HomeMy WebLinkAboutGrant Request - La Pine Mat ClubDeschutes County Board of Commissioners
Discretionary Grant Program
Application Summary
Board Meeting Date: October 2, 2013 or TBD
Organization: La Pine Blue Lightning Mat Club
Organization Description: The La Pine Blue Lightning Mat Club is a youth sports program
that practices and competes from November through June of each year and participates in
community service projects all year. The Club promotes an appreciation of the sport of
wrestling; develops and maintains a wrestling program; encourages positive ideals in members;
and facilitates parents and children in working and playing together.
Project Name: Mat Club Facility
Project Description: In August 2013, the Club unexpectedly lost the use of its existing facility.
Grant funds would be used to support eight months of rental fees in a new location, the La Pine
Event Center, for practice session to be held during the 2013-14 school year.
Project Period: October 2013 — May 2013
Amount of Request: $800
Previous Grants:
10/4/2010
1,000.00
Approved:
Declined:
501(c)3 application process
Today's Date:
Deschutes County Board of Commissioners
PO Box 6005, Bend, OR 97701-6005
1300 NW Wall Street, Suite 200, Bend, OR
Telephone: 541-388-6571 Fax: 541-385-3202
Website: www.deschutes.org
DESCHUTES COUNTY
DISCRETIONARY GRANT PROGRAM APPLICATION
ci/)4/d011
Project Beginning Date:
Amount Requested:
Project Name:
boo
Name of Applicant Organization:
Address:
Project End Date:
Date Funds Needed:
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City & Zip Code:
Contact Name(s):
Fax #:
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Email Address:
Tax ID #:
Telephone #:
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31
On a separate sheet(s), please briefly answer the following questions:
1. Describe the applicant organization, including its purpose, leadership structure, and
activities.
2. Describe the proposed project or activity.
3. Provide a timeline for completing the proposed project or activity.
4. Explain how the proposed project or activity will positively impact the community.
5. Identify the specific communities or groups that will benefit.
6_ Describe how grant funds will be used and include the source and amounts of matching
funds or in-kind contributions, if any. Itemize anticipated expenditures*.
7. If the grant will support an ongoing activity, explain how it will be funded in the future.
Attach:
Proof of the applicant organization's non-profit status.
BOARD OF COMMISSIONERS
ADMINISTRATION
* Applicant inay be contacted during the review process and asked to provide a complete line item budget.
Deschutes County
Discretionary Grant Program Application
Submitted on behalf of La Pine Blue Lightning Mat Club
1. The La Pine Blue Lightning Mat Club is a youth sports program that practices and competes
from November through June of each year and participates in community service projects year
around. The purpose of the LaPine Blue Lightning Mat Club (LBLMC) is to;
- develop and promote an appreciation of the sport of Wrestling amongst parents and youth of
the La Pine area, and to instill a sense of pride in our programs history and their part in it's
future.
- develop and maintain a unified and cohesive wrestling program on and off the mat that
provides wrestlers with a consistent learning environment from preschool thru their senior year
in High School. This includes cooperation and collaboration between club wrestling, Junior High
and High School wrestling programs.
- develop and encourage in the youth members and their families the ideals of good
sportsmanship, honesty, loyalty, courage, respect for others, Community involvement, service
and strong character.
- stress the concepts of parents and children working and playing together in club activities so
that the Club, family, and community will be strengthened in the process.
The LBLMC has a nine member volunteer Board of Directors whose members also serve to
coach the youth under the direction of a named volunteer head coach. LBLMC has been a
certified 501c3 since 2010 and is an incorporated non profit charity with the state of Oregon
2. The proposed activity that we are requesting funding for is assistance with rental expenses in
our new practice facility. As of August of this year we were asked to vacate the premises we
previously used for nightly practices. We had simultaneously put in a request to the La Pine
Park and Recreation to rent the La Pine Event Center for practices three days per week. Due to
the timing of this move and added expense to our annual operations and fund raising efforts, we
are seeking assistance to be sure we can lock down this bill and ensure a safe practice facility for
the 2013-2014 year.
3. This request would be a one time request for the 2013-2014 wrestling season for $900 to cover
our rental fees for 8 months. From that point on we will have more advance time to review our
budget and fund raising opportunities to cover this expense.
