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CITY OF RIVERSIDE RECEIVED <br /> Tax ID# 95-600-0769 NOV 0 7 2017 <br /> DONATION ACCEPTANCE FORM <br /> City of Riverside <br /> City Clerk's Office <br /> Name of Donor: Marie J. Fritts <br /> Address: 2222 Rockwell Rd City: Riverside <br /> State: CA Zip:92506 <br /> Description of donation: Check# 4269 in the amount of$8,200. <br /> Donor estimate of current value: N/A <br /> Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br /> replacement cost: N/A <br /> Intended use: Mrs. Fritts requests that RFD use some of the donation to pay for a <br /> Recognition Dinner to honor the RFD members who responded to the recent hurricanes. The <br /> balance will qo towards other departmental needs. <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 Chief Michael Moore <br /> 35 0c,co-37�t�-2Z <br /> Deposit Account Code: 3500000-384222- <br /> APPROVED I DISAPPROVED <br /> 4011011111MIIMPPIVIAlly <br /> Da a Depart nt Head/Elected Official Signature <br /> [0 /7-7/13, "P-21( <br /> Date Chie ancial 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 />