2017-02-04 Black History Awards GalaAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
1. Agency Name
City of Palm Springs i
Division, Department, or Region (if applicable) R ,
Designated Agency Contact (Name, Title)
Cindy Cairns, Executive Services Administrator
Area CodelPhone Number E-mail
760-322-8362 1 cindy.cairns@palmspringsca.gov
2. Function or Event Information
Does the agency have a ticket policy? Yes ® No ❑
Event Description: Black History Annual Awards Gala
Provide Titte/Explanation
Ticket(s)/Pass(es) provided by agency? Yes ® No ❑
A Public Document
t
ti OF' PALMS PRIM Formj 11
For Official Elsa Only
r APR z4 p� s= 4
OFFICE Or Ti c. MY CL' R��
❑ Amendment (Must Provide Explanation in Pan 3.)
Date of Original Filing:
(month, day, year)
Face Value of Each Ticket/Pass $ 60.00
Date(s) 02 / 04 / 17
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 8 to identify an individual. • Use Section C to identify an outside organization.
Number
A. Name of Agency, Department or Unit of Tickegay Describe the public purpose made pursuant to the agency's policy
Passes
Number
B. Name of Individual of Tiaketlsy Identify one of the following:
(Last, First) Passes
Ceremonial Role ❑ Other ® Income ❑
lichecking 'Ceremonial Role"or'Other' describe below.
Moon, Robert 2 Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ❑X Income ❑
Mills, Chris 2 ffchecking-Ceremonial Role' or'0the/'desoribebeiow•
Public Purpose as defined by PS Resolution No. 22454
C. Name of Outside Organization of Tleket(c)/ I Describe the public purpose made pursuant to the agency's policy
(include address and description) Passes
4. Verification
1 have read and understand
with the requirements. n
Comment:
Regulations 18944.1 and 18942, 1 have verified that the distribution set forth above, is in accordance
David Ready City Manager
Print Name Title (month, day, year)
FPPC Form 802 (212016)
FPPC Tall -Free Helpline: 8661ASK-FPPC (8661275-3772)
Agency Report of: uaiitornia
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 Tickst(s)t
Passes
Describe the public purpose made pursuant to the agency's policy
B. Name of Individual
(Last, First)
Number
of Tlcket(su
Passes
Identify one of the following:
Ready, David
i
Ceremonial Role ❑ Other ® Income ❑
If checking "Ceremonial RoWor'01herclescribeMow,
Public Purpose as defined by PS Resolution No. 22454
Roberts, J.R.
1
Ceremonial Role ❑ Other ® Income ❑
lfchecking "Ceremonial Raie"or"Olnerdescabe Mow:
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ® Income ❑
11 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 Tkket(sy
Passes
Describe the public purpose made pursuant to the agency's policy
FPPC Form 802 (212016)
FPPC Toll -Free Helplins: 8661ASK-FPPC (8661276-3772)