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Home My Public Portal About020_013_Friends of Tybee Theater City of Tybee Island Community Services Contract Award Fiscal Year 2015-16 APPLICATION FOR CASH AWARD This form and all attachments are to be completed and submitted by March 20, 2015 Date: ge 1 Organization requesting City of Tybee I land Community Services Contract ard: Name of Organizatio _ /, n: T/9 Contact Person. 1 Address: ,.r, .9>12t. ''i Contact Email: b 6J / /- 0/ , ontact Phone #: f/--911 3 410W 0 Is this organization an IRS approved 501(C) 3 Non-Profit? Yes No If"yes", please attach your most recent audited financial statement, and a copy of your IRS determination letter. Amount of funds requested: $ E4 Ci Describe how these funds will be used and how the City and citizens of Tybee Island will benefit: These funds will go toward the final phase of restoration of the Tybee Post Theater,which,when reopened,will be Tybee's only multi-use performing arts and movie venue. It will provide our citizens and visitors live music,dance, comedy, storytelling and theatrical performances, as well first-run, children's and classic movies in a venue that symbolizes Tybee's commitment to historic preservation. It also will be a center for community meetings,conferences and school programs, bringing the community together and filling a much-needed role as Tybee's civic center. Our goal is to raise enough money to reopen the theater debt free and financially secure,which will ensure its future success. What percentage of these funds will be matched by your organization? fi .r Will this event or program bring visitors to Tybee Island in off-peak season or months? _ r »Please attach a detailed budget to this request outlining how the money will be used. P.O. Box 2749--403 Buller Avenue,Tybee 1siand,Georgia 33328-2749 (912) 786-4573— FAX(912) 786-9465 174.0 `' ' ` ;,Ems, g ?'" City of Tybee Island Community Services Contract Award \ , Fiscal Year 2015-16 N1 APPLICATION FOR WAIVERS r Name of Organization; r , i ' Provide detail on any waivers (i.e. free or reduced parking, rent or utilities) or City services (i.e. number of hours of security, city worker clean-up, trash and/or recycle bins, building maintenance and upkeep, etc.) that you plan to request for your event(s): The Friends of the Tybee Theater stage several special fundraising events each year that benefit the citizens of Tybee and attract hundreds of visitors to the island, including the Tybee Polar Plunge and Tybee Wine Festival and the Tybee Beach Brew Festival. We request waivers for all special event permits and alcohol permits and seek assistance in waiving Chatham County's fees for use of the Tybee Pier and Pavilion for these events. We also request a waiver of parking fees in the city owned parking lots during the hours of these events. We also request a waiver on all construction permits associated with the restoration of the Tybee Post Theater. Value of the waivers requested: $ t P.O. Box 2 749-- 193 Butler Avenue, l'ybee Island,Georgia, 31328-2749 (912) 786-4573—FAX (912) 786-9465 www.citvofivbee.org 9:29 pm Friends of the Tybee Theater 02/17115 Profit & Loss Prey Year Comparison Accrual Basis January through December 2014 Jan-Dec 14 Jan-Dec 13 SChange Ordinary IncometExpense Income 401 •Membership Income 15.225.00 5.575,00 9.650.00 402•Donations 139,307.22 20,327.00 118,980.22 410•Program Net Income 411 •Program income 2,890.27 0.00 2,890.27 412•Program Expenses -1,198_15 -- 0.00 -1,198.15 Total 410•Program Net Income 1,692-12 0.00 1.592.12 415• Bricks and Stars 6,475.00 2,900.00 3,575.00 420• Fundraising Event Net Income 421 -Fundraising Event income 91,687.69 92,586,72 -899.03 423•Fundraising Event Sponsor 10,300.00 11,275 00 -975.00 424•Fundraising Event Donation 334.22 634.48 - -500.26 426•Fundraising Handling Fee 1,882.12 38.58 1,843.54 429•Fundraising Event Expenses -49,009.51 -55,971.41 6:961.90 Total 420•Fundraising Event Net Income 55,194.52 48,763.37 6,431 15 430-Vendor comp/discount 38.48 35.34 r 114 450-Merchandise Sales Net income 461 •Merchandise Sales Income 916.54 1,233.41 -316.87 Total 460•Merchandise Sales Net income 916.54 1,233.41 -316.87 Total income 218,848.88 78,835.12 140,013.76 Expense 601 •Advertising Expenses 1,500.58 3,012.44 -1,511.86 605-Seminars 452.60 0.00 452.60 610•Bank,Ticket&CC Fees 117.55 61.02 56.54 615•Salaries 3,000.00 6,000.00 -3,000.00 620'Contract Labor 42,542.00 19,642.75 22.89925 627-Dues&Membership Fees 1,027.44 419.00 608 44 630-Equipment 10,543.88 0.00 10,543.88 633.Interest Expense 5.448.83 5,701.33 -252.50 635•Insurance Expense 4,099.00 3,979.00 120.00 637•License&Permits 130.00 30.00 100.00 638•Ma€ntenance&Repairs 1,413.35 295.00 1,118.35 640-Office Supplies 5.076,64 1,766.14 3,310.50 642'Postage 685.1 794.00 -108.89 644•Rentals 3.805,02 0.00 3,805.02 645-Travel and Entertainment 1,475.29 100.00 1,375.29 650-Utilities Expense 2.238.06 2,217,78 