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CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM <br />RECEIVED <br />FES 2 4 2021 <br />City of Riverside <br />City Clerk's Office <br />Name of Donor: (-a 3 b i v ;,/"j (_ <br />��_ lAv city: State: ' Zip: <br />Description of donation:1�_)7cero� <br />1DS M,a�.i� a }lly� <br />Donor estimate of current value: dj 1i 000° a Q <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: t,Wi_ <br />Intended use: r'ylic t (�y� Q%,�fnl i f�FJC.J�� Zil3 Sr,4 716 <br />I��1 CLf % Li/=TiJC� G'y'�1 <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: 8(yc_/LSr[) t: i'oZicz �>zAm771zR)I <br />Deposit Account Code: <br />APPROVED IDISAPPROVED <br />_ Z <br />Date <br />Date <br />Date Submitted to Council <br />Departmh9t Head/Elected Offici4l Signature <br />Chief Financial Officer Signature (if needed) <br />Date Approved by Council (if needed) <br />F <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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