HomeMy WebLinkAbout8.1 DPIE Attch 6
CITY OF DUBLIN
COMMUNITY GROUP/ORGANIZATIONAL
FUNDING REQUEST
ApPLICA TION PACKET
Fiscal Year 2008-2009
Section 2:
Application for
Community Group/Organizational Funding
SECTION 2
Page 1 of21
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CITY OF DUBLIN
Fiscal Year 2008-2009
COMMUNITY GROUP/ORGANIZATION
ApPLICATION FOR FUNDS
COVER PAGE
AGENCY NAME: DUBLIN PARTNERS IN EDUCATION
PROPOSED PROJECT/PROGRAM NAME:
VOCATIONAL MENTORING PROGRAMS
FUNDING AMOUNT REQUESTED:
$15,,000
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DPIE
~)Ublin Pm'tile!'s In Education
Dublin Partners in Education
PO Box 2307
Dublin, CA 94568
925.828.2551 x8024
925.803.9746 fax
email: dpie@dublin.k12.ca.us
January 25, 2008
Mr. Roger Bradley Administrative Analyst
Ms. Joni Pattillo, Assistant City Manager
City of Dublin
100 Civic Plaza
Dublin, CA. 94568
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Dear Mr. Bradley and Ms. Pattillo:
Dublin Partners in Education (DPIE) is submitting a grant proposal request for $15,000
for three DPIE programs - Promotion of the Arts Program, Vocational Mentoring
Program at Dublin and Valley High Schools and Career Days at Fallon and Wells Middle
School.
Last year DPIE experienced a significant amount of growth in all our programs. The
Vocational Mentoring Program was expanded to both semesters as a result of the success
at Dublin High School. In addition a Vocational Mentoring program was started at
Valley High school and Career Days was started at the Middle Schools. DPIE also
reinstated the Principal of the Day Program and due to the positive feedback and success,
plans to increase the program to twice yearly.
The number of guest artists who are visiting our Dublin schools has almost rippled in the
last two years, thanks to many volunteer artists from around the Tri- V alley. We have art
coordinators at each of the Dublin schools and they are requesting more guest artists, as
the teachers many times do not have the expertise to demonstrate art in their classrooms.
Besides coordinating guest artists, DPIE also funds art supplies for the schools, and
coordinates a large Student Award night in May. Last year approximately 450 students,
parents, relatives and neighbors attended the ceremony at the Dublin Regal Cinema.
We respectfully request that U.e City of Dublin consider supporting the rapid growth of
these three very important programs. All ~udents and their families in Dublin would
benefit.
Kirrp Regards. t
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'V ~t, I tt"ii~
Don Biddle
President, Board of Directors
Federal Non-Profit :.0. #94-3207780
Dublin Partners in Education is a non-profit foundation dedicated to fostering
Mutually beneficial business and educatio(l partnerships in order to
Maximize community resources for the students of the Dublin Unified School District.
CITY OF DUBLIN
Fiscal Year 2008-2009
ApPLICATION FOR FUNDS
1. Please select one expense category: 0 Capital X Operating
2. Applicant Information:
Organization! Agency Name
Dublin Partners in Education
Mailing Address P.O. Box 2307
Street Address 8435 Davona Drive
City Dublin
State California
Zip 94568
Executive Director/Chairperson
Work Phone
Email
Don Biddle
Board President (if applicable)
(925)828-2551 ext 8024 dpie@dublin,kI2.ca.us
Work Phone Email
Please list the Primary Project Contact Person who would be able to answer questions about this application and
project/program during the funding period.
Don Biddle
Contact Person for Project/Program
925-828-2551 ext 8024
Work Phone
Email
DPIE Board President
Job Title
925-803-9746
Fax
Federal Tax Identification No. (required)
94-3207780
10048
City of Dublin Business License No. (required)
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Page 3 of21
City of Dublin
Fiscal Year 2008-2009
Application for Funds
3. Proposed Project/Program Information (Do not describe Organization.)
Amount of Funds Requested $
(Maximum $25,000 per project.)
$15,000
Proposed Project/Program Name Operational Expenses for Vocational Mentoring, Career
Day, Principal for a Day, Promotion of the Arts Program and Student Arts Judging and Awards
Night,
Proposed Project/Program Date(s): Start 07 / 01/08 and End ~I 30 I~
mo. day yr.
mo. day yr.
Please note: City Council Grant Funds are distributed on a reimbursement basis. If your Agency
needs a 100% disbursement at the beginning of the Fiscal Year, please indicate this
below and please provide justification for this need.
fitAgency is requesting 100% disbursement at the beginning of the Fiscal Year. If
selecting this option, please provide justification in the blank space below.
o Agency is not requesting 100% disbursement at the beginning of the Fiscal Year.
If selecting this option, please provide the frequency that reimbursements will be
submitted to the City in the blank space below; e.g., monthly, quarterly, at project
completion, etc.
Budget Planning
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City of Dublin
Fiscal Year 2008-2009
Application for Funds
a. How would the requested funds be used?
. Describe, in detail, the PROPOSED PROJECTIPROGRAM (not the Agency).
· Bulleted text is acceptable.
. Identify if the proposed project/program is a new service, or extension of an
existing one.
. An additional page may be added, if needed.
The current programs DPIE is requesting funding for benefit the 5,400 + students ofthe Dublin
Unified School District. They are:
. Career Dav (New) Local business and community volunteers spend a morning sharing
valuable career information and personal professional experiences with Fallon and Wells
8th graders, helping them see all the future possibilities that education can create for them
. Mentor Proe:ram: Dublin and Valley High School students attend a series of
presentations given by local business and community volunteers who share their career
knowledge and professional experiences, offering students "a real world perspective" and
guidance. DPIE pays for the pizza and drinks at this lunchtime presentation to increase
student participation.
. Princioal for a Dav (New) Volunteer business leaders are invited to shadow each school
principal (or district administrator) for a morning to experience first hand the challenges
and successes in education today. A round table discussion involving all participants
follows morning visits. This program was so successful in the fall that we were asked
to repeat it twice yearly!
. Promotion of the Arts: This program encourages our young artists to explore their own
creativity by teaming volunteer artists with Dublin classrooms for additional art
instruction. Art that is generated may be submitted for consideration for Student Awards
Night and Student Art Auction.
b. How would the PROPOSED PROJECTIPROGRAM address an unmet community
need and improve the quality of life for Dublin residents. Why is this project/program
needed? (Additional page may be added, if needed):
The quality of education desired by residents of Dublin far exceeds the very basic
education funded by the State. DPIE seeks to help the Dublin Unified School
District bridge the gap in the type and quality of programs offered to the students.
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c. What documentation!data/records support the need for this PROPOSED
PROJECTIPROGRAM? Please identify your data sources. (Additional page may be
added, if needed.)
With the grant funding we've requested, DPIE's programs will provide enriched
learning opportunities. Our Partnership activities are much like other Partnership
programs nationwide (of which there are over 400,000) and it has been shown that
Partnership programs positively impact students/ schools in these areas: Academic
achievement, School attendance, Career planning, Student enrichment, Self-image and
school pride. (source: www.partnerstoledo.orl:r/partnership.html)
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City of Dublin
Fiscal Year 2008-2009
Application for Funds
d. Specify the PROPOSED PROJECT/PROGRAM population to be served.
The students and families of the Dublin Unified School District
e. Projects/programs must be evaluated to determine if they are being carried out efficiently
and if project/program goals are being met. Please describe how you plan to monitor
your project/program's success and impact.
. An additional page may be added, if needed.
.
The organizational board and committee structure of DPIE ensures that the
programs and sponsorships offered to the teachers and students are appropriate with the
goals of the School District and the community. Dr. Steven Hanke, Superintendent of
DUSD, serves on DPIE's Honorary Council; Pat Kohnen, a member of DUSD's School
Board, serves as a DPIE Board Liaison; Dr. Dave Marken, the Assistant Superintendent,
serves on the DPIE Board of Directors, and Fallon School's Principal, Tess Thomas, serves
on the DPIE Board and Chairs the Program Committee. The needs and evaluations of the
current programs are regularly discussed at Board and committee meetings by the DUSD
administrators and the DPIE Board of Directors. Program participants (volunteers and
students) fill out written evaluation forms after the completion of the various programs.
The information is reported back to the Board of Directors.
A Program Committee of the Board of Directors was formally established to
monitor program activities and outcomes. This year's Chair is Tess Thomas, Principal of
Fallon School. The Program Committee makes recommendations concerning the
expansion, maintenance or curtailment of programs and serves as the evaluation process
for all programs.
A public report is given annually at a formal televised DUSD school board meeting,
and questions and comments are taken from the audience.
