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Item #10 Community Grant Program – July 2016 Cycle 0co Ilorislo AGENDA ITEM COVER SHEET Meeting Date: September 20, 2016 Item # JO Reviewed By: Contact Name: Joy P. Wright Department Director: Contact Number: 407-905-3100 x9-1530 City Manager: Subject: Community Grant Program—July 2016 Cycle Background Summary: The Community Grant Review Board (CGRB) met on August 10, 2016 to discuss the 9 applications received for the Community Grant Program (formerly the Community Merit Awards Program). The Community Grant Program provides financial grants of up to $500 to non-profit organizations and civic groups located within the city limits or outside the city limits but benefit residents of Ocoee. The grant cycle is open twice yearly (January and July) to acknowledge excellence and further the contributions these local organizations bring to the Ocoee community. There is $6,000 allotted for this cycle of the Community Grant Program. The Community Grant Review Board recommended funding 8 organizations in the total amount of$4,000. The Society of St. Vincent de Paul Church was not recommended to receive a grant. The church group proposed using the grant money to pay utility bills for people in need. The CGRB stated that subsidizing bills is not the best way to use the city's grant funds. Issue: Should the Mayor and Commissioners approve the $4,000 funding recommendation made by the Community Grant Review Board? Recommendations Staff respectfully requests that the Mayor and City Commission approve the Community Grant Review Board's recommendation. Attachments: Community Grant applications Minutes of the August 10, 2016 CGRB meeting Financial Impact: $6,000 funding is available for this grant cycle. The total of all recommended grants is $4,000. Organization Requested Recommended 1. Adult Literacy League, Inc. $ 500 $ 500 2. The Gift of Swimming, Inc. $ 500 $ 500 3. Ocoee High School Science Olympiad $ 500 $ 500 4. Police Athletic League of Orlando/Apopka $ 500 $ 500 5. Rotary Club of Ocoee $ 500 $ 500 6. Smart Homes for Vets, Inc. $ 500 $ 500 7. STARS of West Orange $ 500 $ 500 8. Woman's Club of Ocoee $ 500 $ 500 TOTAL: $4,000 TOTAL: $4,000 The following organizations are recommended to receive grants for their proposed projects: 1.Adult Literacy League,Inc. Curriculum and materials to benefit Ocoee students. 2.The Gift of Swimming, Inc. Funding for two,prequalified Ocoee children to receive 34 swim lessons at a reduced rate. 3. Ocoee High School Science Olympiad Registration fees for science competition; Competition and volunteer shirts. 4. Police Athletic League of Orlando/Apopka School supplies and sports equipment for students ages 8 to 16. 5. Rotary Club of Ocoee Dictionaries for all 3`d grade students in Ocoee elementary schools (Citrus, Ocoee, Springlake, Thornebrooke and Westbrooke). 6. Smart Homes for Vets,Inc. Purchase of a KUBI Telepresence Robot to be used in live demos of Family Health Monitoring for veterans. 7. STARS of West Orange Purchase backpacks for students at a cost of$3.50 each. 8. Woman's Club of Ocoee Offset costs for sprinkler system and kitchen repairs. TOTAL AMOUNT RECOMMENDED: $4,000 2 Type of Item: (please mark with an x') Public Hearing For Clerk's Dept Use: Ordinance First Reading Consent Agenda Ordinance Second Reading Public Hearing Resolution X Regular Agenda X Commission Approval Discussion&Direction Original Document/Contract Attached for Execution by City Clerk Original Document/Contract Held by Department for Execution Reviewed by City Attorney N/A Reviewed by Finance Dept. N/A Reviewed by N/A 3 404 MINUTES OF THE CITY OF OCOEE COMMUNITY GRANT REVIEW BOARD MEETING Ocoee AUGUST 10, 2016 florlda CALL TO ORDER- 7:01 pm Chairman Sills called the regular meeting of the Community Grant Review Board to order at 7:01 p.m. in the Commission Conference Room at City Hall. Chairman Sills called for a moment of silence followed by the Pledge of Allegiance. The roll was called and a quorum declared present. PRESENT: Chairman Sills, Member Cortes and Member Rainer. Also present were Community Relations Manager Wright and Recording Clerk Heard. ABSENT: Vice-Chairman Carrington, Member Dunn. APPROVAL OF MINUTES—Regular meeting held on February 10, 2016. Member Rainer, seconded by Member Cortes, moved to approve the minutes of the Community Grant Review Board Meeting held February 10, 2016. Motion carried unanimously. Application No. 1 —Stars of West Orange - 7:04 pm Allisha Douglas attended to represent the organization. She explained this organization is a nonprofit, is currently located in the West Oaks Mall and has been in existence for 13 years. She stated this organization donates backpacks and school supplies for students who receive free or reduced lunch with Orange County Public Schools. This year they provided supplies and backpacks to over 40 schools. Member Rainer inquired when the funds will be used from this grant. Ms. Douglas said any funds that are raised between today and June of 2017 goes towards the next school year of 2017, which will include this grant, if it is awarded. Member Rainer, seconded by Member Cortes, moved to recommend that the City Commission award grant funding of$500 to the Stars of West Orange. The motion carried unanimously. Application No. 2—The Gift of Swimming, Inc. - 7:07 pm Susan Polder attended to represent the organization. She explained this grant will go towards their swim program, which has been ongoing for 13 years. Member Rainer inquired where they hold the swimming lessons. Ms. Polder said their lesson provider is Southwest Aquatics, which is located in Winter Garden, but the grant money that has been awarded in the past has always been used for children living in Ocoee who have applied for scholarships. Member Cortes asked how many children in Ocoee are able to receive free lessons. Ms. Polder indicated the grant will cover at least two children, maybe more. Member Rainer asked if they can guarantee that the grant will go towards an Ocoee resident. Ms. Polder said everybody that applies fills out an application and registration form, which has their address listed, and they also provide supporting documentation that shows whether they qualify for the scholarship. Chairman Sills inquired whether they are connected with the Roper YMCA. Ms. Polder answered in the negative. Chairman Sills asked how many children are currently on their waitlist. Ms. Polder indicated six. She further indicated last year they provided a total of seven swim scholarships to Ocoee children. Member Rainer Community Grant Review Board August 10,2016 asked how their program differs from the City of Ocoee's swim program. Ms. Polder indicated she does not know how the City's program works, but she explained their program in more detail wherein they will receive 20 to 25, ten minute, one-on-one swim instruction/basic swim survival for four to five weeks. Member Rainer asked what age group this is for. Ms. Polder indicated they concentrate on children prior to preschool age where the risk of drowning is greatest. She further explained the scholarship does not end until the child can exhibit the fully-clothed swim-float-swim technique. Member Rainer inquired where their other scholarships come from. Ms. Polder indicated they put on a 5k walk/run, which raised $25,000 last year, and they have various fundraising efforts and apply for grants elsewhere such as the Orlando Magic Youth Foundation. They recently were chosen by Whole Foods for their five percent give-back day, which $4,900 was donated. Chairman Sills, seconded by Member Rainer, moved to recommend that the City Commission award grant funding of$500 to The Gift of Swimming,Inc. Motion carried unanimously. Application No. 3—Rotary Club of Ocoee- 7:10 pm Paul Roy attended to represent the organization. He explained this grant would be put towards the purchase of dictionaries for City of Ocoee third-graders. Member Rainer mentioned she thought dictionaries were outdated. Mr. Roy commented that he has heard that, too, but they are encouraged not only by faculty and staff of elementary schools within the city, but also the appreciation and the looks on the faces of the third-graders that receive something that they can hold in their hands and call their own. He explained that although it is easy to spell check with certain programs, it is not easy to learn alphabetical order or how to use reference tools. Chairman Sills asked if students are using the dictionaries. Mr. Roy stated they are told that they are using them. He shared with the Board that they have been distributing dictionaries for so long that a student who received a dictionary while in the third grade was just awarded a scholarship from the Rotary Club of Ocoee to continue his education in college. Member Cortes asked if the club is looking into ways to make it more technology-driven. Mr. Roy explained they have looked into USB dictionaries and alternative technological dictionaries and have not come up with anything that is as cost effective, but they are researching this along with meeting annually with the principals for all of the Ocoee elementary schools whom have asked them to continue with the regular dictionary distribution. Member Rainer, seconded by Member Cortes, moved to recommend that the City Commission award grant funding of$500 to the Rotary Club of Ocoee. Motion carried unanimously. Application No. 4—Adult Literacy League, Inc. - 7:24 pm Joyce Whidden attended to represent the organization. Chairman Sills asked if they are teaching students at the Ocoee library. Ms. Whidden answered they have a class at the West Oaks Library and also volunteer tutors that work one-on-one with adult students trying to improve their basic reading and writing skills or learn to read/write and communicate in English. They currently have 21 students in the city and 18 volunteer tutors. She expressed they would use the grant money to buy workbooks by New Readers Press, Oxford University Press and Cambridge University Press. Member Rainer inquired on the students' range in age. Ms. Whidden said she has not checked the demographics of the students, but mentioned their oldest student is currently 86 years old and their youngest is 17 years old. She mentioned they meet in a number of different locations within Ocoee, but they are always looking for more places to meet within the City of Ocoee. Member 2 Community Grant Review Board August 10,2016 Rainer further inquired how they solicit for students. Ms. Whidden said that marketing to people who do not read well is a bit of a challenge, but they try to get the word out as much as they can by word of mouth, on the radio and other various ways. Member Rainer asked if this program is for English as a first language or second language. Ms. Whidden explained the two programs they currently have, which is for people where English is a native language and a program for people where English is a second language. Currently they have students from 80 different countries speaking 19 different languages. She emphasized that they focus on English language literacy, which includes reading, writing and communicating in English. She indicated students stay in the program on average 27 months, but they ask for a year of their time, and students meet at least once a week, if not twice. She announced they are always looking for more volunteers. Member Rainer, seconded by Member Cortes, moved to recommend that the City Commission award grant funding of$500 to the Adult Literacy League, Inc. Motion carried unanimously. Application No. 5—Society of St. Vincent de Paul Church - 7:29 pm Robert Fontana and Tony Callabro attended to represent the organization. Chairman Sills inquired whether they are associated with Matthew's Hope. Mr. Fontana answered in the negative and indicated not formally, but they do help each other from time to time. Chairman Sills asked what they would spend the grant money on if they were awarded it. Mr. Fontana said they plan to continue doing the work that they are doing, which is primarily assisting people by paying their utility bill that have lost their jobs or their hours were cut or other factors. He explained their process. Member Rainer asked how their organization differs from the Christian Service Center, which provides the same type of assistance. Mr. Callabro explained that they are in conjunction with Christian Services. They give them food and clothing every week. Chairman Sills explained the Board is trying to make sure the grant funds are used for Ocoee residents. Mr. Callabro indicated he understood and said that their organization helped 75 Ocoee residents last year. Member Cortes inquired about their turnaround time from when a resident calls to when they can get assistance. Mr. Fontana said 24 to 48 hours. Member Rainer asked if they assist with anything else other than utility bills. She stated the Christian Service Center also assists residents with their utility bills. Mr. Callabro informed the Board that they are in conjunction with them, and they do pay some utility bills and help them out. He further explained they receive phone calls from Winter Garden and Ocoee, which does not make a difference,because they will assist whoever needs assistance. He stated if they receive a phone call from Ocoee, they will service them. Member Rainer asked what their criteria are for receiving assistance. Mr. Fontana said they interview them, what happened to them, and why they cannot pay their bill. He further explained they will not support them for the next six months, but they give them a hand to help them through that month or until they get back on their feet. He said there is no criterion. If anyone calls that needs help, they are going to try to help them, but their general rule is to only help them once a year. Member Cortes discussed their financial disclosure. Member Rainer asked how the Board can be assured that the grant funds will go towards Ocoee residents. Mr. Callabro indicated everybody they help is inputted into the database, which they can provide. Chairman Sills, seconded by Member Rainer, moved to recommend that the City Commission deny grant funding of $500 to the Society of St Vincent de Paul Church. Motion carried unanimously. 3 Community Grant Review Board August 10,2016 Application No. 6—Smart Homes for Vets, Inc. - 7:46 pm Dr. Dallas DeFee attended to represent the organization. He stated that this organization is a new nonprofit founded by himself and his fiancée to assist education of veterans, seniors and people with disabilities in using technology for health and improvement. He indicated they are requesting the $500 to acquire the very first robot called Kubee Telepresence Pedestal for home healthcare. Chairman Sills inquired what constitutes a smart home. Dr. DeFee answered monitoring and nurturing of critical functions against falls, heart conditions and safety along with monitoring vital signs, activity levels and medication compliance. He further explained that one of the best uses currently is to facilitate counseling in PTSD patients. Member Cortes inquired if they have received other funds to date. Dr. DeFee indicated they are already funded for the first year. Member Rainer asked how many clients in Ocoee does the organization serve. Dr. DeFee indicated they anticipate at least 12 robots in smart homes within Ocoee before the end of this year. Further discussion ensued regarding the number of veterans in the community that can benefit from a smart home. He indicated their initial target will be the veterans affected with PTSD. Member Cortes indicated the Board usually tends to not give grants to start-up organizations. Dr. DeFee said it was very difficult to obtain the nonprofit status, but they did obtain it and are committed. Member Rainer inquired how many veterans would the $499 help. Dr. DeFee indicated the grant would be for demonstration, which would be used the next two years to connect the City of Ocoee with innovative services in healthcare. Further discussion ensued regarding what entails a smart home. Chairman Sills, seconded by Member Rainer, moved to recommend that the City Commission award grant funding of$499 to Smart Homes for Vets.Inc. Motion carried unanimously. Application No. 7—Ocoee High School Science Olympiad - 8:03 pm Patricia DeNoon, attended to represent the organization. She explained that the Science Olympiad team is an after-school program that consists of students from different science programs. This is a 15 student competition team that attends 23 events. She stated that the grant would be used for the team registration fee, which is $235 and to purchase shirts. She explained they are applying for another grant to help them purchase the supplies. She announced last year the team made a robotic arm, which was placed fourth in regionals. She explained Science Olympiad is a nationwide event that has been in existence for over 35 years. Member Rainer, seconded by Member Cortes, moved to recommend that the City Commission award grant funding of $500 to Ocoee High School Science Olympiad. Motion carried unanimously. 4 Community Grant Review Board August 10,2016 Application No. 8—Woman's Club of Ocoee- 8:10 pm Jackie Titus attended to represent the organization. Chairman Sills stated the Board has granted numerous grants to this organization over the years, but has never granted one for repairs to the building. She explained the 124-year-old building and the location and indicated they are trying to spruce up the place a little bit. She announced this past year the club created Expressions again with the seven Ocoee schools. Member Rainer commented that this grant is going towards a new sprinkler system, but during certain events residents do park on the grass. Ms. Titus indicated the sprinkler system is being installed only in the front of the building. She mentioned they feel they need to upgrade their building a little bit, because of the new development. She further explained many activities and donations they give to the residents of Ocoee. Member Rainer, seconded by Member Cortes, moved to recommend that the City Commission award grant funding of$500 to Woman's Club of Ocoee. Motion carried unanimously. Application No. 9—Police Athletic League of Orlando/Apopka - 8:16 pm Renee Fryer Reed and Chick Fryer attended to represent the organization. Ms. Reed explained the Police Athletic League (PAL), which was founded by Chick Fryer three years ago, saying PAL positively directly impacts the youth through various programs and events. PAL is currently planning a Labor Day event, which will be a baseball game, a Halloween event and a Thanksgiving Day game, which will be with the Ocoee Police Department. Member Rainer inquired why their organization is named PAL of Orlando/Apopka and it does not include Ocoee; and further, asked if all they do are baseball games. Ms. Reed answered they do basketball and football events, but the feedback from the community has been baseball, because it is the most expensive sport. She further explained their name and why it is named Orlando/Apopka, but stated they are directly in Ocoee. Member Cortes asked whether they are affiliated with the National PAL Association. Mr. Fryer said he is one of the founders of PAL; and further, stated every major city in the United States has a PAL, and he is in charge of everything in between Miami to Jacksonville. Member Cortes advised that the PAL up north supplies funds to the clubs and asked whether that will be the case here. Mr. Fryer indicated that they intend to help out in Ocoee. Member Cortes further said she can vouch for the program up north with getting the police involved with the coaching and mentoring programs, because it is very successful. Member Rainer inquired if they give scholarships to the children. Ms. Reed indicated they do give out scholarships for the football and basketball, but it is not monetary. Mr. Fryer announced that the PAL provides soccer and tennis, which many residents are not aware of. Chairman Sills stated it looks as though they are keeping the children off the streets. Ms. Reed indicated that is their main focus. Member Cortes, seconded by Member Rainer, moved to recommend that the City Commission award grant funding of$500 to the Police Athletic League of Orlando/Apopka. Motion carried unanimously. 5 Community Grant Review Board August 10,2016 COMMENTS Chairman Sills explained that the Board has to be very careful when dealing with the taxpayers' money and the grants go towards the best benefit of the Ocoee residents. He explained that sometimes the questions may be harsh, but they want to make sure all of the questions have been answered before this goes before the City Commission. ADJOURNMENT - 8:27 pm Attest: APPROVED: Kathy Heard, Recording Secretary Jim Sills, Chairman 6 CITY OF OCOEE Community Grant Program Application Funding Cycle: JULY 2016 When completing this application, use only the space provided. The only attachment should be the formal organizational support documentation (minutes or letter). Only one entity from each organization is eligible to apply for a grant,per cycle. Applicants may apply for any amount up to $500. DEADLINE to submit application: JULY 29, 2016 0 0000000000000000000000000000000 G?3'.-C C NI s al o G:g Name of Organiza ion: `, Address of Organization: L, X) , A-W D Are OCoeefl3f j Contact person for this application: allAVat. 3 (The contact member must be a member of the organization.) 6 -5 ?, ; Daytime phone number: �/V � .411). mail address: D What are you seeking grant money for? Please provide an itemized cost estimate for each j item you plan to purchase 174.1.1.-fur S Iz l� ter- G3 s .d E' Sore icier-kP� s � j V What dollar amount are you requesting? (The maximum grant award is $500.) 1, Is your •rganizatio •etting funding from any other source for this specific project?' _ I . (9 1 'P..' s t' r •t" lS 01/4-4C/0 J hat is your organizat►o 's primary funding s source. Q, R N✓ h1 off- 01A\IPWW How much money does your organization receive from your primary funding source each year 94 i% G VIA, iip 0\16, 6O bls T ip t3144, 'r --Nf cc ' © C�t at other sources o revenue • •es your izat�have? A ,, 40 U L itt Ai'_C - _ ,• ►A “ e. A I. . ,e , I. * ' I e c A) I IJ D lq e-1-3 �. J-eAs 1' 's, -F"0 �� s r, - What is your an ua for this year? f'A1?-,X 1 s\t, IP @;30 al A C117 Last yeat -- elite,7 ,,o-b ►st the fundrai ers yo r organization hold ? c �� i' '�-}`�-) Lug e ;e P @Aj � w e e ids How many_members, volunteers and/or paid employees does your organization have? How many live in 0e6 Page 2-Community Grant Program Application How many clients does your organization serve? 1 kllo -- 73 Om �ft “ 1-ekieL How man live in Ocoe many . D+ I 00n-- 3 cro P Has your organization_applied for a grant from the City before? J Did you receive a grant from the City of 0 oee? e-5 i e 7- If yes, when, and how much m ey did y receive? �ie5 13 i 1 Oho- DP-1 jr ip `f Does your organization volunteer in the Ocoee community? If yes, what volunteer ctivities do xosusticipate C i te-653-0Arg Dz.r 54-1\1434Q i j) 1\1 1 tcpt e D�,�IrAjvc-cc c �r�-e r l l�J Do-s your organization pro i provide avenue for'Ocoee residents to volunteer? ' `A e .wtt. r aim • .3 z How many yearly volunteer hours does your organization contribute to the community and how are those hours tracked or documented? + � 40 360.5 I\iLc . �e k,rT e�\'be v4(4, i i✓s , 0 g) L D Af S - '� r ei-1•N NDeA)sJ ? 0-� olAw., e . orA - . lease list the specific accomplishments your organization nas achieved in the past 24 months: n •ON 101' Qe 0 tcO • - ,�y e Ti c e Please include any other pertinent information about your organization or this spec! is •rant request that you feel would help the City in making . s decisio • 1_ VIA U�`fie cR A tJ > k� h K k) "4 (i'rr 1 Jk.) GI _ Ai •_ h. ,;a Please attach documentation (meeting minutes or letter) to verify that your organization supports this application. Before submitting this application, please read and sign below: These funds will be utilized within the City of Ocoee or have a direct benefit to the citizens of the City of Ocoee. I 1 +ccordance with the guidelines set forth in this application certified this C7� day of i_ t .. , by _ 1� 4 ' k e, 0 . TES ' Your Name Niiii.e21 tnt 4 ' If 1 Sig,ature Page 3—Community Grant Program Application For more information, please call Community Relations at (407) 905-3100 x 9-1530 or e-mail jwrightaocoee.org. Mail or deliver applications to: Ocoee City Hall 150 N. Lakeshore Drive Ocoee, FL 34761 For Staff Use Only Date Application Received 74f/{. ' / Was Application Received Complete? G,...e 62 If not,Date Application Returned r Non-Profit Status: On file Attached July 29, 2016 To Whom it may concern During our meeting in May 2016,we as a group discussed the application for the$500.00 Grant the City of Ocoee has available to the citizens of Ocoee. We as members of the GFWC WOMAN'S CLUB OF OCOEE, would like to apply. This letter is to replace the minutes, since our secretary is out of town for the summer, and we do not meet again till sept.as a group. Respectfully MARY ARBER PRESIDENT TO FAX w-9 AND IRS TAX EXEMPTION TO JOY A. I CITY OF OCOEE Community Grant Program Application Funding Cycle: JULY 2016 When completing this application, use only the space provided. The only attachment should be the formal organizational support documentation (minutes or letter). Only one entity from each organization is eligible to apply for a grant, per cycle. Applicants may apply for any amount up to $500. DEADLINE to submit application: JULY 29, 2016 00000000000000000000000000000000 Name of Organization: POLICE ATHLETIC LEAGUE OF ORLANDO APOPKA Address of Organization: PO BOX 617380,ORLANDO,FL 32861 Contact person for this application: MRS. RENEE FRYAR (The contact member must be a member of the organization.) Daytime phone number: 407-453-8983 E-mail address:PALORLANDOAPOPKA@GMAIL.COM What are you seeking grant money for? Please provide an itemized cost estimate for each item you plan to purchase. Supplies for school for kids($250)sports equipment for events for kids age 8-16($250). What dollar amount are you requesting? (The maximum grant award is $500.) $500 Is your organization getting funding from any other source for this specific project? No What is your organization's primary funding source? Founders, board member and volunteers personal money. How much money does your organization receive from your primary funding source each year? $5,000 What other sources of revenue does your organization have? We get items donated (food, sports equipment, volunteers) but havent received monetary What is your annual budget for this year? $10,000 Last year? $5,000 List the fundraisers your organization holds? COMMUNITY CAR WASH,TEACH-A-KID(MENTOR PROGRAM) How many members, volunteers and/or paid employees does your organization have? 12 (full-time permanent) How many live in Ocoee? Page 2-Community Grant Program Application s How many clients does your organization serve? Approximately 30 at any given event.However with an average of 5 events per year,we service a minimum of over 200 kids annually. How many live in Ocoee? 75% Has your organization applied for a grant from the City before? No Did you receive a grant from the City of Ocoee? No If yes, when, and how much money did you receive? n/a Does your organization volunteer in the Ocoee community? If yes, what volunteer activities do you participate in? Political Campaigning,Volunteer Coaching,Stay-fd health&nutrition program Does your organization provide a venue for Ocoee residents to volunteer? No How many yearly volunteer hours does your organization contribute to the community and how are those hours tracked or documented? Apprx 288,tracked by log/minutes,submitted&recorded by Organization Secretary. Please list the specific accomplishments your organization has achieved in the past 24 months: Community clean-up,provided free daycare assistance.Mentor for College Prep Exam,crime prevention outreach program/workshop Community clean-up,provided free daycare assistance.Mentor for College Prep Exam,crime prevention outreach program/workshop Please include any other pertinent information about your organization or this specific grant request that you feel would help the City in making its decision: We ask the City the city to get us more involved.We want information on how,when and where we can be of GREAT assistance! Please attach documentation (meeting minutes or letter) to verify that your organization supports this application. Before submitting this application, please read and sign below: These funds will be utilized within the City of Ocoee or have a direct benefit to the citizens of the City of Ocoee. In accordance with the guidelines set forth in this application certified this Clay of by /7 Al a a �- • Print Your Name -1? )/V2i. Signature 4 ... POLICE `?Rte POLICE ATHLETIC IC LEAGUE OF ORLANDO/APOPKA,INC "Filling Playgrounds,Not Prisons" July 28, 2016 To Whom It May Concern: Please note that I fully accept the funding request submitted to the City of Ocoee's Community Grant application by Event Coordinator, Mrs. Renee Fryar-Reed for development of youth programs in Ocoee, Florida. We thank you for your time and attention to this very important request. Sincerely, L/41`t•cL-)`"1111 Daniel Fryar palapopka @gmail.com CEO/President Police Athletic League of Orlando-Apopka, Inc. 750 S.Orange Blossom Trail,Suite 123 Orlando FL 32805 Phone 407-453-8200 Fax 407-674-8601 Email: palorlandoapopka(Wgmail.com Mailing address:Post Office Box 617380,Orlando FL 32861 1. Letter of support on your organization's letterhead or copy of your meeting minutes 2. Signature verifying the grant funds will benefit Ocoee citizens (See bottom of page 2) 3. IRS Tax exempt status letter 4. W-9 form For more information, please call Community Relations at (407) 905-3100 x 9-1530 or e-mail iwright cr ocoee.org. Mail or deliver applications to: Ocoee City Hall 150 N. Lakeshore Drive Ocoee, FL 34761 For Staff Use Only 64//6 Date Application Received d a Prn Was Application Received Complete? /U 6i - If not,Date Application Returned Non-Profit Status On file Attached 3 Form W'9 Request for Taxpayer Give Form to the (Rev.December2014) Identification Number and Certification requester.Do not Department of the Treasury Send to the IRS. Internal Revenue Service 1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank. POLICE ATHLETIC LEAGUE OF ORLANDO APOPKA INC • 2 Business name disregarded entity name,if different from above m kn a 3 Check appropriate box for federal tax classification;check only one of the following seven boxes: 4 Exemptions(codes c Y n9 mp ( apply only to o ❑Individual/sole proprietor or ❑ C Corporation ❑S Corporation ❑ Partnership ❑Trust/estate nstain enti on page 3aidividuals see L single-member LLC Exempt payee code(it any) ❑Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)► m9 disregarded,do not check LLC;check the appropriate box in the line above for Exemption from FATCA reporting o � Note.For a single-member LLC that is cis C the tax classification of the single-member owner. code Of any) o ra Other(see instructions)■ NON-PROFIT ORGANIZATION (Applies to accounts maintained outside the U.S.) E 5 Address(number,street,and apt.or suite no.) Requester's name and address(optional) 6239 EDGEWATER DRIVE SUITE V-1 • co 6 City,state,and ZIP code 0) ORLANDO FLORIDA 32810 7 List account number(s)here(optional) • Part I Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid J Social security number backup withholding.For individuals,this is generally your social security number(SSN).However,for a - resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other — — entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN on page 3. or Note.If the account is in more than one name,see the instructions for line 1 and the chart on page 4 for ( Employer Identification number guidelines on whose number to enter. 4 7 - 2 1 4 3 9 9 5 Part I I Certification Under penalties of perjury,I certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and 2. I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding;and 3. I am a U.S.citizen or other U.S.person(defined below);and 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct. Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions on page 3. Sign signature of ri-I-, Here U.S.person■ �/ ■ 6/0 , �y General Instructions •Form 1098(home mortgage interest),1 -E(student loan interest),1098-T (tuition) Section references are to the Internal Revenue Code unless otherwise noted. •Form 1099-C(canceled debt) Future developments.Information about developments affecting Form W-9(such •Form 1099-A(acquisition or abandonment of secured property) as legislation enacted after we release it)is at www.irs.gov/fw9. Use Form W-9 only if you are a U.S.person(including a resident alien),to Purpose of Form provide your correct TIN. An individual or entity(Form W-9 requester)who is required to file an information If you do not return Form W-9 to the requester with a TIN,you might be subject return with the IRS must obtain your correct taxpayer identification number(TIN) to backup Withholding.See What is backup withholding?on page 2. which may be your social security number(SSN),individual taxpayer identification By signing the filled-out form,you: number(ITIN),adoption taxpayer identification number(ATIN),or employer giving are ou 1.Certify that the TIN you identification number(EIN),to report on an information return the amount paid to is correct(or you are waiting for a number to be Issued), you,or other amount reportable on an information return.Examples of information returns include,but are not limited to,the following: 2.Certify that you are not subject to backup withholding,or •Form 1099-INT(interest earned or paid) 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If •Form 1099-DIV(dividends,including those from stocks or mutual funds) applicable,you are also certifying that as a U.S.person,your allocable share of any partnership Income from a U.S.trade or business is not subject to the •Form 1099-MISC(various types of income,prizes,awards,or gross proceeds) withholding tax on foreign partners'share of effectively connected income,and •Form 1099-B(stock or mutual fund sales and certain other transactions by 4.Certify that FATCA code(s)entered on this form Of any)indicating that you are brokers) exempt from the FATCA reporting,is correct See What is FATCA reporting?on •Form 1099-S(proceeds from real estate transactions) page 2 for further information. •Form 1099-K(merchant card and third party network transactions) Cat.No.10231X Form W-9(Rev.12-2014) OB/12/16 Consumer's Certificate of Exempt R.1100/15 ion issued Pursuant to Chapter 212, Florida Statutes FLORIDA 85.80167719840.4 06/24/2015 06/30/2020 501(C)(3)ORGANIZATION 1 'cabs Number Effective Date Expiration Date Ems... Category This certifies that POLICE ATHLETIC LEAGUE OF ORLANDO APOPKA INC 750 S ORANGE BLOSSOM TRL STE 123 ORLANDO FL 32805-3156 is exempt from the payment of Florida sales and use tax on real property rented,transient rental property rented,tangible personal property purchased or rented, or services purchased. DR-14 im p ortant Information for Exem p t Or g anizations R. lfuis FLORIDA 1. You must provide all vendors and suppliers with an exemption certificate before making tax-exempt purchases. See Rule 12A-1.038,Florida Administrative Code(F.A.C.). 2_ Your Consumer's Certificate of Exemption is to be used solely by your organization for your organization's customary nonprofit activities. 3. Purchases made by an Individual on behalf of the organization are taxable,even if the individual will be reimbursed by the organization. 4. This exemption applies only to purchases your organization makes. The sale or lease to others of tangible personal property, sleeping accommodations,or other real property Is taxable. Your organization must register, and collect and remit sales and use tax on such taxable transactions. Note: Churches are exempt from this requirement except when they are the lessor of real property(Rule 12A-1.070, FA.C.). 5. It is a criminal offense to fraudulently present this certificate to evade the payment of sales tax. Under no circumstances should this certificate be used for the personal benefit of any individual. Violators will be liable for payment of the sales tax plus a penalty of 200%of the tax,and may be subject to conviction of a third-degree felony. Any violation will require the revocation of this certificate. 6. If you have questions regarding your exemption certificate, please contact the Exemption Unit of Account Management at 800-352-3671. From the available options,select°Registration of Taxes,"then"Registration Information,"and finally"Exemption Certificates and Nonprofit Entities." The mailing address Is PO Box 6480, Tallahassee, FL 32314-6480. • INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY P. O. BOX 2508 CINCINNATI, OH 45201 :,� Employer Identification Number: i ,_ ' 47-2143995 Date: $F :r �` DLN: 17053112307015 POLICE ATHLETIC LEAGUE OF ORLANDO Contact Person: APOPKA INC MS. LEE ID# 31208 PO BOX 617380 Contact Telephone Number: ORLANDO, FL 32861 (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 15, 2014 Contribution Deductibility: Yes Addendum Applies: No Dear Applicant: 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. For important information about your responsibilities as a tax-exempt organization, go to www.irs.gov/charities. Enter "4221-PC" in the search bar to view Publication 4221-PC, Compliance Guide for 501(c) (3) Public Charities, which describes your recordkeeping, reporting, and disclosure requirements. -Sincerely, / Director, Exempt Organizations Letter 947 CITY OF OCOEE Community Grant Program Application Funding Cycle: JULY 2016 When completing this application, use only the space provided. The only attachment should be the formal organizational support documentation (minutes or letter). Applicants may apply for any amount up to $500. DEADLINE to submit application: JULY 29, 2016 41 41 41 41 41 41 41 41 41 41 41 41 41 41 41 41 4141 41 41 41 41 41 41 41 41 41 41 41 41 41 41 Name of Organization: Rotary Club of Ocoee Address of Organization: P.O.Box 931,Ocoee, Fl 34761 Contact person for this application: Dr.Dallas DeFee (The contact member must be a member of the organization.) Daytime phone number: 407-607-4498 E-mail address:dallas @drdallasdefee.com What are you seeking grant money for? Please provide an itemized cost estimate for each item you plan to purchase. We purchase dictionaries for every 3rd grade student in an Ocoee elementary school(Citrus,Ocoee,Springlake,Thomebrooke and Westbrooke.. 0.-re- 1 .1-s t x (o bo = 16 136-130.— What dollar amount are you requesting?(The maximum grant award is$500.) $500.00 Is your organization getting funding from any other source for this specific project? No. What is your organization's primary funding source? Fundraiser and grants and membership fees. How much money does your organization receive from your primary funding source each year? Membership fees are $125.00/year/member. What other sources of revenue does your organization have? None, other than personal contributions from individual club members. What is your annual budget for this year? $3000.00 Last year? $3000.00 List the fundraisers your organization holds? Annual Classic Car Show at the Ocoee Founders'Day Festival,our annual Texas Hold'em Poker Fundraiser. And we sell wine at the Ocoee Founders'Day Festival. How many members, volunteers and/or paid employees does your organization have? 12 members all are volunteers. No one is paid How many live in Ocoee? 11 of them either live in or own a business in Ocoee. Page 2-Community Grant Program Application How many clients does your organization serve? Our club raises funds for students who attend the Orange County Public Schools in Ocoee. How many live in Ocoee? 1 W e- .r-- - <‹e -o' k -kL s-1 -e. 1 �� 0 Co-e-e- Has your organization applied for a grant from the City before? Yes Did you receive a grant from the City of Ocoee? Yes If yes, when, and how much money did you receive? We have received the MVP Grant multiple times and have received the Community Grant once. Does your organization volunteer in the Ocoee community? If yes, what volunteer activities do you participate in? Yes we do.We have always volunteered for the Spring Fling,Ocoee Founders Day and whenever the City asks. Does your organization provide a venue for Ocoee residents to volunteer? Yes,we have honorary members who volunteer their time to help the club. How many yearly volunteer hours does your organization contribute to the community and how are those hours tracked or documented? We do not officially track volunteer hours. Please list the specific accomplishments your organization has achieved in the past 24 months: 7-$1000 Scholarships to OHS Seniors. 1204 dictionaries.(4794 dictionaries since 2008) Please include any other pertinent information about your organization or this specific grant request that you feel would help the City in making its decision: All school principals,teachers and students continue to be delighted when we show up wth the dictionaries.For many children this is the first book they can call their own. Please attach documentation (meeting minutes or letter) to verify that your organization supports this application. Before submitting this application, please read and sign below: These funds will be utilized within the City of Ocoee or have a direct benefit to the citizens of the City of Ocoee. In accordance with the guidelines set forth in this application certified this 27th day of July , by Dallas DeFee Z r'Pour N. . A. 4 , Signature Page 3-Community Grant Program Application For more information, please call Community Relations at (407) 905-3100 x 9-1530 or e-mail iwriaht aC�.ocoee.org. Mail or deliver applications to: Ocoee City Hall 150 N. Lakeshore Drive Ocoee, FL 34761 For Staff Use Only Date Application Received 7 D /7#°' Was Application Received Complete? If not,Date Application Returned Non-Profit Status: On file Attached • Rotary ( ?Ø 1 ly Club of Ocoee P.O. Box 931 Ocoee, FL 34761 www.OcoeeRotary.org 7/27/ 2016 CLUB MEETING Minutes Attendance: Paul Roy (President), Eric Hoebbel (Treasurer), Pam Bozkurt (Secretary), Steve Marbais, Dallas DeFee, Andra Thakur, Chuck Castellon, Andre Visser, Chief Brown Guest: Bill Squires, Rotarian from Enfield, CT Discussion: 1. Our upcoming Rotary Social will be at Rusteak next Tuesday, August 2"d, at 5pm. Please be there around 4:45. 2. We discussed the upcoming community grant and the club voted to apply for it to assist with buying dictionaries for every 3rd grade student in all of the Ocoee elementary schools. 3. Paul attended the District Training Seminar at Rosen College. He will be asking district chairs to present to the club. 4. Discussion of changing our official start time was tabled. I 1 A I 44-ir'am Bozk , Secret 1 16-2017 CITY OF OCOEE Community Grant Program Application Funding Cycle: JULY 2016 When completing this application, use only the space provided. The only attachment should be the formal organizational support documentation (minutes or letter). Applicants may apply for any amount up to $500. DEADLINE to submit application: JULY 29, 2016 00004000000000000041 41 000000000000 Name of Organization: SMART HOMES for VETS Inc(501 c3) Address of Organization: 449 W. Silver Star Rd, Suite 493, OCOEE FL 34761 Contact person for this application: Dr Dallas DeFee (The contact member must be a member of the organization.) Daytime phone number: 407-607-4498 E-mail address: Dallas @DrDallasDeFee.com What are you seeking grant money for? Please provide an itemized cost estimate for each item you plan to purchase. Purchase of a KUBI Telepresence Robot(recently reduced, photos attached) What dollar amount are you requesting? (The maximum grant award is $50 ) $499 Is your organization getting funding from any other source for this specific project? No What is your organization's primary funding source? Major Donors($500 or more), and in near future, Grants and Corporate Donations. How much money does your organization receive from your primary funding source each year? Organization began operations Jan 1,2016 and has 2 major"start-up"pledges of$15,750 and over$1,300 in vehicle donations. What other sources of revenue does your organization have? Misc income from rental of assets to non-qualifying service recipients. What is your annual budget for this year? Startup with 2 Ocoee residents as Board Members, 1 in South Caro na. Two Oc residents are advisors. Last year? 0 List the fundraisers your organization holds? Planned"Florida Hometown Heroes"events with partners. How many members, volunteers and/or paid employees does your organization have? Startup with 2 Ocoee residents as Board Members, 1 in South Carolina. Two Ocoee residents are advisors. How many live in Ocoee? Page 1-Community Grant Program Application How many clients does your organization serve? Potentially 50-100 1st year. How many live in Ocoee? Has your organization applied for a grant from the City before? No Did you receive a grant from the City of Ocoee? If yes, when, and how much money did you receive? Weth Does your organization volunteer in the Ocoee c munity? If yes, what volunteer activities do you participate in? Yes, Rotary and Oran a County Seniors Does your organization provide a venue for Ocoee residents to volunteer? No, we plan to use/rent OCOEE Public facilities. How many yearly volunteer hours does your organization contribute to the community and how are those hours tracked or documented? Founder is a full-time volunteer. Please list the specific accomplishments your organization has achieved in the past 24 months: 3 introduction and orientation programs for 3 different consumer-oriented telehealth systems Please include any other pertinent information about your organization or this specific grant request that you feel would help the City in making its decision: KUBI telehealth pedestal will be used in information/demonstration sessions in using technology for FAMILY communication. Please attach documentation (meeting minutes or letter) to verify that your organization supports this application. Before submitting this application, please read and sign below: These funds will be utilized within the City of Ocoee or have a direct benefit to the citizens of the City of Ocoee. In accordance with the guidelines set forth in this application certified this 29 day of July , by DALLAS DEFEE Print Your NT- Signature Page 2—Community Grant Program Application SMART HOMES for VETS Inc 449 W. Silver Start Rd Suite 493 Ocoee, FL 34761 Announcing... Smart Homes for Vets AB The"idiot box"is no ' ioo longer an idiot... a :7; °D but a gateway to private health information& medical communication 7/28/ 2016 INFORMAL BOARD MEETING Attendance: DALLAS DEFEE JANE SPENCER KEN MCLEOD Discussion: 1. Business Plan for Quarter 3, 2016. DALLAS will acquire & install Web-based Fund Accounting Software. 2. SMART HOMES for VETS will apply for the CITY OF OCOEE Community Grant Program to fund acquisition of a KUBI telepresence portal to be used in live demonstrations of Family Health Monitoring. \ / A ___ Dallas DEFEE, CEO, Founder SMART HOMES for VETs Secretary INTERNAL REVENUE SERVICE • DEPARTMENT OF THE Thy F. 0. BOX 2508 CINCINNATI, OH 45201 JA N f L 2016 Employer Identification Number: Date: ri 47-5588085 DLN: 26053407001226 SMART HOMES FOR VETS INC Contact Person: PO BOX 7770973 CUSTOMER SERVICE ID# 31954 WINTER GARDEN, FL 34777-0000 Contact Telephone Number: (877) 829-5500 Accounting Period Ending: December. 31 Public Charity Status: 170 (b) (1) (A) (vi) Form 990/990-EZ/990-N Required: Yes Effective Date of Exemption: December 2, 2015 Contribution Deductibility: Yes Addendum Applies: No Dear Applicant: dera We're pleased to tell you we determined you're exempt from € l under Internal Revenue Code (IRC) Section 501(c) (3) . Donor! contributions they make to you under IRC Section 170. receive tax deductible bequests, devises, transfers or gift ' " t . x 2055, 2106, or 2522. This letter could help resolve status. Please keep it for your records. ,�` k" Organizations exempt under IRC Section 501(c) (3) a either public charities or private foundation. We � M charity under the IRC Section listed at the tcp 44 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 dual information return (Form 990 or Form 990-EZ) or electronic notice the e-Postcard) . If you don't file a required return or notice foX." consecutive years, your exempt status will be automatically 11nRAtiedLiti, If we indicated at the top of this letter that an addendum app ies, enclosed addendum is an integral g part of thin .letter. For important information about your'reaponsibilitiea .as a tax gy organization, go to www.irs.gov/charities. Enter "4221,PC.m ito view Publication 4221-PC, Compliance Guide for 50i(o) (a) which describes your recordkeeping, reporting,, and disclosure e4.41: ' 14400* Aw,AtAk Chief Financial Officer Department of Financial Services Bureau of Accounting 200 East Gaines Street Tallahassee.FL 323994354 Telephone:(950)413-5519 Fax:11150)413- 5550 Substitute Form WO In order to comply with Internal Revenue Service(IRS)regulations.we require taxpayer identification information.This information will be used to determine whether you will receive a Form 1099 for payment(*)made to you by an agency of the State of Florida.and whether payments are subject to Federal withholding.The Information provided below must match the information that you provide to the IRS for Income tax reputing.Federal law requires the State of Florida to take backup withholding from certain future payments if you fall to provide the Information requested. Taxpayer Identification Number(FEIN): 41-558808S Requered IRS Name:• SMAII1 HOMES FOR VETS INC Doing Business As Name: (krst 40 characters exactly as shown on your lax return I Primary Address Information(Address where form 1099 should be mailed) United States(Includes U.S.Possessions&APO*POIDPO) Foreign Country Attention of DALLAS DETEL In Care of: Address:- 449 W SILVER STAR RD SUITE 493 City:• OCOEE State: (FLORIDA :3 Zip Code:' 34/61 - ,1011011100011101111011011401‘ a t ;f:::„1? (clickqere for Business DesIgnatton definitions) C Corporation Nonresident alien Indian Tnbal Government S Corporation Partnership Non-Corporate Rental Agent Government Entity Limited Uability Company I Not for Profit .s° ACIMOCIONIMOMlifgi-A .--A,--01,-.44 (click here for Backup Withholding explanation) Under penalties of perjury.I certify that: 1. The number shown on this form s my correct taxpayer information AND 2. I am subject to backup wthriolding OR 3 I am not-subject to backup withholding because: (a)I am exempt from backup withholding (b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result or failure to report all interest or dividends,or (c)the IRS has notified me that I am no longer stabled to backup withholdrig AND 3.1 am a U.S.oilmen or other US.person(including US.resident alien) Certification Instructions:To certify the statement above,complete your information bearriv,as paperer,and then re-enter your password to subrat your electronic signature. Preparers Name:• DALLAS DEF EE Preparers Title: PRESIDENT r � All applicants must submit: 1. Letter of support on your organization's letterhead or copy of your meeting minutes. 2. Signature verifying the grant funds will benefit Ocoee citizens (See bottom of page 2). All new applicants must also submit: 3. IRS Tax exempt status letter. 4. W-9 form. For more information, please call Community Relations at (407) 905-3100 x 9-1530 or e-mail jwria htCci)_ocoee.ora. Mail or deliver applications to: Ocoee City Hall 150 N. Lakeshore Drive Ocoee, FL 34761 For Staff Use Only Date Application Received ( �h // ✓l Was Application Received Complete? If not,Date Application Returned Non-Profit Status: On file Attached Page 3-Community Grant Program Application CITY OF OCOEE Community Grant Program Application Funding Cycle: JULY 2016 When completing this application, use only the space provided. The only attachment should be the formal organizational support documentation (minutes or letter). Applicants may apply for any amount up to $500. DEADLINE to submit application: JULY 29, 2016 41 41 41 41 41 41 41 41 41 41 41 41 41 41 41 41 414141 41 41 41 41 41 41 41 41 41 41 0041 Name of Organization: 3T p ()ran *t-i Address of Organization: c LAM W . Co or o\ Qr1VC , Nee , FL 3L-110 I Contact person for this application: ils1\�5h k Cja(CtS (The contact member must be a member of the organization.)) Daytime phone number: y0 ) -25(P-q DO E-mail address: s\- L15 \/JO 4mGti • ccm What are you seeking grant money for? Please provide an itemized cost estimate for each item you plan to purchase. c,i,„,Mvo,s; („5 boa-(rek 5 ,5 ,, ' 360 h What dollar amount are you requesting? (The maximum grant award is $500.) 1500 Is your organization getting funding from any other source for this specific project? y-2S . Proy0- ►S ors -86i What is your organization's primary funding source? Commtlnl� (�0ryi-i 3rarN How much money does your organization receive from your primary funding source each year? 7.D 100 3J, boo What other sources of revenue does your organization have? f.na2userS What is your annual budget for this year? X5, 000 Last year? $ "?.01000 List the fundraisers your orga ization holds? Legoia_Ad h'th*s ( - � .�t\dop -a P®\\ �\ 0,ren�-s, Mac s p Fier' p ra,� ' AK•r.�om &T•A`e Or1cu.d 6 Sba r Beais C)kc ihiCk 1 A.. `�xv iekiss/�F�How many members, volunteers and/or paid employees es your organization have? 1p�D sHaookS -zoo k v ciA.x\VeeirS (f board ty\pxy\koOrS How many live in Ocoee? UUltr\c-.Jn NN) v'ok ess kA* 2 l-xard rr.-er efS Page 2-Community Grant Program Application How many clients does your organization serve? How many live in Ocoee? Schno Has your organization applied for a grant from the City before? \)-eS Did you receive a grant from the City of Ocoee? yes If yes, when, and ow much money did you receive? \5 — per /A-k\LAth aNtes S5OO Does your organization volunteer in the Ocoee community? If yes, what volunteer activities do you participate in? yeS &amber oC C_ryvn erc e_ Sm-aS GC- i,J,O. Does your organization provide a venue for Ocoee residents to volunteer? yeS How many yearly volunteer hours does your organization contribute to they community and how are those hours tracked or documented? ()orbit 3iS h /MoN sl mor4of ,1u.\y ( aci6 nS/ 'i 5.0\e )-)Off embCc testis rc1a116i w 1 cuN3 owr oS1 c� v OOuX ees-of ary n n S�e.e.fi5 Please list the speci tc accomplishments your organization has achievedrn the past 24 months: Qn-s-nc)ec crhxn1 5��1� j arNc3 Vas 'GAP \o.) 63(c a \ O C5 S a�\S 0S. c c s- lo 4 -ketOnef S) tchu��lS- Please include any other pertinent information about your organization or this specific grant request that you feel would help the City in making its decision: IA,P are et -cr�ncc( ovr .tear o4 s: no •\ r7N\k nq c arc) `r ce-cie err 1A he 1 pec) +-p ea r1l e_r \Cam' hours P rcLrn S anO S )ko∎ti rshti pS . Please attach documentation (meeting Minutes or letter) to verify that your organization supports this application. Before submitting this application, please read and sign below: These funds will be utilized within the City of Ocoee or have a direct benefit to the citizens of the City of Ocoee. In accordance with the guidelines set forth in this application certified this 3`14‘ day of 34 1y ,by 1\ c■ DC3.6CLS Print Your Name 9/x1.--OLJ-6C/3 Signature Page 3—Community Grant Program Application For more information, please call Community Relations at (407) 905-3100 x 9-1530 or e-mail jwriq ht(a�ocoee.orq. Mail or deliver applications to: Ocoee City Hall 150 N. Lakeshore Drive Ocoee, FL 34761 For Staff Use Only Date Application Received ?/ J6 PP P Was Application Received Complete? yieP — If not,Date Application Returned Non-Profit Status: On file Attached 5TAR3.of West Orange Suootle3 to A33$t ouR 5ttrdent3 o 504 03)orgonitotion S.T.A.R.S.of West Orange,Inc. 9401 West Colonial Drive,Suite 106 Ocoee,FL 34761 407-290-3009 July 12, 2016 To Whom It May Concern: Please note that we fully support the funding request submitted to the City of Ocoee's Community Grant application by the Executive Director, Allisha Douglas, of the S.T.A.R.S. of West Orange program. Sincerely, 411,7t-7/1 ‘ )211 - Peter Gibson President S.T.A.R.S. of West Orange li 'r`a (__(1 Paul Caswell Treasurer S.T.A.R.S. of West Orange CITY OF OCOEE Community Grant Program Application Funding Cycle: JULY 2016 When completing this application, use only the space provided. The only attachment should be the formal organizational support documentation (minutes or letter). Only one entity from each organization is eligible to apply for a grant,per cycle. Applicants may apply for any amount up to $500. DEADLINE to submit application: JULY 29, 2016 00 . 000O4. 4. 4. 4. 4. 4. 4. 4. 4. 4.4. 4. 4. 4. 4. 4. 4. .0 40. 4. 4. Name of Organization: TL c G-lob SI,J 1�,-• rte+ +N g L Address of Organization: 0°5 W l i.d cr y A • W:r`}cr-Grk ra c.. Contact person for this application: San Pd tc e r L k�c.441,./-c‘ 4 41,rc 1) tc (The contact member must be a member of the organization.) Daytime phone number:Ili 905 d 1 S E-mail address: AA-le s, r-t,n5Uyc Lov,c4.,H., What are you seeking grant money for? Please provide an itemized cost estimate for each item you plan to purchase.Curd;� r Qrc-4uca; J OCO C ch,L(.z,� r-cr,a,c 6W en.. 34- tesso w prv'!'ikc.t1 &A a t—rJucrot r .lc aG t11les$o (VS. S40 rrAovtl '12.4 What dollar amount are you requesting?(The maximum grant award is $500.) Sb o Is your organization getting funding from any other source for this specific project? YE s What is your organization's primary funding source? r /, 1 (.b ('On�rlktJ�'+��,3�tundrd�l,Si , orporC�G d,ro+kw,. 121d/D iDV�alaultlirs )1v% (-rer of cior:LAC-U -e1 tµ,(��NF-L►J How much money does your organization receive from your primary funding source each year? 1162,1( C,,,.*r:6l,o;,11C0410.►ail Q,tlrP,d�ti,o �a„ , Lt2k U+ ckla,N1 £S1(. 14 u J What other sources of revenue does your organization have? ('n L t C.e��ri bA►�.,s Own t,c, q v. (o&t,rve) e,scect*;'ur... a Ikc,- Wry kf.A41 e p f' What is your annual budget for this year? y'f��,�3 S� Last year? 1 IL 1 (Lo List the fundraisers your organization holds? , lei l Su cdto t Ah we-t s t( (oc..,ner hra/ku i ) b ri e. L t-tmArc.t How many members, volunteers and/or paid employees does your organization have? hre,v.biers ; toa-r\ed Yxec,,A► j ltlwkcers How many live in Ocoee? Oprrboci. Page 2—Community Grant Program Application • How many clients does your organization serve? aW , , tic How many live in Ocoee? OA Has your organization applied for a grant from the City before? Y�5 Did you receive a grant from the City of Ocoee? If yes, when, and how much money did you receive? F S-t d ►L July 2.015 414111 a1c,(G. Does your organization volunteer in the Ocoee community? If yes, what volunteer activities do you participate in? tip Does your organization provide a venue for Ocoee residents to volunteer? yes 5u Yr'rimer 1nof. hl) SW1f'^ irz2 s j an ,) 1C , [e 6ty How many yearly volunteer hours does your organization contribute to the community and how are those hours tracked or documented? 11 '�`` l� (�4- [,\bd l� -241S thaivi(AU e.Q_, Vb i ur,i'-err- Ske.e S� oar_ �Atc,4 ui.T Please list the specific accomplishments your organization has achieved in the past 24 months: � "^. N 24 it "� -s►, 1u-c, 2614 e SAJ In-)r.-,►n� r,s }�'t�a• e�l �b� dcsrruip c�,k;■at W 5i►,n-, sVNt vrt ska►lr { wrrL U r•-n l of clt� rap b_11,Py„_, Please include any other pertinent information about your organization or this specific grant request that you feel would help the City in 'raking its decision:Ike rcc,t� °. f txUtC ro—t. losk yrer .lolcxll us b prtvidt lle4sa".4 S si bl�' 46•6t b✓tiL o,X t4h- 1.$} `i.ti 'AA," ,rcof : l ess e..s Fo �► •1ckc nvr/ra... r. a c.J s-i 74 c o..4 14,, , St ON ( L)er .t (r dt4. SUJi,��$i S(Aeri�C. SIiL G4.,'Urr,. Cm,— 0c-06( O-r't Please attach documentation (meeting minutes or letter) to verify that your organization supports this application. see a j}c, ,L tc,t-{:, d sure./4, Before submitting this application, please read and sign below: These funds will be utilized within the City of Ocoee or have a direct benefit to the citizens of the City of Ocoee. In accordance with the guidelines set forth in this application certified this 016 day of UI 104, by Print Your Name /70 Sign. ure Page 3—Community Grant Program Application For more information, please call Community Relations at (407) 905-3100 x 9-1530 or e-mail iwriq ht(a�ocoee.orq. Mail or deliver applications to: Ocoee City Hall 150 N. Lakeshore Drive Ocoee, FL 34761 For Staff Use Only Date Application Received �<�' 1 Was Application Received Complete? y,14 If not,Date Application Returned Non-Profit Status: On file Attached The Gift of Swimming, Inc., NPO 205 Windermere Road • Winter Garden, FL 34787 407-905-2815 407-905-5268 fax Att r/1 www.giftofswimming.org July 11, 2016 CITY OF OCOEE 150 N. Lakeshore Drive Ocoee, FL 34761 Dear City Commissioners, We are asking for your support so that we can continue to provide potentially life-saving swim lessons to the children of Ocoee that need it most. The community as a whole benefits when children learn team skills and good decision-making. The Gift of Swimming was established as a 501(c)3 charitable organization in 2003 to address a serious gap in swim education by providing swim training for disadvantaged and developmentally disabled children. Florida loses more children under age five to drowning than any other state. Annually in Florida, enough children to fill three to four preschool classrooms drown and do not live to see their fifth birthday. Every child needs to learn to swim. Every child deserves to learn to swim. Every child deserves to live. Thank you for your previous support and please consider approving this $500.00 Community Grant to provide this vital swim instruction to children that reside in Ocoee. r ely, Po , Joy NVjcGint, Founder theqiftofs ing0,vahoo.com The Gift of Swimming Inc.has received recognition of exemption under Section 501(c)3 of the Internal Revenue Code CITY OF OCOEE Community Grant Program Application Funding Cycle: JULY 2016 When completing this application, use only the space provided. The only attachment should be the formal organizational support documentation (minutes or letter). Applicants may apply for any amount up to $500. DEADLINE to submit application: JULY 29, 2016 41 41 41 41 41 41 41 41 41 41 41 41 41 41 41 41 4141 41 41 41 41 41 41 41 41 41 41 41 41 41 41 Name of Organization: Ocoee High School Science Olympiad Address of Organization: 1925 Ocoee Crown Point Parkway;Ocoee,FL 34761 Contact person for this application: Patricia DeNoon (The contact member must be a member of the organization.) Daytime phone number: 321-297-6174 E-mail address: patricia.denoon @ocps.net What are you seeking grant money for? Please provide an itemized cost estimate for each item you plan to purchase. Team Registration-$235;Competition and Volunteer Shirts-$265 What dollar amount are you requesting?(The maximum grant award is$500.) $500 Is your organization getting funding from any other source for this specific project? Membership Fees($25 per student) What is your organization's primary funding source? Membership Fees How much money does your organization receive from your primary funding source each year? $375 per team of 15 students What other sources of revenue does your organization have? Possible grant from Baptiste Orthodontics($600 toward supplies);Possible spirit night at local restaurant if needed. What is your annual budget for this year? ($1100-$1500) Last year? about$700(purchased most materials the year before with a grant and team did not happen) List the fundraisers your organization holds? Spirit night at local restaurant How many members, volunteers and/or paid employees does your organization have? 15-30 students(each team is up to 15);2-10 teachers/volunteers How many live in Ocoee? 60-75%of students live in Ocoee(others from Winter Garden,Apopka,Pine Hills);40-60%of teachers/volunteers Page 1-Community Grant Program Application How many clients does your organization serve? Our clients are the students at Ocoee High School How many live in Ocoee? 60-75%of OHS students are residents of Ocoee. Has your organization applied for a grant from the City before? No Did you receive a grant from the City of Ocoee? N/A If yes, when, and how much money did you receive? N/A Does your organization volunteer in the Ocoee community? If yes, what volunteer activities do you participate in? Yes,OHS Healthfair,OCPS West LC Elementary Science Fair, Does your organization provide a venue for Ocoee residents to volunteer? Yes,The regional and state Science Olympiad Competitions. How many yearly volunteer hours does your organization contribute to the community and how are those hours tracked or documented? 121 hours;Student Volunteer Logs Please list the specific accomplishments your organization has achieved in the past 24 months: 4th place in Robotic Arm at regionals;Participation in regionals and Envirothon competitions Please include any other pertinent information about your organization or this specific grant request that you feel would help the City in making its decision: The Science Olympiad Team will be entering it's second full year back after a few years off. It is an after school team that is growing and learning. It focuses on STEM events and gives students opportunities for the future. Please attach documentation (meeting minutes or letter) to verify that your organization supports this application. Before submitting this application, please read and sign below: These funds will be utilized within the City of Ocoee or have a direct benefit to the citizens of the City of Ocoee. In accordance with the guidelines set forth in this application certified this 28th day of July ,by Patricia DeNoon Print Your Name Patricia DeNoon Dp0seye1pAed0j, aDeNoon Doke 2018.0]7/00:52:15 d'01 Signature Page 2—Community Grant Program Application All applicants must submit: 1. Letter of support on your organization's letterhead or copy of your meeting minutes. 2. Signature verifying the grant funds will benefit Ocoee citizens (See bottom of page 2). All new applicants must also submit: 3. IRS Tax exempt status letter. 4. W-9 form. For more information, please call Community Relations at(407)905-3100 x 9-1530 or e-mail jwright(a�ocoee.orq. Mail or deliver applications to: Ocoee City Hall 150 N. Lakeshore Drive Ocoee, FL 34761 For Staff Use Only Date Application Received / GlO - � ((61#L-• Was Application Received Complete? If not,Date Application Returned Non-Profit Status: On file Attached Page 3-Community Grant Program Application . Ocoee High School 1925 Ocoee Crown Point Parkway Ocoee, FL 34761 Committed to building a "Healthy Community" for all students, where the fundamental purpose is learning. PHONE (407) 905-3000 FAX (407) 905-3099 To Whom It May Concern: This letter is to verify that the Science Olympiad team is a part of the Ocoee High School community. The team was restarted last year(2015-16)by sponsor, Patricia DeNoon, and is continuing with student President, Cameron Willson and Vice President Ann Marie Glidden. Sincerely, Patricia DeNoon Science Olympiad Sponsor ORANGE COUNTY PUBLIC SCHOOLS The Orange County School Board is an Equal Opportunity Employer. UNITED IN LEARNING U313D'tii FLORIDA Consumer's Certificate of Exemption R.04/11 DC ARTMENT Issued Pursuant to Chapter 212, Florida Statutes OF REVENUE 85-8012622264C-6 04/30/2015 04/30/2020 COUNTY GOVERNMENT Certificate Number Effective Date Expiration Date Exemption Category This certifies that ORANGE COUNTY SCHOOL BOARD 445 W AMELIA ST ORLANDO FL 32801-1129 is exempt from the payment of Florida sales and use tax on real property rented, transient rental property rented, tangible personal property purchased or rented, or services purchased. FLORIDA DR-14 Important Information for Exempt Organizations R.04/11 DEPARTMENT OF REVENUE ", 1.. - You must,provide,all vendors and suppliers with an exemption.certificate before making-tax-exempt purchases. See Rule 12A-1.038, Florida Administrative Code(F.A.C.). 2. Your.Consumer's Certificate of Exemption is to be used solely by your organization for your organization's customary nonprofit activities. 3. Purchases made by an individual on behalf of the organization are taxable, even if the individual will be reimbursed by the organization. 4. This exemption applies only to purchases your organization makes. The sale°or°lease to others of-tangible personal property, sleeping accommodations,or other real property is taxable. Your organization must register, and collect and remit sales and use tax on such taxable transactions. Note: Churches are exempt from this requirement except when they are the lessor of real property(Rule 12A-1.070, F.A.C.). 5. It is a criminal offense to fraudulently present this certificate to evade the payment of sales tax. Under no circumstances should this certificate be used for the personal benefit of any individual. Violators will be liable for payment of the sales tax plus a penalty of 200% of the tax, and may be subject to conviction of a third-degree felony. Any violation will require the revocation of this certificate. 6. If you have questions regarding your exemption certificate, please contact the Exemption Unit of Account Management at 800-352-3671. From the available options, select"Registration of Taxes,"then "Registration Information," and finally"Exemption Certificates and Nonprofit Entities." The mailing address is PO Box 6480, Tallahassee, FL 32314-6480. Form ■11'9 Request for Taxpayer Give Form to the (Rev.December 2014) requester.Do not Department of the Treasury Identification Number and Certification send to the IRS. Internal Revenue Service 1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank. School Board of Orange County,Florida N 2 Business name/disregarded entity name,if different from above • a) rn as a3 Check appropriate box for federal tax classification;check only one of the following seven boxes: 4 Exemptions(codes apply only to Individual/sole proprietor or certain entities,not individuals;see p p ❑ C Corporation ❑S Corporation ❑ Partnership ❑Trust/estate instructions on page 3): a c single-member LLC Limited liability company.Enter the tax classification(C=C corporation,S=S corporation,P=partnership)► Exempt payee code(if any) X �`= tY P Y• ( rP P P P) `o g Note.For a single-member LLC that is disregarded,do not check LLC;check the appropriate box in the line above for Exemption from FATCA reporting c In the tax classification of the single-member owner. code(if any) ac u ra Other(see instructions)► Public School System (Applies to accounts maintained outside as U.S.) E 5 Address(number,street,and apt.or suite no.) Requester's name and address(optional) 1 445 West Amelia Street m 6 City,state,and ZIP code •• Orlando,FL 32801 7 List account number(s)here(optional) Part I Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid I Social security number I backup withholding.For individuals,this is generally your social security number(SSN).However,for a - resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other - - entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN on page 3. or Note.If the account is in more than one name,see the instructions for line 1 and the chart on page 4 for I Employer identification number I guidelines on whose number to enter. - G-q - 0 v 0 1 el I Part II Certification Under penalties of perjury,I certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and 2. I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding;and 3. I am a U.S.citizen or other U.S.person(defined below);and 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct. Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions on page 3. Sign Si s.gnature of 4 (Li R, Here U.S.person Date P. General Instructions •Form 1098(home mortgage interest),1098-E(student loan interest),1098-1 (tuition) Section references are to the Internal Revenue Code unless otherwise noted. •Form 1099-C(canceled debt) Future developments.Information about developments affecting Form W-9(such •Form 1099-A(acquisition or abandonment of secured property) as legislation enacted after we release it)is at www.irs.gov/fw9. Use Form W-9 only if you are a U.S.person(including a resident alien),to Purpose of Form provide your correct TIN. An individual or entity(Form W-9 requester)who is required to file an information If you do not return Form W-9 to the requester with a TIN,you might be subject return with the IRS must obtain your correct taxpayer identification number(TIN) to backup withholding.See What is backup withholding?on page 2. which may be your social security number(SSN),individual taxpayer identification By signing the filled-out form,you: number(ITIN),adoption taxpayer identification number(ATIN),or employer 1.Certify that the TIN you are giving is correct(or you are waiting for a number identification number(EIN),to report on an information return the amount paid to to be issued), you,or other amount reportable on an information return.Examples of information returns include,but are not limited to,the following: 2.Certify that you are not subject to backup withholding,or •Form 1099-INT(interest earned or paid) 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If •Form 1099-DIV(dividends,including those from stocks or mutual funds) applicable,you are also certifying that as a U.S.person,your allocable share of any partnership income from a U.S.trade or business is not subject to the •Form 1099-MISC(various types of income,prizes,awards,or gross proceeds) withholding tax on foreign partners'share of effectively connected income,and •Form 1099-B(stock or mutual fund sales and certain other transactions by 4.Certify that FATCA codes)entered on this form(if any)indicating that you are brokers) exempt from the FATCA reporting,is correct.See What is FATCA reporting?on •Form 1099-S(proceeds from real estate transactions) page 2 for further information. •Form 1099-K(merchant card and third party network transactions) Cat.No.10231X Form W-9(Rev.12-2014) CITY OF OCOEE Community Grant Program Application Funding Cycle: JULY 2016 When completing this application, use only the space provided. The only attachment should be the formal organizational support documentation (minutes or letter). Only one entity from each organization is eligible to apply for a grant, per cycle, Applicants may apply for any amount up to $500. DEADLINE to submit application: JULY 29, 2016 000000000000000 ® 0000000000000000 Name of Organization: Adult Literacy League, Inc. Address of Organization: 345 W. Michigan Street, #100, Orlando, FL 32806 Contact person for this application: Joyce Whidden, Executive Director (The contact member must be a member of the organization.) Daytime phone number: 407-422-1540 E-mail address: iwhidden @adultliteracyleague.org What are you seeking grant money for? Please provide an itemized cost estimate for each item you plan to purchase. We request$500 towards curriculum and materials to benefit Ocoee students. What dollar amount are you requesting? (The maximum grant award is $500.) $500.00 Is your organization getting funding from any other source for this specific project? No other funding specific to the number of Ocoee students served has been received. What is your organization's primary funding source? We have no single dominant funder but receive support from foundations,corporations, individuals and government. How much money does your organization receive from your primary funding source each year? Our largest current funder is Heart of Florida United Way at$65,300. What other sources of revenue does your organization have? Besides the list above, we also hold a special event, Reading between the Wines. What is your annual budget for this year? $671,280 Last year? List the fundraisers your organization holds? Only one: Reading between the Wines. How many members, volunteers and/or paid employees does your organization have? 425 How many live in Ocoee? 22 current tutors/volunteers live in Ocoee Page 1—Community Grant Program Application How many clients does your organization serve? 1100 students currently being served How many live in Ocoee? 32 current students in Ocoee Has your organization applied for a grant from the City before? Yes Did you receive a grant from the City of Ocoee? Yes If yes, when, and how much money did you receive? $500 in 2014 Does your organization volunteer in the Ocoee community? If yes, what volunteer activities do you participate in? We have tutors volunteering for us in Ocoee. Does your organization provide a venue for Ocoee residents to volunteer? Ocoee residents volunteer at the nearest library to where they live. How many yearly volunteer hours does your organization contribute to the community and how are those hours tracked or documented? 9,000 hours annually tracked through online reports. Please list the specific accomplishments your organization has achieved in the past 24 months: Increased the number of students served by 10%and increased successful outcomes by 15%. Please include any other pertinent information about your organization or this specific grant request that you feel would help the City in making its decision: Our organization provides both Adult Basic Education and English Language Literacy to benefit the citizens of Ocoee. This addresses a significant community need. Please attach documentation (meeting minutes or letter) to verify that your organization supports this application. Before submitting this application, please read and sign below: These funds will be utilized within the City of Ocoee or have a direct benefit to the citizens of the City of Ocoee. In accordance with the guidelines set forth in this application certified this 26th day of July , by Joyce Whidden, Executive Director Print Your Name S iM re Donn 9_Pnmmimni+%,rron+Drnnrm Annliro+inn All applicants must submit: 1. Letter of support on your organization's letterhead or copy of your meeting minutes. 2. Signature verifying the grant funds will benefit Ocoee citizens (See bottom of page 2). All new applicants must also submit: 3. IRS Tax exempt status letter. 4. W-9 form. For more information, please call Community Relations at (407) 905-3100 x 9-1530 or e-mail jwright ar7ocoee.org. Mail or deliver applications to: Ocoee City Hall 150 N. Lakeshore Drive Ocoee, FL 34761 For Staff Use Only Date Application Received' /6. Was Application Received Complete? If not,Date Application Returned Non-Profit Status: On file Attached Page 3—Community Grant Program Application Internal Revenue Service Department of the Treasury P. O. Box 2508 Date: February 21 , 2007 Cincinnati, OH 45201 Person to Contact: ADULT LITERACY LEAGUE INC Mr. Schatz ID 31-08701 345 W MICHIGAN ST STE 100 Customer Service Representative ORLANDO FL 32806-4465 Toll Free Telephone Number: 877-829-5500 Federal Identification Number: 23-7076600 Dear Sir or Madam: This is in response to your request of February 21, 2007, regarding your organization's tax-exempt status. In May 1985 we issued a determination letter that recognized your organization as exempt from federal income tax. Our records indicate that your organization is currently exempt under section 501(c)(3) of the Internal Revenue Code. Our records indicate that your organization is also classified as a public charity under sections 509(a)(1) and 170(b)(1)(A)(vi) of the Internal Revenue Code. Our records indicate that contributions to your organization are deductible under section 170 of the Code, and that you are qualified to receive tax deductible bequests, devises, transfers or gifts under section 2055, 2106 or 2522 of the Internal Revenue Code. If you have any questions, please call us at the telephone number shown in the heading of this letter. Sincerely, 7)( *O Michele M. Sullivan, Oper. Mgr. Accounts Management Operations 1 • Form 1N-9 Request for Taxpayer Give Form to the requester.Do not ue eqs (Rev.December 2014) identification Number and Certification red s to theIRS. Department of the Treasury Internal Revenue Service 1 Name(as shown on your income tax return).Name is required on this line;do not leave this line blank. Adult Literacy League,Inc. cv 2 Business name/disregarded entity name,if different from above N a) ca 4 Exemptions(codes apply only• 3 Check appropriate box for federal tax classification;check only one of the following seven boxes: P ,. pp y on to • certain entities,not individuals;see o ❑IndividuaVsole proprietor or 51 C Corporation ❑S Corporation ❑ Partnership ❑Trust/estate instructions on page 3): a c single-member LLC Exempt payee code(if any) tv ❑Umited liability company.Enter the tax classification(C.0 corporation,54 corporation,P=partnership)► Note.For a single-member LLC that is disregarded,do not check LLC;check the appropriate box In the line above for Exemption from FATCA reporting `o code(if any) � H the tax classification of the single member owner. 'c C (Applies to accounls maintained outside de U.S.) a O ❑Other(see instructions}► ri 5 Address(number,street,and apt.or suite no.) Requester's name and address(optional) 0 fl- 345 W.Michigan Street,#100 W 6 City,state,and ZIP code d • rn Orlando, FL 32806 7 List account number(s)here(optional) Part I Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line t to avoid I Social security number backup withholding.For individuals,this is generally your social security number(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the Part I instructions on page 3.For other - 1 - entities,it is your employer identification number(EIN).If you do not have a number,see How to get a TIN on page 3. Or Note.If the account is in more than one name,see the instructions for line 1 and the chart on page 4 for I Employer Identification number guidelines on whose number to enter. 2 3 - 7 0 7 6 6 0 0 Part II Certification Under penalties of perjury,I certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me);and 2. I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue , Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding;and 3. I am a U.S.citizen or other U.S.person(defined below);and 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct. Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the . instructions on page 3. t / Sign Signature of --''�� ' '} l ( /Here U.S.person► ( / /j'( .:{��,,4 �• -�"'� Date► v` 11 kk??General Instructiois •Form 1098(home mortgage IntereAf>92,....ts 1098-E(student loan interest),1098-T (tuition) Section references are to the Internal Revenue Code unless otherwise noted. •Form 1099-C(canceled debt) Future developments.Information about developments affecting Form W-9(such •Form 1099-A(acquisition or abandonment of secured property) as legislation enacted after we release it)is at www.irs.govffw9. Use Form W-9 only if you are a U.S.person(including a resident alien),to Purpose of Form provide your correct TIN. Art individual or entity(Form W-9 requester)who is required to file an information if you do not return Form W-9 to the requester with a TNN,you might be sub/ect return with the IRS must obtain your correct taxpayer identification number(TIN) to backup withholding.See What is backup withholding?on page 2. which may be your social security number(SSN),individual taxpayer identification By signing the filled-out form,you: number(ITIN),adoption taxpayer identification number(ATIN),or employer 1.Certify that the TIN you are giving is correct(or you are waiting for a number identification number(EIN),to report on an information return the amount paid to to be issued), you,or other amount reportable on an information return.Examples of information 2.Certify that you are not subject to backup withholding,or returns include,but are not limited to,the following: •Form 1099-INT(interest earned or paid) 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If applicable,you are also certifying that as a U.S.person,your allocable share of •Form 1099-DIV(dividends,including those from stocks or mutual funds) any partnership income from a U.S.trade or business is not subject to the •Form 1099-MISC(various types of Income,prizes,awards,or gross proceeds) withholding tax on foreign partners'share of effectively connected income,and •Form 1099-B(stock or mutual fund sales'and certain other transactions by 4.Certify that FATCA code(s)entered on this form(if any)indicating that you are brokers) exempt from the FATCA reporting,is correct.See What is FATCA reporting?on •Form 1099-S(proceeds from real estate transactions) page 2 for further information. •Form 1099-K(merchant card and third party network transactions) Cat.No.10231X Form W-9(Rev.12-2014) ( Adult iteracy L League July 26, 2016 Community Grant Program Application City of Ocoee Ocoee City Hall 150 N. Lakeshore Drive Ocoee, FL 34761 Dear City of Ocoee: The Board of Directors extends its gratitude to the City of Ocoee for the opportunity to apply for this Community Grant Program support in the amount of$500. The Board supports this application and looks forward to answering any questions the City of Ocoee may have. We are grateful to our long-time volunteer, Ocoee resident, Cathy Carpenter,for her volunteer service and her assistance in facilitating this grant process for the Adult Literacy League. Kind regards,1 Joyc: 'den Ex: ,e Director 345 W.Michigan Street,Suite 100 • Orlando,FL 32806 • Phone:407.422.1540 • Fax:407.422.1529 E-mail: info @adultliteracyleague.org • www.adultliteracyleague.org A COPY OF THE OFFICIAL,REGISTRATION AND FINANCIAL INFORMATION FOR ORGANIZATION#SC-01925 MAY BE OBTAINED FROM THE DIVISION OF CONSUMER AFFAIRS BY CALLING IOU,FREE WITHIN THE STATE 1-800-435-04?2,REGISTRATION DOES NOT IMPLY ENDORSEMENT APPROVAL,OR RECOMMENDATION BYTHE STATE.NO OUTSIDE INDIVIDUAL OR FIRM HAS BEEN HIRED TO SOLICIT FUNDS ON BEHALF OF THIS ORGANIZATION.100%OF CHARITABLE GIFTS ARE RETAINED BY THIS ORGANIZATION. • Form W-9(Rev.12-2014) Page 2 Note.If you are a U.S.person and a requester gives you a form other than Form 3.The IRS tells the requester that you furnished an incorrect TIN, W-9 to request your TIN,you must use the requester's form if it is substantially 4.The IRS tells you that you are subject to backup withholding because you did similar to this Form W-9. not report all your interest and dividends on your tax return(for reportable interest Definition of a V.S.person.For federal tax purposes,you are considered a U.S. and dividends only),or person if you are: 5.You do not certify to the requester that you are not subject to backup •An individual who Is a U.S.citizen or U.S.resident alien; withholding under 4 above(for reportable interest and dividend accounts opened •A partnership,corporation,company,or association created or organized in the after 1983 only). United States or under the laws of the United States; Certain payees and payments are exempt from backup withholding.See Exempt •An estate ;or estate foreign other than a payee code on page 3 and the separate Instructions for the Requester of Form ( 9 ) W-9 for more information. •A domestic trust(as defined in Regulations section 301,7701-7). Also see Special rules for partnerships above. Special rules for partnerships.Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section What is FATCA reporting? 1446 on any foreign partners'share of effectively connected taxable income from such business.Further,in certain cases where a Form W-9 has not been received, The Foreign Account Tax Compliance Act(FATCA)requires a participating foreign the rules under section 1446 require a partnership to presume that a partner is a financial institution to report all United States account holders that are specified foreign person,and pay the section 1446 withholding tax.Therefore,if you are a United States persons.Certain payees are exempt from FATCA reporting.See U.S.person that is a partner in a partnership conducting a trade or business in the Exemption from FATCA reporting code on page 3 and the Instructions for the United States,provide Form W-9 to the partnership to establish your U.S.status Requester of Form W-9 for more information. and avoid section 1446 withholding on your share of partnership income. Updating Your Information In the cases below,the following person must give Form W-9 to the partnership for purposes of establishing its U.S.status and avoiding withholding on its You must provide updated Information to any person to whom you claimed to be allocable share of net income from the partnership conducting a trade or business an exempt payee if you are no longer an exempt payee and anticipate receiving in the United States: reportable payments in the future from this person.For example,you may need to •In the case of a disregarded entity with a U.S.owner,the U.S.owner of the provide updated information it you are a C corporation that elects to be an S disregarded entity and not the entity; corporation,or if you no longer are tax exempt.In addition,you must furnish a new Form W-9 if the name or TIN changes for the account;for example,if the grantor •In the case of a grantor trust with a U.S.grantor or other U.S.owner,generally, of a grantor trust dies. the U.S.grantor or other U.S,owner of the grantor trust and not the trust;and •In the case of a U.S.trust(other than a grantor trust),the U.S.trust(other than a Penalties grantor trust)and not the beneficiaries of the trust. Failure to furnish TIN.If you fail to furnish your correct TIN to a requester,you are Foreign person.If you are a foreign person or the U.S.branch of a foreign bank subject to a penalty of$50 tor each such failure unless your failure is due to that has elected to be treated as a U.S.person,do not use Form W-9.Instead,use reasonable cause and not to willful neglect. the appropriate Form W-8 or Form 8233(see Publication 515,Withholding of Tax Civil penalty for false information with respect to withholding.If you make a on Nonresident Aliens and Foreign Entities). false statement with no reasonable basis that results in no backup withholding, Nonresident alien who becomes a resident alien.Generally,only a nonresident you are subject to a$500 penalty. alien individual may use the terms of a tax treaty to reduce or eliminate U.S.tax on Criminal penalty for falsifying information.Willfully falsifying certifications or certain types of income.However,most tax treaties contain a provision known as affirmations may subject you to criminal penalties including fines and/or a"saving clause,"Exceptions specified in the saving clause may permit an imprisonment. exemption from tax to continue for certain types of Income even after the payee has otherwise become a U.S.resident alien for tax purposes. Misuse of TINs.If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties. If you are a U.S.resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S.tax on certain types Specific Instructions of income,you must attach a statement to Form W-9 that specifies the following p five items: 1.The treaty country.Generally,this must be the same treaty under which you Line 1 claimed exemption from tax as a nonresident alien. You must enter one of the following on this line;do not leave this line blank.The 2.The treaty article addressing the income. name should match the name on your tax return. 3.The article number(or location)in the tax treaty that contains the saving If this Form W-9 is for a joint account,list first,and then circle,the name of the clause and its exceptions. person or entity whose number you entered in Part I of Form W-9. 4.The type and amount of income that qualifies for the exemption from tax. a. Individual.Generally,enter the name shown on your tax return.If you have changed your last name without informing the Social Security Administration(SSA) 5.Sufficient facts to justify the exemption from tax under the terms of the treaty of the name change,enter your first name,the last name as shown on your social article. security card,and your new last name. Example.Article 20 of the U.S.-China Income tax treaty allows an exemption Note.ITIN applicant;Enter your individual name as it was entered on your Form from tax for scholarship income received by a Chinese student temporarily present W-7 application,line la.This should also be the same as the name you entered on in the United States.Under U.S.law,this student will become a resident alien for the Form 1040/1040A/1040EZ you filed with your application. tax purposes it his or her stay in the United States exceeds 5 calendar years. b. Sole proprietor or single-member LLC.Enter your individual name as However,paragraph s the r 2 io of the of Article Protocol 20 t to the u to apply even after the April 30, shown on your 1040/1040A11040EZ on line 1.You may enter your business,trade, • Chinese allows the provisions of resident 20 to continue to aStat even Cher the or"doing business as"(DBA)name on line 2. Chinese student becomes a resident alien of the United States.A Chinese student who qualifies for this exception(under paragraph 2 of the first protocol)and is c. Partnership,LLC that is not a single-member LLC,C Corporation,or S relying on this exception to claim an exemption from tax on his or her scholarship Corporation.Enter the entity's name as shown on the entity's tax return on line 1 or fellowship income would attach to Form W-9 a statement that includes the and any business,trade,or DBA name on line 2. information described above to support that exemption. d. Other entities.Enter your name as shown on required U.S.federal tax If you are a nonresident alien or a foreign entity,give the requester the documents on line 1.This name should match the name shown on the charter or appropriate completed Form W-8 or Form 8233. other legal document creating the entity.You may enter any business,trade,or DBA name on line 2. Backup Withholding e. Disregarded entity.For U.S.federal tax purposes,an entity that is What is backup withholding?Persons making certain payments to you must disregarded as an entity separate from its owner is treated as a'"disregarded under certain conditions withhold and pay to the IRS 28%of such payments.This entity." See Regulations section 301.7701-2(c)(2)(iii).Enter the owner's name on is called"backup withholding." Payments that may be subject to backup line 1.The name of the entity entered on line 1 should never be a disregarded withholding include interest,tax-exempt interest,dividends,broker and barter entity.The name on line 1 should be the name shown on the income tax return on exchange transactions,rents,royalties,nonemptoyee pay,payments made in which the income should be reported.For example,if a foreign LLC that is treated settlement of payment card and third party network transactions,and certain as a disregarded entity for U.S,federal tax purposes has a single owner that is a payments from fishing boat operators.Real estate transactions are not subject to U.S.person,the U.S.owner's name is required to be provided on line 1.If the backup withholding. direct owner of the entity is also a disregarded entity,enter the first owner that is You will not be subject to backup withholding on payments you receive if you not disregarded for federal tax purposes.Enter the disregarded entity's name on give the requester your correct TIN,make the proper certifications,and report all line 2,"Business name/disregarded entity name."II the owner of the disregarded g nester eq Y if i d t entity is a foreign person,the owner must complete an appropriate Form W-8 your taxable interest and dividends on your tax return. instead of a Form W-9. This is the case even if the foreign person has a U.S.TIN. Payments you receive will be subject to backup withholding If: 1.You do not furnish your TIN to the requester, 2.You do not certify your TIN when required(see the Part II instructions on page 3 for details), Form W-9(Rev.12-2014) Page 3 Line 2 2 However,the following payments made to a corporation and reportable on Form If you have a business name,trade name,DBA name,or disregarded entity name, 1099-MISC are not exempt from backup withholding:medical and health care you may enter it on line 2. payments,attorneys'fees,gross proceeds paid to an attorney reportable under section 6045(0,and payments for services paid by a federal executive agency. Line 3 Exemption from FATCA reporting code.The following codes identify payees Check the appropriate box in line 3 for the U.S.federal tax classification of the that are exempt from reporting under FATCA.These codes apply to persons person whose name is entered on line 1.Check only one box in line 3. submitting this form for accounts maintained outside of the United States by . Company(LLC).If the name on line 1 is an LLC treated as a certain foreign financial institutions.Therefore,if you are only submitting this form Limited Liability P y( ) for an account you hold in the United States,you may leave this field blank, partnership for U.S.federal tax purposes,check the"Limited Liability Company" Consult with the person requesting this form if you are uncertain if the financial box and enter"P"in the space provided.If the LLC has filed Form 8832 or 2553 to institution is subject to these requirements.A requester may indicate that a code is be taxed as a corporation,check the"Limited Liability Company"box and In the not required by providing you with a Form W-9 with"Not Applicable"(or any space provided enter"C"for C corporation or"S"for S corporation.If it is a similar indication)written or printed on the line for a FATCA exemption code. single-member LLC that is a disregarded entity,do not check the"Limited Liability Company"box;instead check the first box in line 3"IndividuaVsole proprietor or A—An organization exempt from tax under section 501(a)or any Individual single-member LLC." retirement plan as defined in section 7701(a)(37) B—The United States or any of Its agencies or instrumentalities Line 4,Exemptions C—A state,the District of Columbia,a U.S.commonwealth or possession,or If you are exempt from backup withholding and/or FATCA reporting,enter in the any of their political subdivisions or instrumentalities appropriate space in line 4 any code(s)that may apply to you. D—A corporation the stock of which is regularly traded on one or more Exempt payee code. established securities markets,as described in Regulations section • Generally,individuals(including sole proprietors)are not exempt from backup 1.1472-1(c)(1)(i) withholding. E—A corporation that is a member of the same expanded affiliated group as a • Except as provided below,corporations are exempt from backup withholding corporation described in Regulations section 1.1472-1(c)(1Hi) for certain payments,including interest and dividends. F—A dealer in securities,commodities,or derivative financial instruments • Corporations are not exempt from backup withholding for payments made in (including notional principal contracts,futures,forwards,and options)that is settlement of payment card or third party network transactions. registered as such under the laws of the United States or any state • Corporations are not exempt from backup withholding with respect to attorneys' G—A real estate investment trust fees or gross proceeds paid to attorneys,and corporations that provide medical or H—A regulated investment company as defined in section 851 or an entity health care services are not exempt with respect to payments reportable on Form registered at all times during the tax year under the Investment Company Act of 1099-MISC. 1940 The following codes identify payees that are exempt from backup withholding. I—A common trust fund as defined In section 584(a) Enter the appropriate code in the space in line 4. 