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HomeMy WebLinkAboutHarmon - 803 - 12-20-2019 803Behested Payment Report A Public Document Behested Payment Report 1. Ele ted Officer or CPUC Me ber (Last name, First name) Date Stamp • ■ vv� RECEIVED 7r, A enC Name eOnly Oso, L.-5 6l DEC 2 0 2019 Agency St et Address G) C ,D (�0 -C�--c SLO CITY CLER C Designated Contact Person (Name and title, ifdifferQnt) ❑ Amendment (See Part 5) Area Code/Phone Number E-mail (Optional) Date of Original Filing: (month, day, year) s-ss0 - TL4 I f+�AO' -� QC, r 2. Payor Information (For additional payors, include an attachment with the names and ddresses.) ?,P— to C A ya o -� Sa ya W i s 0 (6l's /�y Name 1 22()0 L 5 OSOS VCA.1.LC,� Rnf SU 93Lfos Address I city State Zip Code 3. Payee Information (For additional payees, include an attachment with the names and addresses.) C0 w► tM.t,� A,L 1 _ I ' (� cf �r .— -� vu �.v (� c7 S o�.v� L,y 1 S Name 10 3o Soo- kt'000d. - S[� - C_i"k- 9 3Yo I Address city State Zip Code 4. Payment Information (Complete all information.) Date of Payment: 1 a • a 0 • I rl Amount of Payment: (In -Kind FM%0 $ (month. day. year) 51A---4 (Round to whole dollars.) Payment Type: ❑ Monetary Donation or 01n-Kind Goods or Services (Provide description below) Brief Description of In -Kind Payment: A co-.v - Purpose: (Check one and provide description below.) ❑ Legislative ❑ Governmental ,©Charitable Describe the legislative, governmental, charitable purpose, or event: G6L"- �o� u -Fyr' rt_ Vw yy\,Q_ 2'�'d Vl&o4'1� O -� 3 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 • • l Ci By DATE FPPC Form 803 (January/2018) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Behested Payment Report Form 803 is used by elected officers and members of the California Public Utilities Commission (CPUC) to disclose payments made at their behest, principally for legislative, governmental, or charitable purposes. This form was prepared by the Fair Political Practices Commission (FPPC) and is available at www.fppc.ca.gov. When to File File Form 803 within 30 days following the date on -which the payment(s) meets or exceeds $5,000 in the aggregate from a single source in a calendar year. (Section 84224.) Once a single source has made a behested payment of $5,000 or more during the calendar year, subsequent payments of any amount from that source must be reported. Where to File State Qfficia: The official's state agency must receive Form 803 within 30 days of the date the behested payment is made Within 30 days after receipt of the report, the state agency must torward a copy to the FPPC at: 1102 Q Street, Suite 3000, Sacramento, CA 95811 Fax: 916-322-0883 E-mail: Form8L3@fppc.ca.gov Local Officiais: The official's local agency must receive Form 803 within 30 days of the date the behested payment is made. Within 30 days after receipt of the report, the agency must forward a copy to the filing officer who receives the official's original campaign statements. General Information: Behested payments are payments made principally for legislative, governmental, or charitable purposes under Government Code Section 82004.5. These payments are not for personal or campaign purposes. Generally, a donation is made at the behest if it is requested, solicited, or suggested by the official, or otherwise made to a person in cooperation, consultation, coordination with, or at the consent of, the elected officer or CPUC member. This also includes payments behested by the official's agent or employee on the official's behalf. Exception: If the behested payment is made by a state, local, or federal government agency and is principally for legislative or governmental purposes, the payment does not have to be reported. Privacy Information Notice: Information requested by the FPPC is required by and used to administer and enforce the Political Reform Act. Failure to provide information may be a violation subject to administrative, criminal, or civil penalties. All reports and statements are public records available for inspection and reproduction. If you have any questions, please contact the FPPC's General Counsel at 1102 Q Street, Suite 3000, Sacramento, CA 95811 or (916) 322-5660. Instructions Part 1- Identification: Identify the official's name, agency, address, and contact information. Mark the amendment box if changing information on a previously filed Form 803 and include the date of the original filing. Part 2 - Payor Information: Disclose the name and address of the person making the payment. A business address is acceptable. Part 3 - Payee Information: Identify the name and address of the person receiving the payment. A business address is acceptable. Part 4 - Payment Information: Disclose the payment date and amount using the fair market value (FMV) for donated in - kind goods or services. Check one box to identify the type of payment and provide a description if the payment is an in -kind good or service. Check one box to identify the purpose and provide a description. Part 5 - Amendment Description or Comments: Complete this section if amending a previously filed Form 803 or to provide additional or clarifying information. Part 6 - Verification: Date and sign the form under penalty of perjury. Example On April 24, 20XX, at CPUC Member Tully's request, the ABC Corporation made a monetary donation of $5,000 to the Boys and Girls Club. 2. Payor Information (Fe, addisoaal Payo., include-1 erenweei wid, me nonce ­0 wV er. i ABC Corporation 1234 Alpha Ave. Sacramento CA 95814 HMM CM SL�r {9 Ccd. S. Payee Information (Foradditionaiparmi. include an aeechment with the names and edd,w ea.) The Boys and Girls Club 5678 Bravo Blvd. Sacramento CA 95814 add,y ch eF Zy Code 4. Payment Information lconoiete a maamebon) Data of payment: April 24 n2OXX Amount of Payment: pn•wnd riuv,$ 5,000ffloummwnoie awxn, Payment Type: ❑x Monetary Donation or ❑ In -Kind Goods or Services Pneamaeaaua. beaw, Brief Description of In -Kind Payment: Purpose: (caeck endprovide eeacdpft brow) ❑ Legislative ❑ Governmental ® Charitable Describe the legislative, governmental, charitable purpose, or event: Donation to children's community service organization FPPC Form 803 (January/2018) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)