4. The ability to have a facility is primary in the ability to run any sports program. Being able to
pay and secure facility use will not only allow us to run practices but will be the anchor to us
I n Pine 1'1nk & Ik cation lI)isltir_t
(()ffiee) I(r1(15 lust Street
www,lspinrl>arks.ot g
STK T A r
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(Mailing.) I'.tJr. Box ((.)
t ca fine OR 977 it)
I. '41 N31,6 '22 t
TENT OF USER RESPONSII
LACII.,1TY 1S1':
In nitcidcrnti(tn for the use of Lt Pit►e Park & Recretuiun District park areas and facilities, all mser-s agree. to the following;
1 he user assumes the emit': resp,msibiliry and Iiahilit'= for teleses, damages and t.`laiut>: arising out )J injury or damage to riser's
display, erlulptnent and otter prGperry brought onto theltictiri,e, 01 the I I'I:1.) facility reserved and shall indemnify and hold
ltarntless l,l'l I) (tutu any and all liability for any and all such losses, damages and claims arising out of such rise.
'.
Any grenrl> sponsoring. or using, 1 PRI.) -owned facility assumes all liability 14 airy accidents that oe,ur daring the scheduled
reservation tTFl1. 0111w facility,
1,
Hie nst+r sHall be responsible for the conduct of the participants attending the aelivitvievent. lvilht .ze arts is control and
containment t,l litter, and for any damage. le, the prr'In teas beyond ordinary wear and tear,
4. "rho user shall conduit all aartiv'dies 011 the'. Inemi,c in accordance. with any applicable frdcntl. state or local laws, ordinances of
rule,, including all park tcgulations. and shat}! coutply with the regtiircmerte Aiated i the l=ttciiity !lethal Aitl>lit:alion Packet—.
n if apprcn al is granted to the user in bring itt any ,special portable dexo, ices (i.e , Bounce 1 Irnase) for use in ,a 11 111 ( 11011 WGith the
reser'v'ation. the reserving batty cadre vnb1T111 a letter releasing 1.l'i2I.) of liability and ;rust also post a sign at t111 davit.; duri11g
ilae arses inion time that the device is nun 1,1 D's .and LPt1) is not responsible.
1f our i t out consists of anrvte. !brat 75 petalde, the audit i it.cd user shall submit a Certificate of t.irtbihty Insttrrrnce in the ;amount
ill hart $,300,000 per occurrence, naming 1.,1'F I ) as int ;.additional insured. no lam than ((1 days pit or act thu eve,nt..
i'n':rss ;approved by a vehicle p end. No 1110101a 40.1 vchick^: are' alluwrd iia t1ttt pack
$ b`t)person may move ally I,PRP owned equipment and! rsupplies vviilttrtn written teriI1ssisn Irin7lhar I)irteiorafI'tt(s raaad
f,;rcreill101a..
o (.:enc;ellation re( c'ic' el :'U days t,r more prior to this reservation lathe will receive ;a refund of all fr°es, ntitrus ,1 prrxctasin3! fee al
No tehmil! ;sill 1 -he issued if the reset -ration is cancelled loss than ;keys from rhe, event. We rlo not hither cancellation,:
51 to inclement \yr artier.
L('01101
!hit und'rsignc 1, attest Ilial 1 Iravc read and agree to tel>ide by all rites, rat;nlrttitlrls and guideline',, spccifilul Ilcreitat
1. Penni situ ohu1 IS only ,ranted if st;rvit c is dime by a'eau!' er or liicnsc,tl pcaure.r in a dcsi=tett .t and monit+,r;;! ;lr
and if !lost I icluor 1 ial.nlily htsU1:nce !.165011,000 Med; which entre name. 1,41 rine° !'ark ct< I:ecretatlara i)itric l ',is :an
additional i isursad.
2. If alcohol will Ise sold. to included as part of an admission price, I lost Liquor Laabilit) Insiilautcc°,and an (,>1,0.71eml:sttor,
5�tle� 1 ieenst! must be obtained before permission is grained.
