803 Geoff Kors 2019-19-19 Contour Dermatology and Cosmetic Surgery CenterBehested Payment Report A Public DocumeRECEI V ED Behesletl Payment Report
1. Elected Officer or CPUC Member (Last name, First name) Date Stamp • : '
Kors, Geoff EP 19 PM 2: 37 '
Agency Name For Official Use Only
Palm Springs City Council NFICE OF THE CITY CLEI,
3200 E. Tahquitz Canyon Way
(Name and title. if different)
❑ Amendment (See Part 5)
Area CodelPhone 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.)
Contour Dermatology and Cosmetic Surgery Center
Name
42600 Mirage Rd. Rancho Mirage CA 92270
Address City state Zip Code
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
Equality California
Name
3701 Wilshire Blvd #725 Los Angeles CA 90010
Address City State Zip Code
4. Payment Information (Complete all Information.)
Date of Payment: 08/20/19 Amount of Payment: (In-WridFmfv) $ 5,000
(month, day, year) (Round to whole dollars.)
Payment Type: ❑x Monetary Donation or ❑ In -Kind Goods or Services (Provide descnpbon below)
Brief Description of In -Kind Payment:
Purpose: (Check one and provide, description below) ❑ Legislative ❑ Governmental ❑X Charitable
Describe the legislative, governmental, charitable purpose, or event:
Sponsorship of 2019 Equality Awards
5. 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 09/08/19_ By
FPPC Form 803 (January/2018)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)