2019-04-01 Cesar Chavez Breakfast 1st AnnualAgency 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)
Des ignated Agency Contact (Name, Title)
Shari Wrona , Executive Services Adm inistrator
E-mail
,Date.Stamp California 802
Form
For Official Use On ly
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0 Amendme nt (Mus t Provide Explanatron in Part 3.)
Area Code/Phone Number
760-322-8632 shari. wrona@palmspringsca.gov Date of Original Filing:--,-......,.,.--,----,--
(mon th, day, year)
2. Function or Event Information
Does the agency have a ticket policy? Yes [81 No • Face Value of Each Ti ckeUPass $ _2_5_.o_o _____ _
Event Descri ption: Cesar Chavez Breakfast 1st Annual
Provide Title/ Explanation
Date(s) ~~~ ___}______/ __
Ticket(s )/Pass(es) provided by agency? Yes O No~ If no: _P_a_lm_S.:..p_rin-'g"-s_P_R_I_D_E __________ _
Name of Source
Was ticket distribution made at the behest Yes • No ~ If yes : ------------------Offlciar s Name (L ast, First)
of agency official?
3. Recipients
• Use Sect ion A t o identify the agency's department or unit. • Use Sec ti on B t o identify an individual. • Use Section C to identify an outsi de organization.
Number
A. Name of Agency, Department or Unit ofTicket(a)/ 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) Passes
Kors , Geoff Ceremonial Role 0 Other 0 Income 0
ff checking 'Ceremonial ROie" or '0the,. describe below 3 Public Pu rpose as defined by PS Resolution No. 22454,
Section 1 ( d )(v ii)(viii )(xi)
Middleton , Lisa Ceremonial Role 0 Other 0 Income 0
2 If checking 'Ceremon,al ROie" or ·othe," describe below.
Public Purpose as defined by PS Resolution No. 22454,
Section 1 (d)(v ii)(viii)(xi)
Name of Outside Organization Number
C. ofTlcket(s)I Describe the public purpose made pursuant to the agency's policy
(include address and description) Passes
4. Verification
PPC Regulations 18944 .1 and 18 942. I have ve rified that the distribution set forth above, is in accordance
David Ready
Print Name
City Manager
Trtfe (month, day, year)
FPPC Form 802 (2/2016)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
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Agency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
Continuation Sheet
California 802
Form
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.
A. Name of Agency, Department or'Unit of Ticket(s)/
Number
I Passes
---' Number
B. Name of Individual of Ticket(s)/
i (Last, First) Passes
Roberts, J.R.
1
i Name of Outside organization Number
C. ofTicket{s}/
I (inclUde address and description) Passes
Describe the public purpose made pursuant to the agency's policy
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I Identify one of the 'following:
Ceremonial Role D Other IZ[ Income D
If checking ·ceremonial Role" or"Other" describe below:
Public Purpose as defined by PS Resolution No. 22454,
Section 1 ( d)(vii){viii)(xi)
Ceremonial Role D other D Income D
If checking 7Ceremonial Role" or "Other" describe below:
Ceremonfal Role 0 other D Income D
If checking ·ceremonial Role" or"Other" descn·be below:
Ceremonial Role D Other D Income D
If checking •ceremonial Role" or "Other" describe below:
Describe the public purpose made purs_uant to the agency's policy
FPPC Form 802 (2/2016)
FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772)
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Form 802 Additional Tickets for 1st. Annual PS Cesar Chavez Breakfast
Blaisdell, Amy-1, Public Purpose as described by PS Resolution No. 22454, Section l(d)(x)
Goolsby, Denise -1, Public Purpose as defined by PS Resolution No. 22454, Section 1 (d)(x)
Virata, Jay-1, Public Purpose as defined by PS Resolution No. 22454, Section 1 (d)(x)