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Mayor Grant - The Lord's Place001'1.55 R15-055 EXHIBIT "A" COMMUNITY SUPPORT FUNDS REQ UES T FORM Part I - Summary of Request (to be completed by City Clerk) Date of Request: 2/18/2020 Requested by Mayor/Commissioner: Mayor Steven B. Grant Amount Requested: $ 200.00 Recipient/Payee: The Lord's Place Description of project, program, or activity to be funded: The Lord's Place is dedicated to breaking the cycle of homelessness by providing innovative, compassionate and effective services designed to end homelessness. Funding will support the 13th Annual SleepOut event on April 3, 2020 (,see attached). Part II - Availability of funds The annual appropriation of funds available to the requesting Member of the Commission listed above is $ 2,000.00 _- The balance of funds available for the requesting Member of the Commission is $ 600.00 Accordingly: There are funds available as requested ❑ There are insufficient funds available as requested Dated: By: City Clerk Part III -Eligibility Evaluation B" Public funds will not be used to improve private property unless there is a clear public need, purpose and benefit Y The recipient/payee provides services within the City The public purpose is beneficial to the en ire c mm ity ed by such donation Dated: By: Requesting Member of the City Commission ❑ MAIL CHECK TO VENDOR D RETURN CHECK TO DEPS INCLUDE BACK-UP W/ CHECK CITY OF BOYNTON BEACH DIRECT PAYMENT REQUISITION Please issue a check in the amount of TO: The Lord's Place P.O. Box 3265 West Plam Beach, Florida 33402-3265 FOR: Community Investment Funds r Grant Community Investment Funds Requested By: Queenester Nieves Approvals: 3j y;aab Div Head Finance Dept. City Manager $200.00 VENDOR #: 17336 Date: February 27, 2020 FUND DEPT BASIC ELE OBJ AMOUNT 001 1110 511 95 47 200.00 200.M