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Home My WebLink AboutItem 8.1 Budget Study Attch 7 c & d Dublin Fine Arts Foundation Funding Request Review Checklist I~RI 1- A. Application 1 . Date application received*... . . . . . . . . . . .. . .. . . . . . . . .. . . . . . . . .. . .. . . . . . . .. . . . . . (Completed applications are due by 5:00 p.m. on February 5, 2007) 2. Two copies of the completed application form are submitted....... B. Organization Information 1. Name of the organization..................................................... I 2. Is the applicant a nonprofit organization?....................................... I 3. Does the organization has a 501 (c)3 State of California ID#?........ I 4. Does the organization have a current City Business License?...... I C. Funding Request 1. Funding amount requested... ... ... ... ... ... ... .... ...... ... ... ... ... ... ..... 2. Funding Source (i.e. General Fund, CDBG Fund)..................... D. Project Information 1. Proposed project name. . .. . .. . .. . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . .. . .. . . . . .. 2. Project start date... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... ... 3. Project complete date...... ". ... ........................ ... ... ...... ......... 4. Total # of organization clients... ............ ...... ......... ...... ...... ..... 5. # of Dublin businesses / residents will serve......... ............... .... E. Attachments 1. Name and home address of governing board of the organization.. 2. List of current board officers of the organization............ ...... ... ... 3. Current total organization operating budget, including revenue.... 4. Most recent audit or tax return is submitted... ...... ... ......... ......... 5. Document providing evidence of board/organization approval of application and date of approval........................................... 6. Organization's certificate of insurance showing coverage of liability and worker's compensation.... ...... .......... ..... .......... .... 7. Signed affidavit form from each collaborating agency identified for the proposed project (if applicable)................................... 8. Application verification declaration signature page... ...... ... ........ 2/5/2007 No, 1 copy Dublin Fine Arts Foundation Yes 680169575 No $20,000 General Fund Art Takes Place 7/1/2007 6/30/2008 200,000 30,000 Email address only Yes Yes Yes Not provided Unable to read No Yes 1. Is the application complete?* (Y/N).................................................I If no, which sections are incomplete?............................................ ..I 2. Did the applicant organization complete a mandatory I presentation at City Council Public Hearing?* (Y/N).................. 3. Date notification letter of Council Approval of funding & I mandatory financial reporting packet sent............................... 4. Date summary report is submitted to City*......... ...................... I (Report must submit to City by the end of August 2008. Failure to submit a report will result ineligibility for future funding) Qrnplete applica .peorcompl lXl.ove an applica sideratiQn. II Part I A2, E5, E6 II No X Yes Attachment c H:\Budget\COMMGRPS\Dublin Fine Arts Foundation Funding Request Checklist.fJate Printed: 2/23/2007 2:05 PM r' ~ \. tJ F // f"BECEIVED .'~"~. f) lJBLIf\J CITY OF DUBLIN"'NV.~GER'sofflcE COMMUNITY GROUP/ORGANIZATIONAL FUNDING REQUEST ApPLICATION PACKET Fiscal Year 2007-2008 Section 2: Application for Community Group/Organizational Funding SECTION 2 Page 1 of 16 CITY OF DUBLIN Fiscal Year 2007-2008 COMMUNITY GROUP/ORGANIZATION ApPLICATION FOR FUNDS COVER PAGE AGENCY NAME: DUBLIN FINE ARTS FOUNDATION PROPOSED PROJECT/PROGRAM NAME: ART TAKES PLACE: OPERATING EXPENSES FUNDING AMOUNT REQUESTED: $20,000. SECTION 2 Page 2 of 16 CITY OF DUBLIN Fiscal Year 2007-2008 ApPLICATION FOR FUNDS 1. Please select one expense category: 0 Capital X Operating 2. Applicant Information: Organization/Agency Name: Dublin Fine Arts Foundation Mailing Address: P.O. Box 2912 Street Address: none City Dublin, State CA Zip 94568 Lynne Baer Executive Director/Chairperson Martin Inderbitzen Board President (if applicable) 415931-1592 Work Phone 925 485-1060 Work Phone lbaer@earthlink.net Email ndrbtzn@hotmail.com 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. Lynne Baer Consulting Executive Director Contact Person for Project/Program Job Title 415931-1592 Jbaeric{,earthlink.net 415931-0753 -----~._.<--,_._.__..-.-.._~._-~..".,""""""'" Work Phone Email Fax Nonprofit Identification No. (required) 68D169575 City of Dublin Business License No. (required) SECTION 2 Page 3 of 16 City of Dublin Fiscal Year 2007-2008 Application for Funds 3. Proposed Project/Program Information (Do not describe Organization.) Amount of Funds Requested $ 20,000. (Maximum $25,000 per project.) Proposed Project/Program Name Operating Funds for DFAF to manage Art Takes Place Proposed ProjectlProgram Date(s): Start 07 / 01/07 and mo. day yr. End 06 / 30 /08 mo. day yr. 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 Dublin Fine Arts Foundation is requesting $20,000 to provide general operating support as the Foundation implements the three city project Art Takes P~ace. As in the past, funds received from the city allows the foundation to maximize and leverage funding opportunities as well as demonstrate the commitment to the vitality of the arts in the Tri-Valley. The funds will cover fees paid to the consulting director as well as insurance, accounting, and normal expenses to manage the implementation of the ambitious proj ect. Funding has been secured from the communities of Pleasanton and Livermore as well as Dublin and fundraising from the community is in process. While Art Takes P~ace is the most ambitious project the Foundation has undertaken, it is a continuation of its goals to place art in the public spaces of the community. Art Takes P~ace is a year long public art project consisting of highly visible temporary site-specific commissioned artworks located in the 3 communities, youth involvement, public programs and educational experiences that transcend community boundaries. SECTION 2 Page 4 of 16 City of Dublin Fiscal Year 2007-2008 Application for Funds 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): Art Takes Place, centered in Dublin, Pleasanton, and Livermore, will be the first visual arts project to transcend boundaries promoting public awareness and participation in the arts and defining the area as a diverse, interesting and multifaceted place to be. The goal is to provide opportunities for multi generational groups, including youth, to be involved in the arts. As the communities grow and the Tri- Valley becomes more urban, the arts play an important part in enhancing the quality of life. Art Takes Place is a vehicle for articulating the challenges of living in the 21 st Century. Artists, along with community participation, can create artworks that engage and promote dialogue about the arts and the changes taking place in the Tri-Valley. c. What documentation/data/records support the need for this PROPOSED PROJECTIPROGRAM? Please identify your data sources. (Additional page may be added, if needed.) DF AF has had a unique role in the community collaborating with the city and its residents functioning as the local arts agency. DFAF has provided most of the visual arts programming in the community and in a cultural arts assessment survey in 2001, DFAF and, in particular, public art, was recognized as important and vital to the quality of life in the city by 72% ofthe survey respondents. Art Takes Place has been endorsed by the Civic Arts Commissions as well as approved for funding by the City Councils in Dublin, Livermore, and Pleasanton. SECTION 2 Page 5 of 16 City of Dublin Fiscal Year 2007-2008 Application for Funds d. Specify the PROPOSED PROJECT/PROGRAM population to be served. The three communities cover approximately 62 square miles with an estimated population of nearly 200,000. 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 Foundation's Board and the Steering Committee composed of 2 members and staff from each of the 3 communities will continually monitor and evaluate the various components of Art Takes Place throughout the year. Press coverage is another way to gage the impact of the project. A component of the project will be the use of a cell number that the public can access to find out about the project and hear the artists themselves describe their artworks. As part of the cell phone service, the company keeps a detailed record of the number and dates of the calls. f. Specify numbers of clients served by agency, then by PROPOSED PROJECT/PROGRAM: Total Pro osed Participants Served by this Project/Program Total Number of Dublin Residents Served by this Project U to 200,000 Up to 30,000 SECTION 2 Page 6 of 16 City of Dublin Fiscal Year 2007-2008 Application for Funds 5. Financial Information - Operating Budget a. Expense Budget FY 2007-2008 THIS PROJECT/ EXPENSE BUDGET ORGANIZATION PROGRAM GRANT REQUEST Personnel Costs Employee Salaries & Benefits 6,000. 25,000. 15,000. Non-Personnel Costs Services & Supplies 5,500. 10,000. 5,000. Capital Costs Other (please specify) 165,000. Other (please specify) 50,000. TOTAL 11,500. 250,000. 20,000. Further CommentslExplanations (if necessary): Other: Temporary Artworks (4-6 commissions + youth project): Book created at end of project: $165,000. $50,000. SECTION 2 Page 7 of 16 City of Dublin Fiscal Year 2007-2008 Application for Funds b. Revenue Budget FY 2007-2008 REVENUE BUDGET ORGANIZATION PROJECT/PROGRAM CommittedlRestricted Funds (specify source) City of Dublin $15,000. $30,000. City of Pleasanton $30,000. City of Livermore $30,000. City of Dublin (Art in the Parks) $5,000. Business and Individuals (Art in the $30,000. Parks) Non-CommittedlRestricted Funds (specify source) TOTAL $50,000. $90,000. Further Comments/Explanations (if necessary): The Foundation has received pledges from businesses and individuals for Art Takes Place but has not actually received the funds. SECTION 2 Page 8 of 16 City of Dublin Fiscal Year 2007-2008 Application for Funds 6. General Agency Information a. List all years that Organization has previously received City of Dublin funding (not Community Development Block Grant - CDBG). Since its inception in 1988, DF AF has received grants every year to provide cultural activities in the community including "Art in the Parks", "Art in the Schools" and Temporary exhibitions in the Civic Center and throughout the community. b. Describe the population(s) served by the Organization. When DFAF started in 1988, the population of Dublin was approximately 25,000 and is now approaching 50,000. Our ongoing programs have been developed to reach a broad spectrum of the community from school age children to adults with programs in the schools to art in the parks to temporary and permanent installation in public spaces in both the established and new sections of the growing city. c. Describe all the services the Organization currently provides to Dublin residents. · An additional page may be added, if needed. See a. and b. above 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. Yes, see above SECTION 2 Page 9 of 16 City of Dublin Fiscal Year 2007-2008 Application for Funds 7. Required Attachments: o Only one (1) copy per Al!encv of each of the following is required, even with multiple projects/programs submitted. o Applications without the following documents will not be reviewed for funding. o Please label attachments: A. B. C. etc. o A. Names of Governing Board; identify current Board officers. o B. Current total Organization operating budget, including revenue. · Clearly label/identify the program that includes the PROPOSED PROJECT/PROGRAM. o C. Most recent audit report or tax return (if applicable). o 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. o E. Organization's certificate of insurance showing coverage for liability and workers' compensation. of. Application Verification Declaration Signature Page. o G. Signed affidavit form from each collaborating agency named in proposed project/program plan (if applicable). SECTION 2 Page 10 of 16 City of Dublin Fiscal Year 2007-2008 Application for Funds ApPLICATION VERIFICATION I attest that the information contained in this FY 2007-2008 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, 2008. Failure to submit a report will result in ineligibility for future funding. Signatures: Date Executive Director /. /774 - B~ard Pre~dent/ hairperson :J- /:r/..;> 7 Date SECTION 2 Page 11 of 16 City of Dublin Fiscal Year 2007-2008 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: 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 2007-2008 funding application. Executive Director Date Date Project/Program Contact Person SECTION 2 Page 12 of 16 . ~ ~ SALLMANN YANG & ALAMEDA ::' ,X 925L,267772 DUBLIN FINn ARTS FOUNDA nON BALANCE SHEET November 30, 2006 ASSETS :..; --em As: ets: (:ash in B mk - Operating Account Cash in B mk - Reserve Account $ $ '""~t<:.l 0 rrent Assets Total " Ulsets 15,348.58 20,752.02 LIABILITIES AND FUND BALANCES "- ." 