All ()l (1 ` rules :nttl apply
'CC) BE COMPLETED BY APPLIC'AN'T:
1 hereby certify that 1 ani the authorized representative of (he la anization (?r group 1i!,ted and Ilial the
application statements are true to the best ul my knowlcdpc. I agree to abide by (he rules and regulations I`or use
of the L1 R1) facility, as well as all federal, state and local laws, 1 accept responsibility for any vit)1ations as they
may pertain to the facility reserved,
I
l 1 t
rOli or Or'g inizatlorl: 1 M- ,'i°� P �� Y� f �.'
Signal tire of Applicant:_
1
Dale Signed:
District 0 lice • 16405. L°it's! Street • La Pince • Oregon • 97739
.5of7
1..a fine Park tK'. Recreation 1)istriel
(1111101') I(,-105 first Stretch
WWa .lapineprk.lat;
Chlailillii► 1'.(l. Bret GG I
i :1 fine 1 tlt 977.39
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3-11336.222.3
Facility Application
"7 !'leas;; print or type 102101y and fill out completely.
1( applicable. ;mach a copy of the i'crlilicute of Liability I11S111 nee n<laurl;F 1,1'121) els an sulclitilsnlai istaulrtl. t it .(:'( "l'crinpoiary
Sale., l,ieoI1. , l.ulnor liability lnsuranc0,lemporary Restaurant License, andi or Food Fla di 1'11rn1il.
>uhnlit application and Ally all fees at lea)1 3(111ays prior to use.
7 .1nke pay neat. by uaslt of check payable to ""1 .a 1)410 Park & 1lecrcatirtn I.)istdct".
Applicant Information
1 1r431lllatnnl ,\,nn1. .it ,iplrlct a1,li'): -
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['awn lig v{>I4slI)) 11>r Re,ser5'dltlt311
l 1, 11110 Riau, .y'
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1 Reservation Information
l'ayl'i nl the heck tcircic);: )-t (f) W Ftl' l°
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f�eSc'rvaijo❑ - STA k 1 HMI... i;y , t.'% ` AM/ pmt n l idi`l; xt-)13p1
i ' 1" !1 ! f
1Cl earl N in ': I •-_' i'!.. 'L/j 11-:' __.;_.0-i -- ---- -
Cont.lrl I'i'I1 >i of i)i1Y if l',velll:
'lype nl ,li:lirit;:
Cl Birthday pari• 1 Company Picnic i7 Reunion n lunil-raison
S 5t' t{e,1uesied l)a1cta1: -
q
End MIR.: ,*77, _ _ _ I ' N PM 7, ctudin Icm
1Cil:at l:.Npecied AI dor
L Clf1o>et rf 1"3II 1> v at Eve
7 \V0 1.line. 17 Oilier,
1,1
`this event will be: (check all that apply)
1 C!( Il1wL1 to tlic public./ invited oucst0 ))R»len l.o [he pubiie 1&ie nen>tingSaletiei;dinvix`11'•', 3i e ,lay te.'.7
Please bulimic, Ow nmeniiies that you will need:
1 Kitchen'11ac,. 1 I ablos 11 Chairs Ti Picnic.] able.) 1 l',10clricity
A71 Water 77 t)(liei:
- -
Ate there an entertainment' features related to your event? )1 No (1 Yes
Ntitiihcr ill 1N"..IIVl mei Perlin inert) Nanie(i): Purl( :M 0 Iype:
-
..._
Perfonner) ) Narne(s): Performance Iype:
_ - . _ .....-. _
%Vill amplifier) sot atitl be nsed? 71 NI) 7 Yes
Sloan 111140: _-._. 1_nd IIIne:.,. _. 1),acribe sound equipment and itattape:
Will you be erecting And using any tents tie other temporary equipment ti.t.. 'portable hark lcuest? 11 No 71 Y,,,s
1);:wribc equipment used:
_ - - —
District Office • 1( ) First Street • La Pine • t regon 97739
6r)f7
1,fi Pint: Park & Recreation l)istrict
((ffice) 16405 First Street
wtvwhipineparkR.org
(Mailing) P.O. Box (,&I.
I .a Pine OR 977,19
1.ill ri36 2223
R csei'vation Information (cm limed)
s your event involve the tise of alcoholic beverages? T No 0 Yest
4 PUS.: Cheek all that apply: 0 Free/I-lost Alcohol 0;.,\ leohol Sales 0 Host (k'e. Saki;0 0 Win 0 I lard Liquor
Provide the name of the licensed bartender/ caterer to serve Ihe alcoholic beverages.
