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OUTSIDE AGENCY FUNDING REQUEST
FOR CHARITABLE CONTRIBUTION
Application
(Exhibit A)
Fiscal Year 2018/2019
City of Palm Desert
FINANCE DEPARTMENT
73-510 Fred Waring Drive
Palm Desert, CA 92260
760-346-0611, Ext. 382
Fax: 760-341-4564
2018/2019 Outside Agency Funding Application
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INTRODUCTION
Thank you for your interest in the Outside Agency Funding Committee’s funding process for
nonprofit, school and community-based organizations. The Committee’s goal is to provide for
unmet needs and improved services that serve the City of Palm Desert. The Outside Agency
Funding Committee is comprised of a five-member Board: two City Council Members, City
Manager, City Treasurer and City Attorney.
CRITERIA
1. The agency or group (“Applicant”) requesting funds must be in existence of verifiable non-
profit status for a minimum of five (5) years in order to be considered for funding by the Outside
Agency Funding Committee. The Agency must also be presently providing charitable, public
benefit, public welfare or educational services to persons residing in the City of Palm Desert or
its sphere of influence (the “City”); and
2. The applicant has an existing program in place and a staff that is ready and willing to
provide services to the City for the benefit of its residents. Funds will not be contributed to any
agency or group for “startup” costs or new programs or services; and
3. The applicant has submitted to the City an application setting forth in detail its request for
funding, including a statement of purpose detailing specifically the services it intends to provide
for the City, how and where the contribution from the City will be allocated, and the quantity and
quality of such proposed service; and
4. The funds contributed to the applicant will be donated for the purposes of providing services
to the City of Palm Desert, or its sphere of influence, to the extent possible. Said funds are not
designated for salaries or salary reimbursements, dinner/golf or other fundraising events, budget
subsidy, capital equipment or capital improvement projects; and
5. The applicant agrees to use the funds granted by the City to provide only the services
represented in its application for funding to keep verifiable documentation for submittal to the
City as a condition of the Grant; and
6. The City desires to have the services as detailed in the applicant’s application performed for
the City and its residents by the agency or group; and
7. The City will not provide public funds to private individuals or corporations unless there is an
overriding public need; and
8. Where the applicant is an audited entity, the applicant’s independent auditor is required to
make a footnote in the financial statements confirming the use of the City’s contribution in the
manner set forth above, as well as the executed agreement; and
9. Where the applicant received funding for Fiscal Year 2017/2018, all documents must be
submitted and agreement terms complete prior to funding disbursement for FY 2018/2019; and
10. Application and all supporting documents are to be submitted to Niamh Ortega, Finance
Department, City of Palm Desert, 73-510 Fred Waring Drive, Palm Desert, California 92260, by
the end of the business day (5:00 p.m.) on Thursday, February 8, 2018 to be considered for
funding for FY 2018/2019.
2018/2019 Outside Agency Funding Application
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11. FILING INSTRUCTIONS
Please review these instructions carefully in order to completely and accurately file your
application:
1. PREPARE YOUR APPLICATION PACKET containing the following:
One (1) application with original signature, single sided, 8 ½ x 11, white paper,
unbound, unstapled, 3-hole punched. Color copies may be included if desired for
clarity.
Six (6) black & white copies, double-sided, 8 ½ x 11, white paper, unbound,
unstapled, 3-hole punched
Tax Status Verification letter from IRS
Current Roster of Board of Directors, Executives, Trustees or Committee Members
Attachments as necessary for further explanation of application content
2. RETURN COMPLETE APPLICATION PACKET in a sealed envelope via mail or
hand delivery to:
City of Palm Desert
Finance Department
73510 Fred Waring Drive
Palm Desert, CA 92260
CONTENTS: OUTSIDE AGENCY FUNDING APPLICATION – Attn: Niamh
Ortega
3. SUBMIT ON OR BEFORE DEADLINE. Application packet must be received in the
Finance Department by close of business (5:00 p.m.), Thursday, February 8,
2018. Packets which do not include all required information and/or are not completed
in their entirety will be considered unresponsive and will not be reviewed further.
2018/2019 Outside Agency Funding Application
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Application
(Exhibit A)
I. GENERAL INFORMATION
Date of Request:
Amount Requested: $
Name of Agency:
Agency President or
equivalent:
Mailing Address:
Physical Address:
Phone Number:
E-mail address:
Date Agency Established:
No. of Years in Community
(minimum 5 years required)
Federal Taxpayer I.D. No:
Non-Profit Tax Status
(verification must be attached):
501(c)3: ____Yes ____ No
Other class (specify): ___________
Most Recent Year Taxes were
Filed:
If not filed, please explain:
_____________________________
________________________________________
________________________________________
________________________________________
________________________________________
FOR CITY USE ONLY
Date Received: ____________ (due 2/8/18 at 5:00 p.m.)
Original Application
Six Copies B&W
IRS Tax Status letter
Board of Directors or Committee roster
Complete – forward to Committee
- OR -
Incomplete – return to Applicant
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II. STATEMENT OF PURPOSE
1. DESCRIPTION OF AGENCY AND ITS SERVICES (Background and general
description of organization):
2. PROGRAM/SERVICE TO BE FUNDED BY THIS REQUEST (Specific line-item
details regarding your reason for request and how those funds will be spent. Funds
are considered per line item, and appropriate information should be provided to
assist the Committee’s review and decision. Attach additional sheets if necessary):
Item Description Amt requested
Example:
Group support
Counseling for two low-income families for six months ($500 per
family per 6 month period)
1,000
3. Confirm that these programs are available to all eligible participants, without regard
to race, sex, political persuasion, religion, national origin, or age:
4. Total number of persons that benefit from this program: ______
5. Of the total number benefitting, give an estimate of the percentage (%) of Palm
Desert citizens that participate in said benefit:
____ Resident ____ Non-Resident
6. Explain the benefit to the Palm Desert community as a whole:
III. AGENCY INFORMATION
1. How long has this program been in existence? ____/____ Year(s)/Month(s)
2. Are volunteers used by this Agency? ____ Yes ____ No
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3. If volunteers are used, please indicate the number of annual hours and activities
and/or duties performed.
4. Describe the alternative funding sources (dinners, golf events, fashion shows, etc.)
that have been approached during the last year.
5. What type of funding or fundraising activities do you intend to pursue in the
upcoming fiscal year?
IV. AGENCY BUDGET
1. Source of Funding:
A. Community Support List all sources of funding excluding anticipated
contributions from the City of Palm Desert and other valley city governments
for NEXT (2018/2019) fiscal year. (If necessary, attach a separate sheet):
Agency providing funds Reason for contribution Amount (A)
Total Funding Sources excluding City Governments - FY 2018/2019: (A)
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B. Government Support List any local government funding that will be requested in
the NEXT (2018/2019) fiscal year from each of the following city government
agencies:
City
Projected
Request
Amount (B)
Additional Funds Anticipated From
Other Fundraising (dinner/golf
sponsorships [specify type of
fundraising activity]) (C)
Cathedral City
Desert Hot Springs
Indian Wells
Indio
La Quinta
Palm Springs
Palm Desert
Rancho Mirage
Other city:
Total Government Funding
requested – FY 2018/2019: (B) (C)
Total of ALL funding sources anticipated for FY 2018/2019 (A+B+C): $
C. List any local government funding received for the CURRENT (2017/2018)
fiscal year, including the amount your agency requested and the actual amount
received, from each of the following city government agencies:
City
Requested
Amount
Approved Amount
(funds received)
Received from Other Fund-raising
(dinner/concert/golf sponsorships)
Cathedral City
Desert Hot Springs
Indian Wells
Indio
La Quinta
Palm Springs
Palm Desert
Rancho Mirage
Other city:
Total Government Funding
received – FY 2017/2018:
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D. List any and all funding requested from the City of Palm Desert for the
CURRENT (2017/2018) fiscal year, including type of request (sponsorship,
donation, fundraiser, grant, etc.), the amount your agency requested and the actual
amount received, and a description of the funding request:
Type of Request
Requested
Amount
Approved Amount
(amt received) Reason for and/or description of request
Total Palm Desert Funding
received – FY 2017/2018:
E. List any requests you intend to submit to the City of Palm Desert for the NEXT
(2018/2019) fiscal year, including type of request (sponsorship, donation,
fundraiser, grant, etc.), the amount your agency requested and the actual amount
received, and a description of the funding request:
Type of Request
Requested
Amount
Approved Amount
(amt received) Reason for and/or description of request
Total Palm Desert Funding
received – FY 2018/2019:
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2. List amounts requested or received from Community Development Block Grant
(CDBG) funds through the City of Palm Desert. (The City will usually not provide an
additional contribution to those agencies already receiving CDBG funds.):
FY 2017/2018: Amount requested: $______________ Received: $______________
FY 2018/2019: Amount requested: $______________ Received: $______________
3. EXPENDITURES: (Be as detailed as possible. If necessary, attach a separate
sheet.)
GRAND TOTAL OF EXPENDITURES: $ _________________
V. SIGNATURE AUTHORIZATION
1. Identify the principal (President or equivalent) of the applicant agency ultimately
responsible for all organization activity:
NAME:
TITLE:
ADDRESS:
PHONE:
E-MAIL:
2. Signature of authorized official, as identified in Item V, 1:
The undersigned does hereby confirm that the information herein is true and
correct and is submitted in support of and as part of the application for funding.
The undersigned hereby confirms that the applicant agency meets the criteria set
forth herein and agrees to comply with all requirements.
Signature: Date:
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