Riverfest - Special Events Insurance Grant
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MEMORANDUM
August 30, 2005
TO:
The Honorable Mayor and City Council Members
FROM:
Michael C. Van Milligen, City Manager
SUBJECT: Special Event Insurance Grant - Riverfest, Inc.
Assistant City Manager Cindy Steinhauser is recommending approval of a Special
Event Insurance Grant to Riverfest, Inc. in the amount of $1,150.
I concur with the recommendation and respectfully request Mayor and City Council
approval.
~ . 7
Ul L(WI (>l ! /
Michael C. Van Milligen
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G1jJjJIIl"G1l1VII IVI lilt: yr cUll JJruyrcun ana 10 assls! me ~ny In reviewing applications tor the
program. The purpose of the program is to provide up to 50% of the cost of
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11160
DUBUQUE MAIN STREET/CITY OF DUBUQUE
SPECIAL EVENTS GRANT PROGRAM
Purpose
The Special Events Insurance Grant Program is designed to support significant Educational, Social and Historical
projects undertaken by groups and associations in the City of Dubuque.
Funding priorities
The Program includes events which:
. Encourage community-wide social growth
. Have broad appeal
. Advance educational opportunities for a broad range of Dubuque area residents
. Celebrate and further the rich history of the Dubuque citizenry
. May not be financially feasible without assistance for the purchase of appropriate insurance
. No admission fee charge for the public to attend.
Overview
. No religious or political activities can be supported with these funds.
. Grants shall be awarded based on financial need in order to comply with the City of Dubuque insurance
requirements for special events.
. Grants are for the purchase of comprehensive liability insurance for special events. DRAM Shop
insurance is NOT covered under this Program.
. Insurance must be obtained by the event-sponsoring group, in the group's name, with the City of
Dubuque name as additional insured.
. Eligibility includes not-for-profit groups and associations.
. The event must be located within the City of Dubuque and requires a City of Dubuque special event
permit.
. Projects must complete any approval process required by other city departments in conjunction with the
application. Contact the City Clerk's office, 13th & Iowa Streets, for special event application.
. Applications must be submitted to the Dubuque Main Street office not less than 60 days prior to the
event.
. Applications recommended for funding shall be subject to city Council approval.
Eligible activities (must meet at least one of the following criteria)
. Events to which the general public is invited
. Events held on City owned property
. Events sponsored by organizations with leadership including a minimum of 50 percent residents of the
City of Dubuque
. Parades, Rallies or Assemblies
. Festivals or Fund Raisers
. Walks/Marches
. Neighborhood Events
Equal Opportunity
The City of Dubuque and Dubuque Main Street, Ltd. do not discriminate by reason of age, race, religion, color, sex,
national origin or handicap unrelated to the duties of a position of applicants for employment, promotion, demotion
or transfer, recruitment, layoff or termination, compensation, selection for training or participation in recreational
and educational activities.
!derna! Revenue Service
District DIrector
Drpartment of the Treasury
P.O. Box 1121 - Central St4tj
St. T~oul., HO 63188
Date: 2 8 JA~I 1S;~
Employer Identification Number:
Internal Revenue Code
Section 50He)( 4 )
~
R1 "''!r'f est, Inc.
2915 St. Anne Drive
.'Dubuque,'IA .52001
Accountlllg Period Ending:
October 31
Form 990 Required: Ij] Y" (i No
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P.rson. to Contact:
EP/EO:7206-P. Morri.on
Contact Telephone Number.
(314) 425-5651
Dear Applicant:
Based on information supplied, and assuming youi~perations will be as stated
in your application for recognition of exemption, we have determined you are exemr:
from Federal income tax under the provisions of the Internal Revenue Code sectIon
indicated above.
Unless specifically excepted. you are liable for taxes under the Feder~l
Insurance Contributions Act (social sscurity taxes) for each emp10y€e to whom
you PA1 $100 or mnre riuring a calendar year. And~unless excepted, you are also
1 l;ll>le for tax under tl.e Federal Unemployment Tax Act for each employee to wr.om
YOll p'y S50 or more during a calendar quarter if, during the current or precedin~
c.11endJ.:" year. you had one or more employees at any time in each of 20 c;}lendar
weaks or you paid wages of $1.500 or more in any calendar quarter. If you hJ.ve
any questions about exci~e, employment or other Federal taxes. please addres~ them
to this offic3.
If your purpos~s. character. or method of operation change. please let us know
~o we can consider the effect of the change on your exempt status. Also. y~~ shou~d
inform 113 of all changes in your name or address.
The blo~k checked at the top of this letter shows whether you must file FOFID
990. Return of Organization Exempt from Income Tax. If the Yes box is checked.
YOll ;lre only required to file Porm 990 if your gross receipts Pilch year are norrr.allj
->;qro th.'~ $10,000. If a return is required. it must be filed by the 15th day of
the f1 f'.11 r.1on th aft er t'1e end of you.:- annual accounting penod. The law P ;"QV i.des
for a pena~~y of $10 a day. up to a maximum of $5.000. when a return is fil~d late.
unless there is re~lsonable cause for the delay. This penalty may also be charged
If a return is not cOulplete. So, please make sure your return is complet& before
you flle it.
