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HomeMy Public PortalAbout020_020_SEABAR Pirate Fest ICity 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: _March 18, 2015 Organization requesting City of Tybee Island Community Services Contract Award: Name of Organization: TYBEE SEABAR INC. (Tybee Pirate Fest October 8,9,10,11, 2015) Contact Person: Steven Kellam Address: P.O. Box 1970 Contact Email: tybeepiratefest @aol.com_ Contact Phone #: _(912) 713-5466 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: $ 0 Describe how these funds will be used and how the City and citizens of Tybee Island will benefit: What percentage of these funds will be matched by your organization? N/A Will this event or program bring visitors to Tybee Island in off-peak season or months? Yes »Please attach a detailed budget to this request outlining how the money will be used. P.Q. Doi,2749—403 Ruder Avenue,Tybee Island.Georgia 31328-274 (912)7864573 FAX(912) 786-9465 www.eityoftybee.org L1-._r ', r ) City of Tybee Island Community Services Contract Award /, Fiscal Year 2015-16 APPLICATION FOR WAIVERS Name of Organization: TYBEE SEABAR INC. 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): 1. Waiver any Building and Zoning fees that may occur. (Tents, Stage, Bouncy Houses, Rides etc.) 2. Seabar request free use of South Beach Parking Lot for event, and North Beach Lot from 11am- 4pm for parade. 10 free parking passes for the crew from October 6-15, 2014 3. Waiver DPW fees for 25 trash cans, 25 Recycling containers, Barricades, and roping off for parade. Clean streets after parade and during the event. Change flags at 7 flags park (flags will be provided by SEABAR.) Remove and replace (20) Parking stops in the South Beach Parking Lot 4. Waiver all Tybee Police fees for parade and patrol during event. Value of the waivers requested: $ $12,0 00.00 P.O.Box 2749—403 Butler Avenue,Tybee Island,Georgia 31328-2749 {912) 786-4573—FAX(912) 786-9465 ;ewe,.cityoftvbee.o rg 0 evil, z,._ Affidavit Verifying Status 4 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-],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_Steven Kellam (printed name of natural person applying on behalf of individual, business, corporation,partnership, or other private entity). 1) X I am a United States citizen. OR 2) 1 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 of C etia. 16-10 yq .Of f eficial Code of Georgia. S' of Applicant 1 _— !March I8,2015 Date Steven Kellam Printed Name *Alien Registration Number for Non-citizens SUBSC�. BED AND SWON BEFORE ME ON THIS__ THE ..7 (DAY OF ell + ,20 �--, Notary Public i (� . l !r,N:a.'----- — SHARON S.SHAVER My Commission Expires: Notary Public,Chatham County,GA My Commission Expires Dec. 5, 2015 Note: 0.C.G.A. ,¢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 identifying number below: Form 1111119 Request for Taxpayer Give Form to the (Rev.December2014) identification Number and Certification requester. Do nit i Depnrtment of the Treasury send to the IRS. Internal Revenue Service 1 Name las shown on your income tax return).Name is required on this line;do not leave this line blank. TYBEE SEABAR INC. [v 2 Business nameldisregarrleu entity name,if different from above m tso ca 3 Check appropriate box for federal tax classification;check only one of the following seven boxes: 4 Exemptions(codes apply only to 0 ❑IndividuaVsole proprietor or ❑ C Corporation © S Corporation ❑ Partnership ❑Trust/esstate certain instructions ionsion,riot individuals;see m c single-member LLC instructions on page 3): o Exempt payee code Of any) a ❑Limited liability company.Enter the tax classification(C—C corporation,S=S corporation,P---partnership)► p g Note.For a single-member LLC that is disregarded,do not check LLC;check the appropriate box in the line above for Exemption from FATCA reporting S the tax classification of the single-member owner. code(if any) ▪ ®Other(see instructions)► tam:.ra W rb rrwfn:aired d,xs ue the 5 Address(number,street,and apt.or suite no.) Requester's name and address(optional) , P.O.Box 1970 8 City,state,and ZIP code co Tybee Island Georgia 31328 7 List account numbers)here(optional) Part I Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on line 1 to avoid f Social security number backup withholding.For individuals,this is generally your social security number(SSN).However,for a resident 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.If the account is in more than one name,see the instructions for line 1 and the chart on page 4 for Employer Identification number guidelines on whose number to enter. 4 � 6I - 3 1 5 r 7 r 7 I 0 3 Part H Certification Under penalties of perjury,I certify that 1. The number shown on this form is my correct taxpayer 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.citizen or other U.S.person(defined below);and 4.The FATCA code(s)entered on this form(if any)indicating that I am exempt from FATCA reporting is correct. 