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HomeMy Public PortalAbout020_021_Tybee Arts Association City of Tybee Island Community Services Contract Award Fiscal Year 2015-2016 APPLICATION FOR CASH AWARD This form is to be completed and submitted to Finance with your budget request. Date: March 18, 2015 Organization requesting City of Tybee Island Community Services Contract Award: Name of Organization: Tybee Arts Association Contact Person: Marianne Bramble, President Address: PO Box 2344, Tybee Island, GA 31328 Contact Email: mabeachbrrmmett @hotmail.com Contact Phone #: 912-_412-9224 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 funds requested: $ 30,000 (Total) Describe how these funds will be used and how the City and citizens of Tybee Island will benefit: Tybee Arts Association intends to utilize the yearly award from the City of Tybee to enhance efforts that the organization has in place to both continue improvements on the Art Center building, and to bring back the long awaited "Festival of the Arts"in Memorial Park. Tybee Arts Association is requesting aid in funding the construction of a deck or walkway between the two currently existing doors of the Art Center. Recent lighting improvements co-funded by both the City and donors from the Association have improved safety when moving from one side of the building to the other, especially at night, when the majority of the Art Center performances occur. However, visitor (tourist) and member safety remain a concern. By constructing a walkway (either Uut 2749 - 440 Butler .ttenuC. .13br Ibinnd. {. rurg a .313Z8-2%1” 91 1j 'gr. 457; F %X (917) 710.-9t Nww.eitynnybee.org ' • City of Tybee Island Community Services Contract Award Fiscal Year 2015-2016 with decking or a combination of decking and concrete) from the classroom door to the theater door, Tybee Arts believes that handicapped access and mobility into the building would be improved. Tybee Arts also believes that this would direct visitors on a consistently "safe" path as they move from one door (and building) to the other door (and building) during performances or events. T What percentage of these funds will be matched by your organization? 25% Will this event or program bring visitors to Tybee Island in off-peak season or months? both »Please attach a detailed budget to this request outlining how the money will be used. PA). lox '_`4()-403 E3utler Avenue.Tybee Island, Georgia 31328-2749 (9121 7864573-FAX 4912)786-9465 u ww.rity nity her.nrg Forrn -9 Request for Taxpayer Give fomn, to the (Rev_October 2004) identification Nurnber and Certification requester. Do not send to the IRS, D±.��tn,era.>r 11-1*TreE*eury IntirfW Fawn us e•rvlca c.i Name(as reported on your inCDme tax return) 1 & ye_P IL ' .s,-.-.) : i G� u Business name,If drff_rant from above c 0 c q Individual/ 1—i Exempt from backup • i Crtti,ck appropriate box' ❑ Sole proprietor .corporation ❑ Part-Iership ❑ Other ■ - I I withholding i N Address(number. stre.st, and apt, or sulfa no-3 } ; Requester's name and address toptiorlY a o 144-4 o _ 1 ^�[] rye .`� City:states.end ZIP 3•od hee I `sit ' C--_--)P- 3 j YJ\ r? Q �}I rA List account nurnkber(^)here r, ptiono) Mril r Taxpayer identification Number (TiN) Enter your TIN in the appropriate box.The T1N provided must match the name given on line 1 to avoid Social security number backup withholding. For individuals. this is your social security number(SSN). However,for a resident I I Y I 4 1 I l alien, sale 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 chart on page 4 for guidelines on whose number I er wen fi on ret I to enter. I rr I I 1 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) l 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 2 does not apply. For mortgage interest paid. acquisition or abandonment of secured property,cancellation of debt, contributions to an individual retirement arrangement(IRAt. 