2019-02-21 PSHA Member LuncheonAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
1. Agency Name , ,
City of Palm Springs
Division. Deoartment. or
Christina Chartier, Executive Assistant to Mayor and Council
A Public Document
...I j,Date Stamp
'� j AI ��� 2 5 For Official Use Only
❑ Amendment (Must Provide Explanation in Part 3.)
760-322-8366 I christina.chartier alms rin sca. ov Date of Original Filing:
@P P g g (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: PSHA Member Luncheon Date(s) 02 t 21 ) 1g J�—
Pmvlde Tltle/Explanabon
Ticket(s)/Pass(es) provided by agency? Yes ® No ❑ If no:
Name nLCnume
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
Name of Individual
B, N
(Last, First)
Number
of Timber )/
Passes
Identify one of the following:
Middleton, Lisa
Ceremonial Role ❑ Omer ❑x Income ❑
llcheck'ng'Cemmonial Role"or'Other'&scdbebelow.
Public Purpose as defined by PS Resolution No. 22454,
Section 1 d vii ix
KOrs, Geoff
Ceremonial Role ❑ Other I] Income ❑
.�
If checkng'Ceramonial Role"or'Othei` describe below:
Public Purpose as defined by PS Resolution No. 22454,
Section 1 d vii ix
Name of Outside Organization
C. (include address and description)
Number
of Ticket(s)t
Passes
Describe the public purpose made pursuant to the agency's policy
4. Verification
I have read and understand FPPC Regulations 18944.1 and 18942. / have verified that the distribution set forth above, is in accordance
with the requirements.
David Ready City Manager
Signature of Agp cy Heador Designee Print Name Title (month, day, year)
Comment:
FPPC Form 802 (2/2016)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)
Agency Report of: California 8021
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)l
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:
Holstege, Christy
1
Ceremonial Role ❑ Other El Income
If checking "Ceremonial Rote" or'Other' describe below:
Public Purpose as defined by PS Resolution No. 22454,
Section 1 (d)(vii)(ix)
❑
Ceremonial Role ❑ Other ❑ Income
11 checking "Ceremonial Rote" or 'Other' describe below:
❑
Ceremonial Role ❑ Other ❑ Income
If checking "Ceremonial Role" or'Other" describe below:
❑
Ceremonial Role ❑ Other ❑ Income
If checking 'Ceremonial Rode" or "Other describe below:
❑
C.
Name of Outside Organization
include address and description)
(" p " )
Number
of Tlcket(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)