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Cell/butting 12S years <br />City of Everett <br />3002 Wetmore Ave <br />Everett, WA 98201 <br />425-257-8493 <br />In -Kind Contribution Form <br />Contributor Information <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 />Contributed Goads or Services <br />Description of Contributed Goods or Services: 2019 edan <br />VIN 1.1111111, donated by American Fami y Insurance Corporation ervlces <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?: 0 Actual Value CI Appraisal 0 Other <br />If other, please explain: Internet online vehicle valuation site based on the vehicle equipment. <br />Who Made this Value Determination?: NtCB <br />Is there a restriction on the use of this contribution?: ❑ No .0 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?: rg No <br />if yes, please provide the name of the Federal agency and the grant or contract number: <br />0 Yes <br />Signature of Contributor <br />2/7/2023 <br />&) Thank you for your support!? Of <br />Date <br />..... ........ <br />F <br />program/Account Use Onik; <br />Person Receiving Goods or Services on Behalf of Program: <br />0 TKS-AV; PORK) V- t 1 kJ <br />Mk 4012- <br />P me <br />Position <br />14 <br />c 3 <br />nature <br />Date Received <br />Accounting Use Only: <br />Value Recorded DR/CR Account Numbers Dote Entered <br />Data Entry Person JE Number <br />Of[Ice of the City Att eney <br />APPROVED AS 10 FORM <br />David C. Hall, City Attorney <br />July 2010 <br />