forth herein and upon each party's own independent investigation of any and all facts such party deems material. 21. AUTHORITY TO EXECUTE THIS AGREEMENT The person or persons executing this Agreement on behalf of Consultant warrants and represents that he or she has the authority to execute this Agreement on behalf of the Consultant and has the authority to bind Consultant to the performance of its obligations hereunder. The City Manager is authorized to enter into an amendment on behalf of the City to make the following non -substantive modifications to the agreement: (a) name changes; (b) extension of time; (c) non -monetary changes in scope of work; (d) agreement termination. 08/09/2021 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed the day and year first above written. CITY OF TEMECULA By: Maryann Edwards, Mayor ATTEST: By: Randi Johl, City Clerk APPROVED AS TO FORM: STC TRAFFIC, INC. (Two Signatures of corporate officers required unless corporate documents authorize only one person to sign the agreement on behalf of the corporation.) , I �, By: Q 04>r-h 04, Jason Stack, President By: ,' - T ,G By: Peter M. Thorson, City Attorney CONSULTANT STC Traffic, Inc. Attn: Jason Stack 5865 Avenida Encinas, Suite 142B Carlsbad, CA 92008 760 602-4290 1 619 342-8043 fax Jason.Stack ai�stctraffic.com City Purchasing Mgr. Initials and Date: EXHIBIT A Tasks to be Performed The specific elements (scope of work) of this service include all work associated with the preparation of Plans, Specifications, and Estimates as shown on the following: Task 7 — Construction Support & System Integration Task 8 — Corridor Traffic Signal Timing Upgrade Task 9 — As -Built Plans Task 10 — Quality Control & Quality Assurance Task ODC — Other Direct Costs — Data Collection 10 08/09/2021 EXHIBIT B Payment Rates and Schedule Cost for services shall be as per Consultants proposal attached hereto and incorporated herein as though set forth in full but in no event shall the total cost of services exceed $154,670.00 for the total term of the Agreement unless additional payment is approved as provided in the Payment section of this Agreement. 11 08/09/2021 May 15.1018 City of Temecula Department of Public Works Attention: Patrick A. Thomas 41000 Main Street Temecula, CA 92590 Subject: Fiber Optic Communkation System Upgrade Project No. PW 18,05; Highway Safety Improvement Project (HSIP) — Cycle 7 Federal Project No. HSIP7-08-020 Separate Sealed Fee Schedule — Revised Dear Mr. Thomas, As requested to the RFP, STC Traffic submits this fee schedule separately from our proposal for services. The fee schedule table with not -to -exceed (NTE) fee per task and total is shown below. Task Number Tuk Name WE Fee I Project Management $14,220 2 utllt Coordination S4,740 3� Preliminary Engineering $22.720 4 Final Engineering _ _ s4,480 _ 5 y Specifications & Estimates $S,100 6 Bid Assistance _ SIy l _ _ PS>lf Sutttefal 3Lovqq-- 7 Construction Support & Stem Integration 8 Corridor Traffic lignai Timing Upgrade 88,700 9 As -Built Plans $2,270 10 Quality Control & Quality Assurance SS.900 consfrticdp s Support Subtotal , $147,670 OOC Other Direct Costs — Data Collection F S6,800 Total Fee 257,670 STC's proposed fee for the scope of services is not -to -exceed 52S7,670. STC Traffic is a local business and there are no direct costs for mileage. Subconsultant fees for data collection are direct pass through and not marked up. STC's subconsultant NDS cost estimate and STC's fee rates are attached. If you have any questions or comments, please contact me at 714-315-46dO. I am authorized to negotiate and bind the firm to any contracts and agreements We look forward to working with the City of Temecula an this Important project. Sincerely, STC Traffic, Inc. Jason Stack. TE, PTOE President / Founder STC Tralnc, Im- $961 a,renida Enonas Suite l420 Carlsbad, CA 92008 www stctraf t cam 12 08/09/2021 NDi Nwkmal Dorm swv4ytmgs rviem 1535 south La Cwega Blvd Loa Angeles, CA 9OMS Name / Address 5TC Tia0le, Tac. 5365 AYenida I:ncinas I Suite 1428 Carlsbad I CA 192008 Item Oescrptlan P-FIOUR tNTCRSCCTION TURNING MOVEB61E•NT COQTNT'S AT 41 LGCAVONS: PIr1.035I341, I Pt'.R50Ti LOCATI(?iv5 rW.03S9-IIF 2 MRSON LOCA rtONS DT-03SB 24-HOUR VOI,UME TUB% MACFUN E COUNTS AT 12 LOCATMS D Discount - 15% TEMECULA,CA Signature PHONE FAX 1323j792-0090 f3231375-1666 13 ESTIMATE Date ESTIMATE 0 v=016 TEMECUI.A la,D. No. Contact Oty Cost TatA 30 140,00 4,200,,'M It 290.00 3.030.M 12. 60.00 120.N -1200.00 -1.200.00 Total $6,"00 C-MAIL oidaa@ndsdota.com 08/09/2021 Item No. 9 CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Patrick Thomas, Director of Public Works / City Engineer DATE: November 09, 2021 SUBJECT: Accept Improvements and File the Notice of Completion for Pavement Rehabilitation Program — Butterfield Stage Road and Pauba Road, PW 19-08 PREPARED BY: Avlin R. Odviar, Senior Civil Engineer Shawna Bennetts, Associate Civil Engineer RECOMMENDATION: That the City Council: 1. Accept the improvements for the Pavement Rehabilitation Program — Butterfield Stage Road and Pauba Road, PW 19-08, as complete; and 2. Direct the City Clerk to file and record the Notice of Completion, release the Performance Bond, and accept a one-year Maintenance Bond in the amount of 10% of the final contract amount; and 3. Release the Labor and Materials Bond seven months after filing the Notice of Completion, if no liens have been filed. BACKGROUND: On June 16, 2021, the City Manager, under the authorities delegated by the City Council of the City of Temecula in Resolution 2021-16, awarded a construction contract to Hanson Aggregates Pacific Southwest LLC dba ATP General Engineering Contractors, in the amount of $2,733,770.00, and authorized the City Manager to approve changes up to $546,754.00, to construct the Pavement Rehabilitation Program — Butterfield Stage Road and Pauba Road, PW19-08 (Project). The completed project rehabilitated the full width of Pauba Road from Margarita Road to Butterfield Stage Road and Butterfield Stage Road from approximately 230 feet south of Rancho California Road to 405 feet south of De Portola Road. ATP General Engineering Contractors has completed the work in accordance with the approved plans and specifications and to the satisfaction of the Director of Public Works / City Engineer. All work is warranted for a period of one year from October 7, 2021, the date the City obtained "beneficial use" of the Project. The retention for this project will be released pursuant to the provisions of Public Contract Code 7107. The final contract amount is $2,701,860.25, which includes the original contract amount of $2,733,770.00, a net reduction of $81,404.69 based on a balancing of actual contract item quantities, and two contract change order totaling $49,494.94. FISCAL IMPACT: There is no fiscal impact associated with accepting the Project and filing of the Notice of Completion. ATTACHMENTS: 1. Notice of Completion 2. Maintenance Bond 3. Contractor's Affidavit and Final Release RECORDING REQUESTED BY AND RETURN TO: CITY CLERK CITY OF TEMECULA 41000 Main Street Temecula, CA 92590 EXEMPT FROM RECORDER'S FEES Pursuant to Government Code Sections 6103 and 27383 NOTICE OF COMPLETION NOTICE IS HEREBY GIVEN THAT: The City of Temecula is the owner of the property hereinafter described. 2. The full address of the City of Temecula is 41000 Main Street, Temecula, California 92590. 