'r:: B?J;~n.;es : JUG 3.11, nces Beginning of Year :[ hange in Fund Balances Total Fu tld Balances $ $ T o':I'J I iabilities and Fund Balances ;ubmlHed 12/14/06 by Treasurer Georgean Vonheeder-Leopold ~-:',.. v~ :J.a.'ement use only 24,007.99 12,092.61 I4J 004/016 $ 36,100.60 $ 36,100.60 $ 36,100.60 $ 36,100.60 ",1 it; 11",::\ -.J (fPW ",,,1 1\ f.t i", thp !->Qt'l, _ Op{;;[~~E_~____ Combined ,....; ,---~--- REVENUE ~D I" City ot Dublin $ 15,000.00 $ 15,000.00 <:I' ... Miscellaneous-Businesses 1\.0 ~ Miscellaneous-Individuals --J --J Grant --J 1\.0 Total Revenue 15,000.00 15,000.00 EXPENSES Accounting 600.00 600.00 Artists Fees 0.00 Consulting Director 2,000.00 rJ> 2,000.00 > r Insurance 0.00 r is: Filing Fees 30.00 30.00 > Z Website 0.00 Z Miscellaneous 0.00 >-< > Supplies, Postage, Printing 195.09 0.00 195.09 Z G1 Dues 150.00 150.00 ~ > r Total Expenses 2,975.09 0.00 2,975_09 > is: tri eI Net Revenue 12,024.91 0.00 12,024.91 > Other Revenue Bank Interest Income 67.70 67.70 Total Other Revenue 67.70 67.70 Total Other Expenses 0.00 0.00 Change in Fund Balances 12,092.61 000 12,09261 ~ Fund Balances Beg. of Year 0 24,007.99 24,00799 0 <:I' '-.. 215r2007 0 Fund Bal ances End of Year $ 36,~00.69 0.00 $ 36,100.60 11.54 AM t-' ~ . v I c:., ,x 9:25L; 267 77 2 SALLMANN YANG & ALAMEDA @006/016 ,;"'_L Short Form Return of Organization Exempt From Income Tax Under section 501 (c), 527, or 4947(aX1) of the Internal Revenue Code (except black lung benefit trust or private foundation) ~ Fa' organizations with gross receipts less than $100,000 and total assets less than $250,000 at the end of the year. =2.:...?Cf~an, ~ation may have to use a copy of this return to satisfy state reporting requirements. ~::':.":::. tz { ear be innin 7/01 , 2005, and endin 6/30 OMS No. 1545.1150 2005 , 2006 :~;'1:: ~ ". .C i~::,a~s I DUBLIN FINE ARTS ,:?l>'1100' 'p C' 30X 2912 i:prJ"t C" ~ ' . ~O.. DUBLIN, CA 94568 .::,r""" ::''':'....{ ..~ (' o Employer identification number FOUNDATION 68-0169575 E Telephone number 1 _',' ~ ,_ .~; ':'.... ~ F Group Exemp':ion Number. . ~ G Accounting method: ~ Cash [J Accrual Other (specify) .. H Check" [R] if the organization IS not ~:':3=:: :1FINEAR rs. ORG reqUired to attach Schedule B (Form 990, : -~~~e)..:~ ix 501 (c) ( 3 ) .... (insert no.) 4947(a)(1) or 527 990-EZ, or 990-PF). : ~'E"':1'S gross receipts are normally not more than $25,000, The organization need not file a return with the IRS; :'-')(':''05 tc file a return. be sure to file a complete return. Some states require a complete return. ~_._---- -.- --- , _ J, 5b, c:rc 7b, to line .1 to determine gross receipts; if $100,000 or more, file Form 990 _,_:;:...~ 9~C~Z..... ............................ ...........,......... ..,...... '<'~y.gnue, Expenses, and Chan es in Net Assets or Fund Balances (See Instructions) - :".-- .:f;o~s, g:fts, grants, and similar amounts received. . . .. . . .' ,.",..,...,.,.. .,. 'CJ'f:: reverL.:e ir:Juding government fees and contracts .."........................,...". , end eSSE ;sments . . . , . . . . . . . ;i" :;TI(<)(. ') orgariza.1 fons and 4947(a)(1) nonexempt charitable trusts "",-,-sf P;'~ '~h It ~!!!l:feted Schedule A (Fonn 990 or 990- . ....c y 23,127 . t, ' : ,..;' :ie. . . 1 2 3 4 23,103. ',~ 'l). . . . . . 6a 6b 24. . .' ~>~S'. c'Tlount fom sale of 3ssets other than inventory. 5a :)c. -:C. ,P. er basi:; ar d sales expenses. .. . .. . . . . . . . ...,., . 5b : :-" ',: c: . ".e of Bs,ets ,ther than Inventory (line Sa less I.ne 5b) (attach schedule)., . ,. ., . .. . .. .. '"j ac,i\/itie; (attach schedule). If any amount is from gaming, check here.. ~D : .ct 'r-c!';dlr J $ of contributions '.e': 'ed eX;J'!nses other than fundraising expenses '::~" .:'. (' '5S) "0'11 ~ )eclal events and activities (line 6a less line 6b). , ec c" ; vento'y, le;s returns and allowances..........,..,. 7a ::,'J',c'dssolc'.. 7b :':;';: 'J :)ss) frcm "ales of inventory (line 7a less line 7b)... ,.............,......... ,.",. 7c~ ~- '~ :'"~f.~-: ;:-e ~ ). 8 i :c iir2;J..,. 2, 3, 4, 5c, 6c, 7c, and 8) ~ 9~_ '. , ~ ,~:' ,,'r~:'~' amount,. paid (attach schedule). . .. .., . 10 I =?: .r: )' ,"or merr )ers. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . , , , . . , . . , . . . . . , , . . , , . 11 c. '--, : )"'-'oensatir n, and employee benefits. . . . . , . . . . , , . . . 12 ""C'" . aile o:~er payments to independent contractors...,......... ...,...,.".. 13 ;':";"2'. c ld maintenance. . . .,.. . .. . . . . . . .,.. .... . .. 14 crs, .f) :,sl, ;le, and shipping . . . . . . . . . . . 15 ..',,: ,.':p3~ses (cesuibe .. SEE STATEMENT 1).., 16 .. --. "~"e~:"!~ :add lines' 0 through J 6). . . . .. ..' . . . . . . . , , , . , . .. .... . . . . . . . . . . . . . . . . ~ 17 :':':~0^"S or (defict) for the y"ar (line 9 less line 17) "...........,. .......,............. 18 : ~..,~s ?':'Y d balance- at beginning of year (from line 27, column (A)) (must agree with end-ot-year. ;~'"'.i -- n:I:),--:s'!:c:1pnoryea'sreturn)............. ..........."............,., .... ,.,............. 19 ~ 12,062. = '''''>::e~:' .'let asset: or fund balances (attach explanation) , . . .. ................. 20 . . ,. ::n::~E c balance, at end of ear (combine lines 18 throu h 20.....,.. '.......,.. ~ 21 24,008, .::'S~nI":"';!ts -.lolal assets on line 25, column B) are $250,000 or more, file Form 990 instead of Form 990-EZ, (See Instructions) A Beginning of year .@LEnd of year ,.... .............. 12,062.22 24,008. 23 24 25 26 27 23,127. 1,500. 9,681. 11,18I. 11,946. "---: ~.,- : ~vest'11ent~ ; J'~' rv~ ' . ? .. ) ...... .';'n:--.-:; (dr~:~: "'~be ,... ) , .. . .. . . ... . . n -_~:_":~ ~~~: ~'<1r!C'!!' (Ii'. e 27 of column (B) must agree with line 21)..,.. . : _:'"'-:",,;y Act and Paperwork Reduction Act Notice, see the separate instructions. 12,062. O. 12,062. 24,008. O. 24,008. Form 990-EZ (2005) TEEA0803L 02/01/06 . ~ .,~;: 07 F"X 9254267772 SALLMANN YANG & ALAMEDA [4J 007/016 ..~ ~c: y:,:~,,=~~ ?HiE ARTS FOUNDATION __.~:.:::ijiL:iT prc.9!!im Service Accom lishments (See Instructions) '" "::,,,',,t~n's orinarl exemot purpJse? THE EXHIBITION OF ART IN PUBLIC PLACES. ach'ev~d in carry 19 out the organization's exempt purposes. In a clear and concise manner, ;YC'\ !ded, the P Jmber of persons benefited, or other relevant information for each 68-0169575 Pa e 2 'c \'=\3: Expenses (Required for 501 (c)(3) and (4) organizations and 4947(a)(1) trusts; optional for others.) ," ) If this amount includes foreign grants, check here. . . ~ 29a 28a ) If this amount includes foreign grants, check here. . . . ~ ___.._._. .__ ) If this amount Includes forei n rants, check here. .. . ss (a':t ;ch schedule). . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . ....__ If this amount includes foreign grants, check here. . , ~ . ";'- S.T.r!.~ '!xpense~ (add lines 28a throu h 31a ....." ................ 32 . .:i~~~I~:ers, Directors, Trustees and Ke Em 10 ees List each one even if not compensated. See Instructions.) (8) Title and average hours (C) Compensation (If (0) Contributions to (E) Expense account per week devoted not paid, enter -0-.) employee benefit plans and and other allowances to oSition deferred compensation ~ 3Da : ',' \'"'~e 2nd :lddress . , ---.-.--- o. o. o. .. '," "."3:(:' )orrOW from, or make any loans to, any officer, director, trustee, or key employee or were ~.~c; "T',r:'f 'n 2 Dr;er "ear and still unpaid at the start of the period covered by this return?....... .. ,'c.. ':'''ed ir, h Ir 38 instructions and enter the amount involved. . . . . . . . . . . . . . . . . . . . .. 38b U';i'!:,iZ3 'Ie 15, Enter: No _ ______ ''iation (Note the attachment requirement in the instructions) SEE STATEMENT ~ :.~ _:,.::'.iz2lcn 3ngage in "ny activity not previously reported to the IRS? If 'Yes,' attach a detailed descriPtion~ ,~ ~ ,;;: ~ .'" I '.y . . . . . . . , . . . . , , , . . . , , _ 33 "'."'0'; ~;> ':: the orga1'zin or governing documents but not reported to the IRS? If 'Yes,' attach a conformed copy of the changes 34 ",:cn h8C nee 'ne from bush ess activities, such as those reported on lines 2, 6, and 7 (among others), but not reported on Form 990. T, attach .. ," '';':.'';f.' ;CJ reason f,Jr nc' reporling the income on Form 990. T. :'.^ c,~ "'elated ::USii ess gross income of $1,000 or more or 6033(e) notice, reporting, and proxy tax requirements? . .. ,... ... "3X 'et',"rn In Form 99Q.. T for this year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ....,...... n,'/:I';-, ern nation, or substantial contraction during the year? (If 'Yes: at! a slmnt.). . , : ."^(:.; ''.3, ceet or indirect, as described if. the instructions. , ,.. . ,. ...... ~~I " ~'~2'iizatkn .lie Form T2D-POL for this year? . . . . . . . . . . . . . . . , . . . . . . . . . . . . . , . . . . . . o. 'CO:' :n.tal c01tri:.utions included on line 9. . ':"",,"'5, j"c'uded on line 3, for public use of club facilities. . . . . . . . . .. . . . . .. . 39b ,- '-z' ',;'s. E'1ter anount of tax imposed on the organization dunng the year under: O. ; section 4912 ~ O. ; section 4955 ~ O. .= - .~ ')3. Did :he C 'ganization engage in any sectIOn 4958 excess benefit transaction during the year or did it become aware of an ,,:.: sac.:',:, ,n ~om a prior Y8. Ir? If 'Yes, , attach an explanation . . , . , .. ........ ................. _ . . . . . . . . . , . . . . . . . .. .. .. "~>:~,Ol';E. ;ld04~~t'org.ani.zat~~nm.an~~ers.or ~.i~:uanfle~.~er~ons.~uri.n~ .they~~r u~~er.... ~ "''',,:=')')01: Of ta~m line 40c reimbursed by the organization. . . . . . . . . . ~ TEEA0812L 02106106 x O. ------- O. Form 990.EZ (2005) .c'_ 'v 'J t."X lJ.~54 26 777 2 SALLMANN YANG & ALAMEDA 141 008/016 ~::0L:r-.~"?nIE ARTS FOUNDATION ::.~~.;:::.: (~Iote the attachment requirement in the instructions) (Continued) , ::;C' ;':l'S return is filed '"" NONE .. - ,-.: i- :2'9;: ~ GEORGEAN M. VONHEEDER, TREAS '" :: s:' : _ :(2L1 CE ~TER PKWY # 18 0 , PLEASANTON, CA, 68-0169575 Page 3 Telephone no. '"" 925-426-7744 ZIP+4'- 94588 -,s :iur:ng t le calendal year, did the organization have an interest In or a signature or other authority over a 2::C)l",t n 3 foreign c(,untry (such as a bank account, securities account, or other financial account)? .. ...... -',.., -'~, Of tf"e for. ign country: .. ~ ',:".x~:;~S'0' excaptims and filing requirements for Form TO F 90-22.1. 