2019-02-02 Black History Month GalaAgbhcy Report of:
Ceremonial Role Events and Ticket/Pass Distributions
A Public Document
1. Agency Name
City of Palm Springs
Division, Department, or Region (if applicable) 9nt4 14Fl? 911
Christina Chartier, Executive Assistant to Mayor and Council
760-322-8366 1 chdstina.chartier@palmspringsca.gov
2. Function or Event Information
Does the agency have a ticket policy? Yes ® No ❑
Event Description: Black History Month Gala
Provide Ttle/ Explanation
Ticket(s)/Pass(es) provided by agency? Yes ❑ No El
Was ticket distribution made at the behest Yes ❑ No
of agency official?
Date Stamp
,li: 12
❑ Amendment (Must Provide Explanation in Part 3.)
Date of Original Filing:
(month, day, year)
Face Value of Each Ticket/Pass $ 60_00
Date(s) 02 ( 02) 19
If no: Palm Springs Black History Committee
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)l
Describe the public purpose made pursuant to the agency's policy
Passes
Number
B. Name of Individual
of Timber )/
Identify one of the following:
(Last, First)
Passes
Ceremonial Role ❑ other ❑x Income ❑
Moon, Robert
2It
checking' Ceremonial Role" or'Other describe below:
Public Purpose as defined by PS Resolution No. 22454,
Section 1 d vii viii
Ready, David
Ceremonial Role ❑ Other X❑ Income ❑
2WchecWhg'Cemmonial
Role"or'OthePdescdbebelow:
Public Purpose as defined by PS Resolution No. 22454,
Section 1 d x
Name of Outside Organization
C.
Number
of Ticket(s)l
Describe the public purpose made pursuant to the agency's policy
(include address and description)
Passes
4. Verification
I have read and understand FPPC
with the requirements. ^ •I,
Comment:
18944.1 and 18942. 1 have verified that the distribution set forth above, is in accordance
David Ready City Manager
Print Name Title (month, day,, year)
FPPC Form 802 (2/2016)
FPPC Toll -Free Heipline: 8661ASK-FPPC (8661275-3772)
Agency Report of: California
Ceremonial Role Events and Ticket/Pass Distributions 1 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)l
Passes
Describe the public purpose made pursuant to the agency's policy
B. Name of Individual
(Last, First)
Number
of Tlcket(s)l
Passes
Identify one of the following:
Chappell, Denise
2
Ceremonial Role ❑ Other ® Income ❑
If checking "Ceremonial Role" or'01her' describe below:
Public Purpose as defined by PS Resolution No. 22454,
Section 1 (d)(x)
Ceremonial Role ❑ Other ❑ Income ❑
If checking 'Ceremonial Role" or'Other' describe below:
Ceremonial Role ❑ Other ❑ Income ❑
If checking 'Ceremonial Role" or "Other' describe below:
Ceremonial Role ❑ Other ❑ Income ❑
If checking 'Ceremonial Role" or "Other" describe below:
C. Name of Outside Organization
(include address and description)
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: 8661ASK-FPPC (8661276-3772)