3. The Nature of Interest is a Contract which was awarded by the City of Temecula to Hanson Aggregates Pacific Southwest LLC DBA ATP General Engineering Contractors, 4211 Ponderosa Ave., Ste C, San Diego, CA 92123 to perform the following work of improvement: Pavement Rehabilitation Program — Butterfield Stage Road and Pauba Road, PW19-08 4. Said work was completed by said company according to plans and specifications and to the satisfaction of the Director of Public Works of the City of Temecula and that said work was accepted by the City Council of the City of Temecula at a regular meeting thereof held on November 9, 2021. That upon said contract the Arch Insurance Company, Harborside 3, 210 Hudson Street, Ste. 300, Jersey City, NJ 07311 was surety for the bond given by the said company as required by law. 5. The property on which said work of improvement was completed is in the City of Temecula, County of Riverside, State of California, and is described as follows: Pavement Rehabilitation Program Butterfield Stage Road and Pauba Road, PW19-08 6. The location of said property is: Pauba Road from Margarita Road to Butterfield Stage Road and Butterfield Stage Road from approximately 230 feet south of Rancho California Road to 405 feet south of De Portola Road. Dated at Temecula, California, this 9th day of November, 2021. City of Temecula Randi Johl, City Clerk STATE OF CALIFORNIA ) COUNTY OF RIVERSIDE ) ss CITY OF TEMECULA ) I, Randi Johl, City Clerk of the City of Temecula, California, do hereby certify under penalty of perjury, that the foregoing NOTICE OF COMPLETION is true and correct, and that said NOTICE OF COMPLETION was duly and regularly ordered to be recorded in the Office of the County Recorder of Riverside by said City Council. Dated at Temecula, California, this 9th day of November, 2021. City of Temecula Randi Johl, City Clerk CITY OF TEMECULA, DEPARTMENT OF PUBLIC WORKS BOND NO. SU1177949 MAINTENANCE BOND Premium: $230.00 for CITYWIDE PAVEMENT REHABILITATION PROGRAM — BUTTERFIELD STAGE ROAD AND PAUBA ROAD PROJECT NO. PW19-08 KNOW ALL PERSONS BY THESE PRESENT THAT Hanson Aggregates Pacific Southwest LLC DBA ATP General Engineering Contractors 4211 Ponderosa Avenue, STE C San Diego, CA 92123 NAME AND ADDRESS OF CONTRACTOR a Limited Liability Company (hereinafter called "Principal"), and (fill in whether a Corporation, Partnership, or Individual) Arch Insurance Company, Harborside 3, 210 Hudson Street, Ste. 300, Jersey City, NJ 07311-1107 NAME AND ADDRESS OF SURETY (hereinafter called "Surety"), are held and firmly bound unto CITY OF TEMECULA (hereinafter called "Owner") in the penal sum of Two hundred seventy Thousand One Hundred afghty six DOLLARS AND NO CENTS ($270.186.00 1 in lawful money of the United States, said sum being not less than ten percent of the Contract value payable by the said City of Temecula under the terms of the Contract, for the payment of which, we bind ourselves, successors, and assigns, jointly and severally, firmly by these presents. THE CONDITION OF THIS OBLIGATION is such that whereas, the Principal entered into a certain Contract with the Owner, dated the l Ith day of lone 2021 a copy of which is hereto attached and made a part hereof for the construction of CITYWIDE PAVEMENT REHABILITATION PROGRAM — BUTTERFIELD STAGE ROAD AND PAUBA ROAD, PROJECT NO. PW19-08. WHEREAS, said Contract provides that the Principal will furnish a bond conditioned to guarantee for the period of one year after approval of the final estimate on said job, by the Owner, against all defects in workmanship and materials which may become apparent during said period; and WHEREAS, the said Contract has been completed, and was the final estimate approved on this the 7th day of October , 201L• NOW, THEREFORE, THE CONDITION OF THIS OBLIGATION IS SUCH, that if within one year from the date of approval of the final estimate on said job pursuant to the Contract, the work done under the terms of said Contract shall disclose poor workmanship in the execution of said work, and the carrying out of the terms of said Contract, or it shall appear that defective materials were furnished thereunder, then this obligation shall remain in full force and virtue, otherwise this instrument shall be void. As a part of the obligation secured hereby and in addition to the face amount specified, costs and reasonable expenses and fees shall be included, including reasonable attorney's fees incurred by the City of Temecula in successfully enforcing this obligation, all to be taxed as costs and included in any judgment rendered. The Surety hereby stipulates and agrees that no change, extension of time, alteration, or addition to the terms of the Contract, or to the work to be performed thereunder, or to the specifications accompanying the same, shall in any way affect its obligations on this bond, and it does hereby waive notice of any such change, extension of time, alteration, or addition to the terms of the Contract, or to the work, or to the Specifications. Signed and sealed this 14th day of October 20 21 (Seal) Arch Insurance Company SU Tv Debra A. Dentine (Name) Attorney -in -Fact (Title) APPROVED AS TO FORM: Peter M. Thorson, City Attorney Hanson Aggregates Pacific Southwest 1.1-11tdba ATP General Engineering Contractors PRINCIPAL: Ian R. Firth (Name) Vice President (Title) By: David A. Donnelly (Name) Assistant Secretary (Title) NOTE: Signatures of two corporate officers required for corporations. A Notarial Acknowledgement or Jurat must be attached for each of the Surety and Principal Signatures. ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Diego ) On before me, Barbara Jacob, Notary Public (insert name and title of the officer) personally appeared Ian R. Firth, Vice President who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/herttheir authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. 6AkBAPAL.JACOB WITNESS my hand and official seal. Notary Public'California San Diego County Commission My Comm. Expires Feb 2,s Feb 2, 2023 Sig (Seal) ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of San Diego ) On �� fJ� /oZ� before me, Barbara Jacob, Notary Public ' (insert name and title of the officer) personally appeared David A. Donnelly, Assistant Secretary who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. BARBARA L. JACOB Notary Public California Q San Diego CountyCommission M 2274425 Signature (Seal) my Comm. Expires Feb 2, 2023 CALIFORNIA ALL-PURPOSE ACKNOWLEDGMENT A Notary Public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of New York County of Kings On (iT 2 NAa 1` jo �1j before me, Francesca Kazmierczak, Notary Public, personally appeared Debra A. Deming who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signatuij OfNotaryi h lic 11 .�- ' FRANCESCA KAZMIERCZAK NOTARY PUBLIC, STATE OF NEW YORK Registration No. 01 KA6354599 Oualifled in Kings County Commission Ex{ilres February 13,075.