2019-11-19 PS ModCom Preservation AwardsAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document ___________________________ ....,....,.,...,.4-1,,..... __ _
1. Agency Name CIT Y O Pt.L~e§p~N GS California 802
City of Palm Springs Form
Division, Department, or Region (if applicable) For Official Use Only
-,,-,------,-,---,------------.....+f'-fi-lri:-III F THE Cl TY CLE RI Designated Agency Contact (N ame, Ti tle)
Shari Wrona, Executive Services Adm inistrator
Area Code/Phone Number E-mail
760-322-8632 shari .wrona@palmspringsca .gov
D Amendment /Must Provide Explanation in Part 3.)
Date of Original Filing: --,---,--,----/month, day, year)
2. Function or Event Information
Does the agen cy have a ticket policy? Yes 181 No • Face Value of Each Ticket/Pass$ _1_2_5-_0_o ____ _
Event Desc ri ption: PS ModCom Preservation Awa rd s
Provide Tille/ Explanation
__;__; __
Ticket(s)/Pass(es) pro vided by agency? Yes ~ No D If no : ________________ _
Name of Source
Was ticket distribution made at the behest Yes • No l8) If yes: -----------------Official's Name (Last, First)
of agency official?
3. Recipients
• Use Section A to identify the agency's depa rtment or unit. • Use Section B to identify an individ ual . • Use Section C to identify an outside o rganization.
Number
A. Name of Agenc y, Department or Unit of Tlcket(s)/ DHcribe the public purpose made pursuant to the agency's policy
Pa sses
Number B. Name of Individual of Ticket(s)/ Identify one of the following:
(Last, First) Passes
Ceremonial Role D Other Iii Income D
Roberts, J .R. 1 If checking ·ceremonial Role" or "Other" describe below:
Public Pu rpose as described by PS Resolution No. 22454,
Section 1 (d)(vi)(viii)(xi)
Ceremonial Role D Other~ Income D
Moon , Robert I If checking ·ceremonlal Role" or "Other" describe below:
Public Purpose as descri bed by PS Resolution No. 22454,
Section 1 (d)(vi)(vi ii)(xi)
Name of Outside Organization Number
C. of Tl<:ket(s)/ DHcribe the public purpose made pursuant to the agency's policy
(Include addrHs and description) Passes
4. Verification
I have read and understand FPPC Regulations 18944.1 and 18942. I have verified that the distribution set forth abo ve, is in accordance
· e re uireme.tJ.tS.
David Ready City Manager \\-\°'·'~ Print Name Trtle /month, day, year)
Comment:-----------------------------------------
FPPC Form 802 (212016)
FPPC Toll-Free Helpline: 866IASK-FPPC (866/275-3772)