2019-05-15 44th Annual NUSAAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name Li, ate stamp C e ' •
City of Palm Springs .�'��
Division, Department, or Region (if applicable) �� jli For Official use only
By. J 6 20/9J
Designated Agency Contact (Name, Title)
Shari Wrona, Executive Services Administrator
❑ Ame d"rit ( st Provide Eirplenah'on in Part 3.)
760-322-8632 I shari.wrona@palmspringsca.gov I Date of Original Filing:
(monM. tlay, year)
2. Function or Event Information
Does the agency have a ticket policy?
Event Description: 44th. Annual NUSA
Yes ® No ❑
Face Value of Each Ticket/Pass $ 225.00
Date(s) 05 ) 15119
Provide Tille/Explanation
Ticket(s)/Pass(es) provided by agency? Yes ® No ❑ If no:
Name of Source
Was ticket distribution made at the behest Yes ❑ No ® If yes:
Offic al's Name (Last, First)
of agency official?
05/ 19 / 19
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 Tieket(s)l
Describe the public purpose made pursuant to the agency's policy
Passes
B. Name of Individual
Number
of Ticket(s)/
Identify one of the following:
(Last, First)
Passes
�y
Ceremonial Role ❑ Other Idl Income ❑
Moon, Robert
1
hecking'Ca�emonial Rite or'OthMmwnbebe .
Public Pcurpose as described by PS Resolution No. 22454,
Section 1 d vii viii xi
Ceremonial Role ❑ Other ® Income ❑
KOfS, Geoff
1
scking'CemmoNsl Roe'ur'Other' deacnbebelm
Public Pul/chrpose as described by PS Resolution No. 22454,
Section 1 d vii viii xi
Name of Outside Organization
C.
Number
of Ticket(s)l
Describe the public purpose made pursuant to the agency's policy
(include address and description)
Passes
4. Verification
I have read and understand FPPC Regulations 18944.1 and 18942. I have verified that the distribution set forth above, is in accordance
with the requirements.
David Ready City Manager
ure of AgII or Designee Print Name TNe (month, day, year)
Comment:
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 866IASK-FPPC (866/275-3772)
Agency Report of:
Ceremonial Role Events and Ticket/Pass Distributions '
Continuation Sheet A Public Document
Agency Name
City of Palm Sprit
3. Recipients
Use Section A to identify the agency's department or unit. • Use Section H to identify an individual. • Use Section C to identify an outside organization.
A. Name of Agency, Department or Unit
of Ticket(s)1
Passes
Describe the public purpose made pursuant to the agency's policy
B. Name of Individual
(Last, First)
_--Nu__.
mber
of Ticket(s)l
Passes
Identify one of the following:
Middleton, Lisa
1
Ceremonial Role ❑ Other ® Income ❑
cheering 'Ceremonial Rc'e"or'Other describe below:
Public Purpose as described by PS Resolution No. 22454,
Section 1(d)(vii)(viii)(xi)
Holstege, Christy
1
Ceremonial Role ❑ Other ® Income ❑
tfchecking"Cemmonial Role"or"Otheroescnbe below.
Public Purpose as described by PS Resolution No. 22454,
Section 1(d)(vii)(viii)(xi)
Roberts, J.R.
1
Ceremonial Role ❑ Other ® Income ❑
IPohecking "Cemmonial Role"or'Other tlescnbe below:
Public Purpose as described by PS Resolution No. 22454,
Section 1 d vii viii) xi
Ceremonial Role ❑ Other ❑ Income ❑
tfchecking "Ceremonial Role'or "Other'tlescnbe below:
Name of Outside Organization
C.
(include address and description)
'Number)
of Ticket s f
Passes
Describe the public ur ose made pursuant to the a enc s olic
p purpose P agency's policy
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661276.3772)