2019-04-06 Faux Fur Ball V-Island TailsAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name Date Stamp California 802
City o f Pa lm S prings
Division, Department, or Region (if applicable)
Designated Agency Contact (Name , Title)
Shari W rona, Executive Services Administrator
Area Code/Phone Number
760-322-8632
E-mail
sh ari . w ro na@palmspringsca.gov
I '-
Form
For Official Use Only
D Amendment (Must Provide Explanation in Part 3.)
Date of O riginal Filing :--,---,,.......,..---,.-
(month, day. year)
2. Function or Event Information
Does t he agen cy hav e a ticket policy? Yes ~ No • Face Val ue of Each TickeUPass $ _1_75_-_oo _____ _
Event D es cri ption: Faux Fur Ball V-lsland Tails
Provide Title/ Explanation
___J___J __
Ticket(s)/Pass(es) provided by agency? Yes ~ No D If no: _________________ _
Name of Source
Was ticket distribution made at th e behest Ye s • No ~ If yes: ------------------
Official's Name (Last. First)
of agency official?
3 . Recipients
4 .
• Use Sect ion A to identify the agency's d epartment or unit . • Use Secti on B to identify an indivi dual. • Use Section C to iden tify an o utside organization.
Number
A. Name of Agency, Department or Unit of Ticket(s)/ Describe t he public purpose made pursuant to the age ncy's policy
Passes
Number B. Name of Indiv idual of Tic ket(s)/ Identify o ne of the following:
(Last, First) Passes
Middleton , Lisa Ceremonial Role D Other ~ Income D
If Checking ·eeremoniaJ Role" or 'Other' describe below 1 Public Pu rpose as d efin ed by PS Resolution No. 22454 ,
Section 1 (d )(vi i )(viii}(xi )
Roberts, J .R. Ceremonial Role D Other 181 Income D
1 If checking ·ceremonial Role" or ·other' clescnbe below
Publ ic Pu rpose as d efi ne d by PS Resolution No. 22454,
Section 1 ( d)(vi i )(viii)(xi )
Name of Outside Organization Number
C. of Tlcket(s)/ Desc ribe the public purpose made pursuant to the agency's policy
(include address and description) Passes
I have read and understand FPI?. egu/ations 18944.1 and 18942 I have verified that the distribution set forth above, 1s in accordance
Verification ,,
with the requirements. ("' I
David Ready
Signature of Agency 7 or 'o/ e Print Name
Commen t: / /
V
City Manag er
nue (month, day, year)
FPPC Form 802 (212016)
FPPC To ll-Free He lpline: 866IASK-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, Departm~nt or.Unit
I '
I B. Name of Individual
I (Last, First)
_J
I C; Name of Outside·Orgailization
I (inClude address and description)
'
'
Number
of Tlcket(s)/
Passes
Number
of Ticket(s)/
Passes
·Number
of Ticket(s)/
Passes
Describe the public purpose made pursuant to the agency's policy
Identify one of the following: I
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" desctibe below:
,
Ceremonial Role D Other D Income D
If checking "Ceremonial Role" or "Other" describe below:
Ceremonial Role D Other D Income D
ff checking ·ceremonial Role" or-Other" describe below:
'
Describe-the public purpose made pursuant to the agency's policy I
FPPC Form 802 (212016)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)