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Home My Public Portal AboutGreen Team City of Tybee Island Comm unitty Services Cent-act Award Fiscal Year 2013-Il4 ALDPL2CATICIA1 FOR CASF7 AWARD This form is to be completed and submitted to Finance with your budget request. Date: 5.21.13 Organization requesting City of Tybee Island Community Services Contract Award: Name of Organization: City of Tvbee Island Green Team Contact Person: Christopher Shook ® Green Team Chairman Address: 5 Fort Ave. Tvbee Island Ga. 31328 Contact Email: cshookCa�citvoftvbee.ora Contact Phone #: 912.472.5017 Is this organization an IRS approved 501(C) 3 Non-Profit? Yes X No If"yes", please attach your most mcent 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: $2750.00 Describe how these funds will be used and how the City and citizens of Tvbee Island will benefit: The Green Team will host a yearly America Recycles Day Event, as well as participate in other events held on the island throughout the year. We currently use supplies from each department, but as we have arown this need is now greater, reauirina a stand alone budget. Finally, we wish to continue to crow and expand into the community to continue to educate and enact sustainable practices as is part our overall mission statement. What percentage of these funds will be matched by your organization? 0% 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 be used. P.G. Box 2749—403 Butler Avenue, Tybee Island, Georgia 31328-2749 (912) 786-4573 —FAX (912) 786-9465 www.cityoftybee.org f .10 LI' I . v C ty of Iybee fshi nd Communny Serv!cces CCant:°eact Aw2Td FtscR: Yean° 2313-14 Date: 5.21.13 Name of Organization: City of Tvbee Island — Green Team 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 Green Team is reauestina a waiver for the use of Memorial Park, the Pavilion, and the Cafeteria on November 16th 2013. This will be where will hold our 1st annual America Recycles Day event. We are also reauestina use of 12 trash barrels, 12 recvclina containers, and one box of trash bags for this event. Finally, we are reauestina a trash pick — up after the event Ca) 6:00 PM or the following morning. Value of the wavers requested: Unsure of total value of total request P.O. Box 2749—403 Butler Avenue,Tybee Island,Georgia 31328-2749 (912) 786-4573—FAX(912) 786-9465 www.cityoftybee.org Tybee Island Green Team �4 O Operating Budget Request Submitted By:Christopher Shook Itt Green Team Chairman \� Budget Request/ Explaination of Proposed Expenditures ITEM DESCRIPTION FUNDS FUNDS ALLOCATED TO TOTALS REQUESTED Supplies/Materials Supp lies and materials for events,promotions and general operating $2750.00 S&M Line Item $2750.00 Designated Purchasing Agent: Jackie Cary DPW Aministrative Assistant RILEA.S,E Explaination of expenditures: Partnerships , through Items to be purchased are to be used to facilitate the Green Team's efforts by way of events, Leadership and promotions,and general supplies and materials.Some of the events are: p Education , which America Recycles Day,Tybee Island Water and Energy Fair,Community Day etc. inspire Currently all materials used have come from each departments individual line items Actions ,in the community for a The Green Team was on a five year plan to expand beyond the scope of the city.We are now ahead of Sustainable future for schedule and are looking to reach out to the community in just over 3 years! All items that are to be purchased will fall under the principles of the Green Teams Mission Everyone Much of the Items require minimum order quantities which require some investment Our goal is to expand our efforts to citizens as well as continue with current city practices.This effort "P L..E.A E help us make a better world for tommorrow today!" will require promotion as well as sponsoring/participating in related and non related events �..ax Affidavit Verifying Status ge/ for CCnty 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 • Communi Services Contract Award for ( g.eg 1 rea"'1 (printed name of natural person applying on behalf of /indiv...dual,business, corporation,partnership, or other private entity). 1) C/ 1 am a United rted 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 of Code Section 16-10-20 of the Official Code of Georgia. (7,1_44 "---V,VV-i-"? Signatuz�c�f Ap �`ic t 57 27 13 Date 0h .isf ,k4<_ 54)'0L Printed Name * Alien Registration Number for Non-citizens SUBSCRIBED AND SWQM BEFORE ME ON THIS THE a;- DAY OF rF/4 y ,20 13 Notary Public 141-4� AWA'f../71— JERR1S A. BRYANT U Notary Public,Chatham County GA My Commissio> pires: My Commission Expires May 22.2018 Note: O.C.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: