2019-11-19 PS Women in Film Broken GlassAge ncy Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name L H S~\ff:Gi&
9 M~\\: 11
Ci t y of Pa lm Springs cli Y OF P
Division , Department, or Region (if applicable) 20\9NO~
California 802
Form
For Official Use Only
=--:---.,---,-,:------::....---:-----:--::-:-----:::c-:---:----------=o=F~r---t'riH HE e n '< CL ERh Designated Agency Contact (Name, Title)
Sha ri Wrona, Execu tive Services Administrato r
Area Code/Phone Number
760-322-8632
E-mai l
s hari.wrona@palmspri ngsca.gov
0 Amendment (Must Provide Explanation in Part 3.)
Date of Origi nal Filing: 11 118119
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2 . Function or Event Information
Does the agency have a ticket policy? Yes 18) No • Face Value o f Each TickeUPass $ _1_o_o_.o_o _____ _
Event Description: PS Women in Film Broken Glass
Provide Title/ Explanation
Date( s) _!! __ J__~.i._J ~ __J__j __
Ti cket(s)/Pass (es) provided by agen cy? Yes fg) No O If no: _________________ _
Name of Source
Was ticket distribution made at th e behes t Yes • No ~ If yes: ------:::,:;:-:---::-,:-:----::----,--::c-..,,..--------
0,ficial's Name (Las t, First)
of agency official?
3 . Recipients
• Us e Sec tion A to ident ify the agency's department o r unit. • Use Section B to identify an individual. • Use Sect ion C t o identify a n o uts ide organization.
Number
A. Name of Agency, Depa rtment or Unit of Tlc ke t(s)/ Describe th e public purpose made pursuant to the agency's policy
Passes
Number
B. Name of Individual of Ti cket(s)/ Identify one of the following:
(Last, First) Passes
Ceremonial Role 0 Other 0 Income 0
Moon, Rob ert 1 If checking --ce remoma l Role " or ·other" descnbe below;
Public Purpose as described by PS Resolu tion No. 22454 ,
Section 1 (d)(vi)(vii i)(xi )
Cere monial Role 0 Other 0 In come 0
If c hacktng .. Ceremonial Role" or ·Other" describe below
Name of Outside Organization Number
C. of Ti cke t(s)/ Desc ribe the public purpose made pursuant to the agency's policy
(include a ddress and description) Passes
4. Verification
gulations 18944. 1 and 18942. I have verified that the distribution set forth above, is in accordance
with the requireme nts.
David Read y
Print Name
City Manager
nue J/·/9.J°I
(montA, day, year)
FPPC Form 802 (2 /2 016)
FPPC To ll-F ree Helpline: 866 /ASK-FPPC (866/275-3772)