2019-02-16 PS Speaks Jane Fonda EventAgency Report of
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name Date Stamp e '
City of Palm Springs 0
Division, Department, or Region ff applicable) -j ji,�( j.;;-;
For Official Use Only
Designated Agency Contact (Name, Title)
Christina Chartier, Executive Assistant to Mayor and Council
❑ Amendment (Must Provide Explanation in Part 3.)
Area Code/Phone Number E-mail
760-322-8366 christina.chartier alms rin sca. ov Date of Original Filing:
@P P 9 g (month, day, year)
2. Function or Event Information
Does the agency have a ticket policy? Yes ® No ❑ Face Value of Each Ticket/Pass $ 250.00
Event Description: PS Speaks Jane Fonda Event Date(s) 02 / 16 1 1 gg
Provide Tide/Explanation
Tcket(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.
A. Name of Agency, Department or Unit
Number
of Ticket(s)I
Describe the public purpose made pursuant to the agency's policy
Passes
B. Name of Individual
(Lest, First)
Number
of Ticket(s)I
Passes
Identity one of the following:
Moon, Robert
t
Ceremonial Role ❑ Other ❑X Income ❑
Itchecking'Ceremonial Role" or'Otherdescribe below:
Public Purpose as defined by PS Resolution No. 22454,
Section 1 d iii vii viii
Roberts, J.R.
.�
Ceremonial Role ❑ Other 17 Income ❑
Uch&Mng'Cemmonial Rote-or'Other'dewdbe below:
Public Purpose as defined by PS Resolution No. 22454,
Section 1 d iii vii viii
Name of Outside Organization
C. (include address and description)
Number
of Ticket(s)l
Passes
Describe the public purpose made pursuant to the agency's policy
4. Verification
I have read and understand
with the requirements.
Comment:
Regulations 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 (212016)
FPPC Toll -Free Helpline: 8661ASK-FPPC (866/275-3772)