ITY OF C.HULA VISTA
DONATION ACCEPTANCE FORM
Name of donor:
Address: J, (D, I City: Stater Zip: Qi
Description of donation
Donor estimate of curre
Potentialimmediateor initial acquisitionor installationcost, anyon-going maintenanceor replacement cost: ( 1' O,_
Intended use:
Conditions of acceptance or donor designation:
Remarks:
City department receiving donation: \() a3 s P
APPROVED / DISAPPROVED
Date Department Head' s Signature
Date
Date Submitted to Council
Date
City Manager' s Signature
Date Approved by Council
Mayor' s Signature
Note: The City of Chula Vista cannotguaranteefuture funding for repair, maintenance, useor replacementof donated items.
CC: City Council, Finance Department, City Manager' s Office Page I of t