'f .::"le during the calendar year, did the organization maintain an office outside of the U.S.?., ., 'S, e":er the narr e of the forE ign country: .. ~ '-"('0- 49tJ.7(a)(1) r onexempt ;haritable trusts filing Form 990-EZ in lieu of Form 7047 - Check here. . . , . . . .. . . '... '!:::::'. : of '!:!~'Jmpt interest received or accrued during the tax year. .............. ~~ . ~,~C~; 'e that I have examined this relurn, including accompanying schedules and statemenls, and to lhe besl of my knowledge and bejief, IL IS .,ec 'a:;o" of preparer (other than officer) is based on all information of which preparer has any knowledge. ~ D N/A N/A 3;'~1"~'f'~~ ('.4' ':' ficer (g(Q)[?J)f Date MARTIN INDERBITZEN ~ PRESIDENT Type or print name and tllle Check if self. employed ... Pleparer's SSN or PTIN (See ~eOn~ ~1'~c20g W) '-.. '- Dale __ ~ ___.____ SEOBGE \N M. VONHEEDER, EA _~A;-,!:~ m, YANG & ALAMEDA '" 6601. K')LL CENTER PARKWAY, SUITE 180 2tlc -'-'. PLEASA:ITON CA 94566-3118 TEEA0812L 02106106 EIN ... 94-2484789 Phone no.... (925) 426-7744 Form 990-EZ (2005) ,,\~ ~ .,X 925L1267772 SALLMANN YANG & ALAMEDA [4J 009/016 Organization Exempt Under Section 501(cX3) (Except Private Foundation) and Section 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 organizations and attached to their Form 990 or 990-EZ. -- .--_____,____~_.__. _ ...._. ____ ..l.----- Employer identification number OMB No. 1545-0047 ". ~ '-:" /-, ~. '~':.::::Z; 2005 -~:-::c ~ ;.sor.U!dl TI ON 68 - 0169575 -.'T, -: 'satio1 0: the Five Highest Paid Employees Other Than Officers, Directors, and Trustees ,:3-28 :""l:;;I"JCtions. Lis: each one. If there are none, enter 'None.') --~----~-~- -_. "TE. ;; - c: 3ddress of ~ach """'C '.e.. 'leE lJaid !Tore t'"'3'1 ;,50,000 (b) Title and average hours per week devoted to position (c) Compensation (d) Contributions to emoloyee benefit pians' and deferred compensation (e) Expense account and other allowances o o. o. o. ~- - c, ~'otrer e11r,joyees paid ..-...".'" . ~ 0 :>:'~.':';:" sCltion o! the Five Highest Paid Independent Contractors for Professional Services :-: - -~ '- ct c:'s. ~is each one (whether individuals or firms). If there are none, enter 'None. ') ~~ __.___.__.__ _.._ ___M_ 'C ;?~dreS5 of each in' ependent contractor paId more than $50,000 (b) Type of service (c) Compensation o. ,~ ~ - -,:/ :)~!""'ers rec ~;ving over __ :_~~>c;c )"1<':'::';: 'Vices. . _. .... ~ 0 Co"oel'lsation of the Five Highest Paid Independent Contractors for Other Services :>,': e2cr ~ontractor .Ihoperformed services other than professional services, whether individuals or firms. If there are none, '.. -,-, .' See 'ns' .uctlons.) :: z :;.;;r" ;,~ of escr in( ependent contractor paid more than $50,000 (b) Type of service (c) Compensation -- :- c' ;c.:o~s -ec~ iving c' at."er serv'ces. . ~ 0 ..- ..,,:.,.. ~'~'~'l ;tion Act N )tice, see the Instructions for Form 990 and Form 99O-EZ. Schedule A (Form 990 or 990.EZ) 2005 TEEA04C1L 08109/05 - :::; 10 F,X 9254267772 SALLMANN YANG & ALAMEDA L~~_:.:,~G-::-Z) 2[,05 DUBLIN FINE ARTS FOUNDATION 68-0169575 3'l.?tem~rts Abou1 Activities (See instructions.) nc: '~~ year, raE the organ (ation attempted to influence national, state, or local legislation, including any attempt ,'. ""c,' :L:b.ic cpinion on 2 legislative matter or referendum? If 'Yes,' enter the total expenses paid (:T-2:!ion with 11e lobbying activities.,.. ~ $ N/A - w_~ '--: '. :""1 ';<1'9 3f, Part VI-A, or line i of Part VI-B.). . , . . , . . . . . . . . . . . . . . . . .. , . . . .. , . . . . . , , , . .:. - _ . ::' 2ce zr aic ction under section 501 (h) by filing Form 5768 must complete Part VI-A. Other . -~i-:Z2:'01S check ng 'Yes' m Jst complete Part VI-S AND attach a statement giving a detailed description of the J':ying activities. -: ,c'e. year, ra~ the organl ~ation, either directly or indirectly, engaged in any of the following. acts with any . -- ':.;r.:-,"":'YS, trustees, directors, officers, creators, key employees, or members of their families, or with any . ~ :""-'za~;J- "Vith which any such person is affiliated as an officer, director, trustee, majority owner, or prinCipal ',',77" r!',,;,, ,mswer to c'lY question is 'Yes,' attach a detailed statement explaining the transactions.) _~2'.P, exchange, or leasing of p'operty? ..... . . ... .. ,~ -'""J"""!?\ C' other exte nsion of credit? . . . ,'. '3erv'ces,.r facilities? . . . , . . . ; :;y.'.~:' ;0('0"1 (or r.ayment or reimbursement of expenses if more than $l,OOO)?,.., .". 3'''- c/ a.-,y part of its incone or assets? . . . . ,.. . . . . . . . . . . .. , . . . .. . _ , . . . . . .. ,.....,.............,.,....... ~ 'C for scholarships, fellowships, student loans, etc? (If 'Yes,' attach an ':lU determine that recipients qualify to receive payments.)... . .. . . .... . . .. . . , .. , ,. .... '",," ,l S', ~'; 'r 403(0) a lnuity plan for your employees? .. . . . . . . , . . . . . . , . . ' ' . , . . . . . . . . . . . . 3". -::: i :le organi; ation receive a contribution of qualified real property interest under section 170(h)? , . ,.:".c ',,,jntair. ar { separate 3ccount for participating donors where donors have the right to provide advice ,e ._'~;e or dishbjtion of fur ds? . , , . . . . .... . . .. . . , _ , . . . .. . . . . . . " ,. . ., . . . , .. . . . ,.. .,..,.....,... ... ':.'~~~...E'ov;de cred t counsetin;J, debt management, credit repair, or debt ne otiation services? , . , .. ..,..' '~"'S?~ .: lr Non-P 'ivate Foundation Status (See instructions.) l4J 010/016 Pa e2 Yes No 1 X 2a x 2b X 2c x 2d x 2e X 3a 3b 3c x X X X X 4a 4b " .' '~-::..' yivate fou: dation because it is: (Please check only ONE applicable box.) .:~'. Ca~\i811ion of chAches, or association of churches. Section 170(b)(l)(A)(i). 3;:"00:. Seeliol 170(b)(1)(A)(ii). (Also complete Part V.) ':'::'~i)~ or .3. (ooperative hospital service organization. Section 170(b)(1 )(A)(iii). , '2' S',i: ':~ or local g., vernment or governmental unit. Section 170(b)(1 )(A)(v). ",:::2: 'esS'2 'ch organiz 3tion operated in conjunction with a hospital. Section 170(b)(1 )(A)(iii). Enter the hospital's name, city, ,:.;;..:~ h. ---------------------------------------------~---------- . :. ~T:za':i"~ :)perated fer the benefit of a college or university owned or operated by a governmental unit. Section 170(b)(1)(A)(iv) :f-':>,c c')~D'!"t2 <'e Suppor Schedule in Part IV-A.) , . ': ~il."za[iO', that no'ma Iy receives a substantial part of its support from a governmental unit or from the general public. > c" .~~ '70(~)(' )(A)(vi). (A so complete the Support Schedule in Part IV-A.) :'_....."':v ..':.st. Sec~:ion 170(b)(1)(A)(vi). (Also complete the Support Schedule in Part IV-A.) '. .-2: -:)'11.0 Iy receives: (1) more than 33-113% of its support from contribulions, membership fees, and gross receipts _. ' :;:;":':8 it" charitable, etc, functions - subject to certain exceptions, and (2) no more than 33.1/3% of Its support 'S -'~-~S5 'nvs~ 'iment i:1co, ne and unrelated business taxable income (less section 511 tax) from businesses acquired by the '<:,"'z01::or. 2ftE r June 30, 1975. See section 509(a)(2), (Also complete the Support Schedule in Part IV-A.) " 'hat is not ,;ontrolled by any disqualified persons (other than foundation managers) and supports organizations .'V i1} iines 5 thrr ugh 12 above; or (2) section 501 (c) (4) , (5), or (6), if they meet the test of section 509(a)(2). Check the '..~_.~' c'e"3s.2's the type of supporting organization: ... D Type 1 o Type 2 o Type 3 Pr Jvide the following information about the supported organizations. (See instructions.) (a) Name(s) of supported organization(s) (b) Line number from above ~~:.::....~.;~zat;C:-1 Jrganized ,nd operated to test for public safety. Section 509(a) (4). (See instructions.) TEEA0402l 08/09/05 Schedule A (Form 990 or Form 990.EZ) 2005 ','. :.~;: 10 F"X 9254267772 SALLMANN YANG & ALAMEDA I4J 011/016 .'" :>;~ . :?S'O-EZ) 2CJ5 DUBLIN FINE ARTS FOUNDATION 68-0169575 . , --'-~:~':':~';QY< ~ chedule (Complete only if you checked a box on line 10, 11, or 12.) Use cash method of accounting. ~_ _:..: r'" "'/ IJse the worksheet in the instructions for converting from the accrual to the cash method of accounting. Page 3 ." ~,'- :~'':;?'" to" f;sca! Yl!ar ~. "., ;...., '\ I~ (a) 2004 (b) 2003 (c) 2002 (d) 2001 (e) Total . _': .~-): '~: .~t;:b'...'t;cns ',.:r:r: 49,250. 54,875. 30,000. 87,501. 221,626. O. ~ ~, :: ::"''';' . . --.--.-.-.--- ~. :..,'";,:l fees -'?( eived, , . . . -_.-._.__._.,...._,~- "c, 'c-p;."s f'om admissions "~:~"?~;'~~' s~ic' or s~rvi :es p~rformed, .". '~~""~ c,t .>:;!J~;~!: ~, any activity , . ~:.: -'~~ :.,~-.. 'L~~;orls -- - "-r>.~":"': . ,.,. - .'~,. . ~~--'------"- o . ~'i~~'~r;~ ~~ ;m~~~S~~:s, : :r,:;:3ectio~ :: 2(aX5)), ~C..~ ~;:s, arc' u,'ei,ted business : "cc":"'e C,ss secti!,n 511 taxes) '" .. "3,'5 2CGi:;r9d 'ly the organ- __ ~~_'~:~~_:~~e ~~ll. . . . . . . . . . 13. 219. 556. 1 139. 1,927. .:~ ,"S ?','C b'Jslness , e ~3 . . 0, c~.:e~ :ev.",c. 'or the ,. : - ." '22" 0''': and : -,' ~ ,"<:i 10 it or e> pended H._~3,jehalf. . . . . . . , .. . . . . . .. ' . " ,~'.i'o Of selVice!, or ._-~'--';~.'-~~' '~ t'te ? ~-:) 'e""irr-e:-.:al _ ~ ).') no~ ~ ," .:' '; ',a.lie 0;' :,ervices or :::';..'cs generally fu .nished to . '__~~::'.:i~ without ch 3rge . , . , , , ~'-:.-'e" ;"ccrre. Attacr a , . JiJ ""'lot i""'c!'Jde '" -:~-' '~-C"'- ~~, .le Of o. o. o. __::'...:.~~~:;i:'-1:~~--"--,-- 49,263. 55,094. 30,556. .._'.~~_::::,,')slinel:........., 49,263. 55,094. 30,556. ~.._~,~:_:~~.,e 23-,- ...,...... 493. 551. 306. :'-:~.~'O'S descr: bed on linE S 10 or 11: a Enter 2% of amount in column (e), line 24. , , . . . . . . . , " rc~ "D',r rex'ds to show th, name of and amount contributed by each person (other than a governmental unit or publicly , ""..~"T' \J }se total ~Ifts ror 2001 through 2004 exceeded the amount shown in line 26a. Do not file this list with your . --.~ .-'" ':. '^ese excess amounts, ' , . . . . . . . . . . . . . . ' . . . . . . . . . . . . , . . , ' , . . . , ~ O. 223,553. 223,553. :r :.. or 5CS<a);1) test: Enter line 24, column (e)..,...,.,. ~'~cu!"ts from column (e) t:>r lines: 18 1,927. 19 ~ Ub ~d : ;"-":coor! (line ~6c minus I, le 26d total) , . .. .",.,.".",.. . . . . . . . . . . . . . , . . . , . . . . , . , . . , . ,. .. ~ 26e <.::'~2:"'-':.~YCE ntage (Ii ne 26e numerator divided b line 26c (denominator "..................... ~ 26 f .,~~c o:'~:"':"~-ed o!'l'inr: 12: N/A c -:;', .,'( :- ;:r:e~ E, 16, and 17 that were received from a 'disqualified person,' prepare a list for your records to show lhe " ~tc; ,;;: 'ounts -eCt ived in each year from, each 'disqualified person.' Do not file this list with your return, Enter the sum of '''-':>.:'l~S for ecc h year: _ .~ _ _ _ _ _, _ _ _ _ _ (2003) _ _ _ _ _ _ _ _ _ _ _ _ (2002) _ _ _ _ _ _ _ _ _ _ _ _ (2001) _ _ _ _ _ _ _ _ _ _ _ _ _ . ~-:'c--c'.'nt irc!ujed in line 17 that was received from each person (other than 'disqualified persons'), prepare a list for your records ~. ~" -.:~~":-t Jr. "rd arT1ou;,t receIved for each year, that was more than the larger. of (1) the amoun~ on l~ne.25 f<?r the year or (2) ..: :, ' -:' 1St orgar zatlons described In lines 5 through 11 b, as well as individuals.) Do notfJle thiS list With your return. , :: ' : ":,,""'-:S3 t ~tween the amount received and the larger amount described In (1) or (2), enter the sum of these .' (...-"2," :.e '5 amo\Jnh I for each year: '-~ -".:. _ _ _ _ _ _ _ _ _ _ _ _ (2003) _ _ _ _ _ _ ~ _ ___ -... _ _ (2002) _ _ _ _ _ _ _ _ _ _ _ _ (2001) _ _ _ _ _ _ _ _ _ _ _ _ _ ::,~")')'lts from olumn (e) flr lines: 15 16 "7 20 21 ~ 223 553. 1,927. 221,626. 99.14 % -, .' ~ n" and line 27b total ......",. '" -:-- ~ 7-: total 'TIir us line 27d total) . . . . . , . . . . . ., ........ ....... .-: "'jr c',':f Jel 509(a)( ~) test: Enter amount from line 23, column (e) .. ~ 27f . ~, c ,:.::,,),0: per<;~ ,tage (line 27e (numerator) divided by line 27f (denominator)) . . . . , . , . . , . . ~.r.:ef1ta~:!ine 18 column e numerator divided b line 27f denominator ... .,... ~ 27h % ';' '7:n,,,:':S: For 3n organize tion described in line 10, 11, or 12 that received any unusual grants during 2001 through 2004, prepare a ~',. '(':,arc;: ~( show, for ~ach year, the name of the contributor, the date and amount of the grant, and a brief descnplion of the .. . ':.'::':.~ ::.Eat Ire tf is list with your return. Do not include these grants in line 15. TEEA04()3L 02103/06 27c 27d ~ 27e Schedule A (Form 990 or 990.EZ) 2005 ._ ~ 'L\. 9;:5",267772 SALLMANN YANG & ALAMEDA c_'C..~_r.::)'m 990 or 990-EZ) 2(05 DUBLIN FINE ARTS FOUNDATION .. ,.::'~lvate S. :hool QU estionnaire (See instructions,) ~(\ be cem ,Ieted ONL Y by schools that checked the box on line 6 in Part IV) 68-0169575 ':.~-~'::::'( ~ have ::I r IClally nondiscriminatory policy toward students by statement in its charter, bylaws, ~-- -.,--- -'~~~ -~.:n-)eqt. or n a resolution of its governing body? . . . . . . . . ... . . . . .. . . . . .. . . . . . . . . . . . . . . '-'c ')rg?!lize:.ticn include c statement of its racially nondiscriminatory policy toward students in all its brochures, oc :, ;";5, ~':ld 9.lrl'~r written cilmmunications wilh the public dealing with student admissions, programs, ~~~':- ?rS~'!JS!.. .. ...........................,....,.......,.................... ........... 0:: -;carcizat or publicized its racially nondiscriminatory policy through newspaper or broadcast media during .c =. ~;< ~or:citction for stu Jents, or during the registration period if it has no solicitation program, in a way that .C', J(" :cy '.n )wn to all ~arts of the general community it serves?. 0.....0.'.. .....0..0' c.. V8S.' please desc'ibe; if 'No, please explain. (If you need more space, attach a separate statement.) -- '''';''',~:c '0, ~ ~o;"..~ir the following: - .:'"' - :":?':'~' o~. '8 ,acia! cc nposition of the student body, faculty, and administrative staff? , ,n ,: .J ~c;me-' l::-;) that scho arships and other financial assistance are awarded on a racially - -- "':~" '~;"?~o"Y 0, sis? 0 . 0 . . . . . . . . . . . . . . ' . . . . . . . . . .., 0 . . . . . . . . . . . . . . . . . . . . . 0 . . . . . . . . . . 0 0 . . . , c" :::atc':::gJes, brochures, announcements, and other written communications to the publiC dealing ~~ ~'G.~'>S' J!1S, OrOgrf ms, and scholarships? , , . , , , 00' , , , . , c . , . , . . . 0 . . . . , c . . . , . . .. . . . . . . . , 0 , . 0 . . , .~":' : '.',e::: ':y "~e organization or on its behalf to solicit contributions? .. . . . . .. . .... . . .... . . '-~'Ve~ed .~o:O to any of t le above, please explain. (If you need more space, attach a separate statement.) :-;;"":ze.:c 1 discri'l1ir ~te by race in any way with respect to: ."';:~:s O. pivi!eges?c . ". ~'3 p~di::E:s~ . . :y (y ce'",ir istrative staff? -- > :-:T~,''1 "JS or of1e' financial (ssistance? . . . . - :>: :~,?: policies!. . . . 0 0 , , , , :rcq"2ms.:' :'''C'_.'''(;C) 2' ac:ivities? '0. .~'~::":~ :c ary of he above, please explain. (If you need more space, attach a separate statement.) :-~ J'Q2"'za:;:)., receive allY financial aid or assistance from a governmental agency? _. . ~:.,,, xgr'za;j'Jn 5 f!ght ~o S Jch aid ever been revoked or suspended?... . . . . 0 , , . . . . . . . . . . . .: - :.. :::'!ercd 'Yes to either 24-<3 or b, please explain using an attached statement. -.. :"(;2,'za'io 1 certify the t it has complied with the applicable requirements of -: :. J~ ~hrclQ~ 4.05 of REV Proc 75-50, 1975-2 C.B. 587, covenng racial '. ,:-O~.E2.~=_.~ ~~~:ac:1 an explanation. .. . . .. .., . .., , . ... .. TEEA0404L OB/08105 I4J 012/016 Page 4 N/A Yes No 32a 32b .. ~33a ,. I 33b 33c ,. 33di ...,. I 33e 33f . : :'.2 :"'nX 9254267772 SALLMANN YANG & ALAMEDA I4J 013/016 "'C"'~ 'j9C y 990-E2) 20)5 DUBLIN FINE ARTS FOUNDATION 68-0169575 Page 5 Lobbying Expenditures by Electing Public Charities (See instructions.) ~o be com:lleted ONl (by an eligible organization that filed Form 5768) N/ A '~~c:3";zetion b ~Ion s to an affiliated group. Check" b if you checked 'a' and 'limited control' provisions apply, (a) (b) Limits!)O Lobbying Expenditures Affiliated group To be completed totals for ALL electing (The tl,rm 'expenditures' means amounts paid or incurred,) organizations ::::c'Ing expe'ditures to 11fluence public opinion (grassroots lobbying). . . . . . . .: ,~. "'.' ". :';t\Jres to 1fJuence a legislative body (direct lobbying). . . . :","'c.s ;~( J !ines 36 and 37)..,......,................. :- ~ . -:;." :': "~ ,=xpe ,di ures. . . . . . . . . . . . . . , , , , , ... ~:.e'"":Jt pur~o:e expenditllres (add lines 38 and 39)...,..................... . :""':{;~~ "o";axa':>'E amount. Enter the amount from the following table - ",e ~'':'1r>unt on linn 40 is - The lobbying nontaxable amount is- ..... :'':':::::,CCC. 2O$100%,ooootptlhues ]aSmOllooOufnthteoenxclelsnseo40ver.$.soo.. ',000' ~ '. , 'C'.: 1:' ;'f;. $'.000,000. f( ',. ~'.5~C.~1)C $175,000 plus 10% of the excess over $1,000,000 ..,:~: ~J: "::0. er $17,OCQ,OO: ... $225,000 plus 5% of the excess over $1,500,000 -~ ~.,'::'T:',~~Y]. ...,...... .., $1,000,000....."..,............. C . 'C:5 :1o'1taxat Ie amount :enter 25% of line 41) . . . . . . . . . . . . . . . . . . . . . . . . .. . . ~ ~ (2 'nr line 36. E'lter -0- if line 42 is more than line 36. . '::,- 'c-. ~ .;'1e 38. E'lter -0- if line 41 is more than line 38. . . ....:..:...":~~..:.~:..:: r' amount In either line 43 or line 44, ou must file Form 4720. 4 -Year Averaging Period Under Section 501(h) (Some or[ anizations that made a section 501 (h) election do not have to complete all ot the five columns below. See the instructions for lines 45 through 50.) Lobbying Expenditures During 4 -Year Averaging Period ~. 'i~'~ r (a) 2005 (b) 2004 ':::7;:;~J~;) ~ - ---:-':?X2~,I'2 ____ _,__~~~~~::L;~_ -:':? '~.:'Jvinc ~ '-,,: ":"-'-e~. . . . ~ -., -::~",:,,:.\s r"l'J"1w (e) 2003 (d) 2002 (e) Total , """-r",,,'s '00' bying L' _ ,..~;), \..-... '. 1 . ~",::,',"""d-J"~'''''e5. , . . , . , . _. - - -_._,,---~~~- . '__?bbying Activity hy Nonelectina Public Charities .. .~. "~.()O":r J only by 0 ganizations that aid not complete Part VI.A) (See instructions.) / :. L.:nt'.~ers. . . , . . , , . . :',:' "-:, (,'~ 'ar:zati,m Ittemp! to influence national, state or local legislation, including any .' C"~. .: c:riM cr or a legislalive matter or referendum, through the use of: .': ~ 'i: :.',j;:..tis'ament;. . .. . . . " ': c' ,,'J ::>r ""18'18;J€ 11enl (I"c!u je compensation in expenses reported on lines c through h.) , , : r-C":l2ErS !egislator~, or the public. . . . . . . . . . . . . . . . . :-'3. :r :;.J;:hhed or bmadcast statements. .. . . ...... . , . .... ........'".., ....",......... 'l?- a'<;;?rzations foe lobbying purposes. .. ...........,.......,. ... -,.- :::: -.,2G': w:t:-r ',e JlSrators, !t' eir staffs, government officials, or a legislative body. . . . . . . . . . . . . . . 0-""0' st."",: 'S. se.,...'"a. s, conventions, speeches, lectures, or any other means, . . . . . . , , . :y ,:g e);::Y~" iitures (adc lines e through h.). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . .''.:';. 0" ~h'.si ove, also a~tach a statement giVing a detailed description of the lobbying activities. Schedule A (Form 990 or 990-EZ) 2005 TEEA0405L 08/08105 :~:: 13 vnX 9254267772 SALLMANN YANG & ALAMEDA f4l 014/016 ,~so.::z~ 2(05 DUBLIN FINE ARTS FOUNDATION 68-0169575 . .. [:;s;;:~rc "9 Transfers To and Transactions and Relationships With Noncharitable . ;" ;c:n~z;:::it ns (See instructions) _ . '. ',':'C -:;,,_ c- ;anization ( irectly or indirectly engage in any of the following with any other organization described in section 501 (c) ': =:'Jc'e ~0:he- t lan section 501 (c)(3) organizations) or in section 527, relating to political organizations? m_~..:, ': "cen th" r~porting or'lanization to a noncharitable exempt organization of: Page 6 c..-?t"'~'?"'~. Yes No 51 a (i) X - a (ii) X b (i) X b (ji) X b (iii) X b (iv) X b (v) X b(vj\ X C X - " ~r ::S~8J:~". ,-:"'''S3C tlO~Y:;: ',.,,:'- ': c" eXC"2r Jes of aSSl ts with a noncharitable exempt organization. :-'2383 J' oS ,ets from Ci noncharitable exempt organization. . . .. . . . . . '< :<' faci"ti.,s, equipment, or other assets...... .......................,....,...,......,. ;', r:;'~""'e r,t arrangeme lts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,"~" .:: : :;,,,'vi.ces or membership or fundraising solicitations. . . . . . . . . . . . . . . , . . .. . . . .. . , . . ... , . . . . ,o~,. ,': :f ':acilities, equipment mailing lists, other assets, or paid employees. ...... . .. . ., . . ..,.. . ....:'" 2r'3w~r to any of the abo\'e is ''(es,' complete the. following. scl}edule. Column (b) ?hould ~Iways show the fair market valu~ of . '" ~::-:cs, o~her as~ets. or ser\ Ices given by tfie reporting organization. If the organization received less .than fair market value In c.:)' ,'?~S,3.ct!on or s'lanng arrar'gement, show In column (d) the value of the gooos, other assets, or services received: -_.~---~- I - -- , "-,'. (e) (d) " ~ .' ,-- ,. , "' ,.. '~:'Jej Name of noncharitable exempt organization Description of transfers, transactions, and shanng arrangements --_..~_._._.. -.--- ----;- --- -~-~~-~_.. ."-._----~- .- --~---_._-- .---.---- ._---, - .._-~,.~--- - ..-. ..- ~. --- .u_ ~---~_.._-- - ., -------~--- . :;' : =~:;t:! c' ir :Ilrectly affiliated with, or related to, one or more tax.exempt organizations .':: - <:r Cc; ,-;- ~' e Code (other than section 501 (c)(3)) or in section 527? . . . . . . . . . . . . . , . . . .. ::';'.~, e'.;> :" follow:lg;chedule: . . ... ~ 0 Yes lID No -.----.,,- - :'\2rne (a) (b) (9 of o'g,nization Type of organization Description o relationship ---~- -----.-- - -- - --_..._- -- --.+.-- - --_._- - n_._. ------- --------- -. _____.,___.H+ _M .. -----.- --- --_._-~ -''"- - ------ ----._------ _._~~- -.- .__._--~---p-- - Schedule A (Form 990 or 990.EZ) 2005 TEEA0406L 08/08/05 -- '~,:14c;:'HX 9254267772 SALLMANN YANG & ALAMEDA FEDERAL STATEMENTS DUBLIN FINE ARTS FOUNDATION .. ~. -'::11~!\:T 1 '~.'- ''.' ?~J~::Z, f>>~RT I, LII~E 16 '.-.-::-,:: EXPENSES - ... ,- .. .. .::~l'::;:,G ;;I~ECTGR.... $ " -~-. ~ ~ -........- \. ',.-.:., ... TOTAL $ ---,: ~-='i~::XT 2 , : ,; S90-EZ, PART IV '::' -':'" O;.FICE~S, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES TITLE AND AVERAGE HOURS PER WEEK DEVOTED DIRECTOR $ 1 CONTRI- BUTION TO EBP & DC O. $ NAME AND ADIRESS COMPEN- SATION O. $ ;~~T~J '-'~~-_.-? ~'': :O~.JP,~ ~,F ~-C~''\::=J:\~; M. V)NHEEDE:<. 2. BOX 2725 V__?:~"':X., SA 94568 o. o. :::;::.')L~' \VE :.::. :.;:> 68 TREASURER 5 DIRECTOR 1 SECRETARY 1 PRESIDENT 3 TOTAL $ O. $ O. $ - ~-~ -- \ ~': =':C.\~\ ~1ICK o. o. u _.. ~~E-;\'G --'.--:'-: '::TR :LE T. ~;; ~4 ;68 O. o. :-:-- :-:-::::S:<3 ~TZE!\ o. O. ~. :>:,)~ :..~ j ;' C':::.3~1~JTON, c.~ 94566 .-. ~E"'SNT 3 ':".. :?90-EZ, PJ,RT V ':~~:~\?'JING TRANSFER~; ASSOCIATED WITH PERSONAL BENEFIT CONTRACTS 141 015/016 PAGE 1 68~0169575 11:48AM 2,500. 6,000. 145. 35. 548. 347. 106. 9,681. EXPENSE ACCOUNT! OTHER o. o. o. o. o. o. - ".'.,- ':S':;PS:':Z \TION, DURING THE YEAR, RECEIVE ANY FUNDS, DIRECTLY OR :.:. ?l:\-:.' P \EMIUMS ON A PERSONAL BENEFIT CONTRACT?......... NO .::': ==l.:-:: ::RG]~NIZ,\TION, DURING THE YEAR, PAY PREMIUMS, DIRECTLY OR .":;- :::::,C=:::T!...Y, O:~ A PER:;ONAL BENEFIT CONTRACT?.................... NO ~_~.:1~ ?1~ 9254267772 SALLMANN YANG & ALAMEDA I4J 016/016 - . -,-, "\:..