Note: The City of Chula Vista cannot guarantee future funding for repair, maintenance, use or replacement of donated items.
CC: City Council, Finance Department, City Manager’ s Office Page 1 of 2
CITY OF CHULA VISTA
DONATION ACCEPTANCE FORM
Name of donor: ________________________________________________________________ Address:____________________________ City:______________ State:_______ Zip:________ Description of donation:__________________________________________________________ Donor estimate of current value:____________________________________________________ Potential immediate or initial acquisition or installation cost, any on- going maintenance or replacement cost:_______________________________________________________________ Intended use:___________________________________________________________________ Conditions of acceptance or donor designation:________________________________________ Remarks:______________________________________________________________________ City department receiving donation:_________________________________________________
APPROVED / DISAPPROVED
Date Department Head’ s Signature
Date City Manager’ s Signature
Date Submitted to Council Date Approved by Council
Date Mayor’ s Signature
CITY OF CHULA VISTA
DONATION AND GIFT POLICY ACKNOWLEDGEMENT
I have received and read the City of Chula Vista’ s Donation and Gift Policy and understand its provisions. I further understand that when I sign this acknowledgement form, it will be placed in my personnel file.
Employee ( PRINT NAME)
Signature
Date