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2018-10-06 Agua Caliente Dinner in the CanyonsAgency Report of: Ceremonial Role Events and Ticket/Pass Distributions A Public Document 1. Agency Name Date Stamp 1 City of Palm Springs or Christina Chartier, Executive Assistant to Mayor and Council 760-322-8366 1 chdstina.chartier@palmspringsca.gov 2. Function or Event Information Does the agency have a ticket policy? Yes ® No ❑ Event Description: Ague Caliente Dinner in the Canyons Provide 7it/e/Explanation Tickets)/Pass(es) provided by agency? Yes ® No ❑ U Pi2:11 Use Only ❑ Amendment (Must Provide Explanation in Part 3.) Date of Original Filing: (month. day, year) Face Value of Each Ticket/Pass $ 687.50 Date(s) 10 t 06 t 188 If no: Name of Source Was ticket distribution made at the behest Yes ❑ No ® If yes: Official'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. 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 Number of Ticket(s)I Identify one of the following: (Last, First) Passes Moon, Robert Ceremonial Role ❑ Omer ❑ Income ❑ 2 II checWng'Ceremonial Rde'or'Olher' describe below: Public Purpose as defined by PS Resolution No. 22454 Section 1 d vii ix Geoff KOrs Ceremonial Role ❑ Omer ❑ Income ❑ 2 II checWng'Commonlal Rde'or'Other' describe below. Public Purpose as defined by PS Resolution No. 22454 Section 1 d vii ix Name of Outside Organization C. Number of Tlcket(s)l Describe the public purpose made pursuant to the agency's policy (include address and description) Passes 4. Verification I have read and understand F PC Regulations 189444 and 18942. I have verified that the distribution set forth above, is in accordance with the requirements. David Ready City Manager Signature e r Designee Print Name Title (month, day, year) Comment: FPPC Form 802 (212016) FPPC Toll -Free Helpline: 86(1 (866/275-3772) Agency Report of: California Ceremonial Role Events and Ticket/Pass 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 Tlcket(sy Passes Describe the public purpose made pursuant to the agency's policy B. Name of Individual (Last, First) Number of Ticket(s)/ Passes Identify one of the following: David Ready 2 Ceremonial Role ❑ Other ® Income ❑ if checking 'Ceremonial Role"or *Other" describe below: Public Purpose as defined by PS Resolution No. 22454 Section 1(d)(x) Christy Holstege 2 Ceremonial Role ❑ Other ® Income ❑ 1f checking 'Ceremonial Role" or 'Other' describe below: Public Purpose as defined by PS Resolution No. 22454 Section 1 d xi) Ceremonial Role ❑ Other ❑ Income ❑ If checking "Ceremonial Role" or 'Other' describe below: Ceremonial Role ❑ Other ® Income ❑ 1f checking 'Ceremonial Role" or 'Other describe below: Name of Outside Organization C. (include address and description) Number of Ticket(sy Passes Describe the public purpose made pursuant to the agency's policy FPPC Form 802 (2/2016) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)