2017-02-16 Art Palm SpringsAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
1. Agency Name
City of Palm Springs
Division, Department, or Region (ifapplicable)
Designated Agency Contact (Ivame,Title)
Cindy Cairns, Executive Services Administrator
Area GodelPhone Number E-mail
760-322-8362 1 cindy.cairns@palmspringsca.gov
A Public Document
FP t, Ltd ST V E P •
2017 APR 24 PM 5 4 For Official ial Use Only
'ICE U� IilL L'E Y
❑ Amendment (Must Provide Expianah'on in Part 3.)
Date of Original Filing:
(month, day, year)
2. Function or Event Information
Does the agency have a ticket policy? Face Value of Each Ticket/Pass $ 100.00
9 Y P Y� Yes® No
Event Description: Art Palm Springs Date(s) 02 l16 ( 17 02 ) 19 ) 17
Provide Titie/Explanakon
Ticket(s)/Pass(es) provided by agency? Yes ❑ No El If no: Art Palm Springs
Name of Source
Was ticket distribution trade at the behest Yes ❑ No ® Ir yes:
OfhciaPs 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 ofTlcksyalf Describe the public purpose made pursuant to the agency's policy
Passes
Number
B. Name of Individual of Tickegs►/ Identify one of the following:
(Last, First) Passes
Moon, Robert Ceremonial Role ❑ Other iK Income ❑
2 If checking "ceremoniai Role"or, "0ther' describe below,
Public Purpose as defined by PS Resolution No. 22454
Foat, Ginny Ceremonial Role ❑ other ❑9 Income ❑
1 If checking -Ceremonial Role" or "Other' descAbe below.
Public Purpose as defined by PS Resolution No. 22454
Name of Outside Organization Number
C. of Ticke ey Describe the public purpose made pursuant to the agency's policy
(include address and description) Passes
4. Verification
I have read and understand
with the requirements.
Signature of Agency
Comment:
Regulations 18944.1 and 18942. 1 have verified that the distribution set forth above, is in accordance
(month, day, year)
FPPC Form 802 (2/2016)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)
Agency Report of:
Ceremonial Role Events and Ticket/Pass Distributions Form 0
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 8 to identify an individual. • Use Section C to identify an outside organization.
Number
A. Name of Agency, Department or Unit
of Ticket(s)f
Describe the public purpose made pursuant to the agency's policy
Passes
B. Name of Individual
(Last First)
Number
of Tickegail
Passes
Identify one of the following:
Roberts, J.R.
Ceremonial Role ❑ Other El Income ❑
if checking "Ceremonial Role" or'Other" describe below:
Public Purpose as defined by PS Resolution No. 22454
Kors, Geoff
Ceremonial Role ❑ Other ® Income ❑
if checking "Ceremonial Role"or "Other' describe beiow:
Public Purpose as defined by PS Resolution No. 22454
Mills, Chris
Ceremonial Role ❑ Other ® Income ❑
if checking 'Ceremonial Role"or "Other' describe beiow:
Public Purpose as defined by PS Resolution No. 22454
Hart, Kathie
Ceremonial Role ❑ other ® Income ❑
if checking "Ceremonial Role" or ^Other' describe below
Public Purpose as defined by PS Resolution No. 22454
Name of Outside Organization
C.
(include address and description)
Number
of Tickst(s)l
Passes
Describe the public purpose made pursuant to the agency's policy
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)
Form 802 — Additional Tickets for Art Palm Springs 02 16-19 2017
Gladders, Craig-1 Public Purpose as described by PS Resolution No. 22454