HomeMy WebLinkAbout803 JR ROBERTS 2019-10-24 Ed Cauduro fund of the Oregon Community FoundationBehested Payment Report A Public Document
1. Elected Officer or CPUC Member (Last name, First n ame) p t.. l ~a~~Q~~ GS
ROBERTS, JR
Agency Name
.,,.c_1TY_o-=F,.,...P_A.,....L-=--M.,....,s_P_R_1N_G_s ___________ ~~lf THE CITY CLE R1
Agency Street Address
3200 TAHQUITZ CANYON WAY
Behested Payment R.eport
California 803
Form
For Official Use Only
Designated Contact Person (Name and title, if different)
ANTHONY MEJIA CITY CLERK
D Amendm ent (See Part 5)
Area Code/Phone Number E-mail (Optional)
760-323-8204
Date of Original Filing: --,---,,--,----,--
(month, day, year)
2 . Payor Information (For additional payors, include an attachment with the names and addresses.)
ED CAU DURO FUND OF THE OREGON COMMUNITY FOUNDATION
Name
1221 SW YAMHILL ST. SUITE 100 PORTLAND OR 97205
Address City State Zip Code
3 . Payee Information (For additional payees, include an attachment with the names and addresses.)
CITY OF PALM SPRINGS
Name
3200 TAHQUITZ CANYON WAY PALM SPRINGS CA 92262
Address City State Zip Code
4 . Payment Information (Complete all Information .)
10/21 /2019 Date of Payment: ______ _
(month, day, year)
Amount of Payment: (In-Kind FMV) $ _8_,0_0_0,__-----.....----
(Round to whole dollars.)
Payment Type: (8) Monetary Donation or • In-Kind Goods o r Services (Provide description below.)
Brief Description of In-Kind Payment: ------------------------------
Purpose : (Check one and provide description below.) D Legislative D Governm ental (8) Charitable
Describe the legislative, governmental, charitable purpose, or event: ONE-TO-ONE MATCHING GRANT FOR
THE HISTORIC PLAZA RESTORATION (GRANT ID 387227)
5. Amendment Description and/or Comments
6. Verification
I certify, und er penalty of perjury under the laws of the State of Cali fornia
herein is true and complete.
Executed on _...:../ O=-------"-2--~-'---.,,,,....::Z.:;...;;..0_.l .... 9,.....__
DATE
FPPC Form January/2018)
FPPC Toll-e Helpline: 866/ASK-FPPC (866/27S-3772)