Donation Acceptance Forms
City of Los Angeles
9/28/2018 3:28:17 PM
9/28/2018 3:27:20 PM
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CITY OF RIVERSIDE <br /> Tax ID# 95-600-0769 <br /> DONATION ACCEPTANCE FORM <br /> Name of Donor: City of Los Angeles <br /> Address: 200 N. Spring Street City: Los Angeles State: CA Zip: 90012 <br /> Description of donation: Warrant 0300803638 <br /> Donor estimate of current value: $2,750 <br /> Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br /> replacement cost: N/A <br /> Intended use: Purchase of Equipment for the Large Animal Rescue Team. <br /> Conditions of acceptance or donor designation: No Conditions. <br /> Remarks: No Goods or Services were provided by the City in exchange for the donation. <br /> City Department and City Representative receiving donation: Fire Dept/ Captain Tyler Reynolds <br /> Deposit Account Code: 3510000-374222 <br /> APPROVED / DISAPPROVED <br /> 05 /~XIA3Pdr moir <br /> Date Departnt Head/Elected Official Signature <br /> PACti 13-- <br /> Date hie'eincial Officer Signature (if needed) <br /> Date Submitted to Council Date Approved by Council (if needed) <br /> Note: The City of Riverside cannot guarantee future funding for repair, maintenance, use or replacement <br /> of donated items. <br /> Original to City Clerk <br /> cc: City Council, Finance Department, Receiving Department <br />
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