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HomeMy WebLinkAboutJOHNSON 803 10/28/11Behested Payment Report A Public Document 1. Elected Officer or CPUC Member (last name, First name) Date Stamp JOHNSON, RUSSELL CITY OF BAKERSFIELD 1600 TRUXTUN AVENUE, BAKERSFIELD, CA 93301 Designated Contact Person (Name and title, if different) Area Code/Phone Number I E-mail (optional) CT'23 PFD 3: 57 U 7A, ; ❑ Amendment (See Part 5) Behested Payment Report For Official Use Only Date of Original Filing: (month, day, year) ( 1 2. Payor Information (For additional payors, include an attachment with the names and addresses.) PACIFIC GAS & ELECTRIC COMPANY 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: 10/24/11 Amount of Payment: (In-KindFMO $ 5,324.00 (month, day year) (Round to whole dollars.) Payment Type: ® 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 IS Governmental [t ' Charitable Describe the legislative, governmental, charitable purpose, or event: COMMUNITY SAFETY PROJECT AT STANCLIFF COURT AND NAPAL COURT 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 information contained herein is true and complete. Executed on 10/28/11 By OF ELECTED DATE FPPC Form 803 (December/09) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) Behested Payment Report A Public Document This report is for use 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 five thousand dollars ($5,000) in the aggregate from a single source in a calendar year. 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 Officials: 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 forward a copy to the Fair Political Practices Commission (FPPC) 428 J Street, Suite 620, Sacramento, CA 95814. Fax: 916-322-0886 E-mail: Form803a_fppc.ca.gov 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, if applicable. 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. Use Part 5 for additional or clarifying information. Part 5: Amendment Description or Comments: Complete this section if amending a previously filed Form 803 or to provide additional information. Local Officials: 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 82015(b)(2)(B)(iii). 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 includes payments behested by the official or by his or her agent or employee on the official's behalf. 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 question regarding this notice, please contact General Counsel at 428 J Street, Suite 620, Sacramento, CA 95814 or (916) 322-5660. Part 6: Verification: Date and sign the form under penalty of perjury. Example On April 24, 2010, 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 lF,,radi,orm ru ve nLlude an a"arhm~iiw Ph 'ic es anQ rrc ea; ABC Corporation 4_ 1234 Alpha Ave., Sacramento CA 95814 Addles 0, cl"6 byC 3. Payee Information ; ora„ direr n,yees -re The Boys and Girls Club N- 5678 Bravo Blvd.. Sacramento CA 95814 add7- Cq S,ate Lp;:ok 4. Payment Information rwm,zreP,r~ Date of Payment: April 24, 2010 Amount of Payment: i:,: x;•d run $ 5.000 irrmr~n. Aa;: yearl !Rn,;c:o wrye ca,;•.'Payment Type: ©Monetary Donation or In-Kind Goods or Servicesr Brief Description of In-Kind Payment: Purpose:rc- oaxc-!, e:=be'- [I Legislative ❑Govemmental I@Chartabe Describe the legislative, governmental, charitable purpose, or event: Donation to children's community service organization. FPPC Form 803 (December/09) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) Pacific Gas and Elec#ric Compary- Matthew Park 1918 H Street Government Relations Bakersfield, CA 93301 661-321-4466 M2PX@pge.com October 19, 2011 Mr. Phil Burns Building Director City of Bakersfield 1600 Truxton Avenue Bakersfield, CA 93301 Dear Mr. Burns: On behalf of Pacific Gas and Electric Company, I am pleased to transmit to you this check in the amount of $5,324.00 made payable to the City of Bakersfield. At PG&E, we believe that it is important to fund nonprofit organizations in our service territory that provide important services to individuals and families in the region. The City is a great example of community-based leadership and teamwork. This grant is to be used for the Community Safety Project at Stancliff Court and Napal Court. As a charitable contributor to your organization, PG&E is pleased to receive appropriate recognition for this donation, including those examples outlined in your grant application. Please ensure that all recognition provided a a result of this donation be credited t Pacific Gas and Electric Corn n as written in this sentence. In addition, this letter confirms that City of Bakersfield certified in the PG&E grant application that it is in compliance with all local, state, and federal laws, as well as with several PG&E policies. Please ensure that appropriate staff members and officers of the City of Bakersfield read Attachment