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CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM <br />Name of Donor: Riverside Elks Club <br />RECEIVE <br />JUN 12 2019 <br />City of Riverside <br />City Clerk's Office <br />Address: 6166 Brockton Avenue City: Riverside State: CA Zip: 92506 <br />Description of donation: Check #1136 $2,000.00 (Dated 6/5/2019) <br />Donor estimate of current value: N/A <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: N/A <br />Intended use: Riverside Police K9 Unit <br />Conditionsofacceptance or donor designation: N/A <br />Remarks: No Goods or Services were provided by the City in exchange for the donation <br />City Department and City Representative receiving donation: Sergeant Angulo <br />Deposit Account Code: 0000720-225140 <br />APPROVED/DISAPPROVED <br />Date <br />De•art"ien <br />/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 />