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WEST LOS ANGELES COLLEGE PHYSICAL PLANT (West Los Angeles College)

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WEST LOS ANGELES COLLEGE
PHYSICAL PLANT
Donation
or
Loan
of
Educational
Materials
(See reverse side for instructions)
Rev 2/3/03
Please check one:
Donation
Loan
College/Division:
Date:
Initiator:
Phone:
DONOR/LENDER INFORMATION:
Legal name of donor/lender:
Address:
Person to contact:
Phone:
ITEM DESCRIPTION: (Please include quantities and make/model/serial number, when appropriate. Attach a
separate sheet if necessary)
E
XPLAIN HOW ITEM(S) WILL BE UTILIZED IN THE EDUCATIONAL PROGRAM: (Be specific)
ANSWER ALL QUESTIONS REGARDING THE ITEM(S) DESCRIBED ABOVE:
Age of items:
Present value:
Where is/are the items presently located?
Is/are the items disconnected and ready to move?
Delivery/pick up date:
By whom?
If a loan, when is the expected return date?
By whom?
EXPENSE TO THE DISTRICT
AMOUNT
TO THE LENDER:
Transportation to and from the College
Loaned equipment is protected against fire
under the District’s insurance policy, subject
to a deductible of $100,000. Other physical
loss is covered, subject to a deductible of
$100,000. As to liability actions (torts), the
lender shall be responsible. Any claim
arising from use of such loaned item(s) shall
be the responsibility of the lender. The
District insures only against its own
negligence and shall be responsible only for
those losses covered by its insurance limits.
Installation & building modifications
Secondary A&I (additional lighting,
ventilation, etc.)
Utility connections required
Repair and/or modification costs
Estimated annual energy costs
Other:
TOTAL EXPENSE TO THE DISTRICT
Director of College Facilities
APPROVALS:
A
CCEPTANCE OF THE
D
ISTRICT
’
S
INSURANCE PROVISIONS FOR LOANS:
Department Head
Vice President Signature
Director of Business Operations
Signature of Lender
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Instructions
Rev 02/03/03
This form is to be used only for donations and loans of equipment, supplies and monies for educational
purposes. Loan of artwork for exhibit and placement of necessary insurance are secured through
requests for contract (RFC).
DONATIONS OF MONEY
1. Complete all relevant information on the front of this form.
2. Attach the check made payable (endorsed) to the Los Angeles Community College District.
3. Attach an original NF-12 designating the account to which the monies are to be deposited.
DONATIONS OF EQUIPMENT OR SUPPLIES:
1. Complete all items on the front of the form – enter N/A wherever information is not applicable.
2. All donations of equipment require review and approval of the Department Head, Facilities
Manager and Vice President of that affair before transmittal of the donation/loan to the Business
Operations Branch for acceptance by the Board.
Note: All loans require that the lender sign this form as evidence of his/her acceptance of the District’s
insurance provisions.
S
END COMPLETED FORMS DIRECTLY TO
:
Business Services Division
3
rd
Floor
District Offices
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Completed 6 September 2020

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