2017-01-21 Sanctuary Palm Springs Purple Room BenefitAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name
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City of Palm Springs
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APR 24 PSI 5: 44
For Official Use Only
Division, Department, or Region (d applicable)
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Designated Agency Contact (Name, Title)
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Cindy Cairns, Executive Services Administrator
❑ Amendment (must Provide Explanation in Part 3)
Area Code/Phone Number
E-mail
760-322-8362
cind cairns alms rin SCa. ov
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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: Purple Room Benefit for Sanctuary PS Date(s) 01 1 21 1 17 1 1
Provide Tifte/Explanation
Ticket(s)/Pass(es) provided by agency? Yes ® No ❑ 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.
A. Name of Agency, Department or Unit
Number
of Tickat(ay
Describe the public purpose made pursuant to the agency's policy
Passes
B. Name of Individual
Number
of Tieket(s)l
Identify one of the following:
(Last First)
Passes
Ceremonial Role ❑ Other ❑X Income ❑
Roberts, J.R.
2
it checking 'Ceremonial Role"or "Other" descnbe below:
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other X❑ Income ❑
it checking 'Comrnonra! Role" or °Other'•' describe below.
Name of Outside Organization
C.
Number
of Tk kegay
Describe the public purpose made pursuant to the agency's policy
(include address and description)
Passes
4. Verification
I have read and understand FP gulations 18944.1 and 18942. 1
have verified that the distribution set forth above, is in accordance
with the requirements.
David Ready
City Manager LH —),o j
Signature of Agency He7d[Dellilgp Print Name
Title (month, day, year)
Comment:
FPPC Form 802 (2/2016)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)