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f. Specify numbers of clients served by agency, then by PROPOSED
PROJECTIPROGRAM:
SECTION 2
Page 8 of21
5,470
5,470
5,470
5,470
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City of Dublin
Fiscal Year 2008-2009
Application for Funds
5. Financial Information - Operating Budget
a. Expense Budget
FY 2008-2009 THIs PROJECT/
EXPENSE BUDGET ORGANIZATION PROGRAM GRANT REQUEST
Personnel Costs
Employee Salaries & Benefits 75,160 20,000
Non-Personnel Costs
Services & Supplies 12,675
Capital Costs
Other (please specify)
1. Teacher Grants 50,000
2. Winter Concert 1,500
3. Performing Art 1,000 1,000
4. Science Fair 1,500
5. Art Scholarships 1,000 1,000
6. Mentor Program 5,000 5,000
7. New School Gift 5,500
8. Firework Grants 2,000
9. Unbudgeted Programs 1,750
10. Student Art Expenses 4,600 4,600
11. GT Incentive Grant 400
12. Leadership Grant 4,000
13. Principal for a Day 450 450
14. Career Days 200 200
Other (please specify)
1. Student Art Auction 15,500
2. Golf Tournament 21,000
3. CEO Dinner Event 13,450
4. Reserve ...........................5,000
r OTAL 221,685 32,250 15,000
Further Comments/Explanations (if necessary):
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Page 9 of21
City of Dublin
Fiscal Year 2008-2009
Application for Funds
b. Revenue Budget
FY 2008-2009
REVENUE BUDGET ORGANIZATION PROJECTIPROGRAM
Committed/Restricted Funds
(specify source)
Non-Committed/Restricted Funds
(specify source)
Grants 12,500
Student Art Auction 60,000
Golf Tournament 70,000
DPIE Membership 28,400
CEO Dinner 51,500
Miscellaneous 2,200
Fireworks 5,000
Realtors Fund Raising Event 13 ,000
TOTAL 242,600
Further Comments/Explanations (if necessary):
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Page 10 of21
City of Dublin
Fiscal Year 2008-2009
Application for Funds
6. General Agency Information
g Past grant applicants may check this box in lieu of completing item 6 (a-d) if the
program/organizational description on file with the City is correct and current.
o
Although we have been past grant applicants, we have included most of the
information needed to keep all records current. Thank you
a. List all years that Organization has previously received City of Dublin funding (not
Community Development Block Grant - CDBG).
b. Describe the population(s) served by the Organization.
The 5,470 students and their families of the of Dublin Unified School District
c. Describe all the services the Organization currently provides to Dublin residents.
· An additional page may be added, if needed.
DUBLIN PARTNERS IN EDUCATION PROGRAMS &
SUPPORT 2007-2008
I:l Vocational Mentoring Program at Dublin High School
I:l Teacher and School Grants Program
I:l Principal for a Day Program - Spring and Fall (New)
I:l Mentoring Program (New)
Q Career Day (New)
CJ Promotion of the Arts Program
Q Student Art Judging & Awards Night
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CJ Performing Arts Grants
CJ Winter Concert Sponsorship
CJ Science Fair Sponsorship
CJ Pacific Chamber Symphony Sponsorship
CJ New School Gifts
CJ New Teacher Gifts
CJ Barton Reading Pilot Program for Dyslexic Students (at Wells Intermediate School)
CJ Art Scholarship Program
CJ Special Arts Projects Sponsorships
CJ Dublin High School's Athletic Booster Sponsorship
CJ Winter Concert Sponsorships
d. .Has your agency ever previously received funds from the City of Dublin? If yes,
please specify in what Fiscal Years and the amount received each year.
City of Dublin Grants
2001 through 2007
Date Oneratinf! Year Amount
1997 Tax Return Possibly 1996/1997 $10,000
1998 Tax Return Possibly 1997/1998 $10,000
1999 Tax Return Possibly 1998/1999 $10,000
3/20/2001 2000/2001 $10,000
4/22/2002 2001/2002 $10,000
8/26/2002 2002/2003 $10,000
10/27/2003 2003/2004 $10,000
8/27/2004 2004/2005 $10,000
11/21/2005 2005/2006 $12,500
8/28/2006 2006/2007 $12,500
8//01/2007 2007/2008 $12,500
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City of Dublin
Fiscal Year 2008-2009
Application for Funds
7. Required Attachments:
o Only one (l) COpy per A2enCy of each of the following is required, even with multiple
projects/programs submitted.
o Applications without the following documents will !!2! be reviewed for funding.
o Please label attachments: A. B. C. etc.
CJ A. Names of Governing Board; identify current Board officers.
Attachment A
A Honorary Council
Don Babbitt, Heartwood Communities
Stephen Brooks, Alameda County of Education
Jim Gulseth, JG, P.C. Law
Stephen Hanke, Superintendent
Dublin Unified School District
Janet Lockhart, Mayor of Dublin
Roz Perazzo, Chevron Corporation
Tim Sbranti, Dublin City Council
John Sugiyama, Retired DUSD Superintendent
DPIE Board
President - Don Biddle
Vice President - Tess Thomas
Principal, Fallon School
Co-Secretary - Chris Bennett
W orkvantage
Co-Secretary - Kathy De Jong
Perfonnance Management
Treasurer - Bill Moy
Timpson Garcia, LLC
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Board Members cont.:
Angela Fontes
Mom and Volunteer
Ted Hoffman, Jr.
Earl Anthony's Dublin Bowl
Fawn Holman.
Community Volunteer
Kellee Jones
Natural Wood Furniture Depot
Dr. Dave Marken
Assistant Superintendent, Educational Services
Bill Prescott
The Saranac Consulting Group, Inc.
Victor Uno
IBEW Local 595
Alcina Wegrzynowski
Sybase, Inc.
Pat Kohnen
Liaison to DUSD Board
Amy Frantz
DHS Student Representative
Class of 2009
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Page 14 of21
CI B. Current total Organization operating budget, including revenue.
· Clearly label/identify the program that includes the PROPOSED
PROJECTIPROGRAM.
· See Attached
CI C. Most recent audit report or tax return (if applicable).
· See Attached
CI D. Resolution, letter or other document providing evidence of
Board/Organization approval of application, and date approval was granted.
· Board/Organization approval may be pending.
· See Attached - DPIE Board approved Grant request on 1-08-08
Board Meeting Notes attached.
CI E. Organization's certificate of insurance showing coverage for liability and
workers' compensation.
CI
· See Attached
CI F. Application Verification Declaration Signature Page.
· See Attached
CI G. Signed affidavit form from each collaborating agency named in proposed
project/program plan (if applicable).
· N/A
CI H. Copy of IRS Letter of Determination indicating tax exempt status.
· See Attached
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City of Dublin
Fiscal Year 2008-2009
Application for Funds
ApPLICATION VERIFICATION
I attest that the information contained in this FY 2008-2009 grant application is accurate and that
the funds requested will not supplant any other monies secured by the organization.
Attached is a resolution, letter, or other document providing evidence that the Board of Directors
approved the application as submitted. Successful applicants are required to submit a summary
report as soon as possible after submitting the reimbursement request, but not later than August
30,2009. Failure to submit a report will result in ineligibility for future funding.
Signatures:
Executive Director
Date
Board President/Chairperson
Date
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City of Dublin
Fiscal Year 2008-2009
N/A
Application for Funds
COLLABORATION AGENCY
AFFIDA VIT FORM
o This form is to be completed by each collaborating organization as named by the
applicant agency in the proposed project/program.
o Completed forms must be submitted at time of application.
Collaborating Agency Name:
N/A
Agency Division/Department:
Project/Program Title:
Project/Program Role Description (Le., facility space, staff support, etc.):
Agency Project/Program Contact Person
Title
Phone
Email
I attest that the applicant agency and our organization agree to work collaboratively to implement
the proposed project/program as identified in the FY 2008-2009 funding application.
Executive Director
Date
Project/Program Contact Person
Date
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CITY OF DUBLIN
Fiscal Year 2008-2009
COMMUNITY GROUP/ORGANIZATIONAL FUNDING PROGRAM
REQUEST FOR REIMBURSEMENT
AGENCY NAME
N/A
MAILING ADDRESS FOR REIMBURSEMENT:
PROJECT/PROGRAM NAME
CLAIM # OF
TOTAL FUNDING AMOUNT AWARDED TOTAL REIMBURSEMENT REQUESTED THIS PERIOD
$ $
Amount of
Expense Type Reimbursement Requested
(please attach receipts, timesheets, etc.
(Please describe.) Date supporting identified exoenses.)
TOTAL Amount Reouested
(If requesting project/program "start-up" funding, please describe initial funding use above.)
I attest that the above listed expenses are accurate and true and have been used as represented in
the approved funding application.
Submitted by:
Signature:
Date:
SECTION 2
Page 18 of21
CITY OF DUBLIN
JF~caIYear2008-2009
COMMUNITY GROUP/ORGANIZATIONAL FUNDING PROGRAM
SUMMARY REpORT
(Summary Report must be completed and submitted prior to August 31,2009.)
AGENCY NAME
MAILING ADDRESS:
TELEPHONE:
PROJECT/PROGRAM NAME:
TOTAL FUNDING AMOUNT AWARDED
$
TOTAL REIMBURSEMENT RECEIVED
$
1.) How has the PROJECT/PROGRAM addressed an unmet community need and improved
the quality of life for Dublin residents. (Additional page may be added, ifneeded):
2.) Please evaluate the success of your project/program. Were the goals outlined in the
application met? Was the project/program carried out efficiently? Please use the objectives
identified in your application to discuss your program/project's success and impact. Include any
documentation!datalrecords you have that support your conclusions.
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Page 19 of21
City of Dublin
Fiscal Year 2008-2009
SUMMARY REpORT
3) How many total participants were served by this project/program?
How many of those participants are Dublin residents?
I attest that the above listed information is accurate and true.
Submitted by:
Signature:
Date:
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Page 20 of21
AGREEMENT BETWEEN
CITY OF DUBLIN
AND
(insert organization name)
THIS AGREEMENT, dated for identification this _ day of _ 2008, is entered into
between the City of Dublin ("City") and (organization).
RECITALS
A. (organization) has asked City to contribute $ ( Dollars) for use by
(organization) to cover costs in order to provide the services as
described in Exhibit A. The services rendered pursuant to this agreement will be for the
period July 1,2008 through June 30, 2009,
B. City has determined that it is in the interest of the residents of the City of Dublin to make
a donation of $ ( Dollars) for such purpose, provided certain
conditions are met to ensure that the services will benefit the residents of City.
