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CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM <br />Name of Donor John Brendon <br />Address: City: State: Zip: <br />Description of donation: Monetary donation for Hunt Park exercise equipment repairs. <br />Donor estimate of current $500.00 <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: <br />Intended use: Purchase new parts to repair exercise equipment at Hunt Park <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: PRCSD — Parks / Jarin Valencia <br />Deposit Account Code: New Donation Account <br />APPROVED/DISAPPROVED <br />1IJcLi f <br />Date <br />Date <br />EA- <br />epartment Head/Elected Official Signature <br />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 />