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Celebrating T25 years <br />City of Everett <br />3002 Wetmore Ave <br />Everett, WA 98201 <br />425-257-8493 <br />In -Kind Contribution Form <br />u or <br />Name of Business <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 <br />Telephone: 425-864-8045 <br />State: WA Zip Code: 98042 <br />E-mail: janderson@nicb.org <br />Lao <br />00 s .or Services <br />Description of Contributed Goods or Services: 2019 sedan <br />VIN , donated by American ami y nsurance Corporation Services <br />(AFICS) for use as an undercover driver vehicle in proactive vehicle theft investigations. <br />Date(s) Contributed: 2/7/2023 <br />Real or Estimated Value of Contribution: $ 21,150 <br />How was the value determined?: ❑ Actual Value ❑ Appraisal VI 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?: ❑ No 471 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 approval of AFICS. <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 />U Yes <br />Signature of Contributor <br />2/7/2023 <br />Er..) Thank you for your support!! C� <br />Date <br />Person Receiving Goods or Services on Behalf of Program: <br />Printed Name <br />Signature <br />Position <br />Date Received <br />Accounting Use Only: <br />Value Recorded DR/CR Account Numbers Date Entered Data Entry Person !E Number <br />July 2010 <br />