THE MUNICIPALITY OF THAMES CENTRE 4305 Hamilton Road, Dorchester, ON NOL ic3 Phone: 519-268 -7334 Fax: 519-268 -3928 COMMUNITY PARTNERSHIP FUND APPLICATION Organization Name: Address: Contact Person: Telephone: Fax: C_ - 1 /.- E -mail: RE: ( Name of Proposal) Authorized signature Name Position CATEGORIES OF REQUEST FOR ASSISTANCE (check appropriate box(es) Financial Assistance Service Project Organization Fee Waiver(s) Staff Support Equipment/ Materials Supply Insurance Coverage Use of Municipal Property /Facilities Other FUNDING AMOUNT REQUESTED t1 ' I a 2-
DETAILS OF REQUEST FOR ASSISTANCE: IF THIS APPLICATION INCLUDES ANY ASSISTANCE OTHER THAN DIRECT FINANCIAL ASSISTANCE, PLEASE OUTLINE THE DETAILS OF THE REQUEST ( IE. TYPE AND ESTIMATED HOURS OF STAFF SUPPORT, FACILITIES TO BE USED, DATES, ETC.): PROPOSAL SUMMARY: PLEASE PROVIDE A CLEAR AND CONCISE PROPOSAL SUMMARY INCLUDING THE GOALS AND OBJECTIVES OF YOUR PROPOSAL: 3. PLEASE CHECK ONE SUBJECT AREA FOR WHICH YOUR ORGANIZATION IS REQUESTING FUNDS: Tourism /Economic Development Organizations that significantly benefit tourism by bringing in non - Thames Centre residents into Thames Centre. Community Refers to organizations which enable citizens to strengthen the personal or community life of the Municipality of Thames Centre. It also refers to organizations which strengthen neighbourhoods, accessibility, and public involvement in organizations. This category includes quality of life organizations. This category does not include local recreation groups ( ie. sports groups, etc.). Arts Culture & Heritage Refers to organizations which produce, present, distribute, educate and /or encourage the appreciation of and the creation of work in the literary, performing or visual arts. Refers to organizations which represent the creative capacities of citizens or the celebration of racial or ethnic contributions e. g. diversity and multi - culturalism. 3-
Other Note: Organizers of parades are required to provide liability insurance in the amount of $ 2, 000, 000. The cost of obtaining such insurance may form part of any financial assistance application, along with the necessary Municipal Staff support. 4. PLEASE DESCRIBE HOW YOUR PROPOSAL SUPPORTS THE SUBJECT AREA FOR WHICH YOU ARE APPLYING. 4-
ELIGIBILITY 5. ARE YOU A NON - PROFIT ORGANIZATION? YeS NO 6. PLEASE PROVIDE YOUR REVENUE CANADA CHARITABLE REGISTRATION NUMBER ( If Applicable): P) ") 7. HAS YOUR ORGANIZATION MADE ANY OTHER APPLICATION TO THE MUNICIPALITY OF THAMES CENTRE FOR FINANCIAL ASSISTANCE FOR THE CURRENT PERIOD? Yes ' No IF YES, WHEN? 8. HAS YOUR ORGANIZATION RECEIVED FUNDING FROM THE MUNICIPALITY OF THAMES CENTRE IN PRIOR YEARS? 2 Yes No IF YES, HOW MUCH? 1ry r "< A v 9. WILL YOUR ORGANIZATION OR ANOTHER ORGANIZATION BE THE PRIMARY FUNDER OF THIS SERVICE/ PROGRAM? Yes U- No 10. IS YOUR ORGANIZATION LOCATED WITHIN THE MUNICIPALITY OF THAMES CENTRE? Yes No 11. WILL THIS PROGRAM PROVIDE SERVICES TO CITIZENS WITHIN THE MUNICIPALITY OF THAMES CENTRE? GY`Ỳes No 12. WILL THE FUNDS THAT THE MUNICIPALITY PROVIDES YOUR ORGANIZATION BE UTILIZED ONLY BY YOUR ORGANIZATION? I / Yes No 6-
COMMUNITY NEED TO BE ADDRESSED 13. PLEASE OUTLINE WHAT COMMUNITY NEED IS ADDRESSED BY YOUR PROPOSAL: 14. HOW HAVE YOU DETERMINED THE NEED FOR YOUR PROPOSAL Please provide specific data to substantiate)? 15. WHAT EFFORTS HAVE BEEN MADE TO DETERMINE IF THERE ARE SIMILAR PROGRAMS /SERVICES IN THE SAME GEOGRAPHICAL AREA? 16. OUTLINE THE COMMUNITY SUPPORT YOU HAVE RECEIVED FOR YOUR PROPOSAL? 17. HOW WOULD YOUR ORGANIZATION PROMOTE /MARKET THE MUNICIPALITY' S SUPPORT? 6-
ORGANIZATION STRENGTH 18. IS YOUR ORGANIZATION GOVERNED BY A COMMUNITY -BASED VOLUNTEER BOARD OF DIRECTORS? Yes No 19. HOW DOES YOUR ORGANIZATION PARTNER AND COLLABORATE WITH OTHER COMMUNITY ORGANIZATIONS AND FUNDERS? 20 DESCRIBE YOUR ORGANIZATION' S STAFF /VOLUNTEER QUALIFICATIONS AND EXPERIENCE TO UNDERTAKE THIS PROPOSAL. c t `) FINANCIAL CONDITION 21. PLEASE INDICATE BELOW ANY OF YOUR ORGANIZATION' S OUTSTANDING LOANS OR DEFICITS. 22, IS YOUR FUNDING REQUEST DUE TO FUNDING DECREASES FROM OTHER PARTNERS? ( eg. Federal, Provincial, etc.) Yes No 23. WHAT STEPS HAVE YOU TAKEN TO EXPLORE OTHER SOURCES OF FINANCIAL SUPPORT? 7-
24. WHAT WILL BE THE IMPLICATIONS FOR YOUR PROPOSAL IF FINANCIAL ASSISTANCE FUNDING IS NOT GRANTED? 25. IF YOUR ORGANIZATION' S PROPOSAL CONTINUES BEYOND THE GRANT PERIOD, WHERE DO YOU INTEND TO OBTAIN FUTURE FINANCIAL SUPPORT?