AGREEMENT
City and (organization) agree as follows:
1. Recitals
The foregoing recitals are true and correct and are part of this agreement.
2. City Donation
City shall donate $ ( Dollars) to be used by (organization) to be used
for operational support for as described in Exhibit A to this Agreement.
The donation shall be paid upon invoice to the City.
3. Records
(Organization) shall maintain records for project/program review, evaluation, audit
and/or other purposes and make them available to City upon request.
4. Periodic Reports
Upon request by City, (organization) shall provide reports describing the progress made
by (organization) accomplishing the goals and objectives outlined in the work plan.
CITY OF DUBLIN
Dated:
By:
Richard C. Ambrose, City Manager
Dated:
By:
Title:
SECTION 2
Page 21 of21
City of Dublin Application 2008-2009 Insert B
Vocational Program
Insert B- City of Dublin Grant Proposed Budget Funds Requested
Income Expense
Est. Beginning Balance
Earned
Interest Income $ 500 $ -
SAA $ 60,000 $ 15,500
Golf $ 70,000 $ 21,000
Fireworks $ 5,000 $ -
CEO Dinner Event $ 51,500 $ 13,450
Realtors Event $ 13,000 $ -
Total Earned: $ 200,000 $ 49,950
Contributed
Grant Income $ 12,500 $ -
Teacher Grant Income (ACOE) $ 1,500
Corporate Membership $ 23,000
Individual Membership $ 5,400
Misc. Income $ 200
Restaurant Night
Total Contributed: $ 42,600 $ -
Total Income: $ 242,600 $ 49,950
Programs
Student Board Scholarship $ -
Teacher Grants $ 50,000
Winter Concert $ 1,500
Performing Arts Grant $ 1,000 $ 1,000
Science Fair $ 1,500
Art Scholarships $ 1,000 $ 1,000
Mentor Program $ 5,000 $ 5,000
New School Gift $ 5,500
Fireworks Grants $ 2,000
Unbudgeted Programs $ 1,750
SAA Program Expenses $ 4,600 $ 4,600
GT Incentive Grant $ 400
DUSD Leadership Training Grant $ 4,000
Principal For A Day $ 450 $ 450
Career Days $ 200 $ 200
Total Programs: $ - $ 78,900
Admin
Office Supplies $ 1,500
City of Dublin Application 2008-2009 Insert B
Postage $ 1,500
Bank Fees $ 1,500
Outside CPA $ 1,200
Corporate Filing $ 175
Ins - Liability & E&O $ 3,500
ED Expenses $ 300
Board Expenses $ 1,000
Marketing $ 1,500
Office Equipment $ 500
Other (unbudaeted) $ -
Total Admin $ . $ 12,675
Payroll
Payroll
Worker's Comp Insurance $ 2,000
Executive Director $ 35,000
Program Director $ 20,000 $ 20,000
ED Incentive Package $ 2,000
Admin Services $ 15,360
Past Admin. Employee $ 150
Payroll Service (Paychex) $ 650
Total Payroll $ . $ 75,160
Mise
Reserve $ 5,000
Grand Totals: $ 242,600 $ 221,685 $ 32,250
Fonn 8868
(Rev. April 2007)
-)
Application for Extension of Time To File an
Exempt Organization Return
~ File a separate application for each return.
<J..-b
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OMB No. 1545-1709
Department of the Treasury
Internal Revenue Service
. If you are filing for an Automatic 3-Month Extension, complete only Part I and check this box........ ........... _....... ......... ~ [X]
. If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part II (on page 2 of this form).
Do not complete Part 1\ unless you have already been granted an automatic 3-month extension on a previously filed Fonn 8868.
Automatic 3-Month Extension of Time. Only submit original (no copies needed).
Section 501 (c) corporations required to file Form 990-T and requesting an automatic 6-month extension. check this box
and complete Part I only ................................ ....................................................... ....................... . ~ D
All other corporations (including 1120-C filers), partnerships, REMICs, and trusts must use Form 7004 to request an extension of time
to file income tax returns.
Electronic Filing (e-file). Generally, you can electronically file Fonn 8868 if you want a 3-month automatic extension of time to file one of the returns
noted below (6 months for section 501 (c) corporations required to file Form 990- T). However, you cannot file Form 8868 electronically if (1) you want
the additional (not automatic) 3-month extension or (2) you file Forms 990-BL, 6069, or 8870, group returns, or a composite or consolidated Form
990.T. Instead, you must submit the fully completed and signed page 2 (Part II) of Form 8868. For more details on the electronic filing of this form,
visit www.irs,gov/efile and click on e-file for Charities & Nonprofits.
Type or Name of Exempt Organization Employer identification number
print
File by the
due date for
filing your
return. See
instructions.
DUBLIN PARTNERSHIPS IN EDUCATION
Number, street, and room or suite no. If a P.O. box, see instructions.
P. O. BOX 2307
City, town or post office, state, and ZIP code. For a foreign address, see instructions.
DUBLIN, CA 94568
94-3207780
Check type of return to be filed(file a separate application for each return):
[X] Fonn 990 D Fonn 990-T (corporation)
D Fonn 990.BL D Fonn 990- T (sec. 401 (a) or 408(a) trust)
D Fonn 990.EZ D Form 990-T (trust other than above)
D Fonn 990-PF D Fonn 1041-A
D Form 4720
D Form 5227
D Fonn 6069
D Fonn 8870
. The books are in the care of ~ WILLIAM E. MOY
TelephoneNo.~ (925) 829-1928 FAX No. ~ (510) 465-2979
. If the organization does not have an office or place of business in the United States, check this box ................................................... ~ D
. If this is for a Group Retum, enter the organization's four digit Group Exemption Number (GEN) . If this is for the whole group, check this
box ~ D. If it is for part of the group, check this box ~ D and attach a list with the names and EINs of all members the extension will cover.
1 I request an automatic 3.month (6.months for a section 501 (c) corporation required to file Form 990-T) extension of time until
FEBRUARY 15, 2008 ,to file the exempt organization retum for the organization named above. The extension
is for the organization's return for:
~ D calendar year or
~ [X] tax year begin~JUL 1, 2006
, and ending JUN 3 0, 2007
2 If this tax year is for less than 12 months, check reason: D Initial retum
D Final return
D Change in accounting period
3a If this application is for Fonn 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any
nonrefundable credits. See instructions. 3a $
b If this application is for Form 990-PF or 990-T, enter any refundable credits and estimated
tax payments made. Include any prior year overpayment allowed as a credit. 3b $
c Balance Due. Subtract line 3b from line 3a. Include your payment with this form, or, if required,
deposit with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System). -
See instructions. 3c $ N/A
Caution. If you are going to make an electronic fund withdrawal with this Form 8868, see Form 8453-EO and Form 8879.EO for payment instructions.
LHA
For Privacy Act and Paperwork Reduction Act Notice, see instructions.
Form 8868 (Rev. 4-2007)
623831
05-01-07
19000123 748525 19412
2006.08010 DUBLIN PARTNERSHIPS IN EDUC 19412__1
Return of Organization Exempt From Income Tax
Under secllon 501(0), 527, or 4947(a)(1) oUhe Internal Revenue Code (exceptblaok lung
benefit trust or private foundation)
0epartm1l1t of ahe Trll8llllrY
Inll!fl\lll RlMlI1Ul1 ServIce ~ The organization may have to use a copy 01 this relurn to satisfy stale reporting requirements.
A For the 2005 calendar year, or tax year beginnIng JUL 1, 2 05 and endIng JON 30, 006
B Check If Plllllllll C Name 01 organization D Employer Identification number
appllc&bla: useIRS
lebel CI'
print ar
type.
See
SpIlCIII
InallUc.
lions.
UBLIN PARTNERSHIPS IN EDUCATION
Number and streel (or P.O. box II maills not delivered 10 street address)
. O. BOX 2307
City or lown, stale or country, and ZIP + 4 F Amuntllltl mllhod:
UBLIN, CA 94568 D ~~I~
· eotlon 50 (0)(3 organlzatlonsand 4 4 (a)(1) nonexempl e arltable trusts H and I are no~l/cable to section 527 organizations.
must aUach a completed SchedUle A (Form 990 or 99D-EZ). H(a) Is thIs a g~m fO~/ates? D Ves [XJ No
G Webslle:~N/A H(b) Jf"Yes:enler~.Dales~ N/A
J OrganIzation type _anlyllltl~ 501(c)( 3 ).... ~l1lllIftno.1 4947(a)(1) or 527 H(e) N/A UVes UNo
K Check here ~ If the organizatIon's gross receipts are normally not more than $25,000. The H(d) f~'
organization need notllle a return wlll1 tha IRS; but If the organization chooses to Ole a lllturn, ba :Agan
sure to file a completa return. Some slales require a oomplete return. I.. ; It
Ai ,... Ch
L Gross receipts: Add lines 6b, Bb, 9b, and 10b to line 12 ~ 23 0 , 39 a. ~ Sch. B
€e~mli Revenue, Ex ses, and Changes in Net Assets or Fund ~Iance
Contributions, gilts. grants, snd similar amounts received:
a Direct pUblic support ........................................................................
b Indirect public support ....................................................................
o Government contributions (grants) ........................................................
d Total (add lines 1a through 1c) (cash $ 48 , 035 ==non h $
2 Program s8fVlce revenue Including government lees and contracts. . I,
3 MembershIp dues and assessments ...................................... .
4 Interest on savings and lemporary cash Investments .......
5 Dividends and Interest from securities ........................
8 a Gross rents ..................................................... ......
bLess: renlal expenses ..............,........................
o Net lllntallncome or (loss) (subtract line 6b from
7 D1her Invastmentlncome (describe ~
8. Gross amount from sales 01 assets other
than InvenlllfY .........................,......
b Less: cost Dr other basis and safes expen
c Gain or (loss) (attach schedule) ...
d Net gain or (loss) (combIne line 8
9 Special events and activities
a Gross revenue (notlncludl
rtlJlortBd on line is) ......
b Less: direct expenses oth
c Nellncome or (10
10 a Gross sales oft
b l.ess: cost of go old .....
e Gross profit or (10 S '
11 Other revenue (from Pa ,line 103) .........................................................................................................
12 Tolal revenue add lines 1d, 2, 3,4,5, 6e. 7 8d, 9e, 10e, and 11 .....................................................................
= 13 Program servIces (from line 44, column (B)) ................................................................................................
III 14 Management and general (from line 44, column (e)) ....................................................................................
! 16 Fundllllslng (from line 44, column (0)) ...........................,..........................................................................
.n 16 Payments to affiliates (attach schedule) ......................................................................................................
17 Total ensel add lines 16 end 44, column A.......................................................................................
18 Excess or (deficit) for the year (subtract line 17 from line 12) .............................................................,.............
~i 19 Net assets or fund balances at beginning of year (from nne 73, column (A)) .........................................................
~ 20 Oll1er changes In net assets or fund balances (attach explanation) .....................................................................
21 Net assets or fund balances at end 01 year (combine lines 18, 19, and 20) .........................................................
02-113-06 LHA For Privacy Act and Paperwork Reduction Act Nollce, Bee the Beparate Instrucllonl.
/
Form
990
D~-:a
D=e
D=
DF/n81
retum
D=ded
D=~':ullan
-P-~
Roomlsulle
94-3207780
GI
~
c
~
GI
a:
10c
11
12
13
14
1&
18
17
18
19
20
21
10500515 748525 19412
Accrual
48,035.
96.
99 095.
2005.08010 DUBLIN PARTNERSHIPS IN EDUC 19412__1
Form 990'(2005) DUBLIN PARTNERSHIPS IN EDUCATION 94-3207780 Page 2
l~ea~II~1 Statement of All organizations must complete column (A). Columns (B). (e), anti (D) are required for sactlon 501(c)(3)
Functional Expenses anti (4) organizations and section 4947(a)(1) nonexemptcharllable trusts but opllonal for others.
Do not Include amounts reported on line (A) Total (B) Program (e) Management
6b, Bb,9b, 10b, or 16 of Part I. l5: services and I18neral
22 Grants and allocations (attach schedule)
'!C8IlIl $ 0 . fIOlaSIl sO.
If IhIs emaunt Includes fanllgn gmnIs, chICk here ~ 22
23 Specific assistance to Individuals (attach
schedule) ......,............................................ 23
24 Benefits paId to or for members (attach
schedule) ................................................... 24
25 Compensation of officers. dll'Bctors, etc. * ~. 25 3 6 , 618 .
26 Other salaries and wages .....................,..... 26 19 , 430 .
27 Pension plan contributions ........................ 27
28 Other employee benefits ........................... 28
29 PayroU taxes ............................................. 29
30 Professional fundralslng fees ..................... 30
31 Accounting fees ....................................... 31 1, 00. 1 , 200 .
32 Legal fees ................................................ 32
33 SuppAes ................................................... 33
34 Telephone ...............................................' 34
35 Postage and shipping ................................. 35 1 , 200 . 1 , 2 O.
36 Occupancy ................................................ 36
37 Equipment rental and maintenance ............ 37
38 Printing and publications ........................... 38
39 Travel ...................................................... 39
40 Confel'Bnces, conventions. and meetIngs... 40
41 Interest ...................................................... 41
42 Dapl'Bclatlon, depletion, etc. (attach schedule) 42
43 Other expenses not covered above (itemize):
a
b
c
d
13 717.
858.
1i~ 137,705. 94,425. 34,874. 8,406.
OP 98.2.
on and fundralslng solicitation raported In (8) Progmm services? ..................... ~ DYes [XJ No
costs $ N / A ; (II) the amount allocated to Prngmm services $ N / A
Bneml $ N / A . and Iv the amount allocated to Fundralsln $ N A
Fonn 990 (20D5)
** SEE STATEMENT 3
5230 11
02-03-08
10500515 748525 19412
2005.08010 DUBLIN PARTNERSHIPS IN EDUC 19412__1
Form 990(2005) DUBLIN PARTNERSHIPS IN EDUCATION 94-3207780 Page 3
I~Bil~1 Statement of Program Service Accomplishments (See the Instructions.)
Form 990 Is available for public Inspection and, for soma people, serves as the primary or sole source of Information about a particular organization.
How tha public perceives an organization In such cases may be detennlned by the Infonnatlon presanted on Its retum. Therefore, please make sure the
retum Is complete and accurate and fully describes, In Part JII, the organlzatlon's programs and accompDshmenls.
What Is the organization's primary exempt purpose? ~ SEE STATEMENT 4
All organIzations must describe theIr exempt purpose achievements In a clear and concise manner. State the number of
clients served, publications Issued, etc. DIscuss achievements that are not measurable. (Section 501 (c)(3) and (4)
organizations and 4947(a)(1) nonexempt charitable trusts must also enter the amount of grants and allocations 10 others.)
a TEACHER GRANTS - TO PROVIDE ADDITIONAL FUNDING TO EliijANCE
PROGRAMS THAT ARE OUTSIDE OF THE PURVIEW OF THE NO~SI~
BUDGET.
Grants and allocations $
(Grants and allocations $
c SUPPORT OF PROGRAMS,
ORGANIZATIONS
~
(Grants and allocations $
d
Gran1:$ and allocations $
e other program services (attach sc
(Gran1:$ and allocations $
f Total of Program Service ExpiiiSea (sho
If this amount Includes forel n gran1:$, check here ~
) If this amount Includes foral rants. check here ~ D
. . ualllne 44, column (B), Program services) ....................................... ~
523021
Q2.(13-il6
10500515 748525 19412
Program Service
Expensea
(ReqUired for 501(c)(3)
and (4) orgs.. and
4947(a)(1)lrUsls; but
optional for others.)
30,233.
22,219.
41,973.
2005.08010 DUBLIN PARTNERSHIPS IN EDUC 19412__1
94-3207780 Page 4
DUBLIN PARTNERSHIPS IN EDUCATION
U~ajjtiIV~ aJance ts (See the InsttVctfonsJ
Note: Whet8 required, attached schedules and amounts within the description column (A)
should be for end-of-year amounts only. BegInning of year
45 Cash - non-Interest-bearing ...........................................................................
46 Savings and temporary cash Investments '.....................................................
33,307.
47 1 Accounts receivable .................................... 47a
b Less: allowance for doubtful accounts ......... 47b
!'5EES'i --=:-
~
481
b
49
50
.l!l 518
GI
III
en b
<
52
53
54
55 a
b
58
571
b
58
59
60
81
62
III
i 63
:s 64
III
::i
66
Pledges receivable ....................................... 48a
Less: allowance for doubtful accounts 4Bb
Grants receivable .....,.. .... ............................................. .................. ..',.. ..,......
Receivables from officers, directors, trustees,
and key employees ,..... ........................ ................ ...... ............. ....... ...............
Other notes and loans receivable .................. 511
Lsss: allowance for doubtful accounts ......... 51b
Inventories for sale or use ....,.........................................................................
PrepaId expenses and deferred charges ....................................................
Investments - securities .......................................... .. D Cost D F
Investments -land, buildings, and A
equlpmant: basis ........................'................. 668
PAYABLE
37,133. &9
80
61
62
63
84a
64b
65
O. 68
III
i
ii
m
'a
c
::lI
II.
ti 70
.l!l
II 71
III
.! 72
..
GI 73
z
74
70
71
72
S!!5!l!!
--.=
523031
02.03-08
(8)
End Df year
45,144.
2,862.
48,006.
1,352.
1 352.
46,654.
O.
10500515 748525 19412
2005.08010 DUBLIN PARTNERSHIPS IN EDUC 19412__1
94-3207780 Page 5
evenue per e m (See the
B
b
1
2
3
4
B
N/A
b1
b2
b3
==
e;;;
=
==
==
~
c
d
1
2
b
c
=
=:
N/A
b
1
2
3
4
~
E;E
~
=
==
=
=
d
1
2
b
c
E
a
;;;;s
==
d
(A) Name and address
SEE-STATEMENT-S---------
31,160.
o.
o.
Fonn 990 (2005)
523041 Q2.Q3.D8
10500515 748525 19412
2005.08010 DUBLIN PARTNERSHIPS IN EDUC 19412__1
b
(A) Name and address
PAMELA GLYNN
8435DAVONA-DRlVE------------------
DUBLIlf-Ci-9456S------------------
5,458.
o.
o.
=============~~==========
i.ei , ::lm er Infomration the fnstructlons.)
DId the organization e In Ivlly not prevlously reported to the IRS? If 'Yes,' attach a detailed
description of each .... ............. ......... on........... ........................ ............ _... .._. ............ ....... .................................
77 Were any changes made In e organizing or govemlng documents but not reported to the IRS? ..........................................
If "Yes,. attach a conformed copy of the changes.
18 a DId the organIzation have unrelated business gross Income of $1 ,000 or more during the year covered by this retum? .........
b If "Yes,. has It filed a tax retum on Form 990- T for this year? ....................................................................................1!!.l'!!:
79 Was there a liquidation, dissolution, termInation, or substantlal contraction during the year? If .Yes,. attach a statement ......
80 a Is the organizatIon related (other than by association with a statewide or nationwide organization) through common
membership, govemlng bodies, trustees, officers, etc., to any other exempt or nonexempt organization? ..............................
b If .Yes,. enter the neme of the organization" N / A
81 a
b
and check whether It Is LJ exempt or LJ nDnexempt
Enter direct Dr Indirect political expenditures. (See line 81Instnsctlons.) .............................. 81a 0 .
DId the anlzatlon file Form 1120-POL for this r? ......................................................................................................
5231B1m2-ll3-lI8
10500515 748525 19412
2005.08010 DUBLIN PARTNERSHIPS IN EDUC 19412__1
94-3207780 Page 7
Yes No
82a
b
83 a
b
84&
b
85
b
0
d
e
,
D
h
86
b
87
b
88
89 a
b
c
d
90 a
b
918
b
0
92
Old the organization receive donated services or the use of materials, equipment. or facUlties at no charge or at substantially
less than fafr rental value? ..........,. ............ .... .......,......,........'..'......... ....... ................ .............. .......... .... ......... ............,.......
If "Yes, . you may Indicate the value of these Items here. Do not Include this
amount as revenue In Part I or as an expense In Part II.
(See Instructions In Part III.) ..............................................................................................., 82b N / A
Old the organization comply with the pubnc Inspection requirements for retums and exemption applications? ........................
Old the organization comply with the disclosure requirements relating to quid pro quo contributions? ....................................
Old the organization solicit any contrlbutlons or gifts that were not tax deductible? .............................................W.I.A.........
If .Yes,. did the organization Include with every solicitation an express statement that such contrlbutlons or gifts were not
tax deductible? ..... .... .....................'........,................. ......... ,....,......... '" ................. ....... .... ...... ...... ................... .w.1..~.,.......
501(a)(4), (5), oreS) organizations. 8 Were substantially all dues nondeductible by members? ............. ............w.I.~.........
Did the organization make only In-house lobbying expenditures of $2,000 or less? ........................... .....~.........
If .Ves. was answered to either 8Sa or 85b, do not compJste S5c through 8Sh below unless the Q!g ~ a
waiver for proxy tax owed for the prior year. ..,.
Dues, assessments, and similar amounts from members ......................................................
Section 162(e) lobbying and poDtlcal expenditures ......................................................... 85 N I A
_...--........ "'..- 6033{e)~1(A) d.... _ ................~. Nt A
Taxable amount of lobbying and political expenditures (line 85d less 85e) .............. ........ 5 ;: N I A
Does the organization elect to pay the section 6033(e) tax on the amount on line as.. .........:::..................w.I..~.......,.
If section Ei033(e)(1XA) dues notices were sent, does the organization agree to a&e am. " on One 8Sf
to Its reasonable estimate of dues allocable to nondeductible lobbying and po I pend res forthe
followlng tax year? .................. .,. ........ .... ..... .... ............. ....... .......,... ....... ................................,w.I.~. ........
501(c)(7) organizations. Enter: a Initiation fees and capital contributions In
line 12 .................................,..... ,.....'..... ..,...... ............ ....... ............
Gross J'8Ce/pts, Included on Une 12, for pubUc use of club facilities
501(c)(12) OIf1SIllzatlons. Enter: 8 Gross Income from members or.
Gross Income from ather sources. (Do not net amounts due or p
against amounts due or received from them.) ....,.............. 87b N/A
At any time during the year, dld the organization own a 5 terest In a taxable corporation or partnership,
or an entity disregarded as separate from the organ Ions sections 301.n01.2 and 301.no1.3?
If "Yes,. complete Part IX ........................................ .................................................................................
501 (a)(3) organizations. Enter: Amount of tax Impos'Etl 1%atlan during the year under:
secUon 4911~ 0 . ; seeDo 0 . ; section 4955 ~
501 (a)(3) and 501 (c)(4) organizations. Old the engage In any section 4958 excess benefit
:~~:~::c~rI:~~=t:~I~~:c:. ~ e~:::.~~~.~~.~~:~~=.~~..~.~~~.~.~...................,........,..,... B9b
Enter: Amount of tax Imposed on the . gers or disqualified persons during the year under
sections 4912, 4955, and 49S8 ...... ............................................................,.................................... ~
Enter: Amount of tax on line 89c ed by the organization ............................................................... ~
Ust the states with which a c flied ~CA
Number of employees amp! :. erlod that Includes March 12, 2005 ....................................... 90b
The books are In care of ~ A' ~ NTES I TREASURER 20 05 - 0 6 Telephone no. ~ 9 5) 8 - 2 5 51
Located at ~ 8435A'AVO · RIVE , DUBLIN, CA ZIP + 4 ~ 94568
At. any time during endar. r, did the organization have an Interest In or a signature or other authority
over a financial acca' n a to country (such as a bank account, securities account, or other financial
~~~~~~)~t;th~.~;;~~'fO;ig~.~~~~~;;'~..................N/A....................................................................,.....,.........
See the Instructions for exceptions and flUng requlremants for Form TO F 90-22.1, Report of Foreign Bank
and Rnancla! Accounts.
At any time during the calendar year, did the organization maintain an office outsIde of the United States?
If .Yes, · enter the name of the foreIgn country ~ N I A
Section 4947(8)(1) nonexempt charitable trusts tllfng Form 990 fn Ueu of Form 1041. Check here ...................................................... ~ 0
and enter the amount of tax-exempt Interest received or accrued during the tax year ........................... ~ W N / A
Form 990 (2005)
B3a X
83b X
841
~=~-~
== :...-:::: =_...3
BBa
B6b
87a
N/A
N/A
N/A
X
o.
o.
2
523182
lJ2o.D3-D6
10500515 748525 19412
2005.08010 DUBLIN PARTNERSHIPS IN EDUC 19412__1
94-3207780 PageS
(8)
Amount
Excluded by sectlllll512, 513. Dr 514
(e) (D)
":rd:' Amount
code
(E)
Related Dr exempt
function Income
c
d
e
1 MedlcarelMedlcald payments ...........................
D Fees and contracts from government agencies ...
94 Membership dues end assessments ..................
95 Interest on savings and temporary cash Investments ...
96 DIvidends and Interest from securities ...............
97 Net rentsllncome or (loss) from real estate:
a debt.flnanced property .......................................
b not debt.flnanced property .................................
98 Net rentsllncome or (loss) from personal property
99 Other Investment Income .................................
100 Gain or Ooss) from sales 01 assets
other than Inventory ..........................................
101 Net Income or (loss) from special events _._...._.._.
102 Gross profit or (loss) from sales of Inventory
103 Other revenue:
8
b
c
d
99,095.
96.
.. .......... ............... ..... ...... ......................... ~
TO
End-ol-year
assets
No
[XJ No
P,li..... SSN arPTlN
300
523183
02.D3-lIll
Phone no. ~ (510) 832-2325
Form 990 (2005)
10500515 748525 19412
2005.08010 DUBLIN PARTNERSHIPS IN EDUC 19412__1
SCHEDULE A
(Form 990 or 99D-EZ)
Organization Exempt Under Section 501 (c)(3)
(Exoept Prlvate FoundaUon) and SecUon 501(e), 501(1). 501{k),
501(n). or 4947(a)(1) Nonexempt Charitable Trust
Supplementary Information-(See separate Instructions.)
~ MUST be completed by the above orllan/zaUons and attaohed to their Form 990 or 99D-EZ
Employer IdenUnoation number
DUBLIN PARTNERSHIPS IN EDUCATION 94i 3207780
Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees
(See page 1 of the Inslrucllons. List each one. If there are none. enter .None.')
(a) Name and address of each employee paid p~r v:e~k :~Pe~ tgurs (0) Compensation ~Td.ll:::t acc:unt f:S o~er
more than $50,DOO position P c:ompensallon allowances
OMS No. 1545-G047
Department at 1118 Tr8lUlUfY
Inletnel RW8IlU8 Service
2005
~Q~-----------------------------
Total number of other employeBs paid
(b) Type of service
(c) Compensation
NOjE----------------------------
-----------------------------
I
other tIlan professional services, whetller Individuals or
ge 2 of the InslrucUons.)
(a) Name and address ch Indep Bnt contractor paid more than $50,000 (b) Type of service
(0) Compensation
--------------------------------------------
--------------------------------------------
Tolal number of other contractors receiving over
$50,000 for other services ...............................,.................................. ~
o
523101JD2.Q3.0S lHA For Paperwortc ReducUOR Act Notice, lee the InatrucUons for Form 990 and Form 99l1-EZ.
Schedule A (Form 990 or 99HZ) 2006
10500515 748525 19412
2005.08010 DUBLIN PARTNERSHIPS IN EDUC 19412__1
SchedUleA'(Form9900r990-EZ)2005 DUBLIN PARTNERSHIPS IN EDUCATION 94-3207780 Page 2
l~gartm'~1 Statements About Activities (See page 2 of the InslrUcUons.) Yes No
1 During the year, has the organization attemptad to (nDuence netlonal, stata, or local legislation, Including any attempt to Influence
pUblic opInion on a legislative matter or referendum? If "Yes," enter the total expenses paid or Incurred In conneellon with the
lobbying actlvlUes ~ $ $ (Must equal amounts on line 38, Part VI-A, or
line i of Part YI-B.) 1 X
Organizations that made an election under section 501(h) by flOng Form 5768 must complete Part VI-A. Other organizations
checking "YeS' must complete Part VI-S AND attach a statement giving a delal/ed descrIption of the lobbyIng actlvllles.
2 During the year, has the organlzallon, ellher directly or Indlteclly, engaged In any of the following acts with any substantial contributors,
trustees, directors, officers, creators, key employees, or members of their famlUes, or wIth any taxable organization with which any such
person Is affiliated as an officer, director, trostae, majority owner, or principal beneficIary? (If the answer to any question is .Yes, ·
attach a detailed statement explaining the transact/ons.)
8 Sale, exchange, Dr leasing of property? .......................................,...,................,....................................... . 28 X
The organization Is not a private loundation because It Is: (Please check
5 0 A church, convention of churches, or association of ch
BOA school. Section 170(b)(1)(A)(D). (Also complete
7 0 A hospital or a cooperallve hospItal service or
8 D A Federa~ slate. or local government or gove
9 0 A medical research organlzaUon operated
and slate ~
10 0 An organization operated tor the beneftt
(Also complete the Support Soh
111 0 An organization that normally r part of lis support from a governmental unit or from the general pUblic.
Section 170(b)(1)(A)(vl). ( upport Schedule In Part IY.A.)
11b D A communlly trosl Sac v . Also complela the Support Schedule In Part IV-A.)
12 [XJ An orgenlzatlon that no ) more than 33 1J3'l1o of lis support from contributions, membership fees, and gross
receipts from acllvlUes . table, ele., functions - SUbject to certain exceptions, and (2) no more than 33 1J3'l1o of
Its support from n . me and unrelated business taxable Income (less sectlon 511 tax) from businesses acquired
by the organlza r JIU 975. See sectlon 509(a)(2). (Also complete the Support Sohedule In Part IV-A.)
13 0 An organlzaUo at Is not lied by any disqualified persons (other than foundation managers) and supports organIzations dll$erlbed In:
(1) lines 5 throu ..!8bo or (2) secUons 601(c)(4), (5), or (6), If they meet the test of section 509(a)(2). Check the box thatdesctlbes
the type of supporting organization: ~ 0 Type 1 D Type 2 0 Type 3
ProvIde the following Informallon about the supported organlzatlons. (See page 6 01 the Insirucllons.)
o Furnishing of goods, services, or faclllUes? ...........................................................................,............
20
X
b Lending of money or other extension of credit? ................,.................................................................. .....
2b
X
d Payment of compensation (Dr payment or reimbursement of expenses If more than $1,OOO)? ........
2d
X
2e X
n 170(h)? ....................................
de advice
3a
3b
30
X
X
X
41
4b
X
X
gh 6 of the InstrucUons.)
. (b)(1)(A)(HI).
n 'Il 170(b)(1)(A)(v).
n with a hospitaL Section 170(b)(1)(A)(UJ). Enter the hospital', name, olty,
lverslty owned or operated by a governmental unit SectIon 170(b)(1)(A)(lv).
(a) Name(s) of supported organlzalJon(s)
(b)Une number
from above
14 [ J An organization orgenlzed and operated to test for pubHc safety. Section 509(a){4). (See page 6 01 the InstrucUons.)
523111
OZ-G3.OB Schedule A (Form 990 or 990-EZ) 2005
10500515 748525 19412
2005.08010 DUBLIN PARTNERSHIPS IN EDUC 19412__1
Si:heduleA(Form99Dor99D-€Z}2005 DUBLIN PARTNERSHIPS IN EDUCATION 94-3207780 Page 3
I~I~I Support Schedule (Complele only If you checked a box on line 10, 11, or 12.) Use cash method of accounting.
- Note: You msy use lhe worksheet in the Instructions for converting from the E1CCrusJ to the cash method of accounting.
I en ar yelr or ICI yelr
beginning In) .............................. ~ (a) 2D04 (b) 2D03 (e) 2002 (d) 2001 (e) Tolal
15 IJIiIn ,an con u ns
received. (Do not Include unusual
grants. See line 28.) ........,......... 35,564. 36,178. 50,510. 37,735. 159,987.
18 Membership fees received .........
17 Gross receipts from admissions,
merchandise sold or services
performed, or fumlshlng of
faclntles In any activity that Is
related to the orgenlzation's
charllabte,e!c..purpose ............ 129,350. 105,271. 80,582. 50,312. 365,515 "
18 Gross Income from Interest,
dividends, amounts received from
payments on securities loans (sec-
tion 512(a}(5)), renlS, royaltIes, and
unrelated business taxable Inco me
(Jess section 511 taxes) from
businesses acquired by the
organizaUon after June 30, 1975 1, 27 5 .
19 Net Income from unrelated business
activities not Included In line 18 ...
20 ax re.venues ever e
OrDanlZa1lon's benefit an either
palel to It or expended on lis behalf
21 The value of services or facUllles
furnished to the organization by a
governmental unit without charge.
Do not Include the value of services
or facllilles generally furnished to
the pooRe without charge .........
22 r come. c asc e ue.
Do not Include gain or (loss) from
sale 01 capllal assels ...............
23 Tojal of lines 15 through 22 ......
24 Line 23 minus line 17 ...............
25 Enter 1% of line 23 .................. , 4 . ~ 1 , .4 . 1, 84 . 1, 30.
.. lItJ........ ......... .. ....10 ,,11: . En... ... "'I,lhoo 24 ............................................. ~ ...
b Prepare a list for your records to show the name of and Dun n. tti; each person (other than a governmental
unIt or pUblicly supported organization) whose total or iIf 2004 exceeded the amount shown In line 26a.
Do not file thllllstwlth your return. EnlBr the tola . I, IS excess amounts ......................................................... ~ 26b
o Tolal support for secllon 5D9(a)(1) test Enter II III ...................................................,...,........................ 28c
d Add: Amounts from column (e) for lines: 18 19 :;:;:::51
28b ......... ~ 28d N/A
e pubnc support (Hne 26c mInus line 26d ...................................................................................,.............. ~ 28e N A
f Public IU 011 ereenll e line 281, lIP.lIlmto , : ded b line 260 denominator ................................................ ~ 281 N I A 0/.
27 Organizations deacrlbed on line Iuded In lines 15, 16, and 17lhat were received from a "disqualified person: prepare a list for your
records to show the name of, an . eived In each year from, each "disqualified person: Do not file this nIt with your return. Enter the sum 01
such amounts for each year.
(2004) .................... 0.. ....................................9..~. (2002) .................................9..~. (2001) .................................Q..~.
b For any amount Include . was received from each person (other than "dIsqualified persons;, prepare a Ost for your records to show the name or,
and amount received f as more than the larger of (1) the amount on line 25 for the year or (2) $5,000. (Include In the list organizations
described In lines 5 thro ~b' II as individuals.) Do not file thll"at with your return. After computing the difference belw8en the amount received and
the larger amount described In or (2), entsr the sum of these differences (the excess amounts) for each year.
(2004) .................................9..~. (2003) ...... ..............................9..~. (2002) ...............,.................g..~. (2001) ............ .................... .g..~.
c Add: Amounls from column (e) for IIne8: 15 159 , 987 . 16
17 365 , 515 . 20 21 ~ 270
d Add: LIne 27a lolal ... 0 . and line 27b lolal .................. O. ... ~ 27d
e PUblic support (nne 27c lotal minus line 27d tOIal} ................................................................................................ ~ 27e
f Tolal support for sectIon 509(a}(2} test Enler amount on line 23, column (e) ......... ~ 27f 617 , 760 .
g Public support percentage (line ZTe (numerator) divided by line 27f (denominator)) '................................ ~ 27g
h Investment income ercenta e line 18, column enumerator d"JVJded line 27. (denominator ......... ~ 21b . 2 0/.
28 Unusual Grants: For an organIzation described In line 10, 11, or 12 that received any unusual grants during 2001 through 2004, prepare a list for your records to
show, for each year, the name of the contributor, the date end amount 01 the gran~ and a brlel description of the natura of the grant Do IIDt nle this IIat with your
tetum. Do not Include Ihese grants In One 15. NONE
523121 02.03-08 Schedule A (Farm IIIlO or D91l-EZ} 2005
10500515 748525 19412
2005.08010 DUBLIN PARTNERSHIPS IN EDUC 19412__1
S'cheduIeA(Form 990 or 99D-€Z) 2005 DUBLIN PARTNERSHIPS IN EDOCATION
1~e.iUl~.A~1 Lobbying Expenditures by Electing Public Charities (See page 9 of the Inslnlcllons.)
(To be completed ONLY by an eUglble organization that filed Form 5768)
Check ~ a LJ If the organization belongs to an alfIHated group. Check ~
94-3207780 Page 6
N/A
Limits on Lobbying Expenditures
(The term "expenditures. meens amounts paid or IncUrrell)
b U If ou checked *a" and .nmlted conlror provisions apply.
(8) (b)
AlfIliated group To be completed for ALL
totals electing organizations
N/A
36 Tolal lobbying expenditures to Influence pubnc opinion (grassrools lobbylng) ...........................
37 TOlallobbylng expenditures to Influence a legislative body (direct lobbying) ..............................
38 Total lobbying expenditures (edd lines 36 and 37) ...............................................................
39 Other exempt purpose expenditures ... ..............................................................................
40 Total exemptpurposeexpendltUres (add lines 38 and 39) ...................................................
41 Lobbying nontaxable amounL Enter the amount from the following Iable-
If the amount on line 40 Is - The lobbying nontaxable amount I. -
NolllVllrS5ll0.aao .................................... l!D'll 01 lhll 8tnoURI 0" 11111140 .................................
Over $500,000 but"ot over $1.000.000 ............ S100.ooo plus15'l6 or lhe 8llCllSll OVIII' S5llO,OOO .........
Over $1,000,000 but not lMlr $1,500,000 ...,..... $175.000 plus10'l1a Dr lhellllCllSll 0VIII'51,000,ooo .........
Ov.. '1,500,000 but not over S 17,llOO,0ll0 ......... 5225,000 plus 5'l6 01 thll 8llCIISS lMlr $1,500,000 .........
Over 517,000,000 .................................... $1.llOO,OOO ...... ....... ...............,. ......... ...............
42 Grassrools nonlalCable amount (enler25% of line 41) ..................................................,.
43 Subtract nne 42 from line 36. Enter -o-If line 42 Is more than line 36 ...............................
44 Subtract line 41 from line 38. Enter -o-If line 41 15 more than line 38..............................
CauDon: If there Is 8Ilsmount on either line 43 or fine 44, you must file Fi
4-Year Averaging Per.
(Some organizations that made a section 501 (
below. See the Instructions for lines
~
(a)
2005
(0)
2003
(d)
2002
N/A
(8)
Tolal
o.
o.
o.
o.
o.
o.
Yes No
o
d
e
f
II
o.
Sohedule A (Form 990 or 990-€Z) 2005
10500515 748525 19412
2005.08010 DUBLIN PARTNERSHIPS IN EDOC 19412__1
ScheduleAtForm9900r990-EZ)2005 DUBLIN PARTNERSHIPS IN EDUCATION 94-3207780 Page 6
I~RarnVJI~llnformation Regarding Transfers To and Transactions and Relationships With Noncharitable
Exempt Organizations (See page 12 of the Instructions.)
51 Old the reporting organization directly or Indirectly engage In any of the following with any other organization described In section
501(c} of the Code (other than section 501(c)(3) organizations) or in secllon 527, relating to ponUcal organizations?
8 Transfers from the reporting organization to a noncharltable exempt organization at
(I) Cash ... '.................... ...... .... ......., .............................,...... ... ......... ,...., .'.. ..........' ........ ..,...... .... ... .............................. ...... 518(1
(II) Other assets ..... ..... ....'......... ...................... ............................................ ,....... ............. ................. .............. .............. ...... alII)
b Other transactions:
(I) sales or exchanges of assets with a noncharltable exempt organization .................................................................................... b(l)
(II) Purchases of assets from a noncharltable exempt organization ..........................................................,..................................... b(lI)
(III) Rental of facilities, equlpmen~ or other assets ........................................................................................................................ b(lll)
(Iv) Reimbursement arrangements ... ................, ......' .................. ......... ............ ...... ......... ........... ....... ...~....................... b(lv)
(v) loans or loan guarantees ...............................................................,............................................... ....I.......... b(v)
(vi) Performance of services or membership or fundralslng solicitations ............................................... ..........~............... b(vl)
c Sharing of facUmes, equlpmen~ mailing lists, other assets, or paid employees .................................... ~................ c
d If the answer to any of the above Is "Yes,. complete the following schedule. Column (b) should always show ue of the
goods, other assets, Dr servIces given by tho reporting organization. If the organlzallon received less t lue In any
transaction or Sharing arrangemen~ show In column (d) the value of the ooods, other assets, or d. N / A
(a) (b) (c) v (d)
line no. Amount Involved Name of noncharltable exempt organlzallon ~ ~pUon 0 'ffiinsfers, transactIons, and sharing arrangements
~~ ~
~
Yes No
X
X
X
X
X
X
X
X
X
52 a Is the organization dJrecUy or fndlrecUy a
Code (other than sectIon 501(c)(3)) or In
b If "Yes," complete the following schelb!.l!.
(a)
Name of org
III No
(b)
Type of organization
(0)
Description of relationship
02-03-08
Schedule A (Form geO or geD-El) 2005
10500515 748525 19412
2005.08010 DUBLIN PARTNERSHIPS IN EDUC 19412__1
DUBLIN PARTNERSHIPS IN EDUCATION
94-3207780
FORM 990
SPECIAL EVENTS AND ACTIVITIES
STATEMENT 1
GROSS CONTRIBUT. GROSS DIRECT NET
DESCRIPTION OF EVENT RECEIPTS INCLUDED REVENUE EXPENSES INCOME
GOLF TOURNAMENT 50,357. 50,357. 32,417.
STUDENT ART AUCTION 51,446. 51,446. 31,356.
FIREWORKS 59,782. 59,782. 23,019.
SUGIYAMA RETIREMENT 20,682. 12,303.
TO FM 990, PART I, LINE 9 182,267. 99,095.
FORM 990 OTHER EXPENSES STATEMENT 2
(A) (D)
DESCRIPTION TOTAL FUNDRAISING
BANK FEES 1,638. 1,638.
INSURANCE 3,380. 3,380.
MARKETING AND
ADVERTISING 2,150. 2,150.
PROFESSIONAL
DEVELOPMENT 90.
TEACHER GRANTS
STUDENT SCHOLARSHIPS
AND PROGRAMS
WORKER'S
COMPENSATION
INSURANCE 522. 329. 132.
TAXES AND FEES 250.
PAYROLL TAX 2,859. 1,803. 726.
OFFICE SUPPLIES 2,120.
BOARD MEETING
EXPENSES 960.
OFFICE EQUIPMENT
EXPENSE 837. 837.
MEMBERSHIP DUES 100. 100.
SUPPORT OF OTHER
NONPROFIT
ORGANIZATIONS 8,849. 8,849.
MISCELLANEOUS
EXPENSE 60. 60.
TOTAL TO PM 990, LN 43 79,257. 64,682. 13,717. 858.
10500515 748525 19412
STATEMENT(S) 1, 2
2005.08010 DUBLIN PARTNERSHIPS IN EDUC 19412__1
DUBLIN PARTNERSHIPS IN EDUCATION
94-3207780
STATEMENT 3
FORM 990
OFFICER COMPENSATION ALLOCATION
PART II, LINE 25
NAME OF OFFICER, ETC.
EMPLOYEE EXPENSE
COMPENSATION BEN. PLANS ACCOUNTS
PAMELA GLYNN 5,458.
A. PROGRAM SERVICES 3,275.
B. MANAGEMENT AND GENERAL 1, 637 .
C. FUNDRAISING 546.
NAME OF OFFICER, ETC. COMPENSATION
DONNA MCMILLION 31,160.
. A. PROGRAM SERVICES
B. MANAGEMENT AND GENERAL
C. FUNDRAISING
TOTAL PROGRAM SERVICES
TOTAL FUNDRAISING
TOTAL OFFICER, ETC.,
INCLUDED ON PARTS V-A AND V-B
TOTALS
5,458.
3,275.
1,637.
546.
TOTALS
31,160.
18,696.
9,348.
3,116.
21,971-
10,985.
3,662.
36,618.
FORM 990
lZATION'S PRIMARY EXEMPT PURPOSE STATEMENT 4
PART III
EXPLANATION
TO FOSTER MUTUALLY BENEFICIAL BUSINESS EDUCATION PARTNERSHIPS IN ORDER TO
MAXIMIZE COMMUNITY RESOURCES FOR THE STUDENTS OF THE DUBLIN UNIFIED SCHOOL
DISTRICT.
10500515 748525 19412
STATEMENT(S) 3, 4
2005.08010 DUBLIN PARTNERSHIPS IN EDUC 19412__1
DUBLIN PARTNERSHIPS IN EDUCATION 94-3207780
FORM 990 PART V-A - LIST OF OFFICERS, DIRECTORS, STATEMENT 5
TRUSTEES AND KEY EMPLOYEES
EMPLOYEE
TITLE AND COMPEN- BEN PLAN EXPENSE
NAME AND ADDRESS AVRG HRS/WK SATION CONTRIB ACCOUNT
DON BIDDLE PRESIDENT
8435 DAVQNA DRIVE 0.00 o. O. o.
DUBLIN, CA 94568
TESS THOMAS VICE PRESIDENT
8435 DAVONA DRIVE 0.00 o. o.
DUBLIN, CA 94568
ROZ PERAZZO VICE PRESIDENT
8435 DAVONA DRIVE 0.00 o. o.
DUBLIN, CA 94568
ANGELA FONTES
8435 DAVONA DRIVE o. o. o.
DUBLIN, CA 94568
BILL PRESCOTT
8435 DAVONA DRIVE o . o. o.
DUBLIN" CA 94568
DONNA MCMILLION ( CURRENT )
8435 DAVONA DRIVE 31,160. o. o.
DUBLIN, CA 94568
DR. SANDY HARE
8435 DAVONA DRIVE o. o. O.
DUBLIN, CA 94568
VICTOR UNO BOARD MEMBER
8435 DAVONA DRIVE 0.00 o. o. o.
DUBLIN, CA 94568
TIM SBRANTI BOARD MEMBER
8435 DAVONA DRIVE 0.00 o. o. o.
DUBLIN, CA 9456~
ALICE WATERMAN a BOARD MEMBER
8435 DAVONA DRI 0.00 o. O. o.
DUBLIN, CA 94568
TOTALS INCLUDED ON FORM 990, PART V-A 31,160. o. o.
10500515 748525 19412
STATEMENT(S) 5
2005.08010 DUBLIN PARTNERSHIPS IN EDUC 19412__1
DUBLIN PARTNERSHIPS IN EDUCATION
, ,
94-3207780
SCHEDULE A
OTHER INCOME
STATEMENT 6
DESCRIPTION
2004
AMOUNT
2003
AMOUNT
2002
AMOUNT
2001
AMOUNT
PROGRAM SERVICE REVENUE
TOTAL TO SCHEDULE A, LINE 22
o.
o.
o.
o.
37,300.
37,300.
53,683.
53,683.
10500515 748525 19412
STATEMENT(S) 6
2005.08010 DUBLIN PARTNERSHIPS IN EDUC 19412__1
DPIE Meeting Minutes
January 10, 2008
'- )
\!!J
~I ..~' ';' L
~C'e.- :'__JJLtll'.. 1:,~,(~
":. /' I (. '-"""""
o t "1 ~v {/ ::cl.:~? '-- ...--./
ft
Attending:
Executive Board Members: Don Biddle, Kathy de Jong, Tess Thomas, Chris Bennett,
Bill Prescott
Board Members: Alcina Wegrzynowski, Kellee Jones, Fawn Holman
Board of Trustees rep: Pat Kohnen
Excused:, Ted Hoffman, Victor Uno, Angela Fontes, Dave Marken, Bill Moy, Amy Frantz,
Hannah Pulliam
5:15 p.m. Don Biddle opened meeting
December meeting minutes were reviewed.
Bill motioned to approve the minutes;
Kellee seconded approval of December meeting minutes, The Board approved
unanimously,
Don introduced new Program Manager Michelle Haubert and new Event Manager Amy
Miller to the Board.
Amy asked everyone to check their calendars and to respond to her quest for volunteers
the evening of February 1 st for the Waiter event. 12 volunteers are needed.
DPIE Hiring
Don announced that Nancy Silva's last day will be February 2nd and that we will keep the
existing AA job description. Alcina will post the opening on the web site with a deadline
of 2/15/08, Kathy will post an email blast with the job description for board members to
send throughout the community; after one week if response is slow we will place an ad.
Kathy expressed a concern about the knowledge transfer for Access database and Don
stated he will have Nancy train Michelle the basics. In addition, Willa has volunteered to
come and help with the transition of a new AA hire.
ED position: Bill said we have 17 resumes and will try to set up 3-4 candidates, including
Mary Beth Phillips to interview in the DPIE office sometime in the next week.
It was discussed that the office had been rearranged somewhat by Amy and Michelle
and that Don will contact Dave Marken and Tess will contact Julie to see if we can use
the alcove office for additional space for a new ED.
Celebrity Waiter: Fawn stated that she and the team are having a tough time getting
responses to the invitation; however, they are please with the quality/number of our
celebrity waiters: 16 with a goal of 160 guests. Alcina suggested that we re-check with
the waiters to make sure we had received their latest responses. Don volunteered to
bring (and taste-test) his stock of wine for the event
Mentoring program/Middle School Career Day: Don and Chris gave a status update;
the students and mentors both seem to like the new program structure. We'll do a day at
Valley H.S. in the spring.
p{)
-7
Career Days are 1/17 (Fallon) and 1/31 (Wells); first time for both, we'll gather feedback.
The original impetus was Gloria; since she left in the midst, the schools have fended for
themselves with some limited support from Chris. DPIE question for follow-up: how do
we bring this back to being a "DPIE" event, or do we need to?
Funding:
DPIE received $10,500 from Realtors Getting Real; thanks!
Washington Mutual (through Alan Elias) asked DPIE to submit a grant application and
awarded us $2000.
Other:
Meeting with DUSD Board has been re-scheduled for February; the plan is for a quick
reminder and intro of new staff.
City grant process: Board agreed to request $15,000 rather than increase amount.
We may get some volunteer grant writing help from Sharon Marks. Paperwork due
1/25.
Meeting adjourned at 6:25.
Respectfully submitted by Board Member, Kathy de Jong and Chris Bennett
-?
/:C
b-
ACORDm
CERTIFICATE OF LIABILITY INSURANCE
OP 10 JF I DATE (MM/DDNYVY)
DUBLI-l 01/22/08
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMA Tim
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW
PRODUCER
Nonprofit Services Ins. Agency
Dennis Costa
2843 Hopyard Rd. #169
Pleasanton CA 94588
Phone:877-669-5101 Fax: 877-669-5109
INSURED
INSURERS AFFORDING COVERAGE
INSURER A: NIAC
INSURER B: State Compensation Ins. Fund
INSURER C:
INSURER D:
INSURER E:
NAIC#
Dublin Partners In Education
P.O. Box 2307
Dublin CA 94568-1599
COVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR NSR[ TYPE OF INSURANCE POLICY NUMBER 'ili~~TMMlDDIYY DATE IMM/DOIYY LIMITS
GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
"--
A ~ COMMERCIAL GENERAL LIABILITY 2007-12954-NPO 03/09/07 03/09/08 PREMISES (Ea occurence) $ 100,000
f-- ~ CLAIMS MADE ~ OCCUR MED EXP (Anyone person) $10,000
PERSONAL & ADV INJURY $ 1,000,000
X liquor liabili ty GENERAL AGGREGATE $ 1 ,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COM PlOP AGG $1,000,000
II .nPRO- n
POLICY JECT LOC
~TOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
A ANY AUTO 2007-12954-NPO 03/09/07 03/09/08 (Ea accident)
f--
ALL OWNED AUTOS BODILY INJURY
i-- $
SCHEDULED AUTOS (Per person)
-
~ HIRED AUTOS BODILY INJURY
$
~ NON-OWNED AUTOS (Per accident)
- PROPERTY DAMAGE $
(Per accident)
GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $
==l ANY AUTO OTHER THAN EA ACC $
AUTO ONLY: AGG $
EXCESs/UMBRELLA LIABILITY EACH OCCURRENCE $
:=:J OCCUR D CLAIMS MADE AGGREGATE $
$
R DEDUCTIBLE $
RETENTION $ $
WORKERS COMPENSATION AND I TOlty 'Ll~,'r't , IOJ~-
B EMPLOYERS' LIABILITY 1761723-07 12/01/07 12/01/08 $ 1000000
ANY PROPRIETORlPARTNERIEXECUTIVE E.L. EACH ACCIDENT
OFFICERlMEMBER EXCLUDED? E.L. DISEASE - EA EMPLOYEE $ 1000000
~~~MtS~~~~~1o~s below E.L. DISEASE - POLICY LIMIT $ 1000000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
* 10 days notice of cancellation for nonpayment of premium.
CERTIFICATE HOLDER
CANCELLATION
Ci ty of Dublin
100 Civic Plaza
Dublin CA 94568
CITYDUB SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 * DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO so SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENTATIVES.
AUTH 0 REPRESENTATIV
@ ACORD CORPORATION 1
ACORD 25 (2001/08)
7T7
F
City of Dublin
Fiscal Year 2008-2009
Application for Funds
ApPLICATION VERIFICATION
I attest that the information contained in this FY 2008-2009 grant application is accurate and that
the funds requested will not supplant any other monies secured by the organization.
Attached is a resolution, letter, or other document providing evidence that the Board of Directors
approved the application as submitted. Successful applicants are required to submit a summary
report as soon as possible after submitting the reimbursement request, but not later than August
30,2009. Failure to submit a report will result in ineligibility for future funding.
Signatures:
Executive Director I
· · {II,(/ ( lh{~li
Date
1- 2~ --, () &-
Board President/Chairperson
Date
SECTION 2
Page 11 of 16
-. . -. '.'-- .. -. - -....' -.... ..,.~-.
-IF
'-
/
!/1/~~/r- IT
INTERNAL REVENUE SERVICE
P. O. BOX 2508
CINCINNATI, OH 45201
DEPARTMENT OF THE TREASURY
DUBLIN PARTNERSHIP IN EDUCATION
PO BOX 2307
DUBLIN, CA 94568
Employer Identification Number:
94-3207780
DLN:
17053053731073
Contact Person:
MICHAEL A LUDWIG ID# 31470
Contact Telephone Number:
(877) 829-5500
Our Letter Dated:
November 1994
Addendum Applies:
No
,Date: APR 102003
Dear Applicant:
This modifies our letter of the above date in which we stated that you
would be treated as an organization that is not a private foundation until the
expiration of your advance ruling period.
Your exempt status under section 501(a) of the Internal Revenue Code as an
organization described in section 501(c) (3) is still in effect. Based on the
information you submitted, we have determined that you are not a private
foundation within the meaning of section S09(a) of the Code because you are an
organization of the type described in section 509(a) (1) and 170 (b) (1) (A) (vi).
Grantors and contributors may rely on this determination unless the
Internal Revenue Service publishes notice to the contrary. However, if you
lose your section 509(a) (1) status, a grantor or contributor may not rely on
this determination if he or she was in part responsible for, or was aware of,
the act or failure to act, or the substantial or material change on the part of
the organization that resulted in your loss of such status, or if he or she
acquired knowledge that the Internal Revenue Service had given notice that you
would no longer be classified as a section S09(a) (1) organization.
You are required to make. your annual information return, Form 990 or
Form 990-EZ, available for public inspection for three years after the later
of the due date of the return or the date the return is filed. You are also
required to make available for public inspection your exemption application,
any supporting documents, and your exemption letter. Copies of these
documents are also required to be provided to any individual upon written or in
person request without charge other than reasonable fees for copying and
postage. You may fulfill this requirement by placing these documents on the
Internet. Penalties may be imposed for ,failure to comply with these
requirements. Additional information is available in Publication 557,
Tax-Exempt Status for Your Organization, or you may call our toll free
number shown above.
If we have indicated in the heading of this letter that an addendum
applies, the addendum enclosed is an integral part of this letter.
Letter 1050 (DO/CG)
-2-
DUBLIN PARTNERSHIP IN EDUCATION
Because this letter could help resolve any questions about your privatp
foundation status, please keep it in your permanent records.
If you have any questions, please contact the person WD~r ..ame and
telephone number are shown above.
Sincerely yours,
~f~
Lois G. Lerner ~
Director, Exempt Organizations
Letter 1050 (DO/CG)