HomeMy Public PortalAbout100_071_SEABAR's Formal Request for Community Service Award City of Tybee Island Community Services Contract Award
,:/ Fiscal Fiscal 'Year 2013-14
APPLICATION FOR AWARD
This form is to be completed and submitted to Finance with your budget request.
Date: /2.- / --,
Organization requesting City of Tybee Island Community Services Contract Award:
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Name of Organization:
Contact Person: Sle , `" (A
Address: //1 o _ ri X' / 76 7C://5e1,7 0 614 5/3 99
Contact Email: i 'ePfAilr e-57 0Lc-contact Phone #: ' /s9 — 7/
Is this organization an IRS approved 501(C) 3 Non-Profit? Yes No
If"yes", please attach your most recent audited financial statement, a copy of your IRS
determination letter and a copy of your current budget detailing the planned use for the
awarded funds.
Amount of waivers requested: $ Z1 00 c) +`
Describe waivers needed and how the City and citizens of Tybee Island will benefit:
d'i tyl . �G �' 1) P ) PC7 /C.e 5-- ,4_11/'l C C / 1,4671,1"1/4
What percentage of these funds will be matched by your organization? C
Will this event or program bring visitors to Tybee Island in off-peak season or months? Syr
P.O. Box 2749—403 Butler Avenue,Tybee Island,Georgia 31328-2749
(912) 786-4573—FAX(912) 786-9465
tiw'w►w.city bee.o rg
Affidavit Verifying Status
for City Public Benefit Application
By executing this affidavit under oath,as an applicant for a City of Tybee Island,Georgia,Business License or Occupation Tax
Certificate,Alcohol License,Taxi Permit,Contract,or other public benefit as referenced in O.C.G.A. Section 50-36-1, 1 am stating the
following with respect to my application of a City of Tybee Island:
• Business License or Occupational Tax Certificate,
• Alcohol License,
(circle all that apply)
• Taxi Permit,
• Contract
• Communi Services Contras Awa d
for r5 e,i//c-,.k;' VI LA,/'`- (printed name of natural person applying on behalf of
individual, business, corporation,partnership, or other private entity).
1) ± I am a United States citizen.
OR
2) I am a legal permanent resident 18 years of age or older or I am an otherwise qualified alien or non-immigrant under
the Federal Immigration and Nationality Act, 18 years of age or older and lawfully present in the United States.
In making the above representation under oath, I understand that any person who knowingly and willfully makes a false, fictitious,or
fraudulent statement or representation in an affidavit shall be guilty of a violation.$f • Se* ion *- : ' + of the Official Code of
Georgia.
44111)1111 A
i Signature Applicant
`J / •- J/- 13'
Date
7 )/e Xt& - —
Printe Name
*Alien Registration Number for Non-citizens
SUBSCRIBED AND SWORN BEFORE ME ON THIS
THE 1 DAY OF Dc.4-Q6-t-- ,20 l 3_
Notary Public r
DlRNNC Q V
Notary
Public, Chatham County,GA
my commission Expires November 6, 2014
My Commission Expires: Ni CN• 612.o
Note: 0G.G.A. §50-36-1(e)(2)requires that aliens under the federal Immigration and Nationality Act, Title 8 U.S.C., as amended,
provide their alien registration number. Because legal permanent residents are included in the federal definition of"alien", legal
permanent residents must also provide their alien registration number. Qualified aliens that do not have an alien registration number
may supply another ident5ing number below:
Ate' (o/ f ) pit ,)-6z
2013 PIRATES FEST BUDGET
INCOME
Alcohol/Beer Sales 20,000
Coca Cola Sales 2,500.00
Merchandise/T-Shirts 10,000.00
Parade Entry Fees 1,000.00
Sponsorships 50,000.00
Ticket Sales 65,000.00
Event Booth 12,000.00
TOTAL INCOME 160,500.00
COST OF GOODS SOLD
Cost of Alcohol/Beer 8,000.00
T-Shirts/Hats/mist. 6,000.00
TOTAL OF COST OF GOODS SOLD 14,000.00
GROSS PROFIT 146,500.00
EXPENSES
Advertising/Marketing 5,000.00
Childrens Events
Entertainment 6,000.00
Petting Zoo 2,000.00
Decorations 500.00
Prizes and Giveaways 500.00
TOTAL CHILDRENS EVENTS 9,000.00
Parade
Setup and Decorations 1,000.00
Give-away Merchandise 1,000.00
TOTAL PARADE 2,000.00
Entertainment Cost 30,000.00
Administrative Costs
Printing/Postage 600
Posters/Banners/Badges 800
Insurance 2,000.00
Licenses&Permits 600
Sales Tax 6,000.00
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Bank or Creditcard Fees 1,500.00
City Services 5,000.00
Office Supplies 1,000.00
TOTAL ADMINISTRATIVE 17,500.00
Site Preparation
Restrooms 2,000.00
Sound 5,000.00
Lighting 3,000.00
Chairs&Tables 1,000.00
Generators/Cables 10,000.00
Tents 25,000.00
Stage 4,000.00
Fence/Post/Ties 1,000.00
Video/Projector 2,000.00
Site Materials 4,000.00
Decorations 1,500.00
Equipment Rental 500
Labor-Casual 2,000.00
TOTAL SITE PREPARATION 61,000.00
Misc. Event Cost
Security 2,400.00
Golf Carts 500.00
Labor For The Event 5,000.00
Van/Food/Rooms 1,200.00
Sponsor/Tent 1,000.00
Prize Money 500.00
Radio Rental S00.00
Trolley 1,000.00
Storage 1,000.00
Ice 800.00
Contingency 8,000.00
TOTAL MISC.EXP. 21,800.00
TOTAL EXPENSES 146,300.00
SURPLUS/DEFICIT 200
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