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Home My WebLink About96-11 RESOLUTIONRESOLUTION NO. 96-11 A RESOLUTION APPROVING A BUDGET ADJUSTMENT IN THE AMOUNT OF $2,000.00 REPRESENTING DONATION REVENUE FROM THE WAL-MART FOUNDATION AND WAL-MART #5737 TO THE FAYETTEVILLE FIRE DEPARTMENT FOR THE PURCHASE OF LIFE VESTS BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF FAYETTEVILLE, ARKANSAS: Section 1. That the City Council of the City of Fayetteville, Arkansas hereby approves a budget adjustment, a copy of which is attached as Exhibit "A", in the amount of $2,000.00 representing donation revenue from the Wal-Mart Foundation and Wal-Mart #5737 to the Fayetteville Fire Department for the purchase of life vests. PASSED and APPROVED this 21St day of June, 2011. APPROVED: �10#LD J , Mayor ATTEST: By: 104"62 9� - &M&� SONDRA E. SMITH, City Clerk/Treasurer {t111111111f," K/TR�''°oma ®U° FAYETTEVILLECD ; RAS°Je ems'-9sy � ®N° Q.o °awe City of Fayetteville, Arkansas Budget Adjustment Form V11.0425 Budget Year Division: Fire Department Request Date Adjustment Number 2011 1 Department: Fire Department 6/21/2011 BUDGET ADJUSTMENT DESCRIPTION / JUSTIFICATION Recognize donation revenue from The Wal-Mart Foundation and Facility # 5737 to the Fayetteville Fire Department. Prepared By: Ginny Gundlach ggundlach Reference: Budget & Research Use Only Type: A B C rD E P General Ledger Date Posted to General Ledger Checked / Verified Initial Date Initial Date TOTAL BUDGET ADJUSTMENT 2,000 2,000 Increase / (Decrease) Project.Sub Account Name Account Number Expense Revenue Number Uniforms/personal equip 1010.3020.5302.00 2,000 06029. 1101 Donations 1010.0001.4809.00 2,000 06029. 1101 EXHIg GADivs\Fire\Financial\Agenda Items\Wal-Mart Donation\BA_11-xxx_Wal-Mart Donation_Jun11.xis 1 of 1 Division Head Date Budget irector Date Department DirectoV Date ��► � - � La 7' SLI Fin nce Director Date f ff- Daate navpf ate Prepared By: Ginny Gundlach ggundlach Reference: Budget & Research Use Only Type: A B C rD E P General Ledger Date Posted to General Ledger Checked / Verified Initial Date Initial Date TOTAL BUDGET ADJUSTMENT 2,000 2,000 Increase / (Decrease) Project.Sub Account Name Account Number Expense Revenue Number Uniforms/personal equip 1010.3020.5302.00 2,000 06029. 1101 Donations 1010.0001.4809.00 2,000 06029. 1101 EXHIg GADivs\Fire\Financial\Agenda Items\Wal-Mart Donation\BA_11-xxx_Wal-Mart Donation_Jun11.xis 1 of 1 City of Fayetteville Staff Review Form City Council Agenda Items and Contracts, Leases or Agreements June 21, 2011 City Council Meeting Date Agenda Items Only David Dayringer Fire Submitted By Division $ _ $ 11,942.00 Cost of this request Category / Project Budget 1010.3020.5329.00 $ 10,957.31 Account Number Funds Used to Date 06029/1101 $ 984.69 Project Number Budgeted Item Remaining Balance Budget Adjustment Attached �X Fire Department recognize donation revenue from Donations - Fire Program Category / Project Name Donations Program / Project Category Name General Fund Name s "— e Previous Ordinance or Resolution # Date Original Contract Date: 5-2-7-11 Original Contract Number: Date Finance and Internal Services Director Date -f)mS'3v ' ► I ief of Sta Date M or ate Received in Ci t65-27-1 1 P02:22 RCVD Clerk's Office t/v1 AAA . VX Received in Mayor's Office Revised January 15, 2009 CITY COUNCIL AGENDA MEMO To: Mayor and City Council From: David Dayringer, Fire Chief Date: June 21, 2011 THE CITY OF FAYETTEVILLE, ARKANSAS DEPARTMENT CORRESPONDENCE Subject: Recognition and acceptance of a donation to the Fayetteville Fire Department PROPOSAL: Due to the severity of recent inclement weather and flooding, the City of Fayetteville Fire Department has recognized the need for additional rescuer and victim life vests. The department recently experienced thirty- three water rescue calls within approximately four hours. During this event, the department did not have enough rescuer and victim life vests to keep the firefighters and citizens safe. The Wal-Mart Foundation and Facility # 5737 have responded to this need by donating $2,000.00 to the Fayetteville Fire Department to be used for the purchase of rescuer and victim life vests. RECOMMENDATION: Staff recommends a resolution approving a budget adjustment in the amount of $2,000.00 to accept and recognize donation revenue from The Walmart Foundation and