Mankato City Park Flag Pole Requests of $5,000 or less Mrs. Rebecca Fernandez 124 N Commercial Mankato, KS 66956 O: 785-738-0456 M: 785-738-0456 Mrs. Rebecca Fernandez 124 N Commercial Mankato, KS 66956 friendsofmankatocitypark@yahoo.com O: 785-378-3636 M: 785-738-0456 Printed On: 21 November 2017 Requests of $5,000 or less 1
Application Form Organization Information Verification of tax-exempt status* Organization is: Government entity Verification of status Please note: Applications from public charities (501(c)3 organizations) are required to attach verification of charitable status in order to be considered. A state sales tax exemption DOES NOT complete this requirement. Applications from churches and/or government entities are not required to attach a verification document. Please Click Here to view an example of an acceptable IRS Determination Letter. Click Here to view an example of an unacceptable IRS Determination Letter. Please upload an IRS determination letter, charter from parent organization, ect. Physical Address If the physical address of your organization is different than the mailing address, please enter your physical address below. Project Information Project Name* Name of Project. Mankato City Park Flag Pole Amount requested* $2,135.92 Primary objectives* The Foundation has six primary objectives. Which of these does your program or project best addresses: Arts and Culture Printed On: 21 November 2017 Requests of $5,000 or less 2
County or Counties Served* Please check the primary county served by the program/project for which you are requesting funds. Jewell Communities Served* Please list the primary community served by the program/project for which you are requesting funds. Mankato, Ks and surrounding area's due to it being in the City Park. Strategic Doing Project* Was this application generated through Strategic Doing initiative? No Target Population* Please check one or more populations served by the program/project for which you are requesting funds. All Project Description* Briefly describe the program/project for which you are requesting funds. The would like to request funding from the Dane G. Hansen Foundation to purchase and install a flag pole in the Mankato City Park. The City Park is a proud focal point in the community and plays host to many activities ranging from family gatherings to large organized events like concerts, car shows, and the Jewell County Threshing Bee. Because the park serves a central role in the community, and is a source of civic pride, it is an ideal location to display a flag pole. A flag display not only serves to beautify the area but also creates an opportunity to engage civic pride, patriotism, and remembrance of those from this community who have served our country. The local VFW is supportive of the installation of the flagpole and would provide volunteer help. Grant Request Description* If funded, how will you specifically use the Dane G. Hansen funds? 25' Architectural Series Clear Anodized 1 piece Aluminum Pole (storm rated), Spun Aluminum Gold anodized Ball topper, Case Aluminum Revolving Truck, Halyard (50'), Swivel Snaps with vinyl Covers (4 at $8.00 each), Cast Aluminum Cleat (9"), Aluminum Flash Collar, Foundation Sleeve, Steel Base Plate with lightening grounding spike, LED Commercial Quality Solar Powered Pole Mount Light, Shipping via Freight due to size of pole, Sand, Wood Wedges, Concrete (3000psi). Printed On: 21 November 2017 Requests of $5,000 or less 3
Project Objectives* What do you hope to achieve and how will it benefit the people of Northwest Kansas? Instill pride in our community, proudly display our National Flag, add to a growing consensus for the Mankato City Park as a place to gather as a community. Timetable for the Project* When is the project projected to begin and end? For ongoing projects, when will the Dane G. Hansen funds be utilized? It is estimated to begin the middle of March, given the weather is cooperating, or sooner as weather permits. Additional Support Describe additional sources of support (if any) that have been secured or that will be pursued for this project. The Local area VFW, our committee Friends of Mankato City Park, local youth groups and local Individual Veteran support. Sustainability* How will the project/program be sustained in the future? (For capital projects, how will you maintain or operate the item or facility?) The upkeep will be monitored by the VFW and. Evaluation* How will you evaluate the success of the project/program? Be specific. (If funded, this will be helpful when completing the final grant report.) A greater sense of community in the Mankato City Park from all organizations and a sense of patriotism for local travels on HWY 36. Proposal Budget* Complete the budget form attached on the Grant Criteria page under document requirements and upload here. Copy of DGH-Budget-Sheet.pdf Supporting Documents Bid or Estimate A copy of the bid or quote is required for a capital project or purchase. Printed On: 21 November 2017 Requests of $5,000 or less 4
MX-6200N_20171031_152751.pdf Letter of Support 1 A letter of support may be attached, but is not required. Additional Documents If there are additional documents that are critical to the trustees understanding of your proposal, upload them here. Electronic Signature Signature of Applicant* By entering my full legal name here, I warrant the truthfulness of the information provided in this application. Rebecca Fernandez Title of Applicant* Coordinator of the Signature of Principal or College President If this request is for a school or university, the signature of the principal or president is required. If the request is not for an educational institution, skip this step. By entering my full legal name here, I warrant that I have read and support this application. Title of Principal or College President Signature of CEO, Director, Mayor, etc. If this request is for a City, 501 (c)(3) Organization, Government Entity, etc., the signature of the CEO, Director, Mayor, etc., is required. By entering my full legal name here, I warrant that I have read and support this application. Chris Rhea Title of CEO, Director, Mayor, etc. City Administrator Printed On: 21 November 2017 Requests of $5,000 or less 5
Internal Tracking Number* 2017-12-9 501c3* Yes Printed On: 21 November 2017 Requests of $5,000 or less 6
File Attachment Summary Applicant File Uploads Copy of DGH-Budget-Sheet.pdf MX-6200N_20171031_152751.pdf Printed On: 21 November 2017 Requests of $5,000 or less 7
Dane G. Hansen Project Budget Form Organization: Project name: Flag Pole Project List project expenses (be specific) $0.00 25' Architectural Series 25' Clear Anodized 1 iece Aluminum Pole (Storm Rated) $988.00 Spun Aluminum Gold Anodized Ball Topper $30.79 Cast Aluminum Revolving Truck $61.99 Halyard (50') $15.79 Swivel Snaps with vinyl Covers (4@$8.00 each) $32.00 Cast Aluminum Cleat (9") $9.99 Aluminum Flash Collar $21.89 Foundation Sleeve $114.79 Steel Base Plate with lightening grounding Spike $121.19 Light: LED Commercial Quality Solar Powered Pole Mount Light $156.49 Freight: Shipping via Freight Due to size of pole $283.00 Installation by VFW: Sand, Wood, Wedges, Concrete (3000 psi) and Labor $300.00 $0.00 $0.00 *Total Project Expenses $2,135.92 Project Revenue Secured Applied-for Earned Budgeted funds, (Grants, Pending (Fees, ticket In-kind donations can be included- provide equitable dollar amount. gifts received, etc donations) sales, etc) Dane G. Hansen Foundation Request $2,135.92 TOTALS $0.00 $2,135.92 $0.00 *Total Project Revenue $2,135.92 *Revenue and Expense totals should be the same.