2017-03-15 Chamber Golf TournamentAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
1. Agency Name
City of Palm Springs
Division, Department, or Region (if applicable)
Designated Agency Contact (Name,Tltle)
Cindy Cairns, Executive Services Administrator
Area CodelPhone Number E-mail
760-322-8362 1 cindy.cairns@palmspringsca.gov
A Public Document
IT CYF Pr,LM S P R
017 APR 24 PM 5; 1 ry For Official Use Only
ICE OF THE CITY CtE.ni
❑ Amendment (Must Provide Explanation in Part 3.)
Date of Original Filing:
(month, day, year)
2. Function or Event Information
Does the agency have a ticket policy? Yes ® No ❑ Face Value of Each Ticket/Pass $ 175.00
Event Description: PS Chamber Annual Golf Tournament Date(s) 3 f. 15 / 17 1 1
Provide TitielExpianab'on
Ticket(s)/Pass(es) provided by agency? Yes ❑ No ® If no: PS Chamber of Commerce
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 610 identify an individual. • Use Section C to identify an outside organization.
Number
A. Name of Agency, Department or Unit ofTickegoy Describe the public purpose made pursuant to the agency's policy
Passss
Number
B. Name of Individual of ncket(sp Identify one of the following:
(Last First) I pass
Fontana, Mike
Jurasky, Jeff
Ceremonial Role ❑ Other IN Income ❑
1 If checking "Ceremonial Role" or "Other" deScnbe below:
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ❑X Income ❑
1 If checking 'Ceremoniai Role" or `Other' describe below:
Public Purpose as defined by PS Resolution No. 22454
C. Name of Outside Organization I of Ticksgay I Describe the public purpose made pursuant to the agency's policy
nclude address and description)
(iPasses
4. Verification
I have read and understand
with the requirements. %1
Comment:
Regulations 18944.1 and 18942. 1 have verified that the distribution set forth above, is in accordance
David Ready City Manager t-7
Print Name Tile (month, day, year)
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 866fASK-FPPC (8661275-3772)
Agency Report of: callitornia02
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 Tickets)/
Passes
Describe the public purpose made pursuant to the agency's policy
B. Name of Individual
(Last. First)
Number
of Tlekeys)/
Passes
Identify one of the following:
Prest, Dave
t
Ceremonial Role ❑ Other El Income ❑
If checking"Ceremonial Role"or"Otherdescribe below
Public Purpose as defined by PS Resolution No. 22454
Barnhart, Dale
1
Ceremonial Role ❑ other El Income ❑
If checking'Ceremonial Role" or°OthWaescribebelow,
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ® Income ❑
If checking 'Ceremonial Role" or "Other" describe below:
Ceremonial Role ❑ Other ® Income ❑
if checking °Ceremonial Role" or "Other' describe below:
Name of Outside Organization
C. n3
(include address and description)
Number
of Ticket(ey
pip
Describe the public purpose made pursuant to the agency's policy
FPPC Form 802 (2f2016)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)