2017-02-11 Steve Chse Humanitarian AwardsAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name iR E MYS) SM
City of Palm Springs iE� OF PALM SPPINDivision, Department, or Region (if applicable) '
For Official Use Only
z 211 APR 24 PM 5: 4
Designated Agency Contact (Name,Ptle)
I:FI E Cr lie: C11-Y CLI: i•;
Cindy Cairns, Executive Services Administrator
❑ Amendment (Must Provide Explanation in Part 3.)
Area CodelPhone Number E-mail
l Filing:
i i f Original ng:
760-322-8362 cindy.cairns@palmspringsca.gov Date o(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: Steve Chase Humanitarian Awards Date(s) 02 1 11 1 17 1 1
Provide Tide/Explanation
Tickets)/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.
Number
A. Name of Agency, Department or Unit of Tlcket(sy Describe the public purpose made pursuant to the agency's policy
Passes
Number
B. Name of Individual o('Mk"s)► Identity, one of the following:
(Last, First) I Passe
Moon, Robert
Ceremonial Role ❑ Other ® Income ❑
1 if checking "Ceremonial Role" or'Other' describe below:
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other X❑ Income ❑
lrcheckirg "Ceremonial Rode"or `Other' describe below
Name of Outside Organization Number
C. of Tlcket(s►/ Describe the public purpose made pursuant to the agency's policy
(include address and description) Passim
4. Verification
1 have read and understand
with the requirements. At
Comment:
Regulations 18944.1 and 18942. 1 have verified that the distribution set forth above, is in accordance
David Ready City Manager �� 1-7
Print Name Title (month, day, year)
FPPC Form 802 (212016)
FPPC Totl-Free Nelplina: 8661ASK-FPPC (8661275-3772)