HomeMy WebLinkAboutJOHNSON 803 3/18/13Behested Payment Report A Public Document Behested Payment Report
1. Elected Officer or CPUC Member (Last name, First name) I Date Stamp • - •
JOHNSON, RUSSELL
4gency Name
CITY OF BAKERSFIELD
4gency Street Address
1600 TRUXTUN AVENUE, BAKERSFIELD, CA 93301
)esignated Contact Person (Name and title, if different)
Area Code /Phone Number I E -mail (Optional)
For Official Use Only
2013 MAR 18 AEI 11: 46
ERSFIE .DICI, Y Ct.:F
❑ Amendment (See Part 5)
Date of Original Filing:
(month. day, year)
2. Payor I nformation (For additional payors, include an attachment with the names and addresses.)
STATE FARM
Name
Address City State Zip Code
3. Payee Information (For additional payees, include an attachment with the names and addresses.)
CITY OF BAKERSFIELD
Name
1600 TRUXTUN AVENUE BAKERSFIELD CA 93301
Address City State Zip Code
4. Payment Information (Complete all information.)
Date of Payment: 02/13/13
(month. day, year)
Amount of Payment: (in- Kind FMV) $ 5,000.00
(Round to whole dollars.)
Payment Type: ® Monetary Donation or ❑ In -Kind Goods or Services (Provide description below.)
Brief Description of In -Kind Payment: GRANT AWARD FOR 2013 GOOD NEIGHBORHOOD CITIZENSHIP
Purpose: (Check one and provide description below) ❑ Legislative ® Governmental ❑ Charitable
Describe the legislative, governmental, charitable purpose, or event:
PURCHASE EQUIPMENT FOR LICENSE PLATE READER FOR POLICE DEPARTMENT.
5. Amendment Description 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
herein is true and complete.
Executed on 03/18/13 By 10 I
DATE APSIGNATURE OFXLECTED OFFICER OR CPUC MEMBER
FPPC Form 803 (December /09)
FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772)