803 Geoff Kors 2018-12-18 Palm Springs Disposal ServicesBehested Payment Report A Public Document Behested Payment Report
1. Elected Officer or CPUC Member (Last name, First name) �,.'Daie Stamp - • - ,
Kors, Geoffrey ' •
Agency Name Q r ! $ P ` Q 4 For Official Use Only
2018 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.)
Palm Springs Disposal Services
Name
4690 E. Mesquite Ave. P.O. Box 2711 Palm Springs CA 92263
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 all information.)
Date of Payment: 1116/2018 Amount of Payment: (rn4GndFMv) $ 25000.00
(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
Describe the legislative, governmental, charitable purpose, or event:
Sponsorship of Stars Among Us Gala supporting Meals on Wheels Program
5. Amendment Description and/or Comments
S. Verification
p Charitable
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 _a _7 r r� i II
SI ATURE. F ELECTED OFFICER OR CPUC MEMBER
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)