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 inst '.ns an page 4.) Hire I Signature of l I r Here U.S.parson • ly '1` oaf ■ 3� - c,) a) % 6 © O E > ƒ 2 R Q . x % 7 x x . 2 / - 0_ LU q < --`' ............ a E @ OD£ 7 _ Ek a) E \ q 4 � � e § E £ a § LID 0 $ * o �_ C_ 6 0 2 / > p c _ ± ^ ® 2 2 f to E _c k . g �_ k CO \ 3 % \ / C I— \ < b / E . _, . . ¥ � ro ro " m \ m \ < § 2 E b E @ q \ [ on m £ E ra \ P `§m u_ § 6 _ To ¢ 0 E & 2 -0 0_ ra OD CC \ k § M / o q ® 4 x g @ , \ � 0_ Ui 0 < z 11:06 AM Tybee Arts Association 03119!15 Profit & Loss Budget Overview Cash Basis January through December 2015 Jan-Dec 15 Ordinary IncomefExpense Income Event income Advertisement in Programs 2,000.00 Performance Income 20,000.00 Total Event Income 22,000.00 Other Types of Income Membership Dues 3,000.00 Total Other Types of Income 3,000.00 Proceeds from Art Show Art Shows-Gross Proceeds 35,000.00 Art Shows-Pay-out to Artists -28,000.00 Artist Fees 1,600.00 Total Proceeds from Art Show 8,600.00 Program Income Educational Classes 1.200.00 Total Program Income 1.200.00 Total Income 34800.00 Gross Profit 34,800.00 Expense Business Expenses Business Registration Fees 30.00 Dues 400.00 Total Business Expenses 430.00 Contract Services Accounting Fees 3,000.00 Total Contract Services 3.000.00 Events Banners 1,000.00 Casual Labor 2,000.70 Costumes 1,000.00 Hospitality 2,000.00 Music/Scripts 800.00 Other Performance Expenses 1,500.00 Permits 1,800.00 Printing 1,500.00 Set Lighting 600.00 Props 1,200.00 Sound 1,000.00 Stage 1,000.00 Total Set 3,800.00 Supplies for Events 1,500.00 Total Events 16,900.00 Facilities and Equipment Repairs&Maintenance-Building 10,000.00 Utilities 3.500.00 Total Facilities and Equipment 13,500.00 Page 1 11:06 AM Tybee Arts Association 03119/15 Profit & Loss Budget Overview Cash Basis January through December 2015 Jan-Dec 15 Operations Merchant Fees 1,800.00 Postage 400.00 Printing and Copying 600.00 Telephone 2.000.00 Website Support 1,200.00 Total Operations 6.000.00 Other Types of Expenses Insurance-Liability,1?and 0 1,700.00 Other Costs 800.00 Total Other Types of Expenses 2.500.00 Total Expense 42,330.00 Net Ordinary Income -7.530.00 Net Income -7,530.00 Page 2 s I Affidavit Verifying Status -_ i for City Public Benefit Application By executing this affidavit under oath.as an applicant for a Cite 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 m,. application of a City of Tybee Island: • Business License or Occupational Tax Certificate. • Alcohol License. (circle all that apply) • Taxi Permit. • Contract • Community'Ser► ces Conti: t Award fore bra. ii- (printed name of natttrnl person applying on behalf cqf inclivikt41, business, corporation,partnership, or other private entity). 11 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 an person Ivho knowingly and willfully makes a false. fictitious. or fraudulent statement or representation in an affidavit shall be guilt' of a violation of, ection 16-10-20 of i Official Code of Georgia. A i _4 _1.l_ --- :,rar uu-e,.f Applicant Date ilAA - PP E i t `, A ,ti. 1 Printed Name * Alien Registration Number for Non-citizens SUBSC: ED AND SW,-RN BEF*RE ME ON THIS THE___, , DAY of „I . •_t 20 / SHARON S.SHAVER Notary Publix s,_/ - ` _ ..� Notary Public,Chatham County,GA My Commission Expires Dec. 5, 2015 !v ' Commission Expires: _Note: O.C..G._I. §50-364 47)(2) requires that aliens under the federal Immigration and Nationality Act, Title 8 FS:(1, 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. Qualtfted aliens that do raar have an alien registration number may supply another ideruifz irrg number below: