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League of Minnesota Cities Model Policy 7/11/2016 <br />Donation of Surplus Equipment to a Nonprofit Organization Page 5 <br />Exhibit I <br /> <br />Surplus Equipment Form <br /> <br /> <br />Organization Name: ___________________________________________ <br /> <br />Organization Address: <br />_______________________________________ <br />_______________________________________ <br />_______________________________________ <br /> <br />Organization Website: __________________________________________ <br /> <br />(Attach proof of status as a nonprofit corporation under Section 501(c)(3) of the Internal <br />Revenue Code.) <br /> <br />Organization Purpose: ___________________________________________________________ <br />______________________________________________________________________________ <br />______________________________________________________________________________ <br /> <br />Point of Contact <br />Name: ___________________________________________ <br />Address: __________________________________________ <br />__________________________________________________ <br />Email: ____________________________________________ <br />Phone: ____________________________________________ <br /> <br />City Surplus Equipment of Interest: _______________________________________________ <br />_____________________________________________________________________________ <br />_____________________________________________________________________________ <br />_____________________________________________________________________________ <br /> <br />How will the requested Surplus Equipment benefit your organization? <br />______________________________________________________________________________ <br />______________________________________________________________________________ <br />______________________________________________________________________________ <br />______________________________________________________________________________ <br /> <br />How do you plan to transport the surplus property from the City to your location? <br />______________________________________________________________________________ <br />______________________________________________________________________________ <br />______________________________________________________________________________ <br />______________________________________________________________________________ <br />