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CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM <br />Name of Donor: Riverside Rotary Foundation <br />)f Riverside <br />.: k s Office <br />Address: P.O. Box 432 City: Riverside State: CA Zip: 92502 <br />Description of donation: Check for City of Riverside Fire Department File for Life program. <br />Donor estimate of current value: $500.00 <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: N/A <br />Intended use: File for Life program <br />Conditions of acceptance or donor designation: File for Life program <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 <br />Deposit Account Code: <br />APPROVED / DISAPPROVED <br />7/25/2018 <br />Date <br />3500000 / 374222 <br />Department Hed/Elected Official Signature <br />0 <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 />