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CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM Fr.3 <br />Name of Donor: Artemis Institute for Clinical Research C+tj <br />Address: 770 Washington St, Suite 300 City: San Diego State: CA Zip: 92103 <br />Description of donation: Donation for Banner at the Purple Boat Float <br />Donor estimate of current value: $150 <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: NA <br />Intended use: Donation for Banner <br />Conditions of acceptance or donor designation: Offset the cost of banners for Purple Boat Float <br />Remarks: Please deposit $150 into 0120000-374222 and transfer only $110 into 0120000- <br />450039 <br />City Department and City Representative receiving donation: Office of the Mavor-Kathv Youna <br />Deposit Account Code: 0120000-374222 <br />Exp. Account Code: 0120000-450039 <br />APPROVED / DISAPPROVED <br />Date Departmen <br />((/1 AA s <br />eEle-I 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 />