— AIC 0000349861 This Power ofAaorney limits the acts of those named herein, and they have no authority to bind the Company except in the manner and to the extent herein stated. Not valldfor Note, Loan, Letter of Credit, Currency Rate, Interest Rate or Residential Value Guarantees POWER OF ATTORNEY Know All Persons By These Presents: That the Arch Insurance Company, a corporation organized and existing under the laws of the State of Missouri, having its principal administrative office in Jerscy City, New Jersey (hereinafter referred to as the "Company") does hereby appoint: Aklima Noorhassan, Anne L. Potter, Beverly A. Woolford, Cynthia Farrell, Debra A. Deming, Frances Rodriguez, Francesca Kazmierezak Jennifer L. Jakaitis, Kemal Brkanovic, Nancy Schnee, Peter Healy, Susan A. Welsh and Valorie Spates of New York, NY (EACH) its true and lawful Attorney(s)in-Fact, to make, execute, scat, and deliver from the date of issuance of this power for and on its behalf as surety, and as its act and deed: Any and all bonds, undertakings, recognizances and other surety obligations, in the penal sum not exceeding Ninety Million Dollars ($90.000.000.00). This authority does not permit the same obligation to be split into two or more bonds In order to bring each such bond within the dollar limit of authority as act forth herein. The execution of such bonds, undertakings, recognizances and other surety obligations in pursuance of these presents shall be as binding upon the said Company as fully and amply to all intents and purposes, as if the same had been duly executed and acknowledged by its regularly elected officers at its principal administrative office in Jersey City, New Jersey. This Power of Attmney is executed by authority of resolutions adopted by unanimous consent of the Board of Directors of the Company on December 10, 2020, me and accurate copies of which arc hereinafter set forth and arc hereby certified to by the undersigned Secretary as being in full force and effect: "VOTED, That the Chairman of the Board, the President, or the Executive Vice President, or any Senior Vice President, of the Surety Business Division, or their appointees designated in writing and filed with the Secretary, or the Secretary shall have the power and authority to appoint agents and attorneys -in -fact, and to authorize them subject to the limitations set forth in their respective powers of attorney, to execute on behalf of the Company, and attach the seal of the Company thereto, bonds, undertakings, rmognizances and other surety obligations obligatory in the nature thereof, and any such officers of the Company may appoint agents for acceptance of process." This Power of Attorney is signed, scaled and certified by facsimile under and by authority of the following resolution adopted by the unanimous consent ofthe Board of Directors of the Company on December 10, 2020: VOTED, That the signature of the Chamnan of the Board, the President, or the Executive Vice President, or any Senior Vice President, of the Surety Business Division, or their appointees designated in writing and filed with the Secretary, and the signature of the Secretary, the seal of the Company, and certifications by the Secretary, may be affixed by facsimile on any power of attorney or bond executed pursuant to the resolution adopted by the Board of Directors on December 10, 2020, and any such power so executed, scaled and certified with respect to any bond or undertaking to which it is attached, shall continue to be valid and binding upon the Company. In Testimony Whereof, the Company has caused this instrument to be signed and its corporate seal to be affixed by their authorized officers, this 16° day of Aft, 2021.E N� Attested and Certifiedd/�7//]�]�))�1 1' �O� Arch Insurance Company WilaCsiVat fl s EAL yG' 19T Regan .Shulman, Secretary Step en C.chakreaV��� Stephen C. Ruschak, Executive Vice President STATE OF PENNSYLVANIA SS COUNTY OF PHILADELPHIA SS ��Sf6111� I, Michele Tripodi, a Notary Public, do hereby certify that Regan A. Shulman and Stephen C. Ruschak personally known to me to be the same persons whose names are respectively as Secretary and Executive Vice President of the Arch Insurance Company, a Corporation organized and existing under the laws of the State of Missouri, subscribed to the foregoing instrument, appeared before me this day in person and severally acknowledged that they being thercunto duly authorized signed, scaled with the corporate seal and delivered the said instrument as the free and voluntary act of said corporation and as their own free and voluntary acts for the uses and purposes therein set forth. CammYtwt1uh of Pmn%tMIa. Nmery$EN /I f W-14EIE LRMI, tbtary lLWlcPhin1.�C •A.� anEx'ta�y Mich a podi, Notablic tsyCammhsim ExAtli 11 56 2025 My commission expires 07/312025 Conunlnton t4tmhsr J76A622 CERTIFICATION 1, Regan A. Shulman, Secretary of the Arch Insurance Company, do hereby certify that the attached Power of Attorney dated August 16, 2021 on behalf of the person(s) as listed above is a true and correct copy and that the same has been in full force and effect since the date thereof and is in full force and effect on the date of this certificate; and I do further certify that the said Stephen C. Ruschak, who executed the Power of Attorney as Executive Vice President, was on t)trr date of execution of the attached Power of Attorney the duly elected Executive Vice President of the Arch Insurance Company. kc IN T STIMONY WHEREOF, I have hereunto subscribed my name and affixed the corporate seal of the Arch Insurance Company on thisLday of AAA,- Rcliali A. Shulman, Secretary . This Power of Attorney limits the acts of those named therein to the bonds and undertakings specifically named therein and they have no authority tabind the Company except in the manner and to the extent herein stated. .� PLEASE SEND ALL CLAIM INQUIRIES RELATING TO THIS BOND TO THE FOLLOWING ADDRESS: Arch Insurance — Surety Division rSJ 3� 3 Parkway, Suite 1500 s�anM.xrr V Philadelphia, PA 19102 stnt '3 ron �ISf00f� To verify the authenticity of this Power of Attorney, please contact Arch Insurance Company at SuretyAuthentic@archins Please refer to the above named Attorney -in -Fact and the details of the bond to which the power is attached. AICPOA040120 Printed in U.S.A. ARCH INSURANCE COMPANY STATEMENT OF FINANCIAL CONDITION DECEMBER 31, 2020 Assets Cash in Banks Bonds owned Stocks Premiums in course of collection Accrued interest and other assets Total Assets Liabilities Reserve for losses and adjustment expenses Reserve for unearned premiums Ceded reinsurance premiums payable Amounts withheld or retained by company for account of others Reserve for taxes, expenses and other liabilities Total Liabilities Surplus as regards policyholders Total Surplus and Liabilities By: r ' Attest: Executive Vice President, Chief Financial Officer and Treasurer State on J f� SS County of $293,990,621 $ 3,620,730,816 $ 653,208,881 $ 525,571,487 $ 593,248,584 $ 5,686,750,389 $2,577,386,588 $ 946,480,428 $ 377,159,781 $ 170,189,032 $ 483,069,562 4,554,285,393 1,132,464, 997 $5,686,750,389 /2f5r._ a . Gw,---- Executive Vice President, General Counsel and Secretary Thomas James Ahern, Executive Vice President, Chief Financial Officer and Treasurer and Regan Shulman, Executive Vice President, General Counsel and Secretary being duly sworn, of ARCH INSURANCE COMPANY, Missouri; and that the foregoing is a true and correct statement of financial condition of said company, as of December 31, 2020. Subscribed and worn to before me, this a day of ���l,l 1, �OCf - Notary P lic IS N Notary PubBARPARAlic. Elate of New Jersey h `;�;� �'�' Commission Commisson Es Tres Jona ^.7. 2024 2021-113 CITY OF TEMECULA, DEPARTMENT OF PUBLIC WORKS CONTRACTOR'S AFFIDAVIT AND FINAL RELEASE for CITYWIDE PAVEMENT REHABILITATION PROGRAM — BUTTERFIELD STAGE ROAD AND PAUBA ROAD PROJECT NO. PW19-08 Hanson Aggregates Pacific Southwest LLC This is to certify that DBA ATP General Engineering Contractors (hereinafterthe "Contractor") declares to the City of Temecula, under oath, that helshe/it has paid in full for all materials, supplies, labor, services, tools, equipment, and all other bills contracted for by the Contractor or by any of the Contractor's agents, employees or subcontractors used or in contribution to the execution of its Contract with the City of Temecula, with regard to the building, erection, construction, or repair of that certain work of improvement known as CITYWIDE PAVEMENT REHABILITATION PROGRAM — BUTTERFIELD STAGE ROAD AND PAUSA ROAD, PROJECT NO. PW19-08, situated in the City of Temecula, State of California, more particularly described as follows: Butterfield Stage Road and Pauba Road, Temecula, CA ADDRESS OR DESCRIBE LOCATION OF WORK The Contractor declares that it knows of no unpaid debts or claims arising out of said Contract