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 2 does not apply.For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,you are not required to sign the certification,but you must provide your correct TIN.See the instructions on page 3. Sign signature of Here U.S.persya► �- Gate P. General Instructions •Form 1098(home mortgage interest),1098-E(student loan interest),1(198-T (tuition) Section references are to the Internal Revenue Code unless otherwise noted, •Form 1099-C(canceled debt) Future developments.Information about developments affecting Form W-9(such •Form 1099-A(acquisition or abandonment of secured property) as legislation enacted after we release it)is at www.irs.gov/fw9. Use Form W-9 only if you are a U.S.person(including a resident alien),to Purpose of Form provide your correct TIN. An individual or entity(Form W-9 requester)who is required to file an information if you do not return Form W-9 to the requester with a TiiN,you might be subject return with the IRS must obtain your correct taxpayer identification number(TIN) to backup withholding.See What is backup withholding?on page 2. which may be your social security number(SSW),individual taxpayer identification Sy signing the filled-out form,you: number(ITIN),adoption taxpayer identification number(ATIN),or employer 1.Certify that the TIN you are giving is correct(or you are waiting for a number identification number(EIN),to report on an information return the amount paid to to be issued(), you,or other amount reportable on an information return.Examples of information returns include,but are not limited to,the following: 2.Certify that you are not subject to backup withholding,or ▪Form 1099-INT(interest earned or paid) 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If •Form 1099 pN(dividends,including those from stocks or mutual funds) applicable,you are also certifying that as a U.S.person,your allocable share of any partnership income from a U.S.trade or business is not subject to the •Form 1099-MISC(various types of income,prizes,awards,or gross proceeds) withholding tax on foreign partners'share of effectively connected income,and •Form 1099-6(stock or mutual fund sales and certain other transactions by 4.Certify that FATCA code(s)entered on this form(if any)indicating that you are brokers) exempt from the FATCA reporting,is correct.See What is FATCA reporting?on •Form 1099-$(proceeds from real estate transactions) page 2 for further information. •Form 1099-K(merchant card and third party network transactions) Cat.No.10231 X Form W-9(Rev.12-2014) 11-07 AM Tybee Seabar Inc. 33113/15 Profit & Loss Accrual Basis January through December 2014 Jan-Dec 14 Ordinary Income/Expense Income 157.288.40 Cost of Goods Sold 13,484.15 Gross Profit 143,804.25 Expense Administrative Cost 5,658.67 Advertising and Promotion 1,771.75 Automobile Expense 400.00 Charitable Contributions 3.141.00 Childrens Activities 7,500.00 Entertainment 34,035.00 Event Cost 18,581.35 Insurance Expense 5,138.80 Miscellaneous Expense 438.78 Postage and Delivery 85.59 Rent Expense 630.00 Site Prep 71,226.46 Total Expense 148,607.43 Net Ordinary Income -4,803.18 Net Income -4,803.18 Page 1 2015 u���-�~^ rn/��� n �—.� FEST BUDGET INCOME Alcohol/Beer Sales 18'000 Coca Cola Sales 3'200.00 Merchandbe/T-Shids 10,000.00 Parade Entry Fees 1,100.00 Sponsorships 48'000.00 Ticket Sales 63,000.00 Rides 4,000.00 Event Booth 11,000.00 TOTAL INCOME 158'300.00 COST OF GOODS SOLD Cost of Alcohol/Beer 5'000.00 T-Shirts/Hats/misc. 5'500.00 TOTAL OF COST OF GOODS SOLD 10,500.00 GROSS PROFIT 147,800'00 EXPENSES Advertising/Marketing 5,000.00 Childrens Events Entertainment 6'000.00 Petting Zoo 2,450.00 Decorations I,800.00 Stage 3'156.00 Prizes and Giveaways 200.00 TOTAL CHILDRENS EVENTS 12'806.00 Parade Setup and Decorations 500.00 Give-away Merchandise 500.00 TOTAL PARADE 1,000.00 Entertainment Cost 28,000.00 Administrative Costs Printing/Postage 1,000.00 Posters/Banners/Badges 500 Insurance 4,884.00 Licenses& Permits 300 Sales Tax 2,300.00 Bank or Creditcard Fees 200.00 City Fees 1,200.00 Office Supplies 1,000.00 TOTAL ADMINISTRATIVE 11,384.00 Site Preparation Restrooms 2,200.00 Sound 5,000.00 Lighting 4,000.00 Chairs &Tables 1,500.00 Generators/Cables 10,000.00 Tents 30,000.00 Stage 3,000,00 Fe nce/Post/Ties 800.00 Video/Projector 2,400.00 Site Materials 1,500.00 Decorations 1,500.00 Equipment Rental 1,000.00 Labor-Casual 2,000.00 Concrete Blocks 5,000.00 TOTAL SITE PREPARATION 69,900.00 Misc. Event Cost Security 2,200.00 Golf Carts 600.00 Labor For The Event 8,500.00 Va n/Food/Rooms 1,500.00 Photographer 750.00 Prize Money 200.00 Radio Rental 205.00 Trolley 1,000.00 Storage 1,000.00 Ice 750.00 Contingency 3,000.00 TOTAL MISC. EXP. 19,705.00 TOTAL EXPENSES 147,795.00 SURPLUS/DEFICIT 5.00