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OUTSIDE AGENCY FUNDING REQUEST
FOR CHARITABLE CONTRIBUTION
Application
(Exhibit A)
Fiscal Year 2019/2020
City of Palm Desert
FINANCE DEPARTMENT
73-510 Fred Waring Drive
Palm Desert, CA 92260
760-346-0611, Ext. 382
Fax: 760-341-4564
2019/2020 Outside Agency Funding Application
ORGANIZATION NAME:____________________________________________
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 2018/2019, all documents must be
submitted and agreement terms complete prior to funding disbursement for FY 2019/2020; 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, NO
LATER THAN NOON (12:00 P.M.) ON FRIDAY, MARCH 15, 2019 to be considered for funding
for FY 2019/2020.
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2019/2020 Outside Agency Funding Application
ORGANIZATION NAME:____________________________________________
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 packet, single sided, 8 ½ x 11, white paper, unbound, unstapled,
unpunched. Color documents may be included if desired for clarity and detail.
Application packet will contain the following:
Application with original signature
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, all 8 ½ x
11” or smaller in size
Six (6) black & white copies of the above packet, double-sided, 8 ½ x 11, white paper,
unbound, unstapled, 3-hole punched.
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 no later than noon (12:00 p.m.) on Friday, March 15, 2019. Packets
that do not include all required information and/or are not completed in their entirety will
be considered unresponsive and will not be reviewed further.
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2019/2020 Outside Agency Funding Application
ORGANIZATION NAME:____________________________________________
FOR CITY USE ONLY
Application
Date Received: ____________ (due 3/15/19 at noon)
(Exhibit A)
Original Application
IRS Tax Status letter
Board of Directors or Committee roster
Six Copies B&W
Complete – forward to Committee
- OR -
Incomplete – return to Applicant
I. GENERAL INFORMATION
Date of Request:
Amount Requested (min. $5,000): $
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:
Palm Desert Business License No.
(Required for any work or service
performed in PD city limits)
Non-Profit Tax Status (verification 501(c)3: ____Yes ____ No
must be attached): Other class (specify): ___________
Most Recent Year Taxes were Filed: _______ for the period of _________________
If not filed, please explain:
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2019/2020 Outside Agency Funding Application
ORGANIZATION NAME:____________________________________________
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. Add additional rows if necessary):
Item Description Amt requested
Example: Counseling for two low-income families for six months ($500 per 1,000
Group support family per 6 month period)
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:
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2019/2020 Outside Agency Funding Application
ORGANIZATION NAME:____________________________________________
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
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 alternative funding or fundraising activities do you intend to pursue in
the upcoming fiscal year?
IV. AGENCY BUDGET
1. Sources of Funding:
A. Palm Desert Support: List any and all funding requested from the City of Palm
Desert for the CURRENT (2018/2019) fiscal year, including type of request (grant, sponsorship,
donation, fundraiser, grant, etc.), the amount your agency requested and the actual amount
received, and a description of the funding request:
Requested Approved
Type of Request Amount (amt received) Reason for and/or description of request
Total Palm Desert Funding
received – FY 2018/2019:
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2019/2020 Outside Agency Funding Application
ORGANIZATION NAME:____________________________________________
B. Other Local Government Support FY 2018/2019: List any funding requested
and/or received in the CURRENT (2018/2019) fiscal year from each of the following city
government agencies including amount your organization requested, actual amount received,
and a brief description of the request:
Requested Approved Amount Description of request (dinner, golf
City Amount (funds received) sponsorship, concert, contribution)
Cathedral City
Coachella
Desert Hot Springs
Indian Wells
Indio
La Quinta
Palm Springs
Rancho Mirage
Total Other Government Funding
received – FY 2018/2019:
C. All Local Government Support FY 2019/2020: List any funding requested
and/or anticipated in the UPCOMING (2019/2020) fiscal year from Palm Desert and each of the
following city government agencies, amount your organization requested, actual amount
received, and a brief description of request (i.e. grant, sponsorship, donation, fundraiser, etc.):
Projected Request Type of Request (i.e. sponsorship, donation,
City Amount golf tournament, gala, etc.)
Cathedral City
Coachella
Desert Hot Springs
Indian Wells
Indio
La Quinta
Palm Desert
Palm Springs
Rancho Mirage
Total Government
Funding requested
– FY 2019/2020:
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2019/2020 Outside Agency Funding Application
ORGANIZATION NAME:____________________________________________
D. Community Support: List any other sources of anticipated contributions from valley
organizations for NEXT (2019/2020) fiscal year. (i.e. Berger Foundation, RAP Foundation,
Rotary Club, Agua Caliente Band of Mission Indians, etc.):
Anticipated
Agency providing funds Description of Contribution
contribution
Total Community Support - FY 2019/2020:
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 2018/2019: Amount requested: $______________ Received: $______________
FY 2019/2020: Amount requested: $______________ Received: $______________
3. EXPENDITURES: Please list all expenditures associated with the program for which you are
requesting funding. Be as detailed as possible. (If necessary, attach a separate sheet.)
GRAND TOTAL OF EXPENDITURES: $ _________________
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2019/2020 Outside Agency Funding Application
ORGANIZATION NAME:____________________________________________
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,
that the applicant agency meets the criteria set forth herein, and that the applicant
agency agrees to comply with all requirements.
Signature: Date:
- END OF DOCUMENT -
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