which would constitute grounds for any third party to claim a Stop Notice against of any unpaid sums owing to the Contractor. Further, in connection with the final payment of the Contract, the Contractor hereby disputes the following amounts: Description I Collar Amount to Dispute Pursuant to Public Contract Code Section 7100, the Contractor does hereby fully release and acquit the City of Temecula and all agents and employees of the City, and each of them, from any and all claims, debts, demands, or cause of action which exist or might exist in favor of the Contractor by reason of payment by the City of Temecula of any contract amount which the Contractor has not disputed above. CONTR,�I�R: Dated: 1 / By: Signature David A. Donnelly, Assistant Secretary Print Name and Title Item No. 10 ACTION MINUTES TEMECULA COMMUNITY SERVICES DISTRICT MEETING COUNCIL CHAMBERS 41000 MAIN STREET TEMECULA, CALIFORNIA OCTOBER 26, 2021 CALL TO ORDER at 7:50 PM: President Schwank ROLL CALL: Alexander, Edwards, Rahn, Schwank, Stewart CSD PUBLIC COMMENTS — None CSD CONSENT CALENDAR Unless otherwise indicated below, the following pertains to all items on the Consent Calendar. Approved the Staff Recommendation (5-0): Motion by Edwards, Second by Alexander. The vote reflected unanimous approval. 13. Approve Action Minutes of October 12, 2021 Recommendation: That the Board of Directors approve the action minutes of October 12, 2021. 14. Approve Financial Statements for the 4th Quarter Ended June 30, 2021 Recommendation: That the Board of Directors: 1. Receive and file the financial statements for the 4th quarter ended June 30, 2021; and 2. Appropriate $2,300 to Service Level L Operating Budget in Fiscal Year 2020-21. 15. Approve First Amendment with TNT Entertainment Group, LLC, for Additional Entertainment and Technical Services Recommendation: That the Board of Directors approve the first amendment with TNT Entertainment Group, LLC for additional entertainment and technical services and increase payment in the amount of $60,000. CSD DIRECTOR OF COMMUNITY SERVICES REPORT CSD GENERAL MANAGER REPORT CSD BOARD OF DIRECTORS REPORTS CSD ADJOURNMENT At 7:59 PM, the Community Services District meeting was formally adjourned to Tuesday, November 9, 2021 at 5:30 PM for a Closed Session, with a regular session commencing at 7:00 PM, City Council Chambers, 41000 Main Street, Temecula, California. Zak Schwank, President ATTEST: Randi Johl, Secretary [SEAL] Item No. 11 TEMECULA COMMUNITY SERVICES DISTRICT AGENDA REPORT TO: General Manager/Board of Directors FROM: Erica Russo, Interim Director of Community Services DATE: November 9, 2021 SUBJECT: Approve Second Amendment with M & J Paul Enterprises dba Jolly Jumps for Additional Event Services PREPARED BY: Willie Augustine, Community Services Coordinator II RECOMMENDATION: That the Board of Directors approve the second amendment with M & J Paul Enterprises dba Jolly Jumps for additional event services and increase payment in the amount of $30,000, for a total agreement amount of $90,000. BACKGROUND: On April 9, 2018, the Board of Directors approved a Non -Exclusive Event Service Provider Agreement with M & J Paul Enterprises dba Jolly Jumps to provide Event Services through June 2020. On June 27, 2019, the Board of Directors approved a First Amendment entitled Agreement for Event Service Provider, to extend the term of the Agreement through June 2022, and increase the payment in the amount of $30,000. As our traditional events are returning to normal and a few new events are in the planning stages we are in need of additional funds for event services. M & J Paul Enterprises dba Jolly Jumps is a long-standing vendor and we look forward to continuing to work with them on upcoming events. FISCAL IMPACT: Adequate funds of $30,000 have been allocated in the Temecula Community Services District's Fiscal Year 2021-22 Annual Operating Budget. ATTACHMENTS: Second Amendment SECOND AMENDMENT TO AGREEMENT BETWEEN TEMECULA COMMUNITY SERVICES DISTRICT AND M & J PAUL ENTERPRISES OBA JOLLY JUMPS EVENT SERVICE PROVIDER THIS SECOND AMENDMENT is made and entered into as of November 9, 2021, by and between the Temecula Community Services District, a community services district (hereinafter referred to as "City"), and M & J Paul Enterprises dba Jolly Jumps, a corporation, (hereinafter referred to as "Provider"). In consideration of the mutual covenants and conditions set forth herein, the parties agree as follows: This Amendment is made with the respect to the following facts and purposes: a. On April 9, 2018, the City and Contractor entered into that certain Agreement entitled "Non -Exclusive Event Service Provider Agreement," in the amount of $30,000.00. b. On June 27, 2019, the City and Contractor entered into the First Amendment to that certain Agreement entitled "Agreement for Event Service Provider," to extend the term of the agreement to June 30, 2022, increase the payment in the amount of $30,000.00. C. The parties now desire to increase the payment in the amount of $30,000.00, and to amend the Agreement as set forth in this Amendment. 2. Section 1 of the Agreement entitled "TERM" is hereby amended to read as follows: This Agreement shall remain and continue in effect until tasks herein are completed, but in no event later than June 30, 2022, unless sooner terminated pursuant to the provisions of this Agreement. 3. Section 6 of the Agreement entitled "PAYMENT" at paragraph "a" is hereby amended to read as follows: The City agrees to pay Contractor monthly, in accordance with the payment rates and schedules and terms set forth in Exhibit B, Payment Rates and Schedule, attached hereto and incorporated herein by this reference as though set forth in full, based upon actual time spent on the above tasks. Any terms in Exhibit B, other than the payment rates and schedule of payment, are null and void. The SECOND Amendment amount shall not exceed Thirty - Thousand Dollars and No Cents ($30,000.00), for additional event services for a total Agreement amount of Ninety Thousand Dollars and No Cents ($90,000.00). 4. Exhibit B to the Agreement is hereby amended by adding thereto the items set forth on Attachment "A" to this Amendment, which is attached hereto and incorporated herein as though set forth in full. U%NIi7L► ),* 5. Except for the changes specifically set forth herein, all other terms and conditions of the Agreement shall remain in full force and effect. 08/09/2021 IN WITNESS WHEREOF, the parties hereto have caused this Agreement to be executed the day and year first above written. TEMECULA COMMUNITY SERVICES M & J PAUL ENTERPRISES dba JOLLY JUMPS DISTRICT (Two Signatures of corporate officers required unless corporate documents authorize only one person to sign the agreement on behalf of the corporation.) By: Zak Schwank, TCSD President ATTEST: By: Rand! Johl, Secretary APPROVED AS TO FORM: By: Peter M. Thorson, General Counsel By: pli4 Joy I, CEO By: CONTRACTOR M & J Paul Enterprises dba Jolly Jumps Attn: Joy Paul _ 41610 Date Street Murrieta, CA 92562 951 461-9200 info@jollyjumps.net 3 City Purchasing Mgr. Initials and Date: /o i 21 08/09/2021 ATTACHMENT A EXHIBIT B Quotes shall be provided as requested by City staff for each service requested. Cost of services shall be as quoted, but in no event shall the total Agreement amount exceed $90,000.00 as outlined in Section 3 of this First Amendment. The not to exceed payment amount listed herein is an estimated expenditure and this Amendment does not guarantee Vendor this amount in purchases. 08/09/2021 Item No. 12 ACTION MINUTES SUCCESSOR AGENCY TO THE TEMECULA REDEVELOPMENT AGENCY MEETING COUNCIL CHAMBERS 41000 MAIN STREET TEMECULA, CALIFORNIA OCTOBER 26, 2021 CALL TO ORDER at 7:59 PM: Chair Maryann Edwards ROLL CALL: Alexander, Edwards, Rahn, Schwank, Stewart SARDA PUBLIC COMMENTS - None SARDA CONSENT CALENDAR Unless otherwise indicated below, the following pertains to all items on the Consent Calendar. Approved the Staff Recommendation (5-0): Motion by Rahn, Second by Stewart. The vote reflected unanimous approval. 16. Approve Financial Statements for the 4th Quarter Ended June 30, 2021 Recommendation: That the Board of Directors receive and file the financial statements for the 4th quarter ended June 30, 2021. SARDA EXECUTIVE DIRECTOR REPORT SARDA BOARD OF DIRECTOR REPORTS SARDA ADJOURNMENT At 8:00 PM, the Successor Agency to the Temecula Redevelopment Agency meeting was formally adjourned to Tuesday, November 9, 2021, at 5:30 PM for a Closed Session, with a regular session commencing at 7:00 PM, City Council Chambers, 41000 Main Street, Temecula, California. Maryann Edwards, Chair ATTEST: Randi Johl, Secretary [SEAL] Item No. 13 CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Jennifer Hennessy, Director of Finance DATE: November 9, 2021 SUBJECT: Receive and File Assembly Bill (AB) 1600 Financial Reports — Fiscal Year 2020-21 Development Impact Fee Expenditures PREPARED BY: Jennifer Hennessy, Director of Finance RECOMMENDATION: That the City Council receive and file Assembly Bill (AB) 1600 Financial Reports — Development Impact Fee Expenditures. BACKGROUND: Government Code Sections 66006 requires that an accounting of the Development Impact Fees be made public and the information reviewed in a regularly scheduled public hearing. The Legislature finds and declares that the timely and proper allocation of development fees promotes economic growth and is, therefore, a matter of statewide interest and concern. Annually, the City Finance Department staff compiles a report of expenditures made with the Development Impact Fees collected and interest accrued during the year. Staff has compiled the AB 1600 Report for this purpose and recommends acceptance and approval of the report of expenditures made with the Development Impact Fees after hearing public testimony. FISCAL IMPACT: Monies must be used within five years for specified purposes or returned to the developer. All funds are programmed to be spent in accordance with the Fiscal Years 2022-2026 Capital Improvement Program adopted June 8, 2021, by the City Council. ATTACHMENTS: 1. Summary of Development Impact Fees 2. AB 1600 Financial Reports 3. Notice of Public Hearing City of Temecula Summary of Development Impact Fees Fiscal Year 2020-21 Beginning Ending Development Fund Fees Interest FY20-21 Fund Impact Fee Balance Collected Earned Expenditures Balance Open Space Land Acquisition Street Improvements Traffic Signals & Traffic Control Systems Park & Recreation Improvements Corporate Facilities Fire Protection Facilities Library Police Facilities FY20-21 % Funded Capital Improvement Projects Expenditures % Complete with DIFs 31,411 124,133 66 (140,839) 14,771 210.265.718 - Pump Track 563,258 618,369 1,741 (346,549) 836,819 210.265.602 - Overland Drive Extension 210.265.783 - Overland Drive Widening 115,958 88,096 428 0 204,482 n/a 825,455 425,874 2,569 (27,300) 1,226,598 210.290.204 - Urban Forest Management Plan 453 250,535 159 (251,147) - 210.265.711 - Citywide Surveillance Cameras 56,635 83,599 105 (90,000) 50,339 210.165.757 - Station 73 Repayment to General Fund 2,999 380,954 260 (260,000) 124,213 210.290.153 - Library Parking - Phase II 984 74,808 159 0 75,951 n/a 140,839 94.5% 100.0% (5,451) 94.3% 97.2% 352,000 5.3% 100.0% 0 n/a n/a 27,300 32.0% 13.9% 251,147 93.5% 22.2% 90,000 50.5% 100.0% 260,000 97.7% 67.8% 0 n/a n/a City of Temecula OPEN SPACE LAND ACQUISITIONS Government Code 66000 Calculation Fiscal Year 2020-21 The impact fees for Open Space Land Acquisitions are based on the cost of land needed to maintain the City's existing ratio of open space acreage to population. Because these fees are population driven, they apply only to residential development. The fee is $741.15 per residential attached unit (condominium, apartment, townhouse, and duplex), and $1,034.49 per residential detached unit (single family), payable at the time of issuance of a building permit. The fees are adjusted annually based on the percentage increase or decrease, if any, of the Engineering News Record Building Cost Index. Account Description Beginning Fund Balance Fiscal Year 2020-21 Ending Fund Balance Revenues & Other Sources: Developer Fees Interest Income $ 124,133 $ 66 Total Sources $ 124,199 Expenditures & Other Uses: Capital Projects $ 140,839 Total Uses $ 140,839 Total Available $ 31,411 1 $ (16,640)1 $ 14,771 Five Year Revenue Test Using First In First Out Method Unspent Funds Represent Ending Fund Balance June 30, 2021 Revenues Remaining from FY2016-17 $ - Revenues Remaining from FY2017-18 $ - Revenues Remaining from FY2018-19 $ - Revenues Remaining from FY2019-20 $ - Revenues Remaining from FY2020-21 $ 14,771 Total Ending Fund Balance $ 14,771 Five year test met in accordance with Government Code 66001 Capital Improvement Facilities Expenditures Total Project FY20-21 DIF % of Project % Funded Capital Improvement Projects Budget Expenditure Complete With DIF 210.265.718 - Pump Track $ 577,766 $ 140,839 94.47% 100.00% 210.265.703 - Bike Lane and Trail Program $ 2,322,696 $ - 12.52% 3.11 % 210.265.785 - Nicolas Road Multi -Use Trail Ext. $ 450,000 $ - 0.0% 66.67% Total 1 $ 140,839 City of Temecula STREET IMPROVEMENTS Government Code 66000 Calculation Fiscal Year 2020-21 The fees are collected based on the total cost of such improvements and number of peak hour vehicle trips generated by future development. The fee is $1,505.33 per residential attached unit (condominium, apartment, townhouse, and duplex), $2,150.43 per residential detached unit (single family), and $2.94 - $8.22 per square foot of floor area for commercial development, payable at the time of issuance of a building permit. The fees are adjusted annually based on the percentage increase or decrease, if any, of the Engineering News Record Building Cost Index. Account Description Beginning Fund Balance Fiscal Year 2020-21 Ending Fund Balance Revenues & Other Sources: Developer Fees Interest Income $ 618,369 $ 1,741 Total Sources $ 620,110 Expenditures & Other Uses: Capital Projects $ 346,549 Total Uses $ 346,549 Total Available $ 563,258 $ 273,561 $ 836,819 Five Year Revenue Test Using First In First Out Method Unspent Funds Represent Ending Fund Balance June 30, 2021 Revenues Remaining from FY2016-17 $ - Revenues Remaining from FY2017-18 $ - Revenues Remaining from FY2018-19 $ - Revenues Remaining from FY2019-20 $ 216,709 Revenues Remaining from FY2020-21 $ 620,110 Total Ending Fund Balance $ 836,819 Five year test met in accordance with Government Code 66001 Capital Improvement Facilities Expenditures Capital Improvement Projects Total Project Budget FY20-21 DIF Expenditure % of Project Complete % Funded With DIF 210.265.602 - Overland Drive Extension $ 8,082,475 $ (5,451) 94.27% 97.17% 210.265.783 - Overland Drive Widening $ 2,509,400 $ 352,000 5.32% 100.00% 210.265.622 - Medians & Parkways $ 894,838 $ - 74.52% 100.00% 210.265.648 - Murrieta Creek Bridge at Overland $ 25,072,553 $ - 2.93% 20.99% 210.265.613 - Roundabout Improvements - Ynez $ 835,000 $ - 93.09% 32.34% 210.265.534 - Ynez Road Improvements - Ph 1 $ 2,000,000 $ - 0.00% 100.00% 210.265.535 - Ynez Road Improvements - Ph 11 $ 6,571,766 $ - 5.28% 14.79% Total $ 346,549 City of Temecula TRAFFIC SIGNALS AND TRAFFIC CONTROL SYSTEMS Government Code 66000 Calculation Fiscal Year 2020-21 The fees are collected based on the total cost of such improvements and number of peak hour vehicle trips generated by future development. The fee is $213.07 per residential attached unit (condominium, apartment, townhouse, and duplex), and $304.41 per residential detached unit (single family), and $0.43-$1.17 per square foot of floor area from commercial development, payable at the time of issuance of a building permit. The fees are adjusted annually based on the percentage increase or decrease, if any, of the Engineering News Record Building Cost Index. Account Description Beginning Fund Balance Fiscal Year 2020-21 Ending Fund Balance Revenues & Other Sources: Developer Fees Interest Income $ 88,096 $ 428 Total Sources $ 88,524 Expenditures & Other Uses: Capital Projects $ - Total Uses $ - Total Available $ 115,958 $ 88,524 $ 204,482 Five Year Revenue Test Using First In First Out Method Unspent Funds Represent Ending Fund Balance June 30, 2021 Revenues Remaining from FY2016-17 $ - Revenues Remaining from FY2017-18 $ - Revenues Remaining from FY2018-19 $ - Revenues Remaining from FY2019-20 $ 115,958 Revenues Remaining from FY2020-21 $ 88,524 Total Ending Fund Balance $ 204,482 Five year test met in accordance with Government Code 66001 Capital Improvement Facilities Expenditures Total Project FY20-21 DIF % of Project % Funded Capital Improvement Projects Budget Expenditure Complete With DIF 210.265.680 - Traffic Signal Equipment Enh. $ 3,166,788 $ - 25.68% 17.11 % 210.265.682 - Traffic Signal Installation $ 2,652,683 $ - 39.53% 55.78% Total $ - City of Temecula PARK and RECREATION IMPROVEMENTS Government Code 66000 Calculation Fiscal Year 2020-21 The fees are collected for park improvements based on the cost of improvements needed to maintain the City's existing ratio of improved park acreage to population. The fee for recreation facilities is based on the existing ratio of facility replacement cost to population. Because the fees are population driven, it only applies to residential developments. The fee is $2,542.68 per residential attached unit (condominium, apartment, townhouse, and duplex), and $3,549.16 per residential detached unit (single family), payable at the time of issuance of a building permit. The fees are adjusted annually based on the percentage increase or decrease, if any, of the Engineering News Record Building Cost Index. Account Description Beginning Fund Balance Fiscal Year 2020-21 Ending Fund Balance Revenues & Other Sources: Developer Fees Interest Income $ 425,874 $ 2,569 Total Sources $ 428,443 Expenditures & Other Uses: Capital Projects $ 27,300 Total Uses $ 27,300 Total Available $ 825,455 $ 401,143 $ 1,226,598 Five Year Revenue Test Using First In First Out Method Unspent Funds Represent Ending Fund Balance June 30, 2021 Revenues Remaining from FY2016-17 $ - Revenues Remaining from FY2017-18 $ - Revenues Remaining from FY2018-19 $ 65,186 Revenues Remaining from FY2019-20 $ 732,969 Revenues Remaining from FY2020-21 $ 428,443 Total Ending Fund Balance $ 1,226,598 Five year test met in accordance with Government Code 66001 Capital Improvement Facilities Expenditures Capital Improvement Projects Total Project Budget FY20-21 DIF Expenditure % of Project Complete % Funded With DIF 210.265.781 - Bike Lane & Trail - Mini Pump Track $ 95,000 $ - 92.32% 100.00% 210.265.692 - Margarita Rec Center $ 10,881,508 $ - 7.87% 5.51 % 210.265.730 - CRC Renovations $ 8,487,177 $ - 2.48% 22.64% 210.265.787 - Pickleball Courts $ 1,000,000 $ - 0.00% 25.00% 210.290.204 - Urban Forest Management Plan $ 376,230 $ 27,300 1 31.97%1 13.90% Total 1 $ 27,300 City of Temecula CORPORATE FACILITIES Government Code 66000 Calculation Fiscal Year 2020-21 Fees are collected for City administrative and maintenance facilities. The need for future space at the Civic Center is due to the demand of services housed at the Civic Center. The need for maintenance facilities is due to an increase in street and park maintenance. The fee is $312.81 per residential attached unit (condominium, apartment, townhouse, and duplex), $583.43 per residential detached unit (single family), and $0.19 - $0.57 per square foot of floor area for commercial developments, payable at the time of issuance of a building permit. The fees are adjusted annually based on the percentage increase or decrease, if any, of the Engineering News Record Building Cost Index. Account Description Beginning Fund Balance Fiscal Year 2020-21 Ending Fund Balance Revenues & Other Sources: Developer Fees Interest Income $ 250,535 $ 159 Total Sources $ 250,694 Expenditures & Other Uses: Capital Projects $ 251,147 Total Uses $ 251,147 Total Available 1 $ 453 1 $ (453) $ - Five Year Revenue Test Using First In First Out Method Unspent Funds Represent Ending Fund Balance June 30, 2021 Revenues Remaining from FY2016-17 $ - Revenues Remaining from FY2017-18 $ - Revenues Remaining from FY2018-19 $ - Revenues Remaining from FY2019-20 $ - Revenues Remaining from FY2020-21 $ - Total Ending Fund Balance $ - Five year test met in accordance with Government Code 66001 Capital Improvement Facilities Expenditures Total Project FY20-21 DIF % of Project % Funded Capital Improvement Projects Budget Expenditure Complete With DIF 210.265.711 - Citywide Surveillance Cameras $ 3,391,785 $ 251,147 93.46% 22.17% 210.265.780 - Old Town Surveillance/Sound Sys $ 900,000 $ - 0.00% 44.00% Total $ 251,147 City of Temecula FIRE PROTECTION FACILITIES Government Code 66000 Calculation Fiscal Year 2020-21 Fees are collected to provide future fire protection facilities and apparatus. The fee is $342.48 per residential attached unit (condominium, apartment, townhouse, and duplex), $738.08 per residential detached unit (single family), and $0.12 - $0.19 per square foot of floor area for commercial developments, payable at the time of issuance of building permit. The fee is adjusted annually based on the percentage increase or decrease, if any, of the Engineering News Record Building Cost Index. Account Description Beginning Fund Balance Fiscal Year 2020-21 Ending Fund Balance Revenues & Other Sources: Developer Fees Interest Income $ 83,599 $ 105 Total Sources $ 83,704 Expenditures & Other Uses: Capital Projects $ 90,000 Total Uses $ 90,000 Total Available $ 56,635 $ (6,296) $ 50,339 Five Year Revenue Test Using First In First Out Method Unspent Funds Represent Ending Fund Balance June 30, 2021 Revenues Remaining from FY2016-17 $ - Revenues Remaining from FY2017-18 $ - Revenues Remaining from FY2018-19 $ - Revenues Remaining from FY2019-20 $ - Revenues Remaining from FY2020-21 $ 50,339 Total Ending Fund Balance $ 50,339 Five year test met in accordance with Government Code 66001 Capital Improvement Facilities Expenditures Capital Improvement Projects Total Project Budget Total Project Budget % of Project Complete % Funded With DIF 210.165.757 - Station 73 Repayment to General Fund $ 817,400 $ 90,000 50.50% 100.00% Total $ 90,000 City of Temecula LIBRARY Government Code 66000 Calculation Fiscal Year 2020-21 Fees are collected to provide future facilities and materials. Because these fees are population -driven, they apply only to residential development. The fee is $677.25 per residential attached unit (condominium, apartment, townhouse, and duplex), and $945.31 per residential detached unit (single family), payable at the time of issuance of building permit. The fee is adjusted annually based on the percentage increase or decrease, if any, of the Engineering News Record Building Cost Index. Account Description Beginning Fund Balance Fiscal Year 2020-21 Ending Fund Balance Revenues & Other Sources: Developer Fees Interest Income $ 380,954 $ 260 Total Sources $ 381,214 Expenditures & Other Uses: Capital Projects $ 260,000 Total Uses $ 260,000 Total Available 1 $ 2,999 1 $ 121,214 $ 124,213 Five Year Revenue Test Using First In First Out Method Unspent Funds Represent Ending Fund Balance June 30, 2021 Revenues Remaining from FY2016-17 $ - Revenues Remaining from FY2017-18 $ - Revenues Remaining from FY2018-19 $ - Revenues Remaining from FY2019-20 $ - Revenues Remaining from FY2020-21 $ 124,213 Total Ending Fund Balance $ 124,213 Five year test met in accordance with Government Code 66001 Capital Improvement Facilities Expenditures Capital Improvement Projects Total Project Budget FY20-21 DIF Expenditure % of Project Complete % Funded With DIF 210.290.153 - Library Parking - Phase II $ 3,336,895 $ 260,000 97.71 % 67.79% Total $ 260,000 City of Temecula POLICE FACILITIES Government Code 66000 Calculation Fiscal Year 2020-21 Fees are collected to provide future space for police facilities and equipment. The fee is $549.81 per residential attached unit (condominium, apartment, townhouse, and duplex), $310.76 per residential detached unit (single family), and $0.06 - $0.31 per square foot of floor area for commercial development, payable at the time of issuance of a building permit. The fee is adjusted annually based on the percentage increase or decrease, if any, of the Engineering News Record Building Cost Index. Account Description Beginning Fund Balance Fiscal Year 2020-21 Ending Fund Balance Revenues & Other Sources: Developer Fees Interest Income $ 74,808 $ 159 Total Sources $ 74,967 Expenditures & Other Uses: Capital Projects $ - Total Uses $ - Total Available $ 984 $ 74,967 $ 75,951 Five Year Revenue Test Using First In First Out Method Unspent Funds Represent Ending Fund Balance June 30, 2021 Revenues Remaining from FY2016-17 $ - Revenues Remaining from FY2017-18 $ - Revenues Remaining from FY2018-19 $ - Revenues Remaining from FY2019-20 $ 984 Revenues Remaining from FY2020-21 $ 74,967 Total Ending Fund Balance $ 75,951 Five year test met in accordance with Government Code 66001 Capital Improvement Facilities Expenditures Total Project FY20-21 DIF % of Project % Funded Capital Improvement Projects Budget Expenditure Complete With DIF 210.265.522 - Emerg Vehicle Preemption $ 352,000 $ - 70.08% 100.00% 210.265.711 - Citywide Surveillance Cameras $ 3,391,785 $ - 93.46% 18.31 % 210.265.692 - Margarita Rec Center $ 10,881,508 $ - 7.87% 1.26% Total 1 1 $ - Notice of Public Hearing THE CITY OF TEMECULA 41000 Main Street Temecula, CA 92590 A PUBLIC HEARING has been scheduled before the CITY COUNCIL to consider the matter(s) described below. Case No: AB 1600 Annual Report Applicant: City of Temecula, California Location: Citywide Proposal: City Council to Receive and File Report Only Environmental Action: Not Applicable Any person may submit written comments to the City Council before the hearing or may appear and be heard in support of or opposition to the filing of the report at the time of hearing. Any petition for judicial review of a decision of the City Council shall be filed within the time required by, and controlled by, Sections 1094.5 and 1094.6 of the California Code of Civil Procedure. In any such action or proceeding seeking judicial review of, which attacks or seeks to set aside, or void any decision of the City Council, shall be limited to those issues raised at the hearing or in written correspondence delivered to the City Clerk at, or prior to, the public hearing described in this notice. The proposed annual report may be viewed at the public information counter, Temecula Civic Center, City Clerk Department, 41000 Main Street, Monday through Friday from 8:00 a.m. until 5:00 p.m. Questions concerning the project(s) may be addressed to Jennifer Hennessy, Director of Finance, City of Temecula Finance Department, (951) 694-6430. PLACE OF HEARING City Council Chambers 41000 Main Street Temecula, CA DATE OF HEARING November 9, 2021 TIME OF HEARING 7:00 PM Item No. 14 CITY OF TEMECULA AGENDA REPORT TO: City Manager/City Council FROM: Luke Watson, Deputy City Manager DATE: November 9, 2021 SUBJECT: Approve Assignment and Assumption Agreement for Transfer of Rights and Obligations of Development Agreement Between City of Temecula and Temecula West Village, LLC and Settlement Agreement from Temecula Valley West, LLC to SBT Altair, LLC PREPARED BY: Matt Peters, Senior Planner RECOMMENDATION: That the City Council approve an Assignment and Assumption Agreement for Transfer of Rights and Obligations of Development Agreement between City of Temecula and Temecula West Village (TWV), LLC dated January 9, 2018 and Settlement Agreement dated October 26, 2020, from Temecula Valley West, LLC to SBT Altair, LLC. BACKGROUND: The Altair project was approved by the City Council on January 9, 2018 and included four Planning Applications for a 1) General Plan Amendment; 2) Specific Plan; 3) Tentative Tract Map; and 4) Development Agreement for subsequent permits such as grading, infrastructure improvement permitting for on -site and off -site utilities, and resource agency permitting to allow for development of up to 1,750 residential units, limited neighborhood -serving commercial, an elementary school, parks, and open space within a 270-acre area in the southwesterly portion of the City of Temecula, west of Old Town. In addition, the proposed project would construct the Western Bypass, which would link Temecula Parkway with Diaz Road, including widening Vincent Moraga Road. The proposed project site is located within the Murrieta Creek and Santa Rosa Plateau Subunits of the Riverside County Multi -Species Habitat Conservation Plan (MSHCP) Southwest Area Plan. An Environmental Impact Report (EIR) was prepared to evaluate the project's impacts on seventeen (17) environmental factors as required by the California Environmental Quality Act (CEQA), State Clearinghouse No. 2014111029. Shortly after approval of the Altair project, lawsuits were filed by various environmental groups for concerns over biological resources, particularly the anticipated loss of mountain lion habitat, restriction of movement corridors, and potential grading impacts to the southernmost parcel on the site. On October 26, 2020, a Settlement Agreement was reached on these issues by and between the City of Temecula; City Council of the City of Temecula, Ambient Communities, LLC, TWV; and the environmental groups including the Center for Biological Diversity; Sierra Club; Mountain Lion Foundation; and The Cougar Connection; and Endangered Habitats League. DISCUSSION: TWV has submitted a request to assign its interest in the Development Agreement to SBT Altair, LLC ("SBT"). SBT is a joint venture created by TWV, Brookfield Southern California Land LLC (`Brookfield"), and Tri Pointe Homes Holdings ("Tri Pointe"), with each having a 33.3% interest in the Altair project. The assignment provides that SBT will take on all the rights and benefits accruing to TWV as provided in the Development Agreement and that SBT assumes all of TWV's obligations under the Development Agreement. Assignment of the Development Agreement from TWV to SBT changes nothing as it relates to the original entitlements, Conditions of Approval, EIR Mitigation, or Settlement Agreement. Section 13 of the Settlement Agreement provides that TWV may, at its sole discretion, assign all or a portion of its rights and obligations under this Settlement Agreement to an assignee so long as the assignee enters an agreement assuming such rights and obligations (including expressly the jurisdiction of the Riverside County Superior Court and enforceability of the assigned obligations as set forth in Paragraphs 11 and 27), the assignee has financial capacity to fulfill the obligations assigned, and the assignor or assignee provides notice of assignment to all Parties in accordance with this Settlement Agreement and the assignment complies with Section 2.5 of