Name of the f 'fiteii-1 ,jcensd Bartenficr; 1 iur 1.ir-eitsc
if your evein inciude the use, of alcohol 1»I 1..PRD properly, Host Liquor lusannice of 01 least .5,500,00(I pa e')cr u, rence is
required. for oi.(‘oliol .5alt'S: must olso obtain an 01,CC lemporary Soles Licetse.
Will Rind andfor refrosliMelliN he servcd? rir No 71
\Vital lypc DI" relreslmpl$ Will be ,•.:0N'C'Cl?
NWill you he hiring a catercc to serve foofP o 0 Yes
Caterer Name:
Will food tin& or fefreshinents he
ei:hinimts will
Aildres:5:
0 Yes
.ontael
iTempord )itsialar%fli
FOR OFFICE USE °NIA'
Acuity of the following s1Ippkflent1I luciiUcts are required:
17.1 Pr9i2;hor1 iohilit> Insuranc,.!- Doc iliac: _ Receivec,1 on: _
0 hoot of I lost Liquor 1 itibility !mural -we - 1)uo dale-. __. Kccei‘‘-kl ow
1 0.1.,(2C Temporary Sil*s I .icentie - Due fl;lb: _
_ Rece.ivcil .ln:
71.1omporary Rostatirtint I :ieme Due dive: _ __ .
1 Current l'ood 1 itindleN Permit - Duo date: Received on:
A, f f1)., Ati Mpfned ,4,.. l(MeniS WWI be ., jibllli lied ft? [PROW ler,,/ 30 (101, pr lor ro yo'0,)Flum o,' 0 Ma Om* 14,1,,i'mitaw to h:- .ccmfieni..y.i.
Fee Computati(in: Office il.W0111V , .,
t :leaning 8f, Damage Deposii: SI 00 --,,
kcy Code I )sit: $50 z
2 hour minimum: $
slental 1 low s: ""' , , -,S(-) a.,, s per hour .5; 106
(Juni oui area useage:
Out& or ntie: C. Stags: 7 Parking Area 0 Grass $_
Total Amount Due: $,:t,'?\ -15
In mart to hold your I eser varion *111 fees awl deposits must by received in fuIl.,
Paymei nlormation: 1)/Jo.e we oitiv
iJ COSI) r....1 CllUil, i!
,
0 All F,,e.: paid ray. __
I have evaluated the application and in accordance with the A Pine Park 41.4; Recreation District policies, the application is:
Approved lor use 71 Denied fur tr;e.
C RI s:
. ,
Approved by: ._._- - Date of Approval: r:... C!
District Office • I405 First Street •I Pine • Oregon • 97739
7 of 7
To: La Pine Parks and Recreation Board
From: La Pine Blue Lightning Mat Club
Re: Park and Rec Facility Use Proposal, La Pine Event Center
Date: August 2013
Honored Board Member,
The La Pine Blue Lightning Mat Club has been an organized board since May of 2009 and 501 C3
since October of 2010. Each year we serve 40 to 50 wrestlers and their family members in the
recreational and competitive sport of wrestling. Many of our families are scholarshiped into
the program and in return they, and most all other families, participate in several community
service events. This is our way of encouraging community involvement and pride while also
teaching discipline and ethic through the sport of wresting.
The success of the above mentioned mission has lead to the growth of our program, and with
such growth comes the need for added space. Due to that need we are asking you to consider
the following facility use proposal.
Our season would begin in the middle of October and continue through the month of May. The
Mat Club would like to use the Event Center Three nights a week Monday, Tuesday and
Thursday from 6 to 8:30. We do realize that the facility is a major community hub and therefore
understand that a certain amount of flexibility on a regular or intermittent basis may be
necessary.
We would like to offer a $100 per month rental payment.
The mat club has a long term use agreement for 2 full sets of wrestling mats and, as part of this
proposal would like to offer Parks and Rec the use of the mats for tumbling classes. We also
secured a grant and purchased AV equipment which we will be installing in a portable cabinet
that we would also offer for use in Park and Rec programs.
Thank you for your time and consideration of our proposal. We look forward to hearing from
you soon.
Sincerely,
La Pine Blue Lightning Mat Club Board