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Cele:bratlno 12S fear.s <br />Name of Business <br />City of Everett <br />3002 Wetmore Ave <br />Everett, WA 98201 <br />425-257-8493 <br />In-Kind Contribution Form <br />..... ;"li1:L;r•·-,_· ,·?cif#tHi?iltiihtiffot@'lltiilriit. <br />or Individual: National Insurance Crime Bureau <br />Name of Primary Contact: Supervisory Special Agent John Anderson <br />Address: 1313 Broadway, Suite 310 <br />City: Tacoma State: WA Zip Code: 98402 -----------Telephone: 42 5-864-8045 <br />Description of Contributed Goods or Services: 2017 <br />E-mail:janderson@nicb.org <br />VIN O Insurance for use as an undercover driver veh ations. <br />Date(s) Con tributed: .:3::..:/9::./=20=2=2=---------c-------------------­Real or Estimated Value of Contribution: $ $22 ,000 <br />How was the value determined?: -"..-----"□=A-'-'c=-=t=-=ua'--1-V_a_lu-e----□--A-p-p-ra-is_a_l __ _c���O-t-h-er- <br />lf other, please explai n: internet online vehicle valuation site based on the vehicle equipment. <br />Who Made this Value Determination?: NICB -'-'-'--'-'------------------- <br />Is there a restriction on the use of this contribution?: □ No X Yes <br />tf yes, what are the restrictions?: Vehicle donation runs 1 year with renewal based on the needs <br />and approval of Everett Police and approval of PEMCO JJlll""U"'ra,,,n_,_,c�e'-'-. ----"-�----- <br />Was this contribution obtained with or supported by Federal funds?: )(No <br />If yes, please provide the name of the Federal agency and the grant or contract number: <br />5/15/2022 <br />Signature of Contributor <br />� Thank you for your support!! C!IJ <br />Person Receiving Goods or Services on Behalf of Program: <br />Printed Name <br />Signature <br />Accounting Use Only: <br />$ <br />Date <br />Position <br />Date Received <br />□ Yes <br />Value Recorded DR/CR Account Numbers Date fntered Data Entry Person JE Number <br />July 2010