-: .~ .: ~ :; FEDERAL WORKSHEETS DUBLIN FINE ARTS FOUNDATION :: ~-':' ::;." ::' '0RT SCHEDULE FOR 2006 :':~)JECTS IF THE ORGANZIATION WILL MEET THE SUPPORT TEST FOR THE .. ::::::)01 THE JATA ENTERED IN SCREEN 55 FOR THE COLUMN 2005. S;JPPORT ITEMS r~"_ - ~::_::y-: ':, .~)~c "~~:~s~~:::p Et:S RECEIV: D ~:.~\c:s FEC:EIP!~ FROM ':" T.. 'C~:':J NDISE sow OR c.-:'::"". c:::. OR FUK fISHING =. ';;y~,:,":-:y TY ~ ... .. _.. J....._. :: <:~ S :::-il RITABLE r ORPOSE -::;3J ~ 3 INCOME I: ROM INTEl: EST, ,- . m -: { S.~,~-::'Jt;;: RECEIVE! FROM " 5::'::'::27 :':1E5 LOAI'S, .: : ',;.,::.. :rES, /\ND ONRE~ ATED :':;':~.31;:: I ~COME FRCM :. -: s' J',:::;:~::;: ~ D BY THE . :; ',: ::~:T\::':ON AFTEl:1 6/30/19'; 5 ,';:c :::NCOYili FRC"I UNRELA'jED :Y,:S~ l-CTIVITIES NOT INe LUDED ,- :;-Y"';. ,. '. ':'1::E':' ?O' THE "c EITHER .' ..:' :;:=~= CS : TS .. I:'E V.ALUE OF SERVICES CR ":::::::::::;:S F']RIS'lE9 TO THE c' ~T,,'C ",Y " :;OVERl\'MEI, TAL , -:: ::.:.:. ::::;;. DO XO' '. - ---. 1:" SS-::;'JI( ES OR ..." :-.:-:<~ ,.."'!. f~'F:'U: HED TO :: ~.': _:: C ;H THO JT CHARGE c::c.-.s;\ INCOME. )0 NOT nCLUDE ,'''.' ::;:; LOSS) nol.f SALE or , c~:::';"S ;' ...,,'-, 15 T5?OlGH 22 ~. '.~::;<: ~I"lE 1 7 :::::':.;: :. % OF :LI ~E 23 2005 (A) 2003 (el 2002 CD) 30/000. 556. 30,556. 30,556. 306. .. ,....!'~.ONS, IIESCRIBE:O ON LINES 10 OR 11: . C? .'t:';O;INT IN COLUMN (E), LINE 24 -'.= ~.::7 ; ,;...L I:m :VIDUAL CONTRIBUTIONS THAT EXCEED THE LINE 26A AMOUNT .: ~.P.L SJF}'ORT FOil SECTION 509 (A) (1) TEST (LINE 24, COLUMN (E)) :';.';~ THE l>JIOUNTS fROM COLUMN (E) FOR LINES 18, 19, 22, AND 26B .. . ?-':3LIC SUPPORT (J.INE 26C MINUS LINE 26D) . ~'.'?~-'C SUPP')RT PER :ENTAGE (LINE 26E DIVIDED BY LINE 26C) 2004 (8) 23/103. 49,250. 54,875. PAGE 1 68-0169575 11:48AM TOTAL eEl 157,228. o. o. 812. o. o. o. o. 158,040. 158,040. 3/161. O. 158,040. 812. 157,228, 99.49% 24. 13. 219. 23,127. 23,127. 231. 49,263. 49,263. 493. 55,094. 55,094. 551. - ,.," Sl.2 5' 26 7 7 7 2 I . .:::;,z SALLMANN YANG & ALAMEDA !4J001/01f! 925-8i6-8803 California Insurance Center CA Lic. # 0423393 3697 Mt. Diablo Blvd., #300 Lafayette, CA 94549 925-299-1112 .. ." i'~rt$ ;:'0 mdation ,,"'l""\ ~~ Travelers Property Casualty 660422X394206 . '''"''''r" .... 8,200 ,- ::~ :; :.::~. .~.'-\L f:, .) 2,500 '- ,.,C\L ;,',n 300,000 ! ,.",~~~ . ~~ ~.X 9254267772 SALLMANN YANG & ALAMEDA [4] 002/016 ~;\t:.;:; -841 5-8803 California Insurance Center CA Lie. # 0423393 3697 Mt. Diablo Blvd., #300 Lafayette. CA 94549 925-299-1112 .' -,':-:-: Fne Arts FOllndation _ Box 2512 Uy_____.~_~ .;,.,-'.":l:-:";'; " . ,"'-,'"~ ' '~ .', ,'~ -""~,' '}:::,~ I i I Travelers Property Casualty 660422X394206 OS/23/06 05/23/07 ,T ~~, 2,000,000 2,000,000 1,000,000 1,000,000 Excluded 5,000 "'_:~~':, /\g: rr. r~':, rl . <0 .. c"":, '::: )wned or I 416 '0 ~ .., "embers ! ;1 .., ; . '"' g25L:267772 2;'.;; -341 5-8803 California Insurance Center CA Lic. # 0423393 3697 Mt. Diablo Blvd., #300 Lafayette, CA 94549 925-299-1112 .: >'1 F'ne Arts I;::oundation -:'.(\ !;lox :ZS12 . ~" .""~ .~! ~-E", :;~::'r~, Travelers Property Casualty 660422X394206 1.,000,000 -:--"~"'::, C:>nci::lO;ls: Dublin High School Funding Request Review Checklist IAR! 1- ~IPLIC.TI:(llllllItTT.t;;iiIIiVIEW A. Application 1. Date application received*............... . . . . . . .. . . . . . .. . . . . . . . . . . . . . .. .. . . .. . (Completed applications are due by 5:00 p.m. on February 5, 2007) 2. Two copies of the completed application form are submitted....... B. Organization Information 1. Name of the organization..................................................... I 2. Is the applicant a nonprofit organization?...................................... I 3. Does the organization has a 501(c)3 State of California ID#?....... I 4. Does the organization have a current City Business License?...... I C. Funding Request 1. Funding amount requested... ... ... ... ... ... ....... ... ... ... ...... ... ... ... .. 2. Funding Source (i.e. General Fund, CDBG Fund)............... ...... D. Project Information 1. Proposed project name.. ..... .... ......... ..... .......... ......... ........... 2. Project start date... ... ... ... ... ... ... ...... ...... ... ......... ...... ... ......... 3. Project complete date............ ... ... ... ............... ......... ...... ... ... 4. Total # of organization clients...... ...... ......... ......... ... ...... ........ 5. # of Dublin businesses / residents will serve... ......................... E. Attachments 1. Name and home address of governing board of the organization.. 2. List of current board officers of the organization......... ... ......... ... 3. Current total organization operating budget, including revenue.... 4. Most recent audit or tax return is submitted.............................. 5. Document providing evidence of board/organization approval of application and date of approval........................................... 6. Organization's certificate of insurance showing coverage of liability and worker's compensation.... ... ...... ... ... .... ...... .......... 7. Signed affidavit form from each collaborating agency identified for the proposed project (if applicable)... . . . . . . . . . .. . . . . . .. . . . . . . . . . . .. .. 8. Application verification declaration signature page...... ... ... ... ..... I~RI II - POST APiPII..l10NSUBMIITAL 2/5/2007 Yes Dublin High School N/A N/A N/A $7,500 General Fund Dry Grad Night and Every 15 Minutes 9/1/2007 5/31/2008 1 ,466 1 ,466 Yes I Yes I Yes I. Just a letter, no financial/statistical statement are included Yes, 2/13/07 Certificate was requested but not included N/A Yes Yes No X II Partl,E4,E5 II 1. Is the application complete?* (Y/N)................................................. If no, which sections are incomplete?............................................. 2. Did the applicant organization complete a mandatory presentation at City Council Public Hearing?* (Y/N).................. 3. Date notification letter of Council Approval of funding & mandatory financial reporting packet sent............................... 4. Date summary report is submitted to City*... ... ......................... (Report must submit to City by the end of August 2008. Failure to submit a report will result ineligibility for future funding) * Failore to submit a CQ lieati()n before th l!'~ql;Jil1~m~t'!t$'WHI rem() t1frQm funding H:\Budget\COMMGRPS\Dublin High School Funding Request Checklist.xls Attachment d Date Printed: 2/23/2007 2:05 PM C/ -Dc ~~t=j II ~'\ \\ ~-) CITY OF DUBLIN RECEIVED CfTY OF DUBLIN I' COMMUNITY GROUP/ORGANIZATIONAL FUNDING REQUEST ClTYMANAGEHSOFFjCE ApPLICATION PACKET Fiscal Year 2007-2008 Section 2: Application for Community Group/Organizational Funding SECTION 2 Page 1 of 16 CITY OF DUBLIN Fiscal Year 2007-2008 COMMUNITY GROUP/ORGANIZATION ApPLICATION FOR FUNDS COVER PAGE AGENCY NAME: DUBLIN HIGH SCHOOL PROPOSED PROJECT/PROGRAM NAME: "DRY GRAD NIGHT" AND "EVERY 15 MINUTES" FUNDING AMOUNT REQUESTED: $7~ 500.00 $3~500 - DRY GRAD NIGHT $4~000-EVERY 15 MINUTES SECTION 2 Page 2 of 16 CITY OF DUBLIN Fiscal Year 2007-2008 ApPLICATION FOR FUNDS 1. Please select one expense category: o Capital [RJ Operating 2. Applicant Information: Organization/Agency Name Dublin High School Mailing Address 8151 Village Parkway, Dublin, CA 94568 Street Address 8151 Village Parkway City Dublin State CA Zip 94568 Stephen Hanke, Superintendent 925-828-2551 x 8001 Executive Director/Chairperson Work Phone John Ledahl Board President (if applicable) hankesteohen@dublin.k12.ca.us Email ledahl i ohn@dublin.k12.ca.us 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. Carol Shimizu Tim Sbranti Principal, Dublin High School Dublin High School, Activities Director Contact Person for Project/Program Job Title 925-833-3300 x7001 shimizucarol@dublin.k12.ca.us 925-833-3300 x7239 sbrantitim@dublin.k12.ca.us Work Phone Email 925-833-3344 925-833-3344 Fax Nonprofit Identification No. (required) Not Applicable City of Dublin Business License No. (required) Not Applicable SECTION 2 Page 3 of 16 City of Dublin Fiscal Year 2007-2008 Application for Funds 3. Proposed Project/Program Information (Do not describe Organization.) Amount of Funds Requested: $7.500 total for: A) $3.500 for high school seniors "Dry Grad Night" and B) $4.000 for "Every 15 Minutes", (Maximum $25,000 per project.) Proposed Project/Program Name: "Dry Grad Night" and "Every 15 Minutes" Proposed Project/Program Date(s): Start L / ~ / 07 and End _5 _ / 1L /08 a. How would the requested funds be used? "Dry Grad Night" - Each year, a "Dry Grad Night" event is organized for graduated seniors in the district. This event is held the evening of graduation and is organized by the parents of Dublin High School students. This event offers graduated seniors a safe, alcohol and drug free atmosphere in which to celebrate their graduation. It is held off-campus at a location that offers a wide variety of activities throughout the evening, until early the following morning. The requested funds would be used to help defray the costs associated with this event, which costs over $40,000 each year. "Every 15 Minutes" - The "Every 15 Minutes" program is specifically designed to be an interactive student/parent program that involves the entire school community in examining the effects of drinking and driving on students, parents and the community. The program takes place over the course of one week, but many days are spent in preparation for this program. Police, fire rescue, hospital personnel, parents and students are active participants. The requested funds would be used to support the program costs, which will run in excess of $15,000. SECTION 2 Page 4 of 16 City of Dublin Fiscal Year 2007-2008 Application for Funds b. How would the PROPOSED PROJECT/PROGRAM address an unmet community need and improve the quality of life for Dublin residents. Why is this project/program needed? Both of the programs listed in this funding request directly benefit the students of Dublin High School and parents in the Dublin community. c. What documentation/data/records support the need for this PROPOSED PROJECT/PROGRAM? Please identify your data sources. (Additional page may be added, if needed.) . Graduation records . Student Surveys . Teacher Surveys . Parent Surveys SECTION 2 Page 5 of 16 City of Dublin Fiscal Year 2007-2008 Application for Funds d. Specify the PROPOSED PROJECT/PROGRAM population to be served. The "Dry Grad Night" Program will serve lih grade students in the Dublin Unified School district, the staff and the parents. The "Every 15 Minutes" Program will serve the entire student body at Dublin High School and, parents and staff members. e. Projects/programs must be evaluated to determine ifthey 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. The following methods will be used for measuring the success of the program: . Surveys to parents, teaches and students . Analysis of student drug/alcohol awareness . Year-End Program Assessment . Reports to City Council (1) f. Specify numbers of clients served by agency, then by PROPOSED PROJECT/PROGRAM: Total Proposed Participants Served by this Project/Program 1466(DHS students) + 1466 (DUSD students, parents, and staf Total Number of Dublin Residents Served by this Project SECTION 2 Page 6 of 16 City of Dublin Fiscal Year 2007-2008 Application for Funds 5. Financial Information - Operating Budget a. Expense Budget FY 2007-2008 THIS PROJECT! EXPENSE BUDGET ORGANIZATION PROGRAM GRANTR11QUEST Personnel Costs . Non-Personnel Costs Services & Supplies