Mayor Grant FARTHER outreach/ Boynton CDC lamed. Lo
R15-055
EXHIBIT "A"
COMMUNITY SUPPORT FUNDS
REQUEST FORM
Part I -Summary of Request(to be completed by City Clerk)
Date of Request: W Ve m_\•.)p r 1 I / 9
Requested by Mayor/Commissioner: Mayor Steven B. Grant
Amount Requested: $ 200.00
Recipient/Payee: FARTHER Outreach do Boynton Beach CDC
Description of project, program, or activity to be funded: Health & Wellness Retreat
HIV Awareness; $letting our community together to educate and advocate.
Event date: Friday, 12/6/2019 from 8:30 am - 4:30 pm
Part II -Availability of funds
The annual appropriation of funs s available to the requesting Member of the
Commission listed above is $ o(,pp(
The balance of funds available for the requesting Member of the Commission is
$ I/(,00
Accordingly:
There are funds available as requested
There are insufficient funds available as requested
Dated: 11/5-7/_,Q01/ By:
City Clerk
Part III-Eligibility Evaluation
L Public funds will not be used to improve private property unless there is a clear
public need, purpose and benefit
• The recipient/payee provides services within the City
• The public purpose is beneficial to the eni ity by such donation
Dated: t 11 l(91 I I By:
Requesting Member of the City Commission
El MAIL CHECK TO VENDOR ED RETURN CHECK TO DEPT. INCLUDE BACK-UP W/ CHECK
CITY OF BOYNTON BEACH
DIRECT PAYMENT REQUISITION
Please issue a check in the amount of $200.00
VENDOR #:
TO: Boynton Beach CDC
2191 N. Secrest Blvd
Boynton Beach , Fl 33435
FOR: HIV Awareness, Health and Wellness Retreat
Community Support Funds- Mayor Steven Grant
Requested By: Queenester Nieves Date: November 8, 2019
FUND DEPT BASIC ELE OBJ AMOUNT
Approvals: 200.00
Div Head z.A,� .
Cr/ tal Gibson
Finance Dept .
City Manager
Lori LaVerriere
200.00