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CITY OF RIVERSIDE <br /> E <br /> Tax ID# 95-600-0769 F r� <br /> DONATION ACCEPTANCE FORM ,,:{{ <br /> City C1, ,:'s Office <br /> Name of Donor: MySafe:California <br /> Address: 1800 South Brand Blvd #121 City: Glendale State: CA Zip:91204 <br /> Description of donation: 28 smoke detector/fire alarms and 8 carbon monoxide alarms. <br /> Donor estimate of current value: $843.64 <br /> Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br /> replacement cost: None <br /> Intended use: to have available for distribution to Riverside residents who <br /> need a new or replacement alarm. <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: Michael Moore <br /> Deposit Account Code: <br /> APPROVED / DISAPPROVED <br /> Q7O7/—/, <br /> 401 <br /> Date Department Head/Elected Official 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 <br /> of donated items. <br /> Original to City Clerk <br /> cc:City Council, Finance Department, Receiving Department <br />