Facility # 5737 to the Fayetteville Fire Department. BUDGETIMPACT: Upon approval to accept and recognize this donation, the Fire Department's Uniforms / Personal Equipment account will be increased by $2,000.00 and the expenses will be tracked through the City's project accounting system. RESOLUTION NO. A RESOLUTION APPROVING A BUDGET ADJUSTMENT IN THE AMOUNT OF $2,000.00 REPRESENTING DONATION REVENUE FROM THE WAL-MART FOUNDATION AND WAL-MART #5737 TO THE FAYETTEVILLE FIRE DEPARTMENT FOR THE PURCHASE OF LIFE VESTS BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF FAYETTEVILLE, ARKANSAS: Section 1. That the City Council of the City of Fayetteville, Arkansas hereby approves a budget adjustment, a copy of which is attached as Exhibit "A", in the amount of $2,000.00 representing donation revenue from the Wal-Mart Foundation and Wal-Mart #5737 to the Fayetteville Fire Department for the purchase of life vests. PASSED and APPROVED this 21St day of June, 2011. APPROVED: LN ATTEST: By: LIONELD JORDAN, Mayor SONDRA E. SMITH, City Clerk/Treasurer Walmartstores.com: Online Applications Find-ai` :2 FACIE Uz - — ----------- rage i of z Homo About Us f=acts & News Health & VVeliness Career Community & Giving Diversity $ustlinabllity Investors Suppliers Online Applications Confirmation of Application Receipt: You, propo!;4.J'subil'itted to i..;11vairnati �curiaia!!ori. No rurthe.r action on youf ;%,Wt 4, requir'XI. A conli"Matfiwi einail %,Ml sn'.111k to U110 e1nad provided dutiM."'A regisuF*10, 1. P -ease n0le: Appliceti ns, ari5 wott-,.'ry Sn. da set the subrnission date. Orae funding dedsio 5 ronade, You will roc.elve e,' "ED11Gw up stai,s errial 'to Print a co;py et tM� app."a-, ian ,p tc T'i'a", P,:(..V In your crow ser t0nlwl)sr. C:'!,7k hare, to return to the hannegago whell you are Nomination Information Organization Description (required) ilr' i Zip (required) .2. 7 7 011 Telephone (required)7M716.,(4632. E-mail Address (required) Contact Type 'required) P;'k1MiiY Oar.'Eli,-t Contact Information First Name (required) C, - Last Name (required) rayetlev lla Fire Depamyiens Contact Title (required) Ass�-arit Rim Chief Address (required) 303 "Veer"e., S, City (required) Fayetteville State (required) A:kir-as Zip (required) .2. 7 7 011 Telephone (required)7M716.,(4632. E-mail Address (required) Contact Type 'required) P;'k1MiiY Oar.'Eli,-t W I AAAA N6 J� t �,Of h6t Wed) 5 W, 5 -bre, W,4-179(91 C,eW -0- 'ST6,150-,1�2 1%./ Zip (required) Telephone irequilmd) 47 oyv.5 - Fax lkebsito Addross Organization Mission (required) To rxo,.dL otircikLens, quests: and empicy-jes w.1-1 6i to quality Fire. F�-s,-A"e.w"..'MS. nild Community S6�-,rims wi'hlri the �,',[Y iimitS D' 'itevi'lc Current Activity (required) Ourorj�&Nzat-on resporids to calls fpr arilergcnc se""lo"', Close to S;NOP per i range i Orl. St! LICiLl!•at t0chnical tesr.Aias. vew. -,ezoe services - h., zarOus materiels, ri-iotor vehick, accidents, ate Facebook (required) nla Twitter (required) 21 Request History Previous Funding Requests - All Locations (required) N,;A Previous Funding -All Locations (required) NIA hq://www.cybergrants.com/pls/cybergrants/ap_application.§ubniit_app 5/10/2011 Organization Information Legal Name (required) -syeiaev...'e =ire Dopprtmerit Payee Name (required) rayetlev lla Fire Depamyiens Address (required) 303 W Center S, City (required) Peye*i�v:,le State (required) AnKames W I AAAA N6 J� t �,Of h6t Wed) 5 W, 5 -bre, W,4-179(91 C,eW -0- 'ST6,150-,1�2 1%./ Zip (required) Telephone irequilmd) 47 oyv.5 - Fax lkebsito Addross Organization Mission (required) To rxo,.dL otircikLens, quests: and empicy-jes w.1-1 6i to quality Fire. F�-s,-A"e.w"..'MS. nild Community S6�-,rims wi'hlri the �,',[Y iimitS D' 'itevi'lc Current Activity (required) Ourorj�&Nzat-on resporids to calls fpr arilergcnc se""lo"', Close to S;NOP per i range i Orl. St! LICiLl!•at t0chnical tesr.Aias. vew. -,ezoe services - h., zarOus materiels, ri-iotor vehick, accidents, ate Facebook (required) nla Twitter (required) 21 Request History Previous Funding Requests - All Locations (required) N,;A Previous Funding -All Locations (required) NIA hq://www.cybergrants.com/pls/cybergrants/ap_application.§ubniit_app 5/10/2011 waimartstores.com: untme Applications rage /_ of L Previous Funding - This Location (required) No Previous Funding Cate - This Location Area of Focus Focus Area (required) Hea€Ih r. Frss:ss Primary Subcategory (required) Emergency assstar:^,e ^:'o fra:'rs Sam's Club Additional Category Community Served Area Served (required) wash:noton Gender (required) 50% Male v(i z: i�<arrie Age Group (required) 'i QOrh All Ames Ethnic. Background (required, 100: L,, Ail Program Information Grant Typo (required) t-x,•a Community Co:itdnu?iori Requested Grant Amount (required) $2,D00.00 Project Title (required) MAT 5737 Application Program Descripttan (rxaquired)2ecent y we expe-enced 33 yr-ritar reswe his ,Aths l epproxrmateiy ^ ivou;s. Oat- epa, rcaeni :s in ceelof additional rescuer life -vests ir, xdar to provide el, ar . protea°ion for ine :x;n:m ^'-iy. VVe cid not have enough resour or vitAim vests to keen ourlitatigiaers and a.E+za-!s sFxrc. Program Relevancy (required) 1"Iaese, lire vests will proviee er;ier4;ancf res xnss c::'1:is vrith vitally needed ecu: meat. Ec pr-otect avcs in our r esporso dshn. ts. Need Swoon Shop i Shap f aivsoulr.umr ) Imemstionai .tabs Viaecs ) Recalls i Other (rites i Twitter ' Retum Po tiny ` Pwac_y Ca5r. Rights I UO Me-, i Teras o k)se hq-//vwvw.cybergrants.conn/pls/cybergrants/ao_application.submit app 5/10/2011 FY12 Facility Level Giving- Local Community Contribution (LCC) Guidelines Walmart Stores, Sam's Clubs and Logistics Facilities At Walmart, we believe in operating globally and giving back locally. Through our Local Community Contribution program (LCC), facilities are able to support the needs of their local communities by funding organizations working to improve the lives of our associates, customers and neighbors. Areas of Focus for Potential Grantees The Walmart Foundation has areas of focus including Education, Workforce Development / Economic Opportunity, Health and Wellness, Environmental Sustainability, and Hunger Relief. Through the LCC program, the Walmart Foundation requires that all funds are directed to programs that fall within our above focus areas. Education: Examples include programs that re-engage students who have dropped out of high school, improve retention rates of first -generation college students, support teachers and promote childhood literacy. Workforce Development / Economic Opportunity: Examples include job placement efforts, adult education, occupational training, training for English language learners, career counseling, increasing access to earned income tax credit benefits and other state/federal benefits. Health and Wellness: Examples include cooking and meal planning classes for Women, Infants, and Children (WIC) recipients, healthy snacks for kids in summer programs, and support for doctors planning community health programs for underserved children. Environmental Sustainability: Examples include waste reduction programs, and sustainable agriculture initiatives. Hunger Relief: Examples include soup kitchens, food pantries, backpack programs, and school breakfast programs. Sam's Club Additional Focus Areas Sam's Club has recently. finalized a giving strategy that aligns with its brand and focuses on Small Business Support, Youth Entrepreneurship and Health and Wellness. Sam's Club facilities direct funding within the same focus areas as other facilities. Organizations will have the opportunity to identify whether they are working within the Sam's -specific giving areas when they apply online. Small Business Support: Examples include empowering small business particular those with women -and - minority owned businesses. Youth Entrepreneurship: Examples include helping young people choose to stay in school, develop the next generation of entrepreneurs and business leaders, programs that spark the entrepreneurial spirit in today's youth. Health and Wellness: Examples include programs that support nutrition and active lifestyles, educating people of all ages about their health, preventing and managing chronic disease. Eligibility Organizations with programs that benefit communities within the service area of the Walmart, Sam's Club or Logistics facility from which they are requesting funds; fit within one of the Walmart focus areas; and one of the following: • Hold a current tax-exempt status under Section 501(c)(3), (4), (6) or (19) of the Internal Revenue Code, • Are a recognized government entity: state, county, and city agency, including law enforcement or a fire department (including volunteer fire department) that is requesting funds exclusively for public purposes, • Are a K-12 public/private school, charter school, community/junior college, state/private college or university, • Are a church or other faith based organization with proposed projects that address and benefit the needs of the community at large. iii% �tM q 1 Funding Exclusions • Organizations with programs that do not benefit the communities within your service area • Organizations that receive sponsorship at the national level, including American Cancer Society, American Diabetes Association, American Heart Association, Children's Miracle Network, and United Way • Contests or pageants • Political causes, candidates, organizations or campaigns • Advertising, film or video projects • Individuals (requests made solely for the benefit of one person or family) • Research • Sponsorship of fundraising events (walks, races, tournaments, etc.) • Athletic sponsorships • Tickets for contests, raffles or any other activities with prizes • Capital campaigns and endowments • Association memberships • Scholarships (tuition, room and board or any other expense related to college/university/vocational school attendance) • Registration fees • Organizations whose services are limited to its. members • Projects that send products or people to a foreign country • Organizations that deny service to a potential client or beneficiary on the basis of race, religion, color, sex, sexual orientation, age, national origin, ancestry, citizenship, veteran or disability status Annual Budget • Each Walmart, Sam's Club or Logistics facility has an annual budget allocated by the Walmart Foundation. Facility budgets differ based on criteria set by the Walmart Foundation and are not published externally. Funding Cycle • The online application will open in February 2011. • The deadline to apply for funding for FY12 is December 1, 2011. New applications will not be accepted after this date. Application and Award Process • The funding minimum is $250. There is no maximum, although grants are generally less than $5,000. Each facility, as well as the Walmart Foundation, reserves the right to adjust the amount awarded to each organization without prior notice. • Applications must be completed in full and submitted online to be considered for funding. Submitting an online application does not guarantee funding. • Organizations muss apply to facilities in their local community only and for programs that directly affect those communities. Organizations that apply to facilities outside of their service reach will be denied and may face permanent disqualification from the program. • Facility management will review and make initial funding decisions on all submitted requests. • All requests are subject to final approval by the Walmart Foundation. • Organizations will be notified of funding decisions via email. Generally, applications are reviewed and funding decisions are made within 90 days of the submission date. Organization Recognition • Checks will be sent directly to the awarded organization after final funding decisions are made. • Organizations should contact the facility from which funds were awarded to schedule a formal recognition event. Mlmaet mss® 702 S.N/.. 8th St .' BENTONVILLE, ARKANSAS72716wal MA e jj C AIDCO VEND R NUMSE. AA7 1�8— OF INVOICES TO CHECK NUMBER BEAVER LAKE AVIATION, INC. BENTONVILL E 72716. 340356 05 23wd 11 AMOUNT 978577.1 WAL*MART PHARMACYOF PAY 05 19 11 8423630 05-9000 104487770 7W0 THOUSAN6.?. bd EARS AND. NO :CENTS:: TO THE "Fayet'teVilae Fare Departeient ORDER Facility OP `: 303 �+1= Center St; Fayeatevii3e AR 7270E 115978577 1111,4053 &0156 V: 207990013685411' * Wa[mart i �. 'INCLUDES IN PAYMENT 702 S.W. Sth ST. AIDCO NORTH ARKANSAS WHOLESALE CO., INC. OF INVOICES TO SAM'SCLUB BEAVER LAKE AVIATION, INC. BENTONVILL E 72716. PHILLIPS OUTLET STORES PHIPS COMPANIES INC. AMOUNT CMA*USA WAL*MART PHARMACYOF MICHIGAN, INC :.1 40VIA BANK, N A 66.156 ATE`OFCHECK;:::. `.: GHECK(NUMBER :' * VENDOR: Deduction codes are described on the reverse side of this statement. 16 23 11 PAG.F. 0789771. DATE INVOICE NUMBERGROSS STORE NUMBER DOCUMENT NUMBER TYPE CODE* AMOUNT DISCOUNTS/ ALLOWANCES NET AMOUNT MO. DAY YR. 05 19 11 8423630 05-9000 104487770 2,000.00 0.00 2,000.00 t t r� [ I' I r <ssal4tl �i IIs * VENDOR: Deduction codes are described on the reverse side of this statement. RESOLUTION NO. 96-11 A RESOLUTION APPROVING A BUDGET ADJUSTMENT IN THE AMOUNT OF $2,000.00 REPRESENTING DONATION REVENUE FROM THE WAL-MART FOUNDATION AND WAL-MART #5737 TO THE FAYETTEVILLE FIRE DEPARTMENT FOR THE PURCHASE OF LIFE VESTS BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF FAYETTEVILLE, ARKANSAS: Section 1. That the City Council of the City of Fayetteville, Arkansas hereby approves a budget adjustment, a copy of which is attached as Exhibit "A", in the amount of $2,000.00 representing donation revenue from the Wal-Mart Foundation and Wal-Mart #5737 to the Fayetteville Fire Department for the purchase of life vests. PASSED and APPROVED this 21St day of June, 2011. APPROVED: �10#LD J , Mayor ATTEST: By: 104"62 9� - &M&� SONDRA E. SMITH, City Clerk/Treasurer {t111111111f," K/TR�''°oma ®U° FAYETTEVILLECD ; RAS°Je ems'-9sy � ®N° Q.o °awe City of Fayetteville, Arkansas Budget Adjustment Form V11.0425 Budget Year Division: Fire Department Request Date Adjustment Number 2011 1 Department: Fire Department 6/21/2011 BUDGET ADJUSTMENT DESCRIPTION / JUSTIFICATION Recognize donation revenue from The Wal-Mart Foundation and Facility # 5737 to the Fayetteville Fire Department. Prepared By: Ginny Gundlach ggundlach Reference: Budget & Research Use Only Type: A B C rD E P General Ledger Date Posted to General Ledger Checked / Verified Initial Date Initial Date TOTAL BUDGET ADJUSTMENT 2,000 2,000 Increase / (Decrease) Project.Sub Account Name Account Number Expense Revenue Number Uniforms/personal equip 1010.3020.5302.00 2,000 06029. 1101 Donations 1010.0001.4809.00 2,000 06029. 1101 EXHIg GADivs\Fire\Financial\Agenda Items\Wal-Mart Donation\BA_11-xxx_Wal-Mart Donation_Jun11.xis 1 of 1 Division Head Date Budget irector Date Department DirectoV Date ��► � - � La 7' SLI Fin nce Director Date f ff- Daate navpf ate Prepared By: Ginny Gundlach ggundlach Reference: Budget & Research Use Only Type: A B C rD E P General Ledger Date Posted to General Ledger Checked / Verified Initial Date Initial Date TOTAL BUDGET ADJUSTMENT 2,000 2,000 Increase / (Decrease) Project.Sub Account Name Account Number Expense Revenue Number Uniforms/personal equip 1010.3020.5302.00 2,000 06029. 1101 Donations 1010.0001.4809.00 2,000 06029. 1101 EXHIg GADivs\Fire\Financial\Agenda Items\Wal-Mart Donation\BA_11-xxx_Wal-Mart Donation_Jun11.xis 1 of 1 City of Fayetteville Staff Review Form City Council Agenda Items and Contracts, Leases or Agreements June 21, 2011 City Council Meeting Date Agenda Items Only David Dayringer Fire Submitted By Division $ _ $ 11,942.00 Cost of this request Category / Project Budget 1010.3020.5329.00 $ 10,957.31 Account Number Funds Used to Date 06029/1101 $ 984.69 Project Number Budgeted Item Remaining Balance Budget Adjustment Attached �X Fire Department recognize donation revenue from Donations - Fire Program Category / Project Name Donations Program / Project Category Name General Fund Name s "— e Previous Ordinance or Resolution # Date Original Contract Date: 5-2-7-11 Original Contract Number: Date Finance and Internal Services Director Date -f)mS'3v ' ► I ief of Sta Date M or ate Received in Ci t65-27-1 1 P02:22 RCVD Clerk's Office t/v1 AAA . VX Received in Mayor's Office Revised January 15, 2009 CITY COUNCIL AGENDA MEMO To: Mayor and City Council From: David Dayringer, Fire Chief Date: June 21, 2011 THE CITY OF FAYETTEVILLE, ARKANSAS DEPARTMENT CORRESPONDENCE Subject: Recognition and acceptance of a donation to the Fayetteville Fire Department PROPOSAL: Due to the severity of recent inclement weather and flooding, the City of Fayetteville Fire Department has recognized the need for additional rescuer and victim life vests. The department recently experienced thirty- three water rescue calls within approximately four hours. During this event, the department did not have enough rescuer and victim life vests to keep the firefighters and citizens safe. The Wal-Mart Foundation and Facility # 5737 have responded to this need by donating $2,000.00 to the Fayetteville Fire Department to be used for the purchase of rescuer and victim life vests. RECOMMENDATION: Staff recommends a resolution approving a budget adjustment in the amount of $2,000.00 to accept and recognize donation revenue from The Walmart Foundation and Facility # 5737 to the Fayetteville Fire