2019-11-19 PSHA Member LuncheonAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name
City of Palm Springs
Division, De partm en t , or Regi on (if applicable)
Designated Agency Contact (Name, Tille)
Shari Wrona, Executive Services Administrator
Area Code/Phone Number
760-322-8632
E-mail
shari.wrona@palmspring sca.gov
California 802
Form
For Official Use Only
0 Amendment (Must Provide Explanation in Part 3.)
Date of Original F iling: ______ _
(month, day. year)
2 . Function or Event Information
Does the agen cy have a ticket po licy? Yes 181 No • Face Va lue of Each TickeUPass $ _3_o_.o_o _____ _
Event Description: PSHA Member Lu ncheon __J__j __
Provide 1Tlle/ Explanation
Ticket(s)/Pa ss(es) provided by agency? Yes~ No O If no: _________________ _
Name of Source
Was ti cket distribution made at th e behest Yes • No 181 If yes: ------------------
Offiaars Name (Last. Fi rst)
of agency official?
3. Recipients
• Use Section A to iden tify the agency's department or unit. • Use cction B to identify an individual. • Use Section C t o identify an outside organization.
Number
A . Name of Agency, Department or Unit of Tic kel(s)/ Desc ribe the public purpose made pursuant to the agency's policy
Passes
Number
B. Name of Individual of Ticket(s )/ Identify one of the following:
(Last, First) Passes
Ceremoni al Role 0 Other IBJ Income 0
Moon , Ro bert 1 If checl<ing ·eeremon,a/ Rote · or ·other" descnbe below
Public Purpose as described by PS Resolution No. 22454,
Section 1 (d)(vi)(viii)(xi)
Ceremon ial Role 0 Other 0 Income 0
If check,ng ·ceremon,a/ Rote· or -Other' describe b elow
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
I have read and understand FPPC Regulations 18944.1 and 18942. I have verified that the distribution set forth above, is in a ccordance
wi th the requirements.
David Rea dy City Manager
Print Name nue I I· I q ./ 9
(month, day, year)
Comme nt:-------------------------------------------
FPPC F orm 802 (2/2016)
FPPC Toll-Free Hel pline: 866/ASK-FPPC (866/275-3772)