20,28 660•Payroll Tax Expense 229.50 459.00 -229.50 575 Professional Services 60.00 384.67 -324.67 Total Expense 83,844,86 44,862_13 - 36,982.73 Net Ordinary Income 135,004.02 33.972.99 101,031.03 Other InromelExpense Other Income 900-Restoration Grants 42,500.00 25,000.00 17,500,00 905-Interest/Dividend/Cap.Gains 493.09 0.00 493.09 Total Other Income 42,993.09 25,000.00 T 17,993.09 Other Expense 950-Theater Restoration 0.00 0.00 0.00 960-Restoration Professional Fees 0.00 0.00 0.00 980•Mortgage Loan Reduction 0.00 0.00 0.00 Total Other Expense 0.00 0.00 0.00 Net Other Income 42.993.09 25,000.00 17,993.09 Net income 177,997,11 58,972.99 119,024.'12 Page 1 11:10 AM Friends of the Tybee Theater 03!13!15 Profit & Loss Budget Overview Accrual Basis January 2015 Jan 15 Ordinary Income/Expense Income 401 -Membership Income 25,000.00 402-Donations 25,000.00 410-Program Net Income 411 -Program Income 0.00 412•Program Expenses 0.00 Total 410-Program Net Income 0.00 415-Bricks and Stars 8,000.00 420-Fundraising Event Net Income 421 •Fundraising Event Income 110,000.00 423•Fundraising Event Sponsor 11,000.00 424•Fundraising Event Donation 500.00 425•Fundraising Handling Fee 1,500.00 429•Fundraising Event Expenses -60.000.00 Total 420•Fundraising Event Net Income 63,000.00 430-Vendor compldiscount 40.00 450• Merchandise Sales Net Income 451 •Merchandise Sales Income 1,500.00 Total 450•Merchandise Sales Net income 1,500.00 Total Income 122,540.00 Expense 601 -Advertising Expenses 1,500.00 605•Seminars 500.00 610-Bank,Ticket&CC Fees 200.00 615-Salaries 0.00 620•Contract Labor 53,000.00 627• Dues&Membership Fees 1.000.00 630• Equipment 1.000.00 633• Interest Expense 25,000.00 635•Insurance Expense 8,500.00 637•License&Permits 150.00 638-Maintenance&Repairs 5,000.00 640•Office Supplies 5,000.00 642-Postage 800.00 644-Rentals 6,000.00 645-Travel and Entertainment 850.00 650-Utilities Expense 9,000.00 660•Payroll Tax Expense 0.00 675-Professional Services 500.00 Total Expense 118,000.00 Net Ordinary Income 4,540.00 Other Income/Expense Other Income 900-Restoration Grants 0.00 905-Interest/Dividend/Cap.Gains 0.00 Total Other Income 0.00 Other Expense 960-Restoration Professional Fees 0.00 980-Mortgage Loan Reduction 0.00 Total Other Expense 0.00 Net Other Income 0.00 Net Income 4,540.40 Page 1 F74111 W-9 Request for Taxpayer Give form to the liztev.Octob 2004' identification Number and Certification requester_ Do not C•pa-trrwnr 0 the Treehury Send to the IRS. S. Infthiat //may} Nom& Von ur �.L ♦31_f Il!�fi. name.Yt d ant from�IGL ye C /I 4 et p In Jnwdu i? ampt from backup Check appropriate box; Sole proprietor I Ae Corporation L} Partnership D Other ■ I FT w iithhoidinc7 r �ydrG-x Owl" street. and apt.or suite no.A Regwe h is name and address opbonah ! / 1 ,• 1 List c3count numbertsN har?■optional) Part 1 Taxpayer identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on Line Z to avoid 5oclal security number backup withholding. For individuals.this is your social security number(SSN)_ However. for a resident 1 I .1 I 1 I I I 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,ff the account is in more than one name, see the chart on page 4 for guidelines on whose number ,1 r I.an is 0.4 u 'bar to enter. ,I Part II Certification Under penalties of perjury. l certify that: t_ The number shown on this form is my correct gayer 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 person (including a U.S. resident alien). 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 ?does not apply. For mortgage interest paid. acquisition or abando: ant of secured property. cancellation of debt, contributions to an individual retirement arrangement IRA), and generally, payments of . than interest and dividends,you are not required to sign the Certification.but you must provide your correct TIN. ( - 'i instruct. an page 4.) Sign signature of .'/P Here u.s.person r J '`,f� Date r f, Affidavit Verifying Status a , 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,I 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 • Community Services Contract Award for / X1 v• 'j / . , iii et Tinted name of natural person applying on behalf of individual, usiness, corporation arinersh a, or other private entity). I) V 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 knowi,".ly and willfully makes a false, fictitious,or fraudulent statement or representation in an affidavit shall be guilty of a violati•- C•4 e peti. 16-10-20 of the Official Code of Georgia. 7.--� II � „40'. S'_i.tureofAr• "can'" 41, /, 71='/3 Date - j/re-•3 .•". 7770171Z- Printed Name *Alien Registration Number for Non-citizens SUBS,CP,I B AND SW.• ' BEFO ME ON THIS THE l+ J DAY O t. i _ -A ,20 il-s SHARON S.SHAVER Notary Public �' ! + � ,rte Notary Public,Chatham County,GA My Commission Furies D.C. 5, 2015 My Commzssid ',pires: Note: O.C.GA. §50-36-I(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 id ntifying number below: