2019-04-07 PS Rotary Breakfast on the Mountain•Agency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document ---------------------------~Po---------California 802 1. Agency Name Dal~ Sfam p
Form City of Palm Springs
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Designated Agency Contact (Name, Title)
Shari Wrona, Executive Services A dministrator
Area Code/Phone Number
760-322-8632
E-mail
shari .wrona@palmspringsca.gov
D Amendment (Must Provide Explan ation i n Part 3.)
Date of Original Filing :--,---,,--,----,--
(month, day, year)
2 . Function or Event Information
Does the ag ency have a ticket policy? Yes 181 No • Face Va lue of Eac h TickeUPass $ _7_5_.o_o _____ _
Event Descripti on : PS Rotary Breakfast on the Mountain
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 the behest Yes • No ~ If y es : ------,,-,------,---=---------officia l's Name (Last, First)
of agency officia l?
3 . Recipients
• Use Sec tion A t o id entHy the age ncy's d epa rtment o r uni I. • Use Section B t o identify an individual. • Use Section C to identify a n outside organization.
Number
A. Name of Agency, Department o r Unit of Ticket(s)/ Describe the publ ic purpose made pursuant to the agency's policy
Pa sses
Number
B. Name of Individual of Ticket(s)/ Identify one of the following:
(Last, Firs/) Pa sses
Middleton , Li sa Ceremonial Role 0 Other ):81 Income 0
1 If checking •ceremonial Role· or "Othet' descnb e below
Public Purpose as defined by PS Resoluti on No. 22454,
Section 1 (d)(vi i)(viii)(xi l
Roberts, J .R. Ceremonial Role 0 Other ~ Income D
1 If che cl«ng "Ceremonial Role" or "Othet' descnbe below
Public Purpose as defined by PS Resolution No. 22454,
Section 1 (d)(vii)(viii)(xi )
Name of Outside Organization Number
C. of Ticket(s)/ Describe the public purpose made pursuant to the agency's policy
(include address and description) Passes
4. Verification
Regulations 18944.1 and 18942. I have verified that the distribution set forth above, is in accordance
with the require ments.
David Ready
Signature of Agency H Print Nam e
City Manager
nue (month, day, year)
FPPC Form 802 (2/201 6)
FPPC Toll-Free Helpline: 866/ASK-FPPC (8661275-3772)
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.
Number A. Name of Agency, Department or Unit of Ticket(s)/
I Passes
-r Number B. Name of Individual of Ticket(s)/
I (Last, FifSt) Passes
I Name of Outside Organization Number
C. of Ticket(s)I
I {include address and description) Passes -
Describe the public purpose made pursuant to the agency's policy I
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" ar"Other" describe below:
Ceremonial Role D Other D Income D
If checking ·ceremonial Role" ar"O/her" describe below:
Ceremonial Role D Other D Income D
If checking ·ceremonial Rote• 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)