ame of donor:
CITY OF CHULA VISTA
DONATION ACCEPTANCE FORM
Address: 110 y trf 5 - City: _ State: CA Zip 101
Description of donation:;,
Donor estimate of current value: Qk )
Potentialimmediateor initial acquisition or installationcost, anyon-going maintenanceor replacement cost: r). 10-
Intended
J0_
Intended use:
Conditions, of acceptance or donor designation: s?'-
Remarks,
City department receiving donation: Aint nnal
APPROVED / DISAPPROVED
Date
Date
Date Submitted to Council
Date
Department Head' s Signatur
City Manager' s Signature
DateApprovedby Council
Mayor' s Signature
Note: The City of Chula Vista cannot guaranteefuture funding for repair, maintenance, useor replaconienrof donateditems.
CC: City Council, FinanceDepartment, City Manager's Office Page 1 of 2