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CITY OF RIVERSIDE <br />Tax ID# 95-600-0769 <br />DONATION ACCEPTANCE FORM <br />Name of Donor: Cathy Jablonski - Orange Terrace Advisory <br />Address: 20010 Orange Terrace Parkway City: Riverside State: CA Zip: 92508 <br />Description of donation: Movies in the Park- Licensing Fee for Orange Terrace Park <br />Donor estimate of current value: $460.00 <br />Potential immediate or initial acquisition or installation cost, any on-going maintenance or <br />replacement cost: N/A <br />Intended use: Movies in the Park - Purchase Movie Licensing from Swank <br />Conditions of acceptance or donor designation: Host Movies in the park at Orange Terrace <br />Remarks: No Goods or Services were provided by the City in exchange for the donation <br />City Department and City Representative receiving donation: Desiree Gurrola <br />Deposit Account Code: Deposit to account 52050019343620 and increase expenditures in <br />5205005208-42104000 Work order: 0814610-03 in equal amount <br />APPROVED / DISAPPROVED <br />/2-171 <br />Date [)'epartment Head/Elected Official 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 />