Department. BUDGETIMPACT: Upon approval to accept and recognize this donation, the Fire Department's Uniforms / Personal Equipment account will be increased by $2,000.00 and the expenses will be tracked through the City's project accounting system. RESOLUTION NO. A RESOLUTION APPROVING A BUDGET ADJUSTMENT IN THE AMOUNT OF $2,000.00 REPRESENTING DONATION REVENUE FROM THE WAL-MART FOUNDATION AND WAL-MART #5737 TO THE FAYETTEVILLE FIRE DEPARTMENT FOR THE PURCHASE OF LIFE VESTS BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF FAYETTEVILLE, ARKANSAS: Section 1. That the City Council of the City of Fayetteville, Arkansas hereby approves a budget adjustment, a copy of which is attached as Exhibit "A", in the amount of $2,000.00 representing donation revenue from the Wal-Mart Foundation and Wal-Mart #5737 to the Fayetteville Fire Department for the purchase of life vests. PASSED and APPROVED this 21St day of June, 2011. APPROVED: LN ATTEST: By: LIONELD JORDAN, Mayor SONDRA E. SMITH, City Clerk/Treasurer Walmartstores.com: Online Applications Find-ai` :2 FACIE Uz - — ----------- rage i of z Homo About Us f=acts & News Health & VVeliness Career Community & Giving Diversity $ustlinabllity Investors Suppliers Online Applications Confirmation of Application Receipt: You, propo!;4.J'subil'itted to i..;11vairnati �curiaia!!ori. No rurthe.r action on youf ;%,Wt 4, requir'XI. A conli"Matfiwi einail %,Ml sn'.111k to U110 e1nad provided dutiM."'A regisuF*10, 1. P -ease n0le: Appliceti ns, ari5 wott-,.'ry Sn. da set the subrnission date. Orae funding dedsio 5 ronade, You will roc.elve e,' "ED11Gw up stai,s errial 'to Print a co;py et tM� app."a-, ian ,p tc T'i'a", P,:(..V In your crow ser t0nlwl)sr. C:'!,7k hare, to return to the hannegago whell you are Nomination Information Organization Description (required) ilr' i Zip (required) .2. 7 7 011 Telephone (required)7M716.,(4632. E-mail Address (required) Contact Type 'required) P;'k1MiiY Oar.'Eli,-t Contact Information First Name (required) C, - Last Name (required) rayetlev lla Fire Depamyiens Contact Title (required) Ass�-arit Rim Chief Address (required) 303 "Veer"e., S, City (required) Fayetteville State (required) A:kir-as Zip (required) .2. 7 7 011 Telephone (required)7M716.,(4632. E-mail Address (required) Contact Type 'required) P;'k1MiiY Oar.'Eli,-t W I AAAA N6 J� t �,Of h6t Wed) 5 W, 5 -bre, W,4-179(91 C,eW -0- 'ST6,150-,1�2 1%./ Zip (required) Telephone irequilmd) 47 oyv.5 - Fax lkebsito Addross Organization Mission (required) To rxo,.dL otircikLens, quests: and empicy-jes w.1-1 6i to quality Fire. F�-s,-A"e.w"..'MS. nild Community S6�-,rims wi'hlri the �,',[Y iimitS D' 'itevi'lc Current Activity (required) Ourorj�&Nzat-on resporids to calls fpr arilergcnc se""lo"', Close to S;NOP per i range i Orl. St! LICiLl!•at t0chnical tesr.Aias. vew. -,ezoe services - h., zarOus materiels, ri-iotor vehick, accidents, ate Facebook (required) nla Twitter (required) 21 Request History Previous Funding Requests - All Locations (required) N,;A Previous Funding -All Locations (required) NIA hq://www.cybergrants.com/pls/cybergrants/ap_application.§ubniit_app 5/10/2011 Organization Information Legal Name (required) -syeiaev...'e =ire Dopprtmerit Payee Name (required) rayetlev lla Fire Depamyiens Address (required) 303 W Center S, City (required) Peye*i�v:,le State (required) AnKames W I AAAA N6 J� t �,Of h6t Wed) 5 W, 5 -bre, W,4-179(91 C,eW -0- 'ST6,150-,1�2 1%./ Zip (required) Telephone irequilmd) 47 oyv.5 - Fax lkebsito Addross Organization Mission (required) To rxo,.dL otircikLens, quests: and empicy-jes w.1-1 6i to quality Fire. F�-s,-A"e.w"..'MS. nild Community S6�-,rims wi'hlri the �,',[Y iimitS D' 'itevi'lc Current Activity (required) Ourorj�&Nzat-on resporids to calls fpr arilergcnc se""lo"', Close to S;NOP per i range i Orl. St! LICiLl!•at t0chnical tesr.Aias. vew. -,ezoe services - h., zarOus materiels, ri-iotor vehick, accidents, ate Facebook (required) nla Twitter (required) 21 Request History Previous Funding Requests - All Locations (required) N,;A Previous Funding -All Locations (required) NIA hq://www.cybergrants.com/pls/cybergrants/ap_application.