Dry Grad Night $3,500 Every 15 Minutes $4,000 Capital Costs Other (please specify) Other (please specify) TOTAL $7,500 Further Comments/Explanations (if necessary): SECTION 2 Page 7 of 16 City of Dublin Fiscal Year 2007-2008 Application for Funds b. Revenue Budget - NOT APPLICABLE FY 2007-2008 REVENUE BUDGET ORGANIZATION PROJECT/PROGRAM Committed/Restricted Funds (specify source) Non-Committed/Restricted Funds (specify source) TOTAL Further Comments/Explanations (if necessary): SECTION 2 Page 8 of 16 City of Dublin Fiscal Year 2007-2008 Application for Funds 6. General Agency Information a. List all years that Organization has previously received City of Dublin funding (not Community Development Block Grant - CDBG). In prior years, funding for "Dry Grad Night" was provided to Dublin High School via the Dublin Substance Abuse Council. For the past several years, funds were allocated and distributed by the student activities director at Dublin High School. That individual made arrangements to distribute funds/supplies that supported the "Dry Grad Night" safe and sane graduation activities. Funds were provided by the city of Dublin and Dublin Police Services for the "Every 15 Minutes Program" over the past 3 years. b. Describe the population(s) served by the Organization. Students from 9 - 1 th grades; staff and parents c. Describe all the services the Organization currently provides to Dublin residents. · An additional page may be added, if needed. All related to education 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. Funds have been received from the city of Dublin in prior years to assist in the funding of Red Ribbon Week and, Dry Grad Night and Every 15 Minutes at the secondary level. In addition, the city of Dublin generously supported the enhancement of technology in the district by earmarking $100,000 per year for several years. SECTION 2 Page 9 of 16 City of Dublin Fiscal Year 2007-2008 Application for Funds 7. Required Attachments: o Onlv one (1) CODV Der Al!encv of each of the following is required, even with multiple projects/programs submitted. o Applications without the following documents will not be reviewed for funding. o Please label attachments: A. B. C. etc. ~ A. Names of Governing Board; identify current Board officers. ~ B. Current total Organization operating budget, including revenue. · Clearly label/identify the program that includes the PROPOSED PROJECT/PROGRAM. " C. Most recent audit report or tax return (if applicable). rf 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. J E. Organization's certificate of insurance showing coverage for liability and workers' compensation. ~ F. Application Verification Declaration Signature Page. o G. Signed affidavit form from each collaborating agency named in proposed project/program plan (if applicable). SECTION 2 Page 10 of 16 City of Dublin Fiscal Year 2007-2008 Application for Funds ApPLICA TION VERIFICATION I attest that the information contained in this FY 2007-2008 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 30,2008. Failure to submit a report will result in ineligibility for future funding. Signature~: .' t-- ! -, f ~... .. 'I'~ ''j .,' '" I'" ;. j :....,,".~ \; '- ..... Date i 7- ,'" ,t, ^ t' '-- "~'--~v.*,,-,,,,,,,,.A""'-.,..,.~(".. J" ),_\,~~ - ". 'l';, )\/'It.. '. " " Executive Director' 11~7h~ 62/5/0 7 Date Boare Prs!>id8M/Chairperson .J~ SECTION 2 Page 11 of Ib City of Dublin Fiscal Year 2007-2008 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: NA Agency Division/Department: NA Project/Program Title: NA Project/Program Role Description (i.e., 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 2007-2008 funding application. Executive Director Date Project/Program Contact Person Date SECTION 2 Page 12 of 16 CITY OF DUBLIN Fiscal Year 2007-2008 COMMUNITY GROUP/ORGANIZATIONAL FUNDING PROGRAM REQUEST FOR REIMBURSEMENT AGENCY NAME MAILING ADDRESS FOR REIMBURSEMENT: PROJECT/PROGRAM NAME CLAIM # OF TOTAL FUNDING AMOUNT AWARDED TOTAL REIMBURSEMENT REQUESTED THIS PERIOD $ $ Amount of Reimbutsement'~equested Expense Type (Please attach receipts,.~imesheets, etc. (Please describe.) Date supporting identifi~d expenses.) TOTAL Amount R4?ClQested (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 13 of 16 CITY OF DUBLIN Fiscal Year 2007-2008 COMMUNITY GROUP/ORGANIZATIONAL FUNDING PROGRAM SUMMARY REpORT (Summary Report must be completed and submitted prior to August 31, 2008.) 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/data/records you have that support your conclusions. SECTION 2 Page 14 of 16 City of Dublin Fiscal Year 2007-2008 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: SECTION 2 Page 15 of 16 AGREEMENT BETWEEN CITY OF DUBLIN AND (Dublin Unified School District and Soul Shoppe THIS AGREEMENT, dated for identification this _ day of _ 2007, is entered into between the City of Dublin ("City") and Dublin High School. RECITALS A. have asked City to contribute a total of for use by to cover personnel costs for employees of in order to provide the services as described in Exhibit A. The services rendered pursuant to this agreement will be for the period July 1,2007 through June 30, 2008. B. City has determined that it is in the interest ofthe residents of the City of Dublin to make a donation of seven thousand five hundred dollars C$7,500 Dollars) for such purpose, provided certain conditions are met to ensure that the services will benefit the residents of City. AGREEMENT City and Dublin High School agree as follows: 1. Recitals The foregoing recitals are true and correct and are part of this agreement. 2. City Donation City shall donate $ seven thousand five hundred dollars ( $7,500 Dollars) to be used by Dublin High School to be used for operational support for "Dry Grad Night" and "Every 15 Minutes" program as described in Exhibit A to this Agreement. The donation shall be paid upon invoice to the City. 3. Records Dublin High School 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, Dublin High School shall provide reports describing the progress made by Dublin High School 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 16 of 16 Ii 'DUBLIN SCHOOLS DUBLIN UNIFIED SCHOOL DISTRICT - 7471 Larkdale Avenue. Dublin, CA 94568 Steve Hanke, Ed.D., Superintendent Shelley Fischer, Admin. Assistant (925) 828-2551 ext. 8001 (925) 828-2551 ext. 8002 (925) 829-6532 - FAX TO: FROM: DATE: RE: Community Leaders Stephen Hanke, Ed.D. February 2, 2007 Updated Information on Dublin Unified School District Board of Trustees John Ledahl President Term Expires 12/2008 David Haubert Vice President Term Expires 12/2010 Jennifer Henry Term Expires 12/2010 Denis King Term Expires 12/2008 Patricia Kohnen Term Expires 12/2008 ledahliohn@dublin.k12.ca.us Home Ph: 551-5965 Address: 6856 York Drive Dublin, CA 94568 davidhaubert@comcast.net Home Ph: 829-7766 Address: 4886 Redwood Ave. Dublin, CA 94568 ihenry@aalrr.com Home Ph: 351-9139 Address: 8410A N. Lake Drive Dublin, CA 94568 denisk@aol.com Home Ph: (925) 829-9144 Address: 7146 Pitt Court Dublin, CA 94568 pmko@aol.com Home Ph: (925) 828-3623 Address: 7303 lone Ct. Dublin, CA 94568 Matt Spring Student Representative Dublin High School Address: Term Expires 7/2007 Stephen Hanke, Ed.D. Superintendent sprinqer180@hotmail.com 8151 Village Parkway Dublin, CA 94568 HankeStephen@dublin.k12.ca.us Home Ph: 829-8249 Address: 3275 Dublin Blvd. #307 Dublin, CA 94568 '" 2006-07 Final Budget -- t BUDGET INTRODUCTION The 2006-07 Final Budget is the result of a great deal of work and effort by many people involved with the Dublin Unified School District. The Board of Trustees had provided overall direction in the development of the budget. The Board developed its pledge that: "All Dublin Graduates Will Be Lifelong Learners" and adopted the following tenets: . ..We believe that many of our students are learning well . "'Ve believe that many of our students can do better . '.We believe that some of our students are not doing as wen as they can . "We believe that our most important goal is to improve learning for ALL students . '.We believe that we owe ALL our students the best possible educational experience . ..We believe that ALL STUDENTS CAN LEARN The "Board Commitments" frame the district's focus on preparing our students to be successful and productive citizens in the 21 st century by providing an educational program that is second to none. These commitments are: 1. Dublin graduates will receive a rigorous education that prepares them for any postsecondary option. 2. All Dublin students will be responsible citizens and possess the personal qualities, work habits and attitudes to be successful in the world of work Indicators of success include: 1. All 3rd graders will read at grade level at the end of 3rd grade. 2. All 8th graders will pass Algebra 1. 3. AlJ Dublin graduates will be able to communicate competently in at least one other language. 4. 90% of alJ Dublin students in grades 2-11 will pass the CSTs in English, Math, History, and Science. 5. Students pass high standards for graduation. 6. All students take and "pass" the district's character education program, "Dublin PRIDE". (tbd) 7 AJJ students demonstrate competency on the district's personal qualities, work habits and attitudes standards. The "Commitments" will be reviewed annually. Yearly action plans will detail how the district will achieve these commitments and an accountability system will monitor how we are doing. School staff and school site councils have worked together to prepare their individual site council budgets for Student Improvement Plan (SIP) funds. The site budgets reflect District general fund appropriations given on a per student basis, as well as special purpose appropriations from the Dublin Partners in Education. District staff have worked with school site and program level managers to develop the budget. The budget itself is a financial representation of the district's educational plan. The figures in the budget reflect what is known at this point in time. These figures will change. The figures change will occur when the state finally adopts its budget for next year and determines the exact amount of funding for schools. This will change as the next school year goes on, as the district makes adjustments in fine-tuning its programs. Preparation of the budget begins in January with the release of the Governor's proposed budget for the State of California for the upcoming year. In that proposed budget, the Governor indicates his estimate of school revenues. Since the district receives 80% of its funding from the state, the state budget is critical to our operations. The<<>budget gets modified and adjusted many times fr.om January 2005 on. The district's final budget, according to state law, is adopted prior to July 1. But the budget is modified and adjusted many times thereafter. Adoption of the state budget and the closing of the district books, both of which usually occur in the summer months, provide additional information, which causes the budget to be adjusted. Throughout the school year, the budget is monitored closely and continues to be adjusted. The district's budget is comprised of several funds. The General Fund, by far the largest and most significant fund, is approximately $38 million in size. The General Fund is used to account for the day-to-day operations of the district. The General Fund budget for 2005-06 is based on a 4.23% cost of living adjustment (COLA) in funding from the state and emollment growth of 23 8 students. The district's General Fund is divided into two sections: Unrestricted funds and Restricted funds. Restricted funds are monies received by the district, which are categorical in nature, i.e., they can only be used,,for the purposes proscribed by the funding agency. The state and federal governments provide such funding for many such special programs or projects. For example, special education funds are restricted. They can only be spent on students with identified special needs and in the manner outlined in state and federal law. Restricted funds are, in some cases, provided directly to the schools and in other cases are controlled centrally by the district. In either case, how the district spends these monies is determined by restrictions imposed by the granting agency. Umestricted funds are monies which are available to use and are not restricted in their use. The district can spend umestricted monies on whatever programs it chooses. Examples of unrestricted funds include the district's Revenue Limit appropriation, lottery revenues, and rental and lease mcome. '"' , In addition to the General Fund, the district has :-. other special purpose funds. These funds are used to account for monies, which can only be spent on their designated purpose. The funds are designated as follows: A. Special Revenue Funds; Adult Education, Child Nutrition, Special Reserve, Deferred Maintenance B. Capital Project Funds; Building (Bond) Fund, Capital Facilities (Developer Fees) Fund, and County School Services (Modernization); C. Debt Service Funds Bond Interest and Redemption KEY ASSUMPTIONS REVENUES Revenue Limit - The Revenue Limit is the largest and most significant source of funding for the district. It is unrestricted or general purpose in nature. Based on state law, the district receives a set amount of funding per student (its revenue limit). In 2005-06 the revenue limit funding for Dublin is $6,119.51 per student, for a total of $28,593,300. This amount is greater than 2004-05 because of the proposed 4.23% COLA, a projected increase 01'238 students, and reduction of revenue limit deficit. The base Revenue Limit for the district was established at unification and gets adjusted annually by a specified measure of inflation. This annual inflationary/deflationary adjustment is called a Cost of Living Adjustment (COLA). In 2005-06 the State of California has had insufficient resources to fully fund the revenue limit for schools, due to the state funding shortfall. Districts are receiving less in 2005-06 than they are entitled to under the revenue limit formula. The cumulative revenue limit loss due to state funding shortages has now reached $1,642,569 for Dublin Unified. . STATE FUNDING DEFICITS - Reinstated 2003-04 2003-04 .2004-05 2005-06 Statutory COLAs 1.86% 2.41% 4.23% Funding COLAs <-1.2%> 2.41% I 3.06% Funding Deficit 3 002 % 2102% 1.129% Loss of Funding $755,509 $561 ,965 $325,095 I Cumulative Loss $1,642,569 The Revenue Limit is calculated through a complex formula. The base of that formula is a per pupil allocation multiplied by the number of students in the district. Based on a projected average daily attendance (ADA) of 4,632 students and a per pupil allocation of $6,119.51, the base calculation gives a total of $28.6 million. This amount is adjusted by other components of the revenue limit calculation including summer school funding, unemploymen~ insurance rates, classified employee retirement contribution rates, beginning teacher salary adjustments, and meals for needy adjustment. The total revenue limit totals $28,593,300. Local property tax revenues are subtracted from the total to give the amount of state aid necessary to fund the revenue limit. Typically the amount of local property taxes collected is less than the total revenue limit amount. The state makes up the difference with an allocation of state monies. In some districts, though, the amount of local property tax collected is actually larger than the total revenue limit amount. These districts are called Basic Aid districts. They get to keep the entire property tax collection plus a nominal "basic aid" amount of state funding of $120 per pupil. Dublin Unified School District's property tax collections make up 60% of the total revenue limit. The district receives some property tax collections, which formerly were kept by counties. These monies are known as Education Revenue Augmentation Funds (ERAF). Due to a change in state law, counties are now required to give these 5 monies to schools thereby reducing the state aid contribution to the revenue limit. ERAF tax collections do not count as property taxes in determining if a district is Basic Aid. Without ERAF monies, property taxes make up 50%) of the district's revenue limit. Federal Revenue The district receIves approximately $949,578 in federal funding for special purpose programs. The largest federal progranl in the district is a funding allocation for special education, IDEA, Local Assistance. This allocation brings the district approximately $510,833. Other federally funded programs include funding for supplemental books, supplies, and equipment, No Child Left Behind (NCLB), Title I; Basic Grant (Low Income); funds for drug, alcohol, and tobacco education; NCLB - Title II, Teacher Quality; and NCLB - Title III, Limited English Proficient Students); and child nutrition (food services funding). Funding for these programs is entirely categorical, that is the monies received can only be spent for the purpose specified by the granting agency. Federal funding for the district in 2005-06 is expected to decrease primarily due to increased socioeconomic status of Dublin's students. Other State Revenues - Special programs funded by the state are accounted for in the revenue category called Other State Revenues. Lottery revenues and class size reduction, which are not restricted funds, are also included in this category. The amount of Other State Revenues estimated for 2005-06 is $4,125,412. In 1996/97 the state offered incentive funding to districts to reduce class size. $600 per student was given to every student in grades 1,2, and 3 who was in class with 20 or fewer students. Dublin Unified School District participated in this program in all three grades in every school in the district. Implementing this Class Size Reduction program costs more than it was funded. The state is funding the Class Size Reduction program in 2005-06 at $967 per K-3 student for total funding to District of $1,414,188. Other state revenues also include funding for gifted and talented education (GATE), transportation for special education students, education of students with limited English profIciency (EIA), state approved textbooks (State Instructional Materials), Peer Assistance and Review, class size reduction grade nine, child nutrition, and drug, alcohol, and tobacco education. Until the state budget is adopted for 2005-06, it is assumed that these programs will be funded at the same level as in the current year. Except for lottery, mandated costs revenues, and the Class Size Reduction program, any change in nmding has no impact on the district's umestricted , ending balance. The state revenues were regrouped and categorized by state administration to increase flexibility for school districts. Unfortunately the regrouping did not increase funding substantially but just provided some cost of living adjustments and growth. The major changes are itemized below: School improvement programs (SIP) were combined with the school library programs, with no funding allocated to school library at this time. A Pupil Retention Block Grant grouped capped hourly programs (K-12 Core Academic, Grade 2-6 Academically Deficient, Grade K-4 Reading, Grade 7-8 Algebra) with Continuation High School and 10th Grade Counseling. Professional Development Block Grant combined staff development buyback days with teaching as a priority (TAP). New rules apply for statf development days but Dublin has put 6 ~ the funding in the teachers' calendar days ana thus in the teacher salaries. School Safety Consolidated Competition Grant combined safe school planning, safety planning for new schools, conflict resolution programs and various violence prevention programs. Lottery - Proceeds from lottery ticket sales augment school districts' budgets. Lottery funds are distributed throughout the state on a per pupil basis. Actual apportionments of lottery funds typically occur from four to six months after ticket sales, due to the complexities of accounting and distribution of prize winnings. Funding for 2005-06 is budgeted at $135 per pupil, for an annual amount of $619,482. Lottery funding was changed by Proposition 20. The funding was divided into a restricted portion for purposed of instructional texts and continued an unrestricted portion. The unrestricted portion of lottery is $525,213 and restricted is $94,269. The Proposition lottery revenues make up 1.5% of the district's total income in 2005-06. Other Local Revenue - The district anticipates receiving $3,566,597 in Other Local Revenue. The largest source of local revenues are from the Special Education Local Plan Area (SELPA) at $2,537,792. The next largest source is $141,499 from the Regional Occupation Program (RaP). The other local revenue sources are lease and rental income, interest earnings on district monies, and local donation income. Revenues from tenant leases and facility users are projected to be $165,000. Interest rates are expected to remain in the 1 % range and are budgeted at $277,472. EXPENDITURES Classroom Teachers - A total of 259.62 full time equivalent teachers are budgeted for 2005-06. Of this total, 208 are regular classroom teachers, 29 FTE are special education teachers, 6.0 FTE are ESL, 1.2 FTE are Rap teachers and 4.5 are categorically funded teachers; the rest are specialists (physical education, music, etc.). Class size in grades K-3 averages 20 students. Classroom teachers represent 90% of the total cost for certificated employees. The average salary for ft- ... , classroom teachers in the district is $63,538. The di strict pays employee benefits for teachers at an average of $7,694 per teacher. The average cost of a teacher is $71 ,232, the combined total of salary and benefits. Salary negotiations with teachers for 2005-06 have been concluded. As part of a three-year settlement beginning with 2005-06, teachers will receive a salary increase equivalent to the effective Revenue Limit Cost of Living Adjustment adjusted with the deficit and STRS deferral by the state. This increase has been included in the budget. Salary increases for professional growth are included in the budget. This is projected to be 3.06%. The total salary and benefits cost for teachers and instructional aides is $22,112,757. This amount represents 58.6% of the total budget. Other Staff - The total cost for non-instructional staff is $10,243,806. Professional growih and longevity adjustments to salaries have been included in the budget. Non-instructional staff represent 270/'0 of the total budget. Employee Benefits - The district is required by law to provide certain benefits to its employees. These statutory benefits include retirement funding (State Teachers Retirement System, STRS, for certificated employees and Public Employees Retirement System, PERS, for classitled employees), social security contributions (OASDI), Medicare contributions, unemployment insurance (UI), and workers' compensation benefits. The sum total budgeted for statutory benefits for all employees for next year is $4,292,523. In addition to statutorily required benefits, the district provides dental benefits for teachers and a capped fringe benefit amount of $5,915 for each classified full time equivalent. Board members are also offered a capped fringe