2018-02-24 Mizell Senior Center GalaAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name ;.I Y F r AhA sa' i3' •
City of Palm Springs �
Division, Department, or Region (if applicable) ���d I 20 AM 9: 51 For Official Use Only
OF THC cl i Y CLEi
Christina Chartier, Executive Assistant to Mayor and Council
❑ Amendment (Must Provide Expfanadon in Part 3.)
760-322-8366 1 christina.chartier@palmspdngsca.gov I Date of Original Filing: (month, day, year)
2. Function or Event Information
Does the agency have a ticket policy? Yes ® No ❑ Pace Value of Each Ticket/Pass $ 300.00
Event Description: Mizell's Stars Among Us Gala Date(s) 02 1 24 r 18 1 1
Provide Tide/Explanedon
Ticket(s)/Pass(es) provided by agency? Yes ❑ No ® If no: Mizell Center
Name of Source
Was ticket distribution made at the behest Yes ❑ No ® If yes:
Of(raal's Name (Last, First)
of agency official?
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.
A. Name of Agency, Department or Unit
of Tkkot(%Y I Describe the public purpose made pursuant to the agency's policy
Passes
B. Name of Individual of Ticket(sy Identify one of the following:
(Last. First) Passes
Robert Moon Ceremon;al Role ❑ Other ® Income ❑
2 Bcheclf a emonialRole'or Other daumbebelow
Public Purpose as defined by PS Resolution No. 22454
Section 1 d vii
J.R. Roberts Ceremon.ai Role ❑ Other Q ncome ❑
2 ItchecrgQ-(rreamial Role'or'Otherdescrtbe below
Public Purpose as defined by PS Resolution No. 22454
Section 1 d vii
Name of Outside Organization Number
C. {Include address and description) of Tleket(s)l Describe the public purpose made pursuant to the agency's policy
Passes
4. Verification
1 have read and understanPC Regulations 18944 1 and 18942 I have verified that the distribution set forth above, is in accordance
with the requirements. fff
David Ready City Manager
Print Name TWe (month, day year)
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 8661ASK-FPPC {8661276-3772)
Agency Report of: California
Ceremonial Role Events and TickeVPass Distributions Form
Continuation Sheet 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)l
Describe the public purpose made pursuant to the agency's policy
Passes
B. Name of Individual
(� First)
Number
ofPsN
ses
Identify one of the following;
David Ready
Ceremonial Role ❑ Other ® income ❑
2
It Cheudnp 'CeMftVMAl Role' or'Orhel' desMM be.bn
Public Purpose as defined by PS Resolution No. 22454
Section 1(d)(vii)
Suzanne Severin
Ceremonial Rolm ❑ Other ® Incarnc ❑
2
rtcheGdng-Commoniar Rola-mr'Other desmbe below
Public Purpose as defined by PS Resolution No. 22454
Section 1 d vii
Anthony Mejia
Ceremonial vole ❑ other ® Income ❑
2
sehecldnp -�e,-emoner Rde'a'ornaraesame beow
Public Purpose as defined by PS Resolution No. 22454
Section 1 d vii
Ceremonial Role ❑ Other ® Income ❑
it eheeldap'C"moMW Role' or'01W desmbe below
Name of Outside Organization
C. (include address and description)
Number
°f p ms u
Describe the public purpose made pursuant to the agency's policy
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)