HomeMy Public PortalAbout020_014_Garden Club ` ' 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: I Ct (Ti r-r'c- J-[ l 5
Organization requesting City of Tybee Island Community Services Contract Award:
Name of Organization: 1upcc..., +pc_►) C—kt b
Contact Person: .T o ALA 3uv q 1
Address: P 0 --laADY ciDS +T``u �e� slr��� Gpt
Contact Email:Sbu try kcr Q7 Crarr,cas .lie+ Contact Phone #: ct l 2,, r)15 - 31
Is this organization an IRS approved 501(C) 3 Non-Profit? Yes X No
If"yes", please attach your most recent audited financial statement, and a copy of your IRS
determination letter.
Amount of funds requested: $ 500 .C7
Describe how these funds will be used and how the City and citizens of Tybee Island will benefit:
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What percentage of these funds will be matched by your organization? I00 'i!o
Will this event or program bring visitors to Tybee Island in off-peak season or months?
»Please attach a detailed budget to this request outlining how the money will be used.
P.O. Bus 2749—403 Butler Avenue.Tybee Island.Georgia 31328-2749
(912) 786-4513=FAX (912) 786-9465
wr w.ritynftybee.org
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-- City of Tybee Island Community Services Contract Award
alFiscal Year 2015-16
APPLICATION FOR WAIVERS
Name of Organization; k 5 btu s■.co 0.d_ E_ ) C .Lop
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):
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Value of the waivers requested: $
P.O. BO 2749-403 Butler Avenue, Tybee Island,Georgia 31328.2749
(912) 786-4573- FAX(912) 784.9465
viv,is.cityoitN.-bee.org
Application for Cash Award—Tybee Island Garden Club 2015/2016, continued
Camillias and azaleas at the back corner of the building, The Club would like to
continue improving this area in 2015/2016 with a concrete bench ad additional plantings
of flowering shrubs and periennals. (All to be approved in advance by DPW.)
In addition to the Guard House expenditures,the Club will continue maintenance of the
flowering areas of Seven Flags and the Blue Star Marker. The Club also plants annuals
at the Nursing Home in the spring and fall. Now that the grasses and shrubs planted at
Polk Street(at a cost of$1,476) are well established, the Club has requested DPW to take
over the routine maintenance as they are better equipped to maintain this large area in a
manner that best suits the daily activities of the Recycle Center.
The Tybee Island Garden Club has not received a grant from the City since 2011. All
cost since that time have been funded by the Club's fund raising activities.
. ��1,
� ' ^ Affidavit Status
' Verifying
j _ fmr 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,Tax Permit. Contract,or other public benefit as referenced in OC.G.A. Secion5O-36-i, | umstatingthefbUm*bngn/dk
respect to my application of a City of l'ybee Island:
• Business License or Occupational Tax Certificate,
• Alcohol License.
(circle all that apply)
• DmiR,rmk
• Contract
• Community Services Contract Award
I&re~»
for Uf..)e Ffts«me—ur» (printed name of-natural person applying nn6e6olfgfindividual.
buw/nmx, cm7ruxcitiow,porounrs6ip. or other private entity).
~�
~�
1) 1 am a United Stales citizen,
OR
2) ____ < 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 year of age or older and lawfully preseit in the United States. *
In makin2 the above representation under oath, 1 understand that any person who knowingly and willfully makes a false, fictitious,or fraudulent
statement or representation in an 4ffidavit hali be guilty of a violati ffioiu|Code ofGeorgia.
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Si ture of Applicant
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Date
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`^c/�^ �`� �/� � ' � '^v' '�n` ��~^ ..�~--
Printed Name
*Alien Registration Number for Non-citizens
8UBS[ [,AND8 /�E0HTHIS
THE /~Y DAY , .2U /�-'
`\ i /0 Of SMA%OY�G| ��HAVEp
��o�o� PubU. �����'�� m Nnia� p«hU«. ^—'Chatham Count�8A
My Commission .: '�ew-- --- ---'--' m Dec. S. 2015
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Note; 8C.(IA. § 50-36-1(00) 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 oegis/rm/ox number may supply another
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4026929 03112/2015 1:25:30111
02 CLERKO2 111111
PE 9.N1 i,$fi9.93
,� --- PERINNIALS
'War i3c` ` 5@ i6,99-
6.99 ',$84.95
Jet dsln ��►a5 icw 3@ 12
3C 12.99 ',$38.97
-- PERINNIRLS
t410-0441642.F
n,�� rg 12.9 69 T�i64-95 SHRUBS
'41' 1+e,or S —3@ 19.99 x,$59.97
t'i'SifL pO,nt't PERTNNIAES
2@ 29.99 i$59.98
C ►.LA-**; SHRUBS
10 24.99 'i$24.99
CA-A-Z1.1 --SHRUBS
1@ 36.99 1336.99
PERINNIALS
!HOSE ST $440-73
Z2 -10-on -44.07
1@ 25.00 $25.00
LABORi11EL
HOSE ST $421-66
TAXI $30.85
ITEHS 260
CHARGE $492- 51
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