benefit package amount of $1,500 to participate in the district provided and approved health and welfare benefits. The cost of the benefits provided is $697,858. Included in the benefit accounts are the certificated golden handshake and retirement incentive costs of $375,308. This is the second year of payments over 7 $300,000. In the next three years the costs will decline to $115.806, $86,008, and $70,807. District " e has obligations to payout until 2012-2013. The past tlve years health and welfare costs have had double digit increases impacting all units' take home pay. The district took action in 2001-02 to reduce costs by changing to the PersCare medical plan. This provider has large purchasing power and can assist the district in managing the upward spiraling costs of health care. Books & Supplies - 2.6% of the district budget goes for books and supplies. A large portion of that amount comes from state and federal categorical funds. Funds are distributed to program managers, usually on a per student basis, and individual schools and programs have discretion over how they are spent. School allocations are $11.11 per student at the elementary level and $30.48 per student at the middle school and high school. District office program manager allocations have been reduced 30% for the last four years and sites have been reduced 15%. Services, Other Operating Expenses - The district spends $4,411,795 in this expenditure category, or 11.7% of the total budget. The major components include utilities, insurance, contracts for repair services, and non-public school services for severely handicapped children. The district has little or no control over the costs of most of the services in this category. Where appropriate inflationary costs for maintenance agreements, utilities, and insurances have been included. Other Outgo - The net figure of $42,990 is made up of three different functions. The district operates the Regional Occupation Program (ROP) as a joint powers agreement (JP A) with Pleasanton. The district flows the ROP revenue of $433,279 to Pleasanton to run the program. The District also collects indirects, a charge for district overhead or fixed costs to other funds. Indirects are charged to the adult and child nutrition funds. The amount collected form both these funds is $72,818. The district also collects direct charges for the administration of collecting developer and mitigation fees. The district can collect up to 3 % of revenues received. The district is transferring 2004- 05 and our 2005-06 fees in the amount of $317,4 71. Interfund Transfers - In the budget reduction process for 2005-06 the board authorized the borrowing of funds from the Fallon fumiture and equipment allocation per developer built school agreement. This amount is $500,OUO. In addition the district is collecting 8% of the adult fund revenue to support the Adult School principal being paid from general fund. The amount collected is $5,578. FUND BALANCE Beginning Balance - The actual beginning balance for 2005-06 will not be known until September, after the district books are closed. At this time it is projected to be $1,282,259. This amount represents a decrease in fund balance of $238,745. The past years from 2002-03 to the present are difficult years financially for school districts, as the state did not give schools all the statutorily required cost of living adjustment (COLA) but instead cut funding levels. Various revenues have been permanently reduced and this amount is over $2 million for Dublin. This represents a 6.233% deficit in funding, cumulative from prior years. A portion of that deficit has been restored. The state funding deficit is now at 1.129%. Ending Balance - The district spent more than it received in 2004-05 by more than $735,972. This is primarily due to the golden handshake payment of $503,979. The general fund transferred $497,228 of the special reserve balance into the general fund to support the expenditures. During the budget planning for 2005-06 it became apparent that the district would be deficit spending by more than one million dollars. The board took action to reduce the deficit by expenditure reductions of over $500,000 and the addition of a $500,000 loan for new Fallon operations. For the 2005-06 year the district is ddicit spending at $548,240. The general fund is expending $548,240 more in expenditures than it takes in 8 ~ ~ revenues. This is aided by the $500,000 loan for new Fallon operations. The following year the' district growih and the elimination of golden handshake payment should help aid the district in reducing detlcit spending. The ending balance for the last several years IS shown in the graph on the following page. Restrictions on Ending Balance - In the 2005-06 ending balance of $1,239,597 are certain designations that are legally required to be maintained. The district has a $25,000 revolving cash fund. The district warehouse has approximately $78,482 of inventory (stores). Reserves - The state requires districts the size of Dublin Unified to maintain a 3 % reserve. The district meets the requirement. Based on the projected 2005-06 expenditures that reserve requirement is $1,133,494. Districts are allowed to use their reserve funds during the year (they are for emergencies and to help buffer loss of state and other revenues), but they must replenish those reserves at the year's end. r - '-"! " L -- ^ ACCOUNTANTS 400 Capito! Mal!, Suite 1200 Sacramento, CA 95814 www.perry.smlth.com 916,441.1000 INDEPENDENT AUDITOR'S REPORT Governing Board Dublin Unified School District Dublin, California We have audited the accompanying financial statements of the governmental activities, each major fund and the aggregate remaining fund information of Dublin Unified School District, as of and for the year ended June 30, 2006, which collectively comprise Dublin Unified School District's basic financial statements as listed in the Table of Contents. These financial statements are the responsibility of the District's management. Our responsibility is to express an opinion on these financial statements based on our audit. We conducted our audit in accordance with auditing standards generally accepted in the United States of America and the standards applicable to financial audits contained in Government Auditing Standards, issued by the Comptroller General of the United States. Those standards require that we plan and perform the audit to obtain reasonable assurance about whether the financial statements are free of material misstatement. An audit includes examining, on a test basis, evidence supporting the amounts and disclosures in the financial statements. An audit also includes assessing the accounting principles used and significant estimates made by management, as well as evaluating the overall financial statement presentation. We believe that our audit provides a reasonable basis for our opinion. In our opinion the financial statements referred to above present fairly, in all material respects, the respective financial position of the governmental activities, each major fund and the aggregate remaining fund information of Dublin Unified School District as of June 30, 2006, and the respective changes in financial position for the year then ended, in conformity with accounting principles generally accepted in the United States of America. In accordance with Government Auditing Standards, we have also issued our report dated November 28, 2006 on our consideration of Dublin Unified School District's internal control over financial reporting andoLir tests of its compliance with certain provisions of laws, regulations, contracts and grant agreements and other matters. The purpose of that report is to describe the scope of our testing of internal control over financial reporting and compliance and the results of that testing, and not to provide ,m opinion on the internal control over financial reporting or on compliance. That report is an integral part of an audit performed in accordance with Government Auditing Standards and should be read in conjunction with this report in considering the results of our audit. Management's Discussion and Analysis is not a required part of the financial statements, but is supplementary information required by accounting principles generally accepted in the United States of America. We have applied certain limited procedures, which conSisted principally of inquiries of management regarding the methods of measurement and presentation of the required supplementary information, However, we did not audit the information and express no opinion on it. 1\ , .' ... -~ PER R Y - S M i T HA L L P ACCOUNTANTS INDEPENDENT AUDITOR'S REPORT (Continued) Our audit was conducted for the purposes of forming an opinion on the financial statements that collectively comprise Dublin Unified School District's basic financial statements. The accompanying financial and statistical information listed in the Table of Contents, including the Schedule of Expenditure of Federal Awards, which is required by U.S. Office of Management and Budget Circular A-133, Audits of Stqtes, Local Governments, and Non-Profit Organizations, is presented for purposes of additional analysis and is not a required part of the basic financial statements of Dublin Unified School District. Such information has been subjected to the auditing procedures applied in the audit of the basic financial statements and, in our opinion, is fairly stated, in all material respects, in relation to the basic financial statements taken as a whole. Iky- - ~ ur' Sacramento, California November 28, 2006 . 1>0 SUPERINTENDENT Stephen Hanke, Ed.D. (925) 828-2551 BOARD OF TRUSTEES David Haubert (925) 829-7766 Jennifer Henry (925) 351-9139 Denis King (925) 829-9144 Patricia Kohnen (925) 828-3623 John Ledahl (925) 551-5965 DUBLIN SCHOOLS DUBLIN UNIFIED SCHOOL DISTRICT D - 7471 larkdale Avenue, Dublin, CA 94568-1599 . 925-828-2551 . FAX 925-829-6532 February 2, 2007 Ms. Joni Pattillo Assistant City Manager City of Dublin 100 Civic Plaza Dublin, CA 94568 Subject: Community Group Organizational Funding Request Dear Ms. Pattillo: Ihis letter serves to notify you that Dublin Unified School District will place on the next Board of Trustees meeting consent agenda, scheduled for February 13, 2007, the approval of the submission of one or more Community Group/Organizational Funding Request applications to the city of Dublin. Sincerely, Stephen L. Hanke Superintendent SLH/sf , FeR 02 2007 11:56AM DUSD Business Office 925 828 1364 p. 1 ~ t- DUBLIN SCHOOLS DUBLIN UNIFIED SCHOOL DISTRICT ....-- TO: Kimberly Dennis ACSIG CC: ABD Insurance Services FAX: 925/225-0653 707/773-2916 FROM: Patty Benavidez Business Services DATE: February 2, 2007 SUBJECT: Certificate of Insurance PAGES: 1 (this cover sheet) . I1ox.<<e.. (A~~(~ Ja.a 6~ ~5UaMd. {f-~r I/~ · Please issue a certificate of insurance verifying district liability coverage/workers' comp naming the following as additional insured: City of Dublin Attn: Joni Pattillo, Assistant City Manager 100 Civic Plaza P.O. Box 2340 Dublin, CA 94568 Please send the certificate to the attention of Shelley Fischer Office of the Superintendent Dublin Unified School District 7471 larkdale Avenue Dublin, CA 94568 Fax: 925/829-6532 The purpose of the certificate is to provide proof of coverage for grant applications submitted by the District to the City of Dublin for organizational funding requests during the remainder of the 2006/07 fiscal year, and for fiscal year 2007/08.. If you have any questions please call me at (925) 828-2551 extension 8042. Thank you. WE ARE COMMITTED TO THE SUCCESS OF ALL OUR STUDENTS