the Development Agreement. The Assignment expressly provides that SBT accepts the assignment of the Settlement Agreement and agrees to be bound by the terms of the Settlement Agreement, including without limitation Section 13 of the Settlement Agreement. FISCAL IMPACT: None ATTACHMENTS: Assignment and Assumption of the Altair Development Agreement DEVELOPMENT AGREEMENT ASSIGNMENT RECORDING REQUESTED BY: TEMECULA WEST VILLAGE, LLC, a Delaware limited liability company 179 Calle Magdalena #201 Encinitas, CA 92024 Attn: Robert Honer MAIL AFTER RECORDING TO: SBT Altair LLC, a Delaware limited liability company 3200 Park Center Drive, Suite 1000 Costa Mesa, CA 92626 Attention: Nicole Burdette ASSIGNMENT AND ASSUMPTION OF DEVELOPMENT AGREEMENT THIS ASSIGNMENT AND ASSUMPTION OF DEVELOPMENT AGREEMENT is made this day of November, 2021, by and between TEMECULA WEST VILLAGE, LLC, a Delaware limited liability company ("Assignor"), and SBT Altair LLC, a Delaware limited liability company ("Assignee"), with reference to the following facts: A. Assignor, as owner and the City of Temecula, a municipal corporation, organized and existing under the laws of the State of California (the "City"), have entered into that certain Development Agreement dated as of January 9, 2018, and recorded on January 30, 2018 as Instrument No. 2018-0036259 in the Official Records of the County of Riverside, California (the "Development Agreement"). B. On October 26, 2020 the City of Temecula, City of Temecula City Council, Ambient Communities, LLC, Temecula West Village, LLC ("TWV"), Center for Biological Diversity, Sierra Club, Mountain Lion Foundation, and The Cougar Connection, and Endangered Habitats League entered into that certain Settlement and Release Agreement relating to the litigation described therein concerning the project described in the Development Agreement ("Settlement Agreement"). C. Assignor, BROOKFIELD SOUTHERN CALIFORNIA LAND LLC, a Delaware limited liability company (`Brookfield"); and TRI POINTE HOMES HOLDINGS, INC., a Delaware corporation ("Tri Pointe") entered into a Contribution Agreement dated August , 2021 ("Contribution Agreement") whereby it was agreed that the parties to the Contribution Agreement would form a joint venture which is now known as Assignee, with Assignor, Brookfield and Tri Pointe each owning a 33.3% interest of Assignee. D. Pursuant to the terms of that certain Contribution Agreement, Assignor now desires to assign and transfer to Assignee all of Assignor's interest as owner under the Development Agreement, subject to the terms, covenants, obligations, and restrictions set forth therein. NOW THEREFORE, in consideration of the mutual covenants and conditions herein below set forth, it is agreed: 1. Effective upon recordation of a grant deed vesting in Assignee fee title interest in all of the Property that is subject to the Development Agreement (the "Effective Date"), Assignor assigns and transfers to Assignee, all of Assignor's right, title and interest as Owner (as such term is defined in the Development Agreement), in and to the Development Agreement and the Settlement Agreement, subject to the terms, covenants, obligations, and restrictions set forth in each agreement. 2. Assignee hereby accepts the assignment of the Development Agreement and Settlement Agreement as of the Effective Date, and shall be entitled to all rights and benefits accruing to the Owner or TWV as provided in each agreement and hereby assumes all of the Owner's and TWV's obligations as provided in each agreement and agrees to be bound by the terms of the Development Agreement and Settlement Agreement, from and after the Effective Date, including without limitation, as required by Section 2.5.1 of the Development Agreement and Section 13 of the Settlement Agreement. 3. The provisions of this instrument shall be binding upon and inure to the benefit of Assignor and Assignee and their respective successors and assigns. 4. This Assignment and Assumption of Development Agreement may be executed in counterparts which taken together shall constitute one and the same instrument. [Signatures on Following Page] IN WITNESS WHEREOF, Assignor and Assignee have executed this Assignment and Assumption of Development Agreement as of the date set forth above. ASSIGNOR: TEMECULA WEST VILLAGE, LLC, a Delaware limited liability company By: Ambient Communities, LLC, a California limited liability company, Its Manager By: Name: Title: By: Name: Title: A SSIGNFF - SBT Altair LLC, a Delaware limited liability company By: Name: Title: By: Name: Title: ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of ) On before me, (insert name and title of the officer) personally appeared who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature (Seal) ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached, and not the truthfulness, accuracy, or validity of that document. State of California County of ) On before me, (insert name and title of the officer) personally appeared who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) islare subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS my hand and official seal. Signature (Seal) Public Comment Agenda Item No. Non-Agendized Item: For ❑ REQUEST TO SPEAK CITY OF TEMECULA Agendized Item: ❑ Against ❑ Date: /1912- Request to Speak forms for Public Comments or items listed on the Consent Calendar may be submitted to the City Clerk prior to the City Council commencing the Public Comment period. For all Public Hearing or Council Business items on the Agenda, a Request to Speak form may be submitted to the City Clerk rp for to the City Council addressing that item. Once the speaker is called to speak, please come forward to the podium and state your name for the record- < < d Name: ee" '�J Phone Number: Address Email address: If you are representing an organization or group, please give the name: Please note that all information presented at a City Council meeting becomes public record. All information provided is optional. Public Comment Agenda Item No. Non-Agendized Item: For ❑ REQUEST TO SPEAK CITY OF TEMECULA Agendized Item: ❑ Against ❑ Date: / /Yd V2, Z,/ Request to Speak forms for Public Comments or items listed on the Consent Calendar may be submitted to the City Clerk prior to the City Council commencing the Public Comment period. For all Public Hearing or Council Business items on the Agenda, a Request to Speak form may be submitted to the City Clerk prior to the City Council addressing that item. Once the speaker is called to speak, please come forward to the podium and state your name for the record. Name: U Phone Number: % Address: / � )!� �� L G j L rj2-4 107_ Email address: If you are representing an organization or group, please give the name: Please note that all information presented at a City Council meeting becomes public record. All information provided is optional. REQUEST TO SPEAK -- CITY OF TEMECULA 1989 Public Comment: Non-Agendized Item Agendized Item: ❑ Agenda Item No. For ❑ Against ❑ Date: 2Z Request to Speak forms for Public Comments or items listed on the Consent Calendar may be submitted to the City Clerk prior to the City Council commencing the Public Comment period. For all Public Hearing or Council Business items on the Agenda, a Request to Speak form may be submitted to the City Clerk prior to the City Council addressing that item. Once the speaker is called to speak, please come forward to the podium and state your name for the record. Name: Address: Email address: If you are representing an organization or group, please give the name. - Phone Number: Please note that all information presented at a City Council meeting becomes public record. All information provided is optional.