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2018-04-07 Animal Shelter Faux Fur Ballagency Report of: Ceremonial Role Events and Ticket/Pass Distributions A Public Document 1. Agency Name City of Palm Springs "IT ( OF PALM • Division, Department, or Region (if applicable) 70JUL 19 AM 8: 0 For Official Use Only Designated Agency Contact (lvame,Title) E 0 Thk CITY CLF , , Christina Chartier, Executive Assistant to Mayor and Council ❑Amendment (Must Provide Farprartatiort in Part 3.) 760-322-8366 chdstina.chartier@palmspdngsca.gov Date of Original Filing: (month, day, year) 2. Function or Event Information Does the agency have a ticket policy? Yes ® No ❑ Face Value of Each Ticket/Pass $ 150.00 Event Description: Faux Fur BallDate(s) �. _ 0? _ i 18 �� J Provide 711le/Exptartalion Ticket(s)IPass(es) provided by agency? Yes ® No ❑ If no: Name of Source Was ticket distribution made at the behest Yes ❑ No ® If yes: Offiaers 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. Number A. Nave of Agency, Department or Unit of Ticket(s)r Describe the public purpose made pursuant to the agency's policy Passes B• Name of Individual I ofNTicks�gsjf I Identify one of the following: (Last, First) Passes Robert Moon Cemmonlal Role ❑ Other © income ❑ N chedit Ceramoniel Role' or't7 W describe below Public Purpose as defined by PS Resolution No. 22454, Section 1 d vii Ceremonial Role ❑ Other 0 Irimma ❑ J.R. Roberts ltdacbw TerenwialRoW orromerdssaibe below Public Purpose as defined by PS Resolution No. 22454, Name of Outside Organization "" C. (include address and description) of Ticket(sN Describe the public purpose made pursuant to the agency's policy Passes 4. Verification l have read and understand with the acquirements. _ % j Comment: Regulations 18944.1 and 18942. 1 have verified that the distribution set forth above, is in accordance David Ready City Manager Print Name Toe (month day, year'j FPPC Form 802 (212016) FPPC Toll -Free Helpline: 6661ASK-FPPC (8661275-3772) Agency Report of: Ceremonial Role Events and Ticket/Pass Distributions Continuation Sheet Agency Name A Public Document City of Palm Springs 3. Recipients • Use Section A to identify the agency's department or unit. • Use Section $ to identify an Individual. • Use Section C to identify an outside organization. Number A. Name of Agency, Department or Unit ofTIekst(sp Passes Describe the public purpose made pursuant to the agency's policy B. Name of Individual (Laat Fist) Number of 7lckegs}! Passes Identify one of the following: Christy Holstege 1 Ceremonial Role ❑ Other ® Income ❑ ltcneckagT wwnlalRole or'Othee desobe below Public Purpose as defined by PS Resolution No. 22454, Section 1 (d)(vii) Ceremonial Role ❑ Other ❑ Income ❑ 1! thecldnQ'Ceromonlal Rde or 'OtheY describe below Ceremonial Role ❑ other ❑ Income ❑ If diecMng-CeremonWRafe•or &Wdescdbebelow Ceremonial Role ❑ Other ❑ Income ❑ It checMng'Cenw=Aol Rote" ar'Other' describe below C. Name of outside Organization (include address and description) Number of TickkoUs11 Passes Describe the public purpose made pursuant to the agency's policy FPPC Form 8021212016) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)