2020-02-16 GCVC Business BreakfastAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
1. Agency Name
City of Palm Springs
Division. Department, or Region (ifapolicable)
Designated Agency Contact (Name, Title)
Shari Wrona, Executive Services Administrator
Area Code/Phone Number E-mail
760-322-8632 1 shari.wrona@palmspringsca.gov
IT Y We
2o20 APR 16 PH
blic Document
Official Use Only
FFICE OF i HE CIT J CLEF,
❑ Amendment (Must Provide Explanation in Part 3.)
Date of Original Filing: (month, day, year)
2. Function or Event Information
Does the agency have a ticket policy? Face Value of Each Ticket/Pass $ 30.00
9 Y p Y� Yes® No
Event Description: GCVC Business @ Breakfast Date(s) 02 / 01 / 20 021 01 / 20
Provide Title/Explanation
Ticket(s)/Pass(es) provided by agency? Yes ® No ❑ If no:
Name of Source
Was ticket distribution made at the behest Yes ❑ No ® If yes:
of agency official?
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)l Describe the public purpose made pursuant to the agency's policy
Passes
Number
B. Name of Individual of Ticket(s)I Identify one of the following:
(Last, First) I Passes
Ceremonial Role ❑ Other ❑ Income ❑
Middleton, Lisa 1 If checking "Ceremonial Role" or"Other' describe below
Public Purpose as described by PS Resolution No. 22454,
Section 1 d vi viii xi
Ceremonial Role ❑ Other ❑ Income ❑
If checking "Ceremonial Role" or "Other' describe below-
C• Name of Outside Organization I of Ticket(s)I I Describe the public purpose made pursuant to the agency's policy
(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
thirements.
David Ready City Manager
Signature ofAgency H gnee Print Name Title (month, day, year)
Comment:
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 866/ASK-FPPC (8661276-3772)