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RECEIVED <br /> CITY OF RIVERSIDE JUL 2 6 2018 <br /> Tax ID#95-600-0769 <br /> DONATION ACCEPTANCE FORM City of Riverside <br /> City Clerk's Office <br /> Name of Donor: ��vlt✓ meta o C-CAL-141r)/a, <br /> Address: 545-5" A i4D r t1 i i d City: C-05 n 11 S State: CA Zip: '2 6'a4 <br /> Description of donation: Weil u '5 c``11 -10 k ii S,C4 Lti44A <br /> CG 's Lift I vi (341 a-pit Cst_ in {i t/e SS f c r�l�'IZ <br /> Donor estimate of current value: a5)000 <br /> Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br /> replacement cost: Nl <br /> Intended use: (1J f' rlis5 -Pr-Dr/yr, -Co r 611( QinP i"s ick C=vmpf a v-eio <br /> , <br /> Conditions of acceptance or donor designation: WI 11 cis ,'vL1rk <br /> >iJe U Vte ss 1,a 02,1,T.-±.1�P s <br /> Remarks: No Goods or Services were provided by the City in exchange for the donation <br /> City Department and City Representative receiving donation: "--ft,t k2Lr1kesouras <br /> Deposit Account Code: Md UO )0 - 1 - 21 - �C a lncrrO-` 3ga- <br /> APPROVED/ DISAPPROVED <br /> 7/( I /1 g <br /> Date Depa • - -.; Elected Official Signature <br /> Dep, <br /> ._ <br /> Date tef Fin" 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 /> Original to City Clerk <br /> cc:City Council, Finance Department, Receiving Department <br />