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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)