2017-03-24 Senior Inspiration AwardsAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
1. Agency Name
City of Palm Springs
Division. Deoartment, or Region (if applicable)
Cindy Cairns, Executive Services Administrator
760-322-8362 i cindy.cairns@palmspringsca.gov
A Public Document
fi E DSP
• 1
11 APR 24 PM S. Ff 3 For Official Use Only
ILCE OF THE C!r it 4�� �tr.
❑ 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 $ 30.00
Event Description: 25th Annual Senior inspiration Awards Date(s) 31 24 1 17 1 1
Provide Title/Explanation
Ticket(s)/Pass(es) provided by agency? Yes ❑ No I&] If no: County of Riverside
Name of Source
Was ticket distribution made at the behest Yes ❑ No ® IT 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 Tickskey Describe the public purpose matte pursuant to the agency's policy
Passes
B.
Mills, Chris
Cairns, Cindy
Name of Individual
(Last, First)
of Ticke4sy I Identify one of the following:
es Pass
Ceremonial Role ❑ Other [3 Income ❑
If checking "Ceremonial Role" or "Other" descr be below:
1 Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other 0 Income ❑
t it checking "Ceremonial Role" or "Other' describe below:
Public Purpose as defined by PS Resolution No. 22454
C. Name of Outside Organization I of Tlckat♦al/ Describe the public purpose made pursuantto the agency's policy
(include address and description) passes
4. Verification
1 have read and under
with the requirements -
re of Agency N
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)
Agency Report of: LailTOMia
Ceremonial Role Events and TicketlPass 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 S to identify an individual. • Use Section C to identify an outside organization.
Number
A. Name of Agency, Department or Unit
of TlckatlsW
Passes
Describe the public purpose made pursuant to the agency's policy
B. Name of Individual
(Last, First)
Number
of Ticket(s)l
pates
Identify one of the following:
Dunn, Charles
Ceremonial Role ❑ Other ® Income ❑
Of checking -Ceremonial Role'or-Othei" describe below:
Public Purpose as defined by PS Resolution No. 22454
Thompson, Wanda
1
Ceremonial Role ❑ Other ® Income ❑
11checkmg°Cer9monralRoW'or"Other'describebelow.,
Public Purpose as defined by PS Resolution No. 22454
Lopez, Janice
Ceremonial Role ❑ Other ® Income ❑
it checking "Ceremonial Role"or'01her"describebelow:
Public Purpose as defined by PS Resolution No. 22454
Goolsby, Denise
Ceremonial Role ❑ Other ® Income ❑
llchecking`CeremonlatRcie"or°Othee'descdbebelow:
Public Purpose as defined by PS Resolution No. 22454
Name of Outside Organization
G. �
(include address and description)
Number
of 11cket(a)1
pain
Describe the public purpose made pursuant to the agency's policy
FPPC Form 802 (212016)
FPPC Tall -Free Helpline: 8661ASK-FPPC (8661275-3772)
Form 802 — Additional Tickets for 25th Annual Senior Inspiration Awards 3/24/2017
Piepho, Rob —1, Public Purpose as described by PS Resolution No. 22454
Ball, Marilyn —1, Public Purpose as described by PS Resolution No. 22454
Weisberg, Marge —1, Public Purpose as described by PS Resolution No. 22454
Minne, Charles —1, Public Purpose as described by PS Resolution No. 22454
Williams, Steve —1, Public Purpose as described by PS Resolution No. 22454
Gardner, Dan —1, Public Purpose as described by PS Resolution No. 22454
Belgrave, Paul —1, Public Purpose as described by PS Resolution No. 22454
Belgrave, Judy —1, Public Purpose as described by PS Resolution No. 22454
Donenfeld, Doug —1, Public Purpose as described by PS Resolution No. 22454
Katz, Suzy —1, Public Purpose as described by PS Resolution No. 22454
Katz, Bennett —1, Public Purpose as described by PS Resolution No. 22454
Mitchell, Steph —1, Public Purpose as described by PS Resolution No. 22454
Halcomb, Chris —1, Public Purpose as described by PS Resolution No. 22454