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Behested Payment Report A Public Document._ <br />,R „,.,,..,--la ,..—.,._.Seip sted Payment Report <br />1. Elected Officer or CPUC Member (Last name, First name) RLC6NVED <br />Giselle Hale <br />Agency NameFo OWUsely <br />Redwood City Council F ':' <br />''-.hi _`-J _­ <br />20 21 <br />Agency Street Address <br />1017 Middlefield Rd, Redwood City city or Red Cit Clerk city <br />Designated Contact Person (Name and title, if different)Amendmendm nt ( <br />n ❑ ent (See Part 5) <br />Area Code/Phone Number E-mail (Optional) Date of Original Filing: <br />650-521-2134 giselle@gisellehale.com (month, day, year) <br />2. Payor Information (For additional payors, include an attachment with the names and addresses.) <br />CalWater <br />Name <br />341 N Delaware St, San Mateo, CA 94401 San Mateo CA 94401 <br />Address City State Zip Code <br />3. Payee Information (For additional payees, include an attachment with the names and addresses.) <br />SMCU Community Fund (ATTN: Support Services) <br />Name <br />350 Convention Way Redwood City CA 94063 <br />Address City State Zip Code <br />4. Payment Information (Complete all information.) <br />Date of Payment: 1/6/21 Amount of Payment: (In-KindFMV) $ $10,000 <br />(month, day, year) (Round to whole dollars) <br />Payment Type: ❑x Monetary Donation or ❑ In -Kind Goods or Services (Provide description below) <br />Brief Description of In -Kind Payment: <br />Purpose: (Check one and provide description below.) ❑ Legislative ❑ Governmental x❑ Charitable <br />Describe the legislative, governmental, charitable purpose, or event: Donation in support of childcare providers <br />impacted by Covid 19 <br />5. Amendment Description and/or Comments <br />6. Verification <br />I certify, under penalty of perjury under the laws of the State of California, that to the best of my knowledge, the information contained <br />herein is true and complete. <br />Executed on i11 121 B <br />1/DATE <br />y <br />SIGNATURE OF ECE'CFE0 OFFICER OR CPUC MEMBER <br />FPPC Form 803 (January/20114) <br />FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-377) <br />