A to this letter, which describes those requirements. Should any change in circumstances pertaining to any of the requirements listed above occur at any time, City of Bakersfield must notify Pacific Gas and Electric Company immediately. At Pacific Gas and Electric Company, we take great pride in the community partnerships we have created and we are grateful for the opportunity to acknowledge and support citizens and organizations committed to making California a better place to live and work. Sincerely, Matthew Park Attachment Please complete the attached tax receipt form and return it to us in the enclosed self- addressed envelope. Thank you very much! ~Wv P ifiC P7 Saab SNW, BNY Won WC:S MU292 A, FhvrJseo, CA Evam". AMA OWN f 1j ElBe Date: 09127/2011 Check No. 2997454 Pay $'«*«**`5,324.00' t11 - 'FIVE THOUSAND THREE HUNDRED TWENTY-FOUR"" AND 00/100 DOLLARS To The Order Of Cn CITY OF BAKERSFIELD PUBLIC WORKS DEPARTMENT 1501 TRUXTUN AVE BAKER'SFIELD CA 93301 112000 299 7t. Wi' 4011302920j: 0 S99 ?Bill ACCOUNTS PAYABLE a. RFINNNCE and CFO r nti~+ ~TgEAS1JgEq CITY OF BAKERSFIELD Check no. Date Your account number Payment Document Our account with you Invoice Date Discount NetAmount Comments 96357 09/26/11 0.00 5,324.00 Mail to: Gigie Barnes Totals: USD 0.00 5,324.00 For Payment Inquiries, Call 1-800-756-PAID SpecW1 Handle Code: 02 Pacific Gas and Electric Company 77 Beale Street, San Francisco, CA 94105 Not Negotiable Pacific Gas and Electric Company Charitable Contribution Acknowledgement In order for Pacific Gras and Electric Company (PG&E) to comply with the Revenue Reconciliation Act of 1993, we ask that you acknowledge our charitable contribution to your organization. Please do so within 15 days of receipt, by completing and returning this form in the enclosed postage paid envelope. 1. Date contribution received 2. Indicate the amount of cash or describe any property received from PG&E $ or description 3. Please indicate whether or not any goods or services were provided by your organization to PG&E in consideration for this contribution. (Such as the value of any food, beverage or entertainment received at fundraising events). Yes -or- No If Yes, please describe what was provided to PG&E and give a good-faith estimate of the value of the goods or services. Description Estimated Value Name of PG&E Contact: .lones, Tam Note: Penalties of `Sl0 per contribution (capped at S5, 000) maj, be imposed by the IR,~ on charities that fail to make the required disclosure. The penalties apply° fi)r, failure to snake the disclosure or for making a disclosure that is incomplete or inaccurate. The information above is provided for the purposes of complying with IRS requirements and is accurate to the best of my knowledge. Organization Contact Name: Title in Organization: Organization Name: City of Bakersfield Organization Tax Ill#: Signature: Date: OFFICE USE ONLY: Vendor No.: 1042762 Amount: $5,324.00 Check No.: 2997454 Fiscal Year: 2011 Request No. 94357 ATTACHMENT A 1. The City of Bakersfield is, and shall remain, in compliance with all federal, state, and local laws, rules, and regulations, including if applicable the California Nonprofit Integrity Act of 2004; 2. The City of Bakersfield does not and shall not, in its by-laws, policies, or practices, discriminate on the basis of race, color, religion, age, sex, national origin, ancestry, physical or mental disability, medical condition, veteran status, marital status, pregnancy, sexual orientation, gender identity, or any basis prohibited by applicable law; 3. This donation will be used only for charitable purposes, and will not be used to promote or oppose any candidate or ballot measure, to advocate any legislative or administrative action, or to personally benefit or compensate any elected official; and, 4. The City of Bakersfield and each of its grantees, if any, is in full compliance with all statutes, Executive Orders, and regulations restricting or prohibiting U.S. persons from engaging in transactions and dealings with countries, entities, or individuals subject to economic sanctions administered by the U.S. Department of the Treasury's Office of Foreign Assets Control, and the City of Bakersfield does not and shall not promote or engage in violence, terrorism, bigotry, or the destruction of any state, or make grants or otherwise furnish support of any kind to any individual or entity that engages in such activities. Should any change in circumstances pertaining to any of the requirements listed above occur at any time, the City of Bakersfield will notify PG&E immediately. Because the grant from PG&E is contingent on the City of Bakersfield meeting all of the requirements above, please note that if they are not met, the grant will be void and PG&E may require that it must be repaid in full.