6.a) NPS Donation FormI'Mr�{r ,
SCAN DIA
DONATION FORM FOR PUBLIC IMPROVEMENT PROJECTS, MEMORIALS,
TRIBUTES, WORKS OF ART
(Including funding proposals for the above purposes)
DONOR INFORMATION
Name:
Addres
Phone: -
Email: VPS -!,toy
Hereby makes a proposal to fund and/or construct a Public Improvement Project, memorial,
tribute, or work of art consisting of
11 _
The intended purpose of this donation is
Proposed location
Donation subject to the following restriction (if any): h. 0 In of
Condition, Conservation and Maintenance Requirements:
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What type of materials will be used in the proposed Project?eSr►�,A
What is the intended life span of the Project? 2 3 ea-rS
What short and long-term maintenance may be required and what is the anticipated cost of such
The City of Scandia will make reasonable efforts to accommodate the intended purpose of the
donation but reserves the right to utilize, relocate and/or dispose of any item through donated
funds as the City of Scandia may deem fit.
This agreement shall not take effect until the City Council for the City of Scandia has
specifically accepted this donation by a resolution receiving and affirmative vote of two-thirds of
the Council.
D r Date
Donor Date
Recommended:
Department Head Date
Accepted:
City Administrator Date