HomeMy WebLinkAbout803 Robert Moon 2019-11-04 Jeff Grubbe, Chairman, Agua Caliente Tribe of Cahuilla IndiansRECEIVED
Behested Payment Report A Public DocuAi"bMtOF PALM SPRINGSeehested Payment Repo"
1. Elected Officer or CPUC Member(Lastname, First name) 2 19 NOi� astaPrl 3; a '
Robert Moon, Mayor
City of Palm prings
3200 E. Tahquitz Canyon Way, Palm Springs, CA
Anthony Mejia, City Clerk, City of Palm Springs
Area Code/Phone Number E-mail (Optional)
(760) 323-8206 Anthony.mejia@palmspringsca.gov
For Official Use Only
OF ICE OF THE CITY CL
❑ Amendment (see Pan 5)
Date of Original Filing:
(month, day year)
2. Payor Information (For additional payors, include an attachment with the names and addresses.)
Jeff Grubbe, Chairman, Agua Caliente Tribe of Cahuilla Indians
5401 Dinah Shore Drive Palm Springs CA 92262
Address City State Zip Code
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
City of Palm Springs Veterans Day Parade
Name
3200 E. Tahquitz Canyon Way Palm Springs CA 92262
Address City State Zip Code
4. Payment Information (Complete all information)
Date of Payment: 10/17/2019 Amount of Payment: on-KindFMV) $ $5.000
(month. day, year) (Round to whole dollars.)
Payment Type: ❑x Monetary Donation or ❑ In -Kind Goods or Services (provide description betow)
Brief Description of In -Kind Payment:
Purpose: (Check one andprovide description below) El Legislative [I Governmental ❑Charitable
Describe the legislative, governmental, charitable purpose, or event: Sponsorship of the Palm Springs
Veterans Day Parade
5. Amendment Description andlor Comments
6. Verification
I certify, under penalty of perjury under the laws of the State of California, that to the best of my knowledge, the information contained
herein is true and complete.
Executed on Oct 31, 2019 By
DATE
FPPC Form 803 (January/2018)
FPPC Toil -Free Helpline: 866/ASK-FPPC (866/275-3772)