HomeMy WebLinkAbout803 Robert Moon 2019-10-24 Ed Cauduro Fund of the oregon Community FoundationBehested Payment Report A Public Document
1. Elected Officer or CPUC Member (Last na me, Fir st name) R CE I \6.fellta mp
MOON , ROBERT CIT Y O P i\ LH SPRING S
Agency Name
CI TY OF PALM SPRIN GS
Agency Street Address
3200 TAHQUITZ CANY ON W AY
2019 OC 24 AH IQ: 04
OF FICE F THE CITY CLE R,
B ehested Pay m e nt R eport
California 803
Form
For Official Use Only
Designated Contact Person (Name and ti tle, if different)
A NTHONY MEJIA C ITY C LERK
D Amendment (See Part 5)
Area Code/Phone Number E-mail (Optional)
Date of O rigi n a l Filin g: ______ _
(month, day. year)
760-323-8204
2. Payor Information (For additional p ayors, incl ude an attachment with the names and addresses.)
ED CAUDURO FUND O F T HE OREGON COMMUNITY FOUN DA TI O N
Name
1221 S W YAMHI L L S T . SU ITE 100 PO RT LAN D OR 97205
Address City State Zip Code
3 . Payee Information (For additional p ay ees, include an a tta chment with the names and ad dresses.)
CITY OF PA LM S PRI N GS
Name
3200 T A HQUITZ CANYON WAY PALM SPR IN GS CA 92262
Address City State Zip Code
4 . Payment Information (Co mplete all informa tion.)
Date of Payment: __ 1_01_2_1_12_0_1_9 _ Amount of Payment: (I n-Kind FMVJ $ 8 ,000 --(""'Ro-u-nd-,-t-o -wh-o-,-le_d,...ol.,...lars-. ..,..) --(month, day, year)
Payment Type: [8] M o netary Do nation or D In-Kind Goods or Services (Provide description below.)
Brief Description of In-Kind Payment: ------------------------------
PU rpose: (Check one and provide description below.) D Legislative D Governm ental [8] Cha rit ab le
Describe the legislative, governmental, charitable purpose, or event: ONE-T O-ONE MATCH IN G G RANT FOR
THE H ISTORI C P LAZA RESTORATION (G RANT ID 387227)
5 . Amendment Description and/or Comments
6. Verification
I certify, u nder penalty of perjury un der the laws of the Stal.l;l-E~ellf(;unt,
h erein is true and c omplete.
Executed on
best of my knowledge, the informa tion contained
FPPC For m 803 (January/2018)
FPPC Toll-Free Helpline : 866/ASK-FPPC (866/27S-3772)