1—An organization exempt from tax under section 501(a),any IRA,or a —A bank as defined in section 581 custodial account under section 403(b)(7)if the account satisfies the requirements K—A broker of section 401(0(2) L—A trust exempt from tax under section 664 or described in section 4947(a((1) 2—The United States or any of its agencies or instrumentalities M—A tax exempt trust under a section 403(b)plan or section 457(g)plan 3—A state,the District of Columbia,a U.S.commonwealth or possession,or Note.You may wish to consult with the financial institution requesting this form to any of their political subdivisions or instrumentalities determine whether the FATCA code and/or exempt payee code should be • 4—A foreign govemment or any of its political subdivisions,agencies,or completed. instrumentalities Line 5 5—A corporation Enter your address(number,street,and apartment or suite number).This is where 6—A dealer in securities or commodities required to register in the United the requester of this Form W-9 will mail your information returns. States,the District of Columbia,or a U.S.commonwealth or possession 7—A futures commission merchant registered with the Commodity Futures Line 6 Trading Commission Enter your city,state,and ZIP code. 8—A real estate investment trust 9—An entity registered at all times during the tax year under the Investment Part I.Taxpayer Identification Number(TIN) Company Act of 1940 Enter your TIN In the appropriate box.If you are a resident alien and you do not 10—A common trust fund operated by a bank under section 584(a) have and are not eligible to get an SSN,your TIN is your IRS individual taxpayer identification number(ITIN).Enter it in the social security number box.If you do not 11—A financial institution have an ITIN,see How to get a TIN below. 12—A middleman known in the investment community as a nominee or If you are a sole proprietor and you have an EIN,you may enter either your SSN custodian or EIN.However,the IRS prefers that you use your SSN. 13—A trust exempt from tax under section 664 or described in section 4947 If you are a single-member LLC that is disregarded as an entity separate from its The following chart shows types of payments that may be exempt from backup owner(see Limited Liability Company(LLC)on this page),enter the owner's SSN withholding.The chart applies to the exempt payees listed above,1 through 13. (or EIN,it the owner has one).Do not enter the disregarded entity's EIN.If the LLC is classified as a corporation or partnership,enter the entity's EIN. IF the payment is for... THEN the payment is exempt for... Note.See the chart on page 4 for further clarification of name and TIN combinations. Interest and dividend payments All exempt payees except How to get a TIN.If you do not have a TIN.apply for one Immediately.To apply for 7 for an SSN,get Form SS-5,Application for a Social Security Card,from your local SSA office or get this form online at www.ssa.gov.You may also get this form by Broker transactions Exempt payees 1 through 4 and 6 calling 1-800-772-1213.Use Form W-7,Application for IRS Individual Taxpayer through 11 and all C corporations.S Identification Number,to apply for an ITIN,or Form SS-4,Application for Employer corporations must not enter an exempt Identification Number,to apply for an EIN.You can apply for an EIN online by payee code because they are exempt accessing the IRS website at www.irs.govlbuslnesses and clicking on Employer only for sales of noncovered securities Identification Number(EIN)under Starting a Business,You can get Forms W-7 and acquired prior to 2012. SS-4 from the IRS by visiting IRS.gov or by calling 1.800-TAX-FORM (1-800-829-3676). Barter exchange transactions and Exempt payees 1 through 4 11 you are asked to complete Form W-9 but do not have a TIN,apply for a TIN patronage dividends and write"Applied For"in the space for the TIN,sign and date the form,and give it to the requester.For interest and dividend payments,and certain payments made Payments over$600 required to be Generally,exempt payees z with respect to readily tradable instruments,generally you will have 60 days to get reported and direct sales over$5,000 1 1 through 5 a TIN and give it to the requester before you are subject to backup withholding on payments.The 60-day rule does not apply to other types of payments.You will be Payments made in settlement of Exempt payees 1 through 4 subject to backup withholding on all such payments until you provide your TIN to payment card or third party network the requester. transactions Note.Entering"Applied For"means that you have already applied for a TIN or that you intend to apply for one soon. r See Form 1099-MISC,Miscellaneous Income,and its instructions. Caution:A disregarded U.S.entity that has a foreign owner must use the appropriate Form W-8. • Form W-9(Rev.12-2014) Page 4 Part II.Certification 'You must show your individual name and you may also enter your business or DBA name on To establish to the withholding agent that you are a U.S. arson,or resident alien, the"Business name/disregarded entity"name line.You may use either your SSN or EIN(if you 9 9 Y person. have one),but the IRS encourages you to use your SSN. sign Form W-9.You may be requested to sign by the withholding agent even it List first and circle the name of the trust,estate,or pension trust.(Do not furnish the TIN of the items 1,4,or 5 below indicate otherwise, personal representative or trustee unless the legal entity itself Is not designated in the account For a joint account,only the person whose TIN Is shown in Part I should sign title.)Also see Special rules for partnerships on page 2. (when required).In the case of a disregarded entity,the person identified on line 1 'Note.Grantor also must provide a Form W-9 to trustee of trust. must sign.Exempt payees,see Exempt payee code earlier. Note.If no name is circled when more than one name is listed,the number will be Signature requirements.Complete the certification as indicated in items 1 considered to be that of the first name listed. through 5 below. Secure Your Tax Records from Identity Theft 1.Interest,dividend,and barter exchange accounts opened before 1984 and broker accounts considered active during 1983.You must give your Identity theft occurs when someone uses your personal information such as your correct TIN,but you do not have to sign the certification. name,SSN,or other identifying information,without your permission,to commit 2.Interest,dividend,broker,and barter exchange accounts opened after fraud or other crimes.An identity thief may use your SSN to get a job or may file a 1983 and broker accounts considered inactive during 1983.You must sign the tax return using your SSN to receive a refund, certification or backup withholding will apply.If you are subject to backup To reduce your risk: withholding and you are merely providing your correct TIN to the requester,you •Protect your SSN, must cross out item 2 in the certification before signing the form. 3.Real estate transactions.You must sign the certification.You may cross out 'Ensure your employer is protecting your SSN,and item 2 of the certification. •Be careful when choosing a tax preparer. 4.Other payments.You must give your correct TIN,but you do not have to sign If your tax records are affected by identity theft and you receive a notice from the certification unless you have been notified that you have previously given an the IRS,respond right away to the name and phone number printed on the IRS incorrect TIN."Other payments"include payments made in the course of the notice or letter. requester's trade or business for rents,royalties,goods(other than bills for if your tax records are not currently affected by identity theft but you think you merchandise),medical and health care services(including payments to are at risk due to a lost or stolen purse or wallet,questionable credit card activity corporations),payments to a nonemployee for services,payments made In or credit report,contact the IRS Identity Theft Hotline at 1-800-908-4490 or submit settlement of payment card and third party network transactions,payments to Form 14039. certain fishing boat crew members and fishermen,and gross proceeds paid to For more information,see Publication 4535,Identity Theft Prevention and Victim attorneys(including payments to corporations). Assistance. 5.Mortgage interest paid by you,acquisition or abandonment of secured Victims of identity theft who are experiencing economic harm or a system property,cancellation of debt,qualified tuition program payments(under problem,or are seeking help in resolving tax problems that have not been resolved section 529),IRA,Coverdell ESA,Archer MSA or NSA contributions or through normal channels,may be eligible for Taxpayer Advocate Service(fAS) pension distributions,and pension distributions.You must give your correct TIN,but you assistance.You can reach TAS by calling the TAS toll-free case intake line at do not have to sign the certification. 1-877-777-4778 or TTY/TOD 1-800-829-4059. What Name and Number To Give the Requester Protect yourself from suspicious emails or phishing schemes. Phishing is the creation and use of email and websites designed to mimic legitimate business For this type of account: Give name and SSN of: emaiis and websites.The most common act Is sending an email to a user falsely 1.Individual The individual claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft. 2.Two or more individuals(joint The actual owner of the account or, The IRS does not initiate contacts with taxpayers via emails.Also,the IRS does account) if combined funds,the first not request personal detailed information through email or ask taxpayers for the individual on the account' PIN numbers,passwords,or similar secret access information for their credit card, 3.Custodian account of a minor The minor' bank,or other financial accounts. (Uniform Gift to Minors Act) If you receive an unsolicited email claiming to be from the IRS,forward this 4.a.The usual revocable savings The grantor-trustee' message to phishingOirs.gov.You may also report misuse of the IRS name,logo, trust(grantor is also trustee) or other IRS property to the Treasury Inspector General for Tax Administration b.So-called trust account that is The actual owner' (TIGTA)at 1-800-366-4484.You can forward suspicious emails to the Federal not a legal or valid trust under Trade Commission at:spamOuce.gov or contact them at www.ftc.gov/idtheft or state law t-877-IDTHEFT(1-877-438-4338). 5.Sole proprietorship or disregarded The owner' Visit IRS.gov to learn more about identity theft and how to reduce your risk. entity owned by an individual 6.Grantor trust filing under Optional The grantor Privacy Act Notice Form 1099 Filing Method 1(see Regulations section 1,671-4(b)(2)(i) Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons(including federal agencies)who are required to file information returns with the IRS to report interest,dividends,or certain other income paid to For this type of account: Give name and EIN of: you;mortgage interest you paid;the acquisition or abandonment of secured 7.Disregarded entity not owned by an The owner property;the cancellation of debt;or contributions you made to an IRA,Archer individual MSA,or HSA.The person collecting this form uses the Information on the form to 8.A valid trust,estate,or pension trust Legal entity' file information returns with the IRS,reporting the above information.Routine uses of this information include giving it to the Department of Justice for civil and 9.Corporation or LLC electing The corporation criminal litigation and to cities,states,the District of Columbia,and U.S. corporate status on Form 8832 or commonwealths and possessions for use in administering their laws.The Form 2553 information also may be disclosed to other countries under a treaty,to federal and 10.Association,club,religious, The organization state agencies to enforce civil and criminal laws,or to federal taw enforcement and charitable,educational,or other tax- intelligence agencies to combat terrorism.You must provide your TiN whether or exempt organization not you are required to file a tax return.Under section 3406,payers must generally 11.Partnership or multi-member LLC The partnership withhold a percentage of taxable interest,dividend,and certain other payments to a payee who does not give a TIN to the payer.Certain penalties may also apply for 12.A broker or registered nominee The broker or nominee providing false or fraudulent information. 13.Account with the Department of The public entity Agriculture in the name of a public entity(such as a state or local government,school district,or prison)that receives agricultural program payments 14.Grantor trust filing under the Form The trust 1041 Filing Method or the Optional Form 1099 Filing Method 2(see Regulations section 1.671-4(b)(2)(i) (B)) 'List first and circle the name of the person whose number you furnish.It only one person on a pint account has an SSN,that person's number must be furnished. 2 Circle the minor's name and furnish the minor's SSN. -4- SOCIETY OF ST. VINCENT DE PAUL, If you have any questions, please contact the person whose name and telephone number are shown in the heading of this letter. Sincerely yours, Robert Choi Director, Exempt Organizations Rulings and Agreements Enclosure(s) : Publication 4221-PC Letter 2419 (DO/CO) -5- SOCIETY OF ST. VINCENT DE PAUL, Revenue Procedure 80-27, 1980-1 C.B. 677, section 4.02, part 6, provides that a group exemption letter may be issued covering subordinates, of which one or more have been organized prior to 15 months of the date of submission of the group exemption request, only if all subordinates agree to prospective exemption from the filing date of the group exemption request. Since you have subordinates that were organized prior to 15 months of the date of your application and your subordinates have agreed to prospective exemption, the exempt status of all of your subordinates is effective August 13, 2007 the date your request was submitted. Your subordinates are required to file Federal income tax return(s) , Form 1120 and pay taxes due, for each year or part of a year that ended prior to the effective date of your group exemption. UNRELATED BUSINESS INCOME Any of your subordinates that have over $1,000 in unrelated business income under Section 511 of the Code may be subject to file a Form 990-T, Exempt Organization Business Income Tax Return. In this letter we are not determining whether any of your subordinates, present or proposed activities are unrelated trade or business as defined in Section 513 of the Code. Letter 2419 (DO/CG) i CITY OF OCOEE Community Grant Program Application Funding Cycle: JULY 2016 When completing this application, use only the space provided. The only attachment should be the formal organizational support documentation (minutes or letter). Applicants may apply for any amount up to $500. DEADLINE to submit application: JULY 29, 2016 000000000000000000000 ® 000 ® 00000 Name of Organization: Soclay OF ST V//CIY / Gfe- }lid- RL SuRI�EC VM) C"AFFENcr Address of Organization: Pt/ �A =RCARbF/V VIII/ L4JlV D. Wrur Z C7i1 RoE�l, �Z 37�T Contact person for this application: R DER f 119/ff"A'4- (The contact member must be a member of the organization.) Daytime phone number: 01 876- LJ Z/N E-mail address:ZEUREF.93 YAHHcfl.C94 What are you seeking grant money for? Please pr�9vide an itemized cost estimate for each item you plan to purchase. T7) / "/c'T PEOP14. VE1VNG' "tap my/1%16 J//iR (,1�JGlrY Nu-5. What dollar amount are you requesting?(The maximum grant award is $500.) g`500 Is your organization getting funding from any other source for this specific project? IVO WRc5uk t_ o iz t " `-ic of ikdasol f?crkswave/ PO1Vi mvs) How much money does�y/our or ganization receive from your primary funding source each year? �(/pl�o(mnT ! # ^ac 1 611 What qther sou ices of revenue does your organization have? 5 FINOg/1s , cogpoRorf cowl-lops, z-IC/T FaA/P PAM TrPUBL)c. What is your annual budget for this ea ? IWO Pew'T MIT 16/1 P EF We CxfEcT TO /' r rif(sos As Pic. Last year? 4 yy/9 3`/ (iCTUAJ-) a O/5 List4e4 fKdaisers? or oaanization holds? OR„_ SOLICIT I T FUNDS fnT P1 )-I X. How many membe s, olunte rs and/or p id employees does your organization have? ft/ As r /4 (R-l� VOA1N?&X$) PR-10 Eil/''bYEE5 =O How many live in Ocoee? Few Page 2-Community Grant Program Application How many clients does your organization serve? Cao5 /'A/ i,Di51 F/tAtIL y OBERS How many live in Ocoee? ao15) F MIL y MCNR1fS Has your organization applied for a grant from the City before? YE; Did you receive a grant from the City of Ocoee? YES If yes, when, and how much money did you receive? R-06115- V)/.5 500 Does your organization volunteer in the Ocoee community? If yes, what volunteer activities do you participate in? YES, WE 1/1.5-1T C L I t-4/7-s hi HO/i/E.b F/A/A A/019-1, /4E2J> WMT U77LIT y 81Li5. Does our organization provide ven a for Ocoee residents to volunteer? YtS� WE Ask itak- Who IIT� MfsS Tb VOLuti 2 TO 110u' The Co/tW4')7y. How many yearly volunteer hours does your organization contribute to the community and how are those hours tracked or documented? 1911 He/Rs Al Ad15. SEyr7.-A y I PeR a at/al/ kkM Y- COA/Fat C'r Ep Ts lb DI DC EShi✓ au/i/C lL or aim-/l/DZ). Please list the specific accomplishments your organization has achieved in the past 24 months: AW/!ID TWO *50o SC1U-/9IPSft)� ?Z S7U /VTS TI/IS Ye 9R, WE V15/TF� a5'/ F"MlILl Es SAND PR)D 37 OW, TD / L-P CLI&/rs. W� Cori rn/Uea TD G)V� FDD D�4r/I Ti A/c 'J Oft „TO TO R i sr)m-t SEvlccc iN oc.O 774 rr' F$ 7)/c fl'E ss. Please include any of er pertinent information about your organization or this specific grant req est that you feel would help the Cit in making its decision: OUR C1 uReh Dc TEc FooD To C)-R1sr SERV)etS M OC66,e . E F,¢,K/L/ES wow 1 c ur C/A/CGU©JNG BEA5 141H-icy OUR CaVFERE,VCC Ayys >z=oR Please attach documentation (meeting minutes or letter) to verify that your organization supports this application. 15Eg Am D 7//d/6 /W 11/t/j-s,. Before submitting this application, please read and sign below: These funds will be utilized within the City of Ocoee or have a direct benefit to the citizens of the City of Ocoee. d In accordance with the guidelines set forth in this application certified this A ?' day of To-Y 2►at,, by ?oBFR r F6iJmNR • Print Your Name A I Signature // 1. Letter of support on your organization's letterhead or copy of your meeting minutes /2. Signature verifying the grant funds will benefit Ocoee citizens (See bottom of page 2) 13. IRS Tax exempt status letter ov/ti 4. W-9 form For more information, please call Community Relations at (407) 905-3100 x 9-1530 or e-mail iwright aC�ocoee.orq. Mail or deliver applications to: Ocoee City Hall 150 N. Lakeshore Drive Ocoee, FL 34761 For Staff Use Only / Date Application Received �� `�`/6 Was Application Received Complete? If not,Date Application Returned Non-Profit Status On file Attached 3 MOWN ((t@unn )-iJ = hb h (06,`"",i.....ST.VINCENT DE PAUL SOCIETY—RESURRECTION CONFERENCE MEETING MINUTES—JULY 18.2016 II;// Page 1 of 2 The meeting was called to order by Co-President Robert at approximately 6:33 pm with an opening prayer. The following members were present: Robert Fontana,Tony Calabro, Angie Calabro.Eloise Bakker, JoAnn Toruno,Maryori Escobar,Steve Labadie,Sharon Fontana,Joe Perez.Guest:German Escobar. • Robert introduced German Escobar,recipient of one of our scholarship awards. He is present to receive our$500.00 scholarship check to Valencia • Our Father,Hail Mary and Glory be to the Father prayers were said for the recovery of those who are ill and for the victims and families of the attacks on police around the country. • Joe read the minutes of the June 14,2016 meeting. The members present approved the minutes. • Eloise gave the treasurer's report. The balance in our savings account is$4,196.78. The opening balance on June 8,2016 in the new checking account was$9,408.00. Deposits to the new account were$700.00 transferred from the old account,and$1,772.00 from the June Church deposit. Six checks were written totaling$2,872.07. The Black Bag deposit was$23.00. The closing balance in the new account on July 18,2016 was$9,030.93. A total of$994.60 has been credited to the old account due to credits provided by the bank for disputed ACH debit amounts. At this point,it appears that the disputed debits against the old account have all been credited back to the account, and the old account is still open with a balance of$994.60 as of July 18,2016. The checks drawn on the new account included two checks for$250.00 each for the June and July contributions to the St. Peter Claver Prison Ministry,$100.00 donation to the sewing ministry for prayer blankets.$500.00 to the Tenaj Salon Institute for the scholarship for Carmen Marquez,$184.84 to the St.Vincent de Paul Orlando Council,$139.32 for the telephone bill,$57.01 for checks for the new account,as well as$1,390.90 for clients. JoAnn moved approval of the report,and Sharon seconded. • The next meeting will be held on Monday,August 1,2016 at 6:30 pm. • The medical bus will be here on Friday,August 5th.Shirley volunteered to cover the whole day. • Martha picked up the bus schedule Marjory had prepared,and will update it for August while she is in Denver. • Robert reported on the quarterly meeting this past Saturday - A Council budget was presented. Joe Mazloom from Holy Family is new treasurer - Annunciation Conference's micro loan program was described—the conference has deposited$20.000.00 with the credit union for the credit union to loan to clients—clients apply for loans to the credit union—credit union and conference must approve loans- clients pay 18%interest to the credit union for loans of less than$500.and 5%interest for loans over$1000—the credit union returns the interest to the conference account—the maximum loan amount is$2000 max—credit union debits conference account for loans that default. - Prison ministry report—only 3%recidivism rate(national is 50%)—only take those into program that are homeless when released—ministry is partnering with 2""Harvest,they provide food to the clients—clients are provided suits by Men's Warehouse for job interviews. - A retreat is coming up at the San Pedro center in October - Next year's Gala will be in the last week in January. The cost will be $75 for Vincentians,and$100 for not-Vincentians. Tickets will be sold for a raffle for a four- day vacation at a Sandals resort Each conference has been given 40 tickets to sell. Tickets are one for$15,two for$25,and five for$50 - Profit on last years Gala was$12,000. - There will be a TV show broadcast on EWTN in October highlighting activities of three St.Vincent de Paul conferences,including St.Peter Claver Prison Ministry in Orlando. .....o...4a,s,o.i p.y.rrsrd 9«.d•q..f pa Nos 9 eat•.4•y....t p•u.r.:.w[..t,.rom[ r:a.f..1 p..aandr:Sw Y!•aro..l p.awe ar f*•nt ZS:35-30 .11\,.`lr,+ST.VINCENT DE PAUL SOCIETY—RESU'RREC'TION CONFERENCE MEETING MINUTES—JULY 18.2016 Page 2 of 2 - The St Andrews Conference has an Art program with children who live near St.Andrews Church. The program aims to provide children with a purpose through art. They have a I 41 71121110S• y� �eP n�� g�p p� M�((�p )—iii— keriti I V1N kNT DEcrAftt°§U� IE r ui~c� C I'ION tO\ N fdo. a' ...(w7ate iv,a•l ya yaw web ea:7«a aka,ed yas pat.ab...:Tau•aMyw•d fait bef qe L:wad.dp vowel we:Meia.1 pro ouC.1ae:7 aaa b 1•4aa••1 fait e•wab me f2tubir.15:35-361 ?Al* • * ST,VINCENT DE PAUL SOCIETY-1 RESURRECTION CONFERENCE MEETING MINUTES—JULY 18.2016 Page 2at2 rs - The St Andrews Conference has an Art program with children who live near St Andrews Church. The program aims to provide children with a purpose through art. They have a fund raising program making holiday cards for client food baskets, and have asked conference to support their program by ordering cards. - Council will do a Walk for the Poor event in March.Conferences are requested to provide kilikAptisupport rt mentioned-6K6cmxhas? • Mana iii g on putting together a of event instead of a conference Walk for the Poor event for this year. She is looking to have an American and a Brazilian band. JoAmi suggested maybe doing a raffle. Robert suggested an ice cream social. Maryori suggested having a heritage event Tony believes we should do a Walk for the Poor event again • Joe said we should pursue setting up a microloan program similar to the one Ascension Conference has.Robert said we will discuss the proposal further at future meetings. • Cary is filling in at Catholic Charities while Sandy is on vacation. • Maria has already reserved the Hall for the Quarterly President's Meeting in April 2017. • Sharon passed out Sewing ministry prayer blankets for our clients. They are also making toys they will have for us to give to clients later this year. • Clients were discussed. The following home visits were made: - Steve and Jeannine 3 - Marla and John 1 Joe reported he has a draft of a new Case Record form that he will be sending out copies to members. Co-President Robert closed the meeting with a closing prayer at 7:56 pm. The next meeting will be on Aug 1',2016,at 6:30 pm. Mimao were WeWaei by tae Para ...(ee7aaa&pry ad yea Noe..e t ad..1 d chary ad pa me*d:J:7 ova.:l el .fee.wl 9■a.4 me V:. ._.ad feet.L K:deb ad yw..:vra.e:7•aa L bags as ye.bus Y me f7Xae(a 25:35-361 tl+I • INTERNAL REVENUE SERVICE DEPARTMENT OF THE TREASURY P. O. BOX 2508 CINCINNATI, OH 45201 Employer Identification Number: }; 13-5562362 Es DLN: 508154014 SOCIETY OF ST. VINCENT DE PAUL, Contact Person: COUNCIL OF THE UNITED STATES JOY M McCOY ID# 31495 58 PROGRESS PKY Contact Telephone Number: MARYLAND HEIGHTS, MO 63043-3706 (877) 829-5500 ( f(( (((t— I({ f Addendum Applies: Yes NOV 19 2008 4 Dear Applicant: We have considered your application for a group exemption letter recog- nizing your subordinates as exempt from federal income tax under section 501(a) of the Internal Revenue Code as organizations of the type described in section 501(c) (3) . Our records show that you were recognized as exempt from federal income tax under section 501(c) (3) of the Code. Your exemption letter remains in effect. Based on information you supplied, we recognize your subordinates whose names appear on the list you submitted as exempt from federal income tax under section 501(c) (3) of the Code. Additionally, we have classified the organizations that you operate, supervise, or control, and that are covered by your notification to us, as organizations that are not private foundations because they are organizations of the type described in section 509(a) (2) of the Code. Donors may deduct contributions to your subordinates as provided in section 170 of the Code. Bequests, legacies, devises, transfers, or gifts to your subordinates or for their use are deductible for federal estate and gift tax purposes if they meet the applicable provisions of section 2055, 2106, and 2522 of the Code. Your subordinates whose gross receipts each year are normally more than $25,000 are each required to file Form 990, Return of Organization Exempt Prom Income Tax, by the 15th day of the fifth month after the end of their annual accounting period. If you prefer, you may file a group return for those subordinates that authorize you in writing to include them in that return. If you are required to file Form 990 for your own activities, you must file a separate return and may not be included on any group return that you file for your subordinates. The law imposes a penalty of $20 a day when a return is filed late, unless there is reasonable cause for the delay. However, the maximum penalty imposed cannot exceed $10,000 or 5 percent of gross receipts for the year, whichever is less. For organizations with gross receipts exceeding $1,000,000 in any year, the penalty is $100 per day per return, Letter 2419 (DO/CG) -2- SOCIETY OF ST. VINCENT DE PAUL, unless there is reasonable cause for the delay. The maximum penalty for an organization with gross receipts exceeding $1,000,000 shall not exceed $50,000. This penalty may also be charged if a return is not complete, so your subordinates should make sure their returns are complete before filing them. For tax periods beginning after December 31, 2006, organizations with gross receipts of $25,000 or less must file an annual electronic notice, Form 990-N. Organizations included in a group return are excepted from this requirement. Alternatively, organizations with gross receipts of $25,000 or less may file a complete Form 990 Package. Your subordinates are required to make their annual information return, Form 990 or Form 990-EZ, available for public inspection for three years after the later of the due date of the return or the date the return is filed. You and your subordinates are also required to make available for public inspection your group exemption application, any supporting documents and this exemption letter. Copies of these documents are also required to be provided to any individual upon written or in person request without charge other than reason- able fees for copying and postage. You may fulfill this requirement by placing these documents on the Internet. Penalties may be imposed for failure to comply with these requirements. Additional information is available in Publication 557, Tax-Exempt Status for Your Organization, or you may call our toll free number shown above. As of January 1, 1984, each of your subordinates is liable for social security taxes under the Federal Insurance Contributions Act on remuneration of $100 or more they pay to each of their employees during a calendar year. Your subordinates are not liable for the tax imposed under the Federal Unemployment Tax Act (FUTA) . Each year, at least 90 days before the end of your annual accounting period, please send the items listed below to the Internal Revenue Service Center at the address shown below. 1. A statement describing any changes during the year in the purposes, character, or method of operation of your subordinates; 2. A list showing the names, mailing addresses (including Postal ZIP codes) , actual addresses if different, and employer identification numbers of subordinates that, since your previous report: a. Changed names or address; b. Were deleted from your roster; or c. Were added to your roster. 3. For subordinates to be added, attach: a. A statement that the information on which your present group exemption letter is based applies to the new subordinates; b. A statement that each has given you written authorization to add its name to the roster; c. A list of those to which the Service previously issued exemption rulings or determination letters; Letter 2419 (DO/CO) -3- SOCIETY OF ST. VINCENT DE PAUL, d. A statement that none of the subordinates is a private foundation as defined in section 509(a) of the Code if the group exemption letter covers organizations described in section 501(c) (3) ; e. The street address of each subordinate whose mailing address is a P.O. Box; and f. The information required by Revenue Procedure 75-50, 1975-2 C.B. 587, for each subordinate that is a school claiming exemption under section 501(c) (3) . Also include any other information necessary to establish that the school is complying with the requirements of Revenue Ruling 71-447, 1971-2 C.B. 230. This is the same information required by Schedule B, Form 1023, Application for Recognition of Exemption Under Section 501(c) (3) of the Internal Revenue Code. 4. If applicable, a statement that your group exemption roster did not change since your previous report. Please mail the information requested in this letter to the following address: Internal Revenue Service Ogden UT 84201 Your Group Exemption Number is 5496. Your subordinates are required to include this number on each Form 990, Return of Organization Exempt From Income Tax, and Form 990-T, Exempt Organization Business Income Tax Return, that they file. Please advise your subordinates of this requirement and provide them with the Group Exemption Number. 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. If the heading of this letter indicates that an addendum applies, the enclosed addendum is an integral part of this letter. Because this letter could help resolve any questions about the exempt status and foundation status of your subordinates, you should keep it for your records. Letter 2419 (DO/CG)