I APPLICATION CHECKLIST: PLEASE CONFIRM BELOW THAT YOUR ORGANIZATION HAS PROVIDED THE FOLLOWING INFORMATION ATTACHED WITH YOUR APPLICATION: 1. Application Submitted Date: Octt- V--)() 2. Articles of Incorporation or Vision Statement Yes No or Mission Statement 2. A list of current Board Members B' Yes No 3. Financial information: a) Previous year' s financial statement Yes No reviewed by professional accountant if assistance is greater than $ 5, 000) b) Current year' s budget P/ Yes No c) Next year' s budget lt es No d) 3 year business plan ( new organization) s L i Yes No 4. Letter of confirmation from the Board L Yes No of Directors showing that the Board approved this proposal. 9-
Thorndale Agricultural Society 2414 Executive and Directors Executive: President Ryan Elliott 161 King Street, PO Box 141, Thorndale, ON NOM2P0 519-670 -1301 Vice President vacant at this time Past President Ian Ferguson 23633 Fairview Road, Thorndale, ON NOM2P0 519-282 -3480 Treasurer Brenda Tipping 200 Main Street, PO Box 258, Thorndale, ON NOM 2P0 519-549 -0060 Secretary Nancy Urquhart RR 2, Thomdale ON, NOM 2P0 519-461 - 1079 Directors: Connie Bontje 21493 Fairview Rd, RR 2, Thorndale ON, NOM 2P0 519-461 -0515 Lauren Bontje 21493 Fairview Rd, RR 2, Thorndale ON, NOM 2P0 519. 461-0515 Mary Lou Bontje RR 2, Thorndale ON, NOM 2P0 519-461 -1146 Sandra Brown 200 Agnus Street, Unit 6, Thorndale, ON NOM 2P0 519-281 -5053 Jessie Cook RR 2, Thorndale ON, NOM 2P0 519-461 - 1115 Kelly Cook RR 2, Thorndale ON, NOM 2P0 519-461 - 1115 Amanda Elliott 1003 Perth Rd 139, RR 2, Granton ON, NOM 1V0 519-670 -1301 Marilyn Flanigan RR # 2, Thorndale ON, NOM 2P0 519-461 - 1539 Cally Jo Fritz 316489 31st Line, Embro ON, NOJ 1 JO 519-475 -0118 Lauren Gilchrist 11 Hueston Dr, Thorndale ON, NOM 2P0 519-933 -7796 Melanie Heard 315793 31st Line, Embro, ON NOJ 1J0 519-703 -0955 Brent Hryniw RR 2, Lakeside ON, NOM 2G0 519-283 -6241 Shelley Isabelle 32 Meadowbrook Lane, Thorndale ON, NOM 2P0 519-461 -0032 David Johnson RR 2, Thorndale ON, NOM 2P0 519-461 -9048 Shelley Kay RR 4, Thamesford ON, NOM 2M0 519-461 -1370 Gary Koenig RR 1, Arva ON, NOM 100 519-461 -1293 Ed Lee RR 2, Thorndale ON, NOM 2P0 519-461 -1936 Mel Lee 257 King St, Thorndale ON, NOM 2P0 519-461 -1306 Bob Luyben RR 4, Thamesford ON, NOM 2M0 519-461 -9318 Janice Miller 22147 Fairview Road, Thorndale, ON NOM 2P0 519-461 -0634 Gillian Partridge 287 King St, Thorndale, ON NOM 2P0 519-461 -1600 Wayne Partridge 96-287 King St, Thorndale ON, NOM 2P0 519-461 - 1600 Angela Patterson RR 3, St Marys ON, N4X 106 519-461 -0043 Homecraft: President Norma Poel 5787 Cobble Hills Road, Thamesford, ON NOM 2M0 519-461 - 1701 Secretary Laura Langford RR 4, 18126 Wyton Rd, Thamesford, ON NOM 2M0 519-461 -9408
