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CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM <br />0X019 <br />Name of Donor: Heroes Restaurant and Brewery <br />Ci':y of Rive 51de <br />Address: 3397 Mission Inn Ave. City: Riverside State: CA Zip:c `5 Yl' -'''r'° thrice <br />Description of donation: $150 Sponsorship check <br />Donor estimate of current value: $150.00 <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: NA <br />Intended use: Sponsorship of the 52 things to do in Riverside (Deck of cards) <br />Conditions of acceptance or donor designation: Business (Heroes) will be featured in the deck <br />of cards <br />Remarks: No Goods or Services were provided by the City in exchange for the donation <br />City Department and City Representative receiving donation: Office of the Mavor-Kathv Young <br />Deposit Account Code: 0120000-374222 <br />Exp. Account Code: 0120000-453925 <br />APPROVED / DISAPPROVED <br />Date <br />ex id. 4- 1 (.1,, {Lk) <br />Department Head/Elected Official Signage <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 />