2017-02-25 Mizell Senior Center GalaAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
A Public Document
1. Agency Name I R E GIRVIEU
City of Palm Springs �� I I, P A L M SPRING
Division, Department, or Region (if applicable) 4n
Designated Agency Contact (Name,Title) `
Cindy Caims, Executive Services Administrator
Area CodelPhone Number I 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: Mizell Senior Center Stars Among Us
Provide Title/Explanation
Tickets)/Pass(es) provided by agency? Yes ® No ❑
For Official Use Only
24 PM 5: 43
OF 7hIE c1 rY CLE t ji
❑ Amendment (Must Provide Explanaton in Part 3.)
Date of Original Filing:
(month, day, year)
Face Value of Each TickeUPass $ 300.00
Date(s) 02 1 25 1 17 1 1
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 outsidc organization.
Number
A. Name of Agency, Department or Unit of Ttcket(y! Describe the public purpose made pursuant to the agency's policy
Passes
Number
B. Name of Individual of 7lcket(sN Identify one of the following:
(Last, First) I Pasg*$
Moon, Robert
Ceremonial Role ❑ Other ❑X Income ❑
it checking 'Ceremonial Role" or Other descnbe below_
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other 21 Income ❑
i/ checking "Ceremonial Roie^ or °Other' dasu ibe below:
Name of Outside Organization Number
C. of Tk:ket(su Describe the public purpose made pursuantte the agency's policy
(include address and description) Passes
4. Verification
1 have read and understand
with the requirements.
Agency Head or
Comment:
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 Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)