2019-02-09 DAP Humanitarian AwardsAgency Report of
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name Date stamp 1
City of Palm Springs e
Division, Department, or Region (if applicable) 13 For official Use only
2U19
Designated Agency Contact (Name, Title) .
Christina Chartier, Executive Assistant to Mayor and Council
❑ Amendment (Must Provide Explanation in Pad 3.)
760-322-8366 I christina.chartier alms rin sca. ov I Date of Original Filing:
@P P 9 g (month. day, year)
2. Function or Event Information
Does the agency have a ticket policy? Face Value of Each Ticket/Pass $ 1,000.00
9 Y P Y Yes ® No ❑
Event Description: DAP Humanitarian Awards Date(s) 02 y 09/ 1 gg
Provide rtle/Explanalron
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:
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 ncket(s)l
Describe the public purpose made pursuant to the agency's policy
Passes
B. Name of Individual
Number
of Ticket(s)t
Identify one of the following:
(Last, First)
Passes
Middleton, Lisa
Ceremonial Role ❑ Omer ❑X Income ❑
1
1/check'ng'Cemmonlal Role'or'Other'descdbe below:
Public Purpose as defined by PS Resolution No. 22454,
Section 1 d vii viii
HolStege, Christy
Ceremonial Role ❑ Omer Income ❑
1
1l cbeckng'Ceremontal Role' or'Other dawnbe below:
Public Purpose as defined by PS Resolution No. 22454,
Section 1 d vii Viii
Name of Outside Organization
C.
Number
of Ticket(s)I
Describe the public purpose made pursuant to the agency's policy
(include address and description)
Passes
4. Verification
I have read andirderstand FPPC Regulations 18944.1 and 18942. 1 have verified that the distribution set forth above, is in accordance
with the raAitl"nts.
David Ready City Manager
Print Name Title (month, day, year)
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)
Agency Report of: 1 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 Ticket(s)/
Passes
Describe the public purpose made pursuant to the agency's policy
B.
Name of Individual
(Last, First)
Number
of Ticket(s)/
Passes
Identify one of the following:
Roberts, J.R.
1
Ceremonial Role ❑ Other El Income
if checking 'Ceremonial Role" or 'Other" describe below:
Public Purpose as defined by PS Resolution No. 22454,
Section 1 (d)(vii)(viii)
❑
Ceremonial Role ❑ Other ❑ Income
1f 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)
(� p )
Number
of Ticket(s)/
Passes
Describe the public purpose made pursuant to the agency's policy
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)