§ubniit_app 5/10/2011 waimartstores.com: untme Applications rage /_ of L Previous Funding - This Location (required) No Previous Funding Cate - This Location Area of Focus Focus Area (required) Hea€Ih r. Frss:ss Primary Subcategory (required) Emergency assstar:^,e ^:'o fra:'rs Sam's Club Additional Category Community Served Area Served (required) wash:noton Gender (required) 50% Male v(i z: i�<arrie Age Group (required) 'i QOrh All Ames Ethnic. Background (required, 100: L,, Ail Program Information Grant Typo (required) t-x,•a Community Co:itdnu?iori Requested Grant Amount (required) $2,D00.00 Project Title (required) MAT 5737 Application Program Descripttan (rxaquired)2ecent y we expe-enced 33 yr-ritar reswe his ,Aths l epproxrmateiy ^ ivou;s. Oat- epa, rcaeni :s in ceelof additional rescuer life -vests ir, xdar to provide el, ar . protea°ion for ine :x;n:m ^'-iy. VVe cid not have enough resour or vitAim vests to keen ourlitatigiaers and a.E+za-!s sFxrc. Program Relevancy (required) 1"Iaese, lire vests will proviee er;ier4;ancf res xnss c::'1:is vrith vitally needed ecu: meat. Ec pr-otect avcs in our r esporso dshn. ts. Need Swoon Shop i Shap f aivsoulr.umr ) Imemstionai .tabs Viaecs ) Recalls i Other (rites i Twitter ' Retum Po tiny ` Pwac_y Ca5r. Rights I UO Me-, i Teras o k)se hq-//vwvw.cybergrants.conn/pls/cybergrants/ao_application.submit app 5/10/2011 FY12 Facility Level Giving- Local Community Contribution (LCC) Guidelines Walmart Stores, Sam's Clubs and Logistics Facilities At Walmart, we believe in operating globally and giving back locally. Through our Local Community Contribution program (LCC), facilities are able to support the needs of their local communities by funding organizations working to improve the lives of our associates, customers and neighbors. Areas of Focus for Potential Grantees The Walmart Foundation has areas of focus including Education, Workforce Development / Economic Opportunity, Health and Wellness, Environmental Sustainability, and Hunger Relief. Through the LCC program, the Walmart Foundation requires that all funds are directed to programs that fall within our above focus areas. Education: Examples include programs that re-engage students who have dropped out of high school, improve retention rates of first -generation college students, support teachers and promote childhood literacy. Workforce Development / Economic Opportunity: Examples include job placement efforts, adult education, occupational training, training for English language learners, career counseling, increasing access to earned income tax credit benefits and other state/federal benefits. Health and Wellness: Examples include cooking and meal planning classes for Women, Infants, and Children (WIC) recipients, healthy snacks for kids in summer programs, and support for doctors planning community health programs for underserved children. Environmental Sustainability: Examples include waste reduction programs, and sustainable agriculture initiatives. Hunger Relief: Examples include soup kitchens, food pantries, backpack programs, and school breakfast programs. Sam's Club Additional Focus Areas Sam's Club has recently. finalized a giving strategy that aligns with its brand and focuses on Small Business Support, Youth Entrepreneurship and Health and Wellness. Sam's Club facilities direct funding within the same focus areas as other facilities. Organizations will have the opportunity to identify whether they are working within the Sam's -specific giving areas when they apply online. Small Business Support: Examples include empowering small business particular those with women -and - minority owned businesses. Youth Entrepreneurship: Examples include helping young people choose to stay in school, develop the next generation of entrepreneurs and business leaders, programs that spark the entrepreneurial spirit in today's youth. Health and Wellness: Examples include programs that support nutrition and active lifestyles, educating people of all ages about their health, preventing and managing chronic disease. Eligibility Organizations with programs that benefit communities within the service area of the Walmart, Sam's Club or Logistics facility from which they are requesting funds; fit within one of the Walmart focus areas; and one of the following: • Hold a current tax-exempt status under Section 501(c)(3), (4), (6) or (19) of the Internal Revenue Code, • Are a recognized government entity: state, county, and city agency, including law enforcement or a fire department (including volunteer fire department) that is