You are not r8quired to file Federal income tax returns unless youars ~~bjec~
to the tax on unrelated business income under section 511 of the Internal Revenue
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For more information, please contact:
City Clerks Office, 589-4121, or
City of Dubuque
mailto:
50 West 13th
Dubuque, Iowa 52001
Dubuque Main Street, 563-588-4400
dbqmainsr@mwci.net
909 Main Street; Suite 22LL
Dubuque, Iowa 52001
DUBUQUE MAIN STREET/CITY OF DUBUQUE
SPECIAL EVENTS GRANT PROGRAM
ApPLICATION
Cover Page
Contact Information:
1. Name of organization: For office use:
'1<. \ \) er-.feqr --r NC. : Date received
t)onnc ,
2. President name: Gif)TeJL 3. Large Grant Administrator:
Phone: SC03- fj53.'S E-mail: Phone: E-mail:
2a. Mailing address 3a. Mailing address:
~3L\2 c~~ry' ~i" .
utJ0Qu~.J.A SLoat
4. Bud et Information:
Total grant funds
requested
Any other support
provided
Total cost (A + B)
A. I J \ SO · nJ
1,/5D C. I) 1 0 '2;36'0
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Grant signed by organization president 1/0 ('c~ \lI.JlJ..t. 0 ~
Copy of association minntes approving application 1\ () ~ ~~
Attachments. approval from City departments, if applicable ~ <;7 Lb.L Ii{) lOA :fe7(", '
B.
5. Check IisJ;--
~ Cover page and grant application attached
6. If the applicant is incorporated, please complete
A. Applicant's Legal Name and Federal Tax ID B. Type of Organization (enter - public or
# 'R I uer4r. J l\\C. ~~:~~ n~~~fi~~vate for profit or specify if
-It 4::2- H11 ebB CIUIL NOY\ prcirl
Cltj J=€STI V A \
Please insure authorized person signs assurances. Unsigned applications can not be accepted.
ASSURANCES
I hereby certify that, to the best of my knowledge, all of the information contained in the Application is true and
correct. I understand that Dubuque Main Street, Ltd. and the Dubuque City Staff reserve the right to request
modifications of this application during the process of contract negotiation and, as finally approved by Dubuque
Main Street and the Dubuque City Staff, the Application shall be part of the Contract with the City of Dubuque.
The Applicant certifies:
1. agreement to submit further documents as required by the City of Dubuque to determine project and
organization eligibility; and
2. agreement that grant award funds are allocated on behalf ofthe grantee through a purchase order to a
vendor and will not be paid to the grantee directly without prior approval and adequate documentation as
determined by the City of Dubuque; and
3. agreement to submit requests for purchase order and reports of ~ctivities as directed by the City of
Dubuque; and
4. agreement to maintain any other specific records, as may be determined necessary by the City of
Dubuque, to the overall evaluation of the project; and
5. agreement that the application has been reviewed and approved by the applicant's Board of Directors (or
equivalent) prior to submission; and
6. agreement that no costs incurred for the program prior to authorization by the City of Dubuque,
Managers Office, shall be reimbursable and that any funds not spent during the contract period will be
forfeited.
i yi~~ ~epresentative
IV\ ~dl\ael ,J
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Date
m\chc\eJ
Printed Name
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':Qc. JlTW.l)6UAC/v
title
NARRATIVE
(3 Sections)
SECTION 1. ORGANIZATIONAL EXPERIENCE
A. Please state which of your association's/event's goals this project will be addressing. ~~O
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03
DUBUQUE MAIN STREET/CITY OF DUBUQUE
SPECIAL EVENTS GRANT PROGRAM
INSTRUCTIONS
Contact Information:
1. Enter the name of your organization, which must cover the area in which the
project is located.
2. Enter the name of the association president and phone number (and e-mail
address)
2a. Enter the mailing address of the association president.
3. Enter the name and phone of the Grant Administrator (ifit is different from the
president) who will be fully responsible for this project, phone and e-mail.
3a. Enter the mailing address of the Grant Administrator (if different from
association president.)
Budget information:
A. List the Total Grant funds you are requesting from the Special Events Grant
Program.
B. If your project is receiving additional funding support or donations of services
and you are choosing to list those, enter the total figure from your budget page.
C. Total the cost ofthe project by adding A and B, enter this total in C.
5. Check list:
This is a reminder of the required steps to a complete application. A reminder that a
copy of the association minutes showing the association has approved the application
is to be attached. Also attach any required approvals from other City departments. If
the project requires approval and it is not attached, this may delay approval of
funding.
6. If your association is incorporated, please complete the grid.
A. Enter the legal name and federal identification number
B. Enter the type of organization - public non-profit, private non-profit, etc.
Assurances
This MUST be signed by the organization president or other person certified to sign
on behalf of the association. This signed statement will become part of the agreement
with the City of Dubuque, as will the grant application.
Narrative
There are three narrative sections to be completed. Please follow the instructions
regarding number of pages that can be attached. Contact Dubuque Main Street with
questions or concerns that arise while working to complete the application.
Section 1. Organizational Experience - no attachments are allowed to this page.
A. Each year associations are asked to submit goals to the Community Development
Advisory Commission. Please list which of these goals the project your association
is undertaking, will be addressed. Note: Goals and this project should be consistent
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with your by-laws.
B. Please summarize your annual budget and funding sources. For example our
annual budget is $12,000. We receive $8,000 from the Small and Large programs
and $2000 from the X bank and $2,000 in dues from members ($1 each household).
Section 2. Project Description - two pages can be added to this page. Explain where the
project will take place. In the remaining space and with at most 2 more pages if needed,
describe your project in detail. Introduce the project idea and then explain all of the steps
that must be completed.
Section 3. Proposed Total Project Budget
Note: Some of these figures are requested on the Cover Sheet.
OTHER RESOURCES - OPTIONAL
BUDGET DETAIL - OPTIONAL
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