Commissioner Penserga Freedom Shores Elementary R15-055
EXHIBIT "A"
COMMUNITY SUPPORT FUNDS
REQUEST FORM
Part I - Summary of Request (to be completed by City Clerk)
Date of Request:
Requested by Mayor/Commissioner: Commt'Sc lon ex- 4 ►S&o&
Amount Requested: $ 1009,000
Recipient/Payee: – ..
Description of project, program, or activity to be funded: Frethryx S ores vWa
&weld -14 Poi OF' S &* IvvNGh b4-,
Part II -Availability of funds
The annual appropriation of funds available to the requesting Member of the
Commission listed above is $4 0.09. -ea—.
The balance of funds available for the requesting Member of the Commission is
Accordingly:
VThere are funds available as requested
❑ There are insufficient funds available as requested
Dated: / D y OMBy: 47 .4401--
City Clerk
Part III-Eligibility Evaluation
• Public funds will not be used to improve private property unless there is a clear
public need, purpose and benefit
El The recipient/payee provides services within the City
❑ The public purpose is beneficial to the entire community served by such donation
Dated: /O/)Op/ By: j _� �•
Requesting A -m e City Commission
S:\CC\WP\COMMUNITY INVESTMENT FUNDS\Community_Support_Funs_Policy.2015.doc
❑ MAIL CHECK TO VENDOR I] RETURN CHECK TO DEPT. L INCLUDE BACK-UP W/ CHECK
CITY OF BOYNTON BEACH
DIRECT PAYMENT REOUISITION
Please issue a check in the amount of $1,000.00
VENDOR #:
TO: Freedom Shores Elementary
3400 Hypoluxo Road
Boynton Beach, Fl 33436
FOR: Freedom Shores Elementary-use to pay off student lui
Community Support Funds- Commissioner Penserga
Requested By: Queenester Nieves Date: October 16,2019
FUND DEPT BASIC ELE OBJ AMOUNT
Approvals: 001 1110 511 95 47 1,000.00
Div Head (/ AtelbAt3t___
Cr stal A. Gibson
Finance Dept.
Tim Howard
City Manager
Lori LaVerriere
1,000.00