CITY OF MERCED
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:________________________________________________________________________ Department Receiving Donation:_____________________________________________________________
APPROVED/ DISAPPROVED
Date Department Head Signature
Date City Manager Signature
Approval
of City Council Required if Donation Exceeds $5,000.
Date Submitted to Council Date Approved by Council
Date Mayor Signature
NOTE: The City of Merced cannot guarantee future funding for repair, maintenance, use or replacement of donated items. cc: City Council, Finance Department, City Clerk
CITY OF MERCED, CALIFORNIA
DONATION AND GIFT POLICY ACKNOWLEDGEMENT
I have received and read the City of Merced Donation and Gift Policy and understand its provisions.
Employee (PRINT Name)
Employee Signature
Date