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RECEIVED <br /> CITY OF RIVERSIDE NOV 1 6 2017 <br /> DONATION ACCEPTANCE FORM <br /> City of Riverside <br /> City Clerks Office <br /> Name of Donor: FTeLOpowtet <br /> Address: 1 t(1,' 1 S ( P+€ City: 1Z,1 ") State: C44- Zip: 't S o3 <br /> Description of donation: ?s-LxcAi 11 7�� t.�c,,►t� s, <br /> Donor estimate of current value: 411,000,cza <br /> Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br /> replacement cost: 104 e— ,.���� No-1- <br /> Intended <br /> o"1Intended use: %-r-oszke4 OF o4,L.ovo1>`.aT <br /> Conditions of acceptance or donor designation: 0#40Air. <br /> Remarks: <br /> City Department receiving donation: ?ot.Tec DEsefotromai <br /> APPROVED 1 DISAPPROVED <br /> ' ' 7 ent Head/ElecOfficial Signature <br /> Date Depa�me g <br /> Date hief ''na cial 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 /> cc: City Council, Finance Department,City Clerk <br />
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