2017-03-17 Desert AIDS Project DinnerAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name RE(°& T
City of Palm Springs 1 f' TY OF P A L H SPRIFJC7For
Division, Department, or Region (if applicable) 7Use
2111 APR 24 PM 5*. 43
Designated Agency contact (Name, Title) OFFICE OF iE CiTY CAE
Cindy Cairns, Executive Services Administrator
❑ Amendment (Must Provide Explanation in Pad 3.)
Area CodelPhone Number I E-mail
780-322-8362 1 cindy.cairns@palmspringsca.gov
Date of Original Filing: (month, day, year)
2. Function or Event Information
Does the agency have a ticket policy? Yes ® No ❑
Event Description: DAP Dinner at My Place Shaken 2017
Provide Title/Explanation
Ticket(s)/Pass(es) provided by agency? Yes ® No ❑
Was ticket distribution made at the behest Yes ❑ No
of agency official?
Face Value of Each Ticket/Pass $ 200.00
Date(s) 31 17 1 17 _f_ .
If no:
Name of Source
If yes:
Official's Name (Last, First)
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(ey Describe the public: purpose made pursuant to the agency's policy
Passes
B.
Roberts, J.R.
Name of Individual
(Last, First)
of Ticket(*)( I Identify one of the following:
Passes
Ceremonial Role ❑ Other ® Income ❑
1 it checking -Ceremonral Role' or "Other" describe below:
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other X❑ Income ❑
it checking "Ceremonial Role" or "Other' describe below:
Name of Outside Organization Number
C. (include address and description) of PPaass�eN Deed public purpose made pursuant to the agency's policy
4. Verification
1 have read and understand
with the requirements. /'
Comment:
Regulations 18944.1 and 18942. 1 have verified that the distribution set forth above, is in accordance
David Ready City Manager +i.Do I-7
Print Name Title (month, day, year)
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 866iASK-FPPC (8661275-3772)