requesting funds exclusively for public purposes, • Are a K-12 public/private school, charter school, community/junior college, state/private college or university, • Are a church or other faith based organization with proposed projects that address and benefit the needs of the community at large. iii% �tM q 1 Funding Exclusions • Organizations with programs that do not benefit the communities within your service area • Organizations that receive sponsorship at the national level, including American Cancer Society, American Diabetes Association, American Heart Association, Children's Miracle Network, and United Way • Contests or pageants • Political causes, candidates, organizations or campaigns • Advertising, film or video projects • Individuals (requests made solely for the benefit of one person or family) • Research • Sponsorship of fundraising events (walks, races, tournaments, etc.) • Athletic sponsorships • Tickets for contests, raffles or any other activities with prizes • Capital campaigns and endowments • Association memberships • Scholarships (tuition, room and board or any other expense related to college/university/vocational school attendance) • Registration fees • Organizations whose services are limited to its. members • Projects that send products or people to a foreign country • Organizations that deny service to a potential client or beneficiary on the basis of race, religion, color, sex, sexual orientation, age, national origin, ancestry, citizenship, veteran or disability status Annual Budget • Each Walmart, Sam's Club or Logistics facility has an annual budget allocated by the Walmart Foundation. Facility budgets differ based on criteria set by the Walmart Foundation and are not published externally. Funding Cycle • The online application will open in February 2011. • The deadline to apply for funding for FY12 is December 1, 2011. New applications will not be accepted after this date. Application and Award Process • The funding minimum is $250. There is no maximum, although grants are generally less than $5,000. Each facility, as well as the Walmart Foundation, reserves the right to adjust the amount awarded to each organization without prior notice. • Applications must be completed in full and submitted online to be considered for funding. Submitting an online application does not guarantee funding. • Organizations muss apply to facilities in their local community only and for programs that directly affect those communities. Organizations that apply to facilities outside of their service reach will be denied and may face permanent disqualification from the program. • Facility management will review and make initial funding decisions on all submitted requests. • All requests are subject to final approval by the Walmart Foundation. • Organizations will be notified of funding decisions via email. Generally, applications are reviewed and funding decisions are made within 90 days of the submission date. Organization Recognition • Checks will be sent directly to the awarded organization after final funding decisions are made. • Organizations should contact the facility from which funds were awarded to schedule a formal recognition event. Mlmaet mss® 702 S.N/.. 8th St .' BENTONVILLE, ARKANSAS72716wal MA e jj C AIDCO VEND R NUMSE. AA7 1�8— OF INVOICES TO CHECK NUMBER BEAVER LAKE AVIATION, INC. BENTONVILL E 72716. 340356 05 23wd 11 AMOUNT 978577.1 WAL*MART PHARMACYOF PAY 05 19 11 8423630 05-9000 104487770 7W0 THOUSAN6.?. bd EARS AND. NO :CENTS:: TO THE "Fayet'teVilae Fare Departeient ORDER Facility OP `: 303 �+1= Center St; Fayeatevii3e AR 7270E 115978577 1111,4053 &0156 V: 207990013685411' * Wa[mart i �. 'INCLUDES IN PAYMENT 702 S.W. Sth ST. AIDCO NORTH ARKANSAS WHOLESALE CO., INC. OF INVOICES TO SAM'SCLUB BEAVER LAKE AVIATION, INC. BENTONVILL E 72716. PHILLIPS OUTLET STORES PHIPS COMPANIES INC. AMOUNT CMA*USA WAL*MART PHARMACYOF MICHIGAN, INC :.1 40VIA BANK, N A 66.156 ATE`OFCHECK;:::. `.: GHECK(NUMBER :' * VENDOR: Deduction codes are described on the reverse side of this statement. 16 23 11 PAG.F. 0789771. DATE INVOICE NUMBERGROSS STORE NUMBER DOCUMENT NUMBER TYPE CODE* AMOUNT DISCOUNTS/ ALLOWANCES NET AMOUNT MO. DAY YR. 05 19 11 8423630 05-9000 104487770 2,000.00 0.00 2,000.00 t t r� [ I' I r <ssal4tl �i IIs * VENDOR: Deduction codes are described on the reverse side of this statement.