2020-02-01 Mizell Center GalaAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
1. Agency Name CI
City of Palm Springs
or Region
Designated Agency Contact (Name, Title)
Shari Wrona, Executive Services Administrator
Area Code/Phone Number E-mail
760-322-8632 1 shari.wrona@paimspringsca.gov
2. Function or Event Information
Does the agency have a ticket policy? Yes ® No ❑
Event Description: Mizell Center Stars Among Us Gala
Provide Title/Explanation
Ticket(s)/Pass(es) provided by agency? Yes ❑ No El
Was ticket distribution made at the behest Yes ❑ No
of agency official?
A Public Document
Y Oi W tWPRI : 1
APR 16 PM 2: 419 For Official Use Only
CE OF THE CITY CI_F{;
❑ Amendment (Must Provide Explanation in Part 3.)
Date of Original Filing:
(month, day, year)
Face Value of Each Ticket/Pass $ 350.00
Date(s) 02 t 01 / 20 02/ 01 / 20
If no: Mizell Senior Center
Name of Source
If yes:
Official's Name (Last, First)
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(s)I Describe the public purpose made pursuant to the agency's policy
Passes
Number
B. Name of Individual of Ticket(s)l Identify one of the following:
(Last, First) Passes
Ceremonial Role ❑ Other ❑ Income ❑
Woods, Dennis 2 If checking "CemmonialRole" or"Other'descnbebelow
Public Purpose as described by PS Resolution No. 22454,
Section 1 d vi viii xi
Ceremonial Role ❑ Other ❑ Income ❑
Flood, Glenn If checking 'Ceremonial Role" or"Other' describe below.
Public Purpose as described by PS Resolution No. 22454,
Section 1 d x
Name of Outside Organization Number
of (s)/ Describe the public purpose made pursuant to the agency's policy
C. (include address and description)
Passes
4. Verification
I have read and understand FPPC Regulations 18944.1 and 18942. l have verified that the distribution set forth above, is in accordance
zz7— requirements.
David Ready City Manager
Signature of Agency Head or Print Name Title (month, day, year)
Comment:
FPPC Form 802 (2/2016)
FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772)
Agency Report of:
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 Ticket(s)I
Describe the public purpose made pursuant to the agency's policy
Passes
B. Name of Individual
(Last, First)
Number
of Tlcket(s)I
Passes
Identify one of the following:
Ceremonial Role ❑ Other El Income ❑
Ames, Harold
2
If checking "Ceremonial Role" or "Other' describe below:
Public Purpose as described by PS Resolution No. 22454,
Section 1 (d)(x)
Ceremonial Role ❑ Other ® Income ❑
Mejia, Anthony
2
If checking"Ceremonial Role" or"Other"describe below:
Public Purpose as described by PS Resolution No. 22454,
Section 1 (d)(x)
Ceremonial Role ❑ Other El Income ❑
Goedhart, Veronica
1
Ifchecking"Ceremonial Role" or"Other'describebelow:
Public Purpose as described by PS Resolution No. 22454,
Section 1 (d)(x)
Ceremonial Role ❑ Other ® Income ❑
Pauley, Nancy
1
If checking "Ceremonial Role" or"Other'describe below:
Public Purpose as described by PS Resolution No. 22454,
Section 1 (d)(x)
Name of Outside Organization
C. address and description)
include
( p )
Number
of Ticket(s)l
Passes
Describe the public purpose made pursuant to the agency's policy
FPPC Form 802 (2/2016)
FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772)