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CITY OF RIVERSIDE <br /> RECEIVED <br /> Tax ID# 95-600-0769 JAN 0 9 2018 <br /> DONATION ACCEPTANCE FORM City of Riverside <br /> City Clerk's Office <br /> Name of Donor: Ellen DeGeneres <br /> Address: City: State: Zip: <br /> Description of donation: See attached List <br /> Donor estimate of current value: $9,875 <br /> Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br /> replacement cost: N/A <br /> Intended use: Donated electronics, kitchen items and gift cards intended to show <br /> appreciation for Arlanza Fire Station No. 7's strike team service at the Thomas Fire in Ventura. <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 Department— Chief <br /> Moore <br /> Deposit Account Code: N/A <br /> APPROVED/ DISAPPROVED <br /> /- 31Y <br /> Date Dep- • -cted Official Signature <br /> I -4 - 18 _ <br /> Date Chie Fin.nc - •fficer 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 />