Laserfiche WebLink
CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM <br />Name of Donor: HUB International <br />AddressPO Box 2158 <br />OCT 24 2019 <br />City of Riverside <br />City Clerk's Office <br />City: Riverside State: CA Zip: 92516 <br />Description of donation: Wellness Marketing Funds <br />Donor estimate of current value: $13,280.17 <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: N/A <br />Intended use: Funds will be used for Wellness activities. <br />Conditions of acceptance or donor designation: Wellness initiatives <br />Remarks: No Goods or Services were provided by the City in exchange for the donation <br />City Department and City Representative receiving donation: Human Resources - Stephanie Holloman <br />Deposit Account Code: 2100000-453221 <br />APPROVED/DISAPPROVED <br />10/16/2019 <br />Date // rt Head/ ed ed Official Si nature <br />G' <br />Date Chief Financia�o VcerSignature (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 />