2021-08-04 Justin CliftonAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
1. Agency Name CITY
City of Palm Springs
Division. Department, or Renion (itaonlicablel 2021
Designated Agency Contact (Name, Titre) I
Shari Wrona, Executive Services Administrator rL
760-322-8632 1 shari.wrona@paimspringsca.gov
2. Function or Event Information
Does the agency have a ticket policy? Yes ® No ❑
Event Description: PS Hospitality Association Luncheon
Provide Title/ Explanation
Ticket(s)IPass(es) provided by agency? Yes ® No ❑
A Public Document
F P,0490 .W I N G .,
-3 AM 7= 35 1 For Offialal Use Only
OF THE CITY Ci_E P
❑ Amendment fWst Provide Explanation in Part 3.)
Date of Original Filing:
(month, day, year)
Face Value of Each Ticket/Pass $ 50.00
Date(s) 07 1 22 1 21 07 1 22 1 21
If no:
Name of 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.
A. Name of Agency, Department or Unit of Ticket($)/ Describe the public purpose made pursuant to the agency's policy
Passes
Name of Individual Number
B. of Ticket(e)l identify one of the following:
(Last, First) Passes
Middleton, Lisa Ceremonial Role ❑ Other ❑X Income ❑
1 ft checking -Ceremonial Role-or
'Qhef ibe descrbelow.
Public Purpose as defined by PS Resolution No. 22454,
Section 1 d vi vii viii
Ceremonial Role ❑ Other El Income ❑
7t checking -Ceremonial Role' or'Olher'describe below.
Name of Outside Organization Number
C. (include address and description) of Ticket(sy Describe the public purpose made pursuant to the agency's policy
Passes
4. Verification
1 have read and understand FPPC Regulations 18944.1 and 18942. 1 have verified that the distribution set forth above, is in accordance
with the requirements.
�=& �&Justin Clifton City Manager
r Sign e of Agency He r Designee Print Name Tide (month, day, year)
Comment:
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)
Agency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
9. Agency Name C!T OF HALM H SPRING"For
•
City of Palm Springs
Division, Department, or Region (if applicable) AUG q AN 7•5al Use Only
Designated Agency Contact (Name, Title) WP OF THE CITY CI_r_.
Shari Wrona, Executive Services Administrator [:1 Amendment (Must Provide Explanation in Part 3.)
760-322-8632 I shari.wrona@palmspringsca.gov I Date of Original Filing:
(month, day, year)
2. Function or Event Information
Does the agency have a ticket policy? Yes ® No ❑
Event Description: PS Chamber Luncheon & Installation
Provide Title/ Explanation
Tickets)/Pass(es) provided by agency? Yes ® No ❑
Face Value of Each Ticket/Pass $ 70.00
Date(s) 06 1 22 1 21 06 OF 22 1 21
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 Ticket(sy Describe the public purpose made pursuant to the agency's policy
Passes
B. Name of Individual of Ticket(sy Identify one of the following:
(Last, First) Passes
Middleton, Lisa Ceremonial Role ❑ Other ❑ Income ❑
1 if checking 'Ceremonial Role' or -Ocher' describe below:
Public Purpose as defined by PS Resolution No. 22454,
Section 1 d vi vii viii
Holstege, Christy Ceremonial Role ❑ Other ❑ Income ❑
it checking "Ceremonial Role"or -Other" describe below.
Public Purpose as defined by PS Resolution No. 22454,
Section 1 d vi vii viii
Name of Outside organ}zation Number
C. (include address and description) of Ticket(sy Describe the public purpose made pursuant to the 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
with the equlrements.
Justin Clifton City Manager
Signat of Agency Head Vesignee Print Name Title (month, day, year)
Comment:
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)
Agency Report of: California
02
Ceremonial Role Events and Ticket/Pass Distributions '
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 Ticket(sy
Describe the public purpose made pursuant to the agency's policy
Passes
B. Name of Individual
(Last First)
Number
of Tlcket{sj!
Passes
Identify one of the following:
Ceremonial Role ❑ Other El Income ❑
Woods, Dennis
1
Itchecking'['cremauafRole* a'Ofher•describebelow
Public Purpose as defined by PS Resolution No. 22454,
Section 1 (d)(vi)(vii)(viii)
Ceremonial Role ❑ Other ® Income ❑
Clifton, Justin
1
It checking 'Ceremonial Rofe-or'Olher" describe below
Public Purpose as defined by PS Resolution No. 22454,
Section 1 d vi viii xi
Ceremonial Role ❑ Other ® Income ❑
Virata, Jay
ll checking "CeremonialRore'or'01her'descrrbebelow-
Public Purpose as defined by PS Resolution No. 22454,
Section 1 d x
Ceremonial Role ❑ Other El Income ❑
Reyes, Bryan
Hcheckirrg-CeremoniafRole'or'Oiher'descrfbebelow-
Public Purpose as defined by PS Resolution No. 22454,
Section 1 (d)(x)
Name of Outside Organization
C, (include address and description)
Number
of Ticket(syl
Passes
Describe the public purpose made pursuant to the agency's policy
FPPC Form 802 (212016)
FPPC Toll -Free Helpline; 6661ASK-FPPC (8661275-3772)
Form 802 — Additional Tickets for 06.22.21 PS Chamber Luncheon & Installation
Nalder, Kevin — Public Purpose as described by PS Resolution No. 22454, Section 1(d)(x)