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HomeMy WebLinkAbout2017-05-19 Harvey Milk Diversity BreakfastAgency Report of: Ceremonial Role Events and Ticket/Pass Distributions 1. Agency Name City of Palm Springs , , Department, or Region (if applicable) Designated Agency Contact (Name,Titla) Christina Chartier, Executive Assistant to Mayor and Council Area Code/Phone Number E-mail 760-322-8366 1 chdstina.chartier@palmspdngsca.gov 2. Function or Event Information Does the agency have a ticket policy? Yes ® No ❑ Event Description: Harvey Milk Diversity Breakfast Provide TildelExplanation Ticket(s)/Pass(es) provided by agency? Yes ® No ❑ Am blic Document pRiN • e a ( UGG 15 AM 7: 3 For Official Use Onty ❑ Amendment (Must Provide Explanation in Part 3.) Date of Original Filing: {month, day, year) Face Value of Each Ticket/Pass $ 65.00 Date(s) d5 119 1 17 .___JI If no: Name or Source Was ticket distribution made at the behest Yes ❑ No ® If yes: Official's Name (Last, First) of agency official? 3. Recipients • Use Section A to identify the agency's department or unit. • Use Section B to identify an individual. • Use Section C to identify an outside organization. Number A. Name of Agency, Department or Unit of Tiakat(s)l Describe the public purpose made pursuant to the agency's policy Passes Name of Individual Number B. (Last, First) ofP �s)l Identify one of the following: Moon, Robert Foat, Ginny Ceremonial Role ❑ Other © Income ❑ 1 !t chocking "Ceremonial Role" or "Other' deeorlbe below: Public Purpose as defined by PS Resolution No. 22454 Ceremonial Role ❑ Other 9 Income ❑ 3 Il checking "Ceremonial Role" or "Other' describe below: Public Purpose as defined by PS Resolution No. 22454 Name of Outside Organization I Number I C. (include address and description) of Tlekags)l Describe the public purpose made pursuant tothe agency s policy Passes 4. Verification i have read and understand FPPC Regulations 18944.1 and 18942. 1 have verified that the distribution set forth above, is in accordance e requirem�ts. 2 David Ready City Manager 9'l o —17 Signature otAgen ignee Print Name Title (month, day, year) Comment: FPPC Form 802 (212016) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661276-3772) Agency Report of: California Ceremonial Role Events and Ticket/Pass Distributions Form Continuation Sheet A Public Document Agency Name City of Palm Springs 3. Recipients • Use Section A to identify the agency's department or unit. -Use Section B to identify an individual. • Use Section C to identify an outside organization. Number A. Name of Agency, Department or Unit of Ticketls)1 Passes Describe the public purpose made pursuant to the agency's policy B. Name of Individual (Last, First) Number of Tickegs)/ Passes Identify one of the following: Roberts, J.R. 1 Ceremonial Rote ❑ other ® Income trchecking"Ceramoniai Role'of'0ther'ds8crfbebel0Wl Public Purpose as defined by PS Resolution No. 22454 ❑ Ceremonial Rde ❑ Other ❑ Income ❑ It checking 'Cemmonlal Role' or "Other" descdbe below' Ceremonial Role ❑ Other ❑ Income kr checking `Cersmowai Role' or -other' descrIbe below ❑ Ceremonial Role ❑ Other ❑ Income If checking "Ceremoniai Role" or'Other' dedcilbe below - ❑ C. Name of Outside Organization (include address and descrl on ) Number of Tlcketlsu Passes Describe the public purpose made pursuant to the agency's policy FPPC Form 802 (212016) FPPC Toll -Free Helpline: 8661A$K-FPPC 18661275-3772)