2017-02-08 Library Foundation FundraiserAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributi ns A Public Document
1. Agency Name R 1~? Y CU
City of Palm Springs ;li OF PALH SPqitti
Division, Department, or Region (if applicable) - RIM
2�1 APR 24 PM 5� �
Designated Agency contact (Name,TiNe) OFFICE Or THE CI _ ,.
Cindy Cairns, Executive Services Administrator
❑ Amendment (Must Provide Explanation in Part 3.)
Area code/Phone Number E-mail
760-322-8362 1 cindy.cairns@palmspringsca.gov Date of Original Filing:
y. @palms rin sca. p g gov (month, day, year)
2. Function or Event Information
Does the agency have a ticket policy? Face Value of Each Ticket/Pass $ 250.00
9 Y P Y• Yes® No
Event Description: PS Library Foundation Fundraiser Date(s) 02 1J 17 _1_ 1
Provide Title/Explanabion
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:
Oficia!'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 Tickegau Describe the public purpose made pursuant to the agency's policy
Passaa
B.
Moon, Robert
Name of Individual
(Last, First)
of Tick" )1 I Identify one of the following:
Passes
Ceremonial hole ❑ Other ® Income ❑
if checkng 'Ceremonial Role" or "Other' describe below:
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ❑X Income ❑
I checking 'Ceremonial Role" or'Other' describe below:
Name of Outside Organization Numberof Describe the public purpose made pursuant to the agency's olic
(include address and description) Pass su P Ppolicy
Passes
4. Verification
1 have read and under
with the requirements.
Comment:
Regulations 18944.1 and 16942. 1 have verified that the distribution set forth above, is in accordance
David Ready
Print Name
City Manager �I�1 u
Title (month, day, year)
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)