Donation Acceptance Forms
Coupang Global LLC
4/7/2020 10:19:27 AM
4/7/2020 10:19:19 AM
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CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM <br />Name of Donor: Coupang Global LLC <br />Address: 1560 Sierra Ridge Drive, City: Riverside_ State: CA—Zip: 92507 <br />Description of donation: GIKO 1200 N95 filtering facepiece (4,000) <br />Donor estimate of current value: $13,000 <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: None <br />Intended use: NIOSH approved face masks <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: <br />Deposit Account Code: 9915400885-37422200 <br />APPROVED / DISAPPROVED <br />4-7-2020 <br />Date <br />Department He /Elec e Official Signature <br />Date Chief Financial Officer Signature (if needed) <br />Date Submitted to Council <br />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 />Attest: <br />Collee . Nicol, City Clerk <br />APP VED AS E'W <br />B <br />CHI ASSISTANT CITY ATTORNEY <br />
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