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Cele fir wtlaq 1]5 years <br />City of Everett <br />3002 Wetmore Ave <br />Everett, WA 98201 <br />425-257-8493 <br />Name of Business <br />or Individual: <br />In -Kind Contribution Form <br />942 <br />National insurance Crime Bureau <br />Name of Primary Contact: Supervisory Special Agent John Anderson <br />Address: 1313 Broadway, Suite 310 <br />City; Tacoma <br />Telephone: 425-864-8045 <br />State: WA zip Code: 98402 <br />E-mail: janderson a]nicb.org <br />Fs p `Ser�fl ICes; <br />Description of Contributed Goods or Services: 2017 <br />VIN: donated by PEMCO Insurance for use as an undercover driver <br />vehice inproac ive au o e and gang investigations. <br />Date(s) Contributed: 319/2022 <br />Real or Estimated Value of Contribution: $ $22,000 <br />How was the value determined?: ❑ Actual Value ❑ Appraisal (Other <br />If other, please explain: 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?: 0 No ,Yes <br />if yes, what are the restrictions?: Vehicle donation runs 1 year with renewal based on the needs <br />and approval of Everett Police and am roval of PEMCO Insurance. <br />was this contribution obtained with or supported by Federal funds?: -XNa ❑ Yes <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 />z) Thank you for your support!! Cr <br />Date <br />x:C �.,x-:.:��ys„�xiir�e�.�i.� irY' .c�:.. - ��;e_ �.�-:: A ' d - <br />`' :.:.�. _ .�� rim ����V <br />. . ��rrF�i'}{ �.. .. .. .. .. ✓..:_.., .... f.:.•.:..:.. ...� .. F I• <br />-.fl@S. •5t-vi +-.ti�.. .y� r i <br />-- � <br />33F.� .. •%+..]' w^NJA.. -- . n... r., �.:...: <br />Person Receiving Goods or Services an Behalf of Program: <br />Printed Name <br />Position <br />Signature <br />Date Received <br />Accounting Use Only: <br />Vuiue Recorded DR/CR A.ccount Numbers <br />Date Entered <br />DON Entry Person JE Number <br />July 2010 <br />