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CITY OF RIVERSIDE RECEIVE® <br /> Tax ID#95-600-0769 <br /> DONATION ACCEPTANCE FORM DEC 1 1 2017 <br /> City of Riverside <br /> Name of Donor: Riverside Elks City Clerk's Office <br /> Address: 6166 Brockton Ave. City: Riverside State: CA, Zip: 92506 <br /> Description of donation: $2,000—Ck. #1023 <br /> Donor estimate of current value: $2,000 <br /> Potential immediate or initial acquisition or installation cost, any on-going maintenance or replacement cost: <br /> Will partially fund purchase of canine. Total cost for purchase of canine, training and equipment usually runs <br /> $20,000, which will be fully funded by accumulated donations. <br /> Intended use: Purchase of canine for RPD <br /> Conditions of acceptance or donor designation: None <br /> Remarks: No Goods or Services were provided by the City in exchange for the donation <br /> City Department and City Representative receiving donation: Linda Fonze <br /> Deposit Account Code: 0000720-225140 <br /> APPROVED/ DISAPPROVED <br /> 12/6/17 <br /> Date <br /> Cieparttmt Head/Elected icial Signature <br /> Date Chief Financial 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 of donated <br /> items. <br /> Original to City Clerk <br /> cc:City Council, Finance Department, Receiving Department <br />