Thorndale Agricultural Society Income And Expense Statement January 1, 2013 - December 31, 2013 Accounting Method: Cash Description Quantity Amount INCOME REVENUE Grants Entry Fees Gates Space Rental 3, 000. 00 808. 05 17, 716. 72 1, 479, 08 Sponsorship Interest Specials Miscellaneous Homecraft Ladies Night Dinner Theatre Farmer's Night TOTAL OTHER INCOME TOTAL INCOME 17 PI EXPENSES PRIZE MONEY Judges 4H Clubs, School Fair & Juniors Delegate /Affiliation Fees & Expenses Homecraft general expenses Honorariums Security Printing Supplies & Stationary Postage Advertising Insurance Donations Trophies, Ribbons & Prizes Miscellaneous Garbage & Portable Toilets Hall Rentals Capital Expenses Sound Demolition Derby Paramedics 21. 897. 20 265. 01 269. 52 257. 20 6, 144. 89 15,340. 53 22, 321. 37 11, 248. 84 6, 855. 50 1, 375. 00 1, 051. 87 2, 380. 89 839. 34 3, 200. 00 300. 00 127. 32 667. 38 11, 605. 41 2, 742. 12 2, 700. 00 3, 291. 11 1, 626. 33 1, 005. 00 250. 00 787. 37 1, 050. 00 5, 642, 48 402, 50 100,748,41 100, 748.41 2014-01. 26 1: 12: 41 PM Page 1 of 2
Description Quantity Amount Farmers Night 5, 947. 73 Parade 2, 675. 00 Attractions 10, 577. 77 Bank Charges & Interest 7. 00 Ladies Night 6, 973. 19 Ambassador Competition 1, 250. 00 Sponsorship 184. 33 Annual Meeting 62. 79 Bleacher & Scissor Lift Rental 1, 307. 50 Dinner Theatre 19,496. 92 TOTAL EXPENSES 96, 381. 85 TOTAL EXPENSE 96, 381. 85 Total Income 100, 748.41 Total Expenses 96, 381. 85 NET INCOME 4,366. 56 This statement may Include capital gains. Adjustments on sale of assets and /or asset sales. Balances portray accounting information and shouldn't be used for tax calculations. 2014-01- 261: 12:41 PM Page 2 of 2
Thorndale Agricultural Society Annual Budget Expense Projected Spending 2015 Actual 2015 Projected Spending 2014 Actual 2014 Prize Money Judges 4 -H clubs, school fair Homecraft expenses Security Office supplies Advertising Garbage, Portable Toilets Trophies, Ribbons Demolition Derby Paramedics Parade Attractions Ambassador Competition 14, 000. 00 2, 500. 00 1, 600. 00 1, 000. 00 500. 00 1, 200. 00 8, 000. 00 1, 100. 00 3, 500. 00 6, 200. 00 500. 00 4, 500. 00 12, 000. 00 1, 500. 00 58, 100. 00 14, 000. 00 11, 769. 50 2, 000. 00 2, 405.00 1, 500. 00 1, 579. 50 1, 000. 00 519. 49 500. 00 444. 00 1, 200. 00 349. 67 7, 500. 00 9, 539.47 1, 000. 00 1, 060. 00 2, 500. 00 3, 097. 93 6, 200.00 6, 200. 00 500. 00 500. 00 4, 000. 00 4, 530. 00 10, 000. 00 13, 576. 81 1, 250. 00 1, 409. 47 53, 150. 00 56, 980. 84
St.. THORNIDALE AGRICULTURAL SOCIETV 200 Main Street, PO Box 258 Thorndale, ON NOM 2100 519-549 -0060 bdtipping(a vahoo. ca October 17, 2014 Mary Ellen Weatherhead Director of Financial Services /Treasurer Municaiplity of Thames Centre 4305 Hamilton Road Dorchester, ON NOL 1G3 Dear Ms. Weatherhead, We are applying for funding from the Municipality of Thames Centre to support our annual Thorndale Fall Fair. I have included the application, list of Executive & Directors of the Board for 2014, budget for current year (completed as best as possible as year has not finished) and budget for upcoming year. Please accept this letter as confirmation of approval to apply for these funds. The Executive Team has signed on behalf of the Board of Directors. President Ryan Elliott Secretary Nancy Urquhart Brenda Tipping Treasurer If you have any questions, please feel free to contact me directly at 519-549 -0060 or via email at bdtipping @yahoo.ca. Thank you for your time and consideration of this request. Sincerely, AL Brenda Tipping Treasurer