Donation Acceptance Forms
4/6/2020 2:21:10 PM
4/6/2020 2:21:07 PM
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CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM <br />Name of Donor: Maxi Foods LLC <br />Address: 8616 California Ave <br />Description of donation <br />City: Riverside State: CA Zip:92504_ <br />Indivival hand sanitizer (6 boxes of 2000 ea <br />Donor estimate of current value: <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: N/a <br />Intended use: For city employees PPE gear <br />Conditions of acceptance or donor designation: <br />Remarks: No Goods or Services were provided by the City in exchange for the donation <br />City Department and City Representative receiving donation: Gaby Plascencia <br />Deposit Account Code: <br />APPROVED / DISAPPROVED <br />3-28-20 <br />Date Department Head/Elected Offi ' 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 />
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