2019-04-04 Boys & Girls Club Be a Hero Gala.
Agency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document ------------------------------------1. Agency Name t
City of Pa lm Sprin gs
Division, Department, or Region (if applicable)
Designated Agency Contact (Name, Title)
Shari Wrona, Executive Services Administrator
Area Code/Ph one Number
760-322-8632
E-mail
s hari.wrona@palmspringsca.gov
Date Stamp California 802
Form
For Official Use Only
0 Amendment (Must Provide Explan ation in Part 3.)
Date of Original FIiing : __ .....,.......,.. __ _
(month, day, year)
2 . Function or Event Information
Does the agency have a ticket poli cy? Yes ~ No • Fa ce Val ue of Each TickeUPass $ _1_oo_._o_o ____ _
Eve nt Des cription: Boys & Girls Clu b Be a Hero Gala
Provide Title/ Explanation
Date(s) ~~~ __}__} __
Ticket(s)/Pass(es) provided by agency? Yes ~ No O 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 t o identify th e agency's departme nt o r unit. • Use Section B t o identify an individnal. • Use Section C to identify an o utside organi:iation.
Numbe r
A. Nam e of Agency, Department or Unit of Tic ket(s)/ Describe the public purpose made pursuant to the agency's policy
Passes
Number B. Name of Individual of Tlcket(s)I Identify one of the following:
(Last, First) Passes
Holstege , Ch risty Ceremon ial Role 0 Other IBJ Income 0
If checking ·cetemonlal Rote· or 'Othe,. describe betow· 1 Pu blic Pu rpose as defined by PS Resolution No. 224 54,
Section 1 (d )(vii)(viii)(xi )
Middleton , Lisa Ceremonial Role 0 Other [gj I ncome 0
1 If checking ·ceremonial ROie · or ·othe,. descnbe below.
Public Purpose as defi ned by PS Resoluti on No. 224 54 ,
Section 1 (d )(vii )(vi ii )(xi)
Name of Outside Organization Number
C. of Tlcket(s)/ Describe the public purpose made pursuant to the agency's policy
(include address and description) Passes
4. Verification
I have read and understand FP C Regulations 18944.1 and 18942. I h ave verified that the distribution set forth above, is in accordance
with the requirements.
David Read y
Print Name
Ci ty Manager
n tte (month, day, year)
FPPC Form 802 (2/2016)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)
•
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
' Passes
' -------------·· -------Nu-mber s. Name of Individual of Ticket(s}/
i (Last, First) Passes
I Number
C. Name of Outside Organization of Ticket(s)f
I (include address and description) Passes
--
Describe the public purpose made pursuant to the agency's policy ' I
I
----------------·
Identify one of the following: I
'
Ceremonial Role D Other D Income D
If checking •ceremonial Ro/e"or "Other" descn·be below:
Ceremonial Role D Other D Income D
/!checking ·ceremoniaf Role" or "Other" describe below:
Ceremonial Role D Other D Income D
If checking "Ceremonial Role" or "Other" describe below:
Ceremonial Role D Other D Income D
If checking •ceremonial Role" or "Other" describe below:
' Describe the public purpose made pursuant to the agency's policy I
FPPC Form 802 (2/2016)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
J