2017-01-19 PSUSD Foundation Benefit ConcertAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
1. Agency Name
City of Palm Springs
Division, Department, or Region (if appiicabie) t
Designated Agency Contact (Name, Title) 01
Cindy Cairns, Executive Services Administrator
Area Code/Phone Number E-mail
760-322-8362 1 cindy.cairns@paimspringsca.gov
2. Function or Event Information
Does the agency have a ticket policy? Yes ® No ❑
Event Description: PSUSD Foundation Benefit Concert
Provide Tde/Explanatfon
Ticket(s)/Pass(es) provided by agency? Yes ® No ❑
A Public Document
Wit VEN Ei)
Or PALH SP
For Official Use Only
APR 24 PM 5:144
ICE OF TKL CI T ,,`
❑ Amendment (Must Provide Explanation in Part 3.)
Date of Original Filing:
(month, day, year)
Face Value of Each Ticket/Pass $ 125.00
Date(s) 01 1_ 19 1. 17
If no:
Name of Source
Was ticket distribution made at the behest Yes ❑ No ® If yes:
Official's Name (Lost, 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 ickegsli Describe the public purpose made pursuant to the agency's policy
Passes
Number
B. Name of Individual of Ticket(sy Identify one of the following:
(Last, First) Passes
Ceremonial Role ❑ Other ❑ Income ❑
Mills, Chris 2 fichecking `Ceremonial Rde"or`Other' describe below,
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ other ❑ Income ❑
Roberts, J.R. 1 ff checking "Ceremoniai Role" or "Ofhae, describe below.
Public Purpose as defined by PS Resolution No. 22454
Name of Outside Organization Number
C. of 7ickagey Describe the public purpose made pursuant to the agency's policy
(Include address and description} Passes
4. Verification
I have read and unders4FPPegulations 18944.1 and 18942. 1 have verified that the distribution set forth above, is in accordance
with the requirements.
David Ready City ManagerSignature of Agency Head Print Name Title (month, day, year)
Comment:
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)
Agency Report of: -
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 Tickags)/
Passes
Describe the public purpose made pursuant to the agency's policy
B.
Name of Individual
(Last First)
Number
of Tickegs)I
Passes
Identify one of the following:
Foat, Ginny
2
Ceremonial Role ❑ Other El Income
if checking "Ceremonial Role"or"Other'describe below:
Public Purpose as defined by PS Resolution No. 22454
❑
Ceremonial Role ❑ Other ❑ Income
!f checking `Ceremonief Rde- or ^Other' descnbe below
❑
Ceremonial Role ❑ Other ® Income
ff checking "Ceremonial Role"or "Other describe below
❑
Ceremonial Role ❑ other ® Income
frchecking 'Ceremonial Role" or'Other' describe below:
❑
�-
Name of Outside Organization
(include address and description)
Number
of Tickegsp
Passes
Describe the public purpose made pursuant to the agency's policy
FPPC Form 8021212016)
FPPC Toll -Free Helpllne: 8661ASK-FPPC 1866/275-3772)