803 Geoff Kors 2018-12-18 Agua Caliente Band of Cahuilla IndiansBehested Payment Report A Public Document Behested Payment Report
1. Elected Officer or CPUC Member (Last name, First name) i Date gt�rtp
Kors, Geoffrey
Agency Name 2 18 DEC 18 F;1 �, :rFor official Use only
Palm Springs City Council
Agency Street Address
3200 E. Tahquitz Canyon Way
Designated Contact Person (Name and title, if different)
❑ Amendment (See Part 5)
Area Code/Phone Number E-mail (Optional) Date of Original Filing:
7605370061 (month, day, year)
2. Payor Information (For additional payors, include an attachment with the names and addresses.)
Agua Caliente Band of Cahuilla Indias
Name
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.)
Mizell Senior Center
Name
480 S. Sunrise Way Palm Springs CA 92264
Address City State Zip Code
4. Payment Information (Complete allinformation.)
Date of Payment: 12/05/2018
Amount of Payment: (In-KindFMv) $ 5000.00
(month, day, year) (Round to whole dollars.)
Payment Type: p Monetary Donation or ❑ In -Kind Goods or Services (Provide description below)
Brief Description of In -Kind Payment:
Purpose: (Check one and provide description below.) ❑ Legislative ❑ Governmental 0 Charitable
Describe the legislative, governmental, charitable purpose, or event:
Sponsorship of Stars Among Us Gala supporting Meals on Wheels Program
6. Amendment Description and/or 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
12/18/18
DATE
By SIGNATURE OF ELECTED OFFIC
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/27S-3772)