2017-03-24 Womans Club LuncheonAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
1. Agency Name
City of Palm Springs
Dlvision, Department, or Region (if applicable)
vesignatea Agency t;onzacz (frame, tme)
�t
Cindy Cairns, Executive Services Administrator
760-322-8362 1 cindy.cairns@palmspringsca.gov
2. Function or Event Information
Does the agency have a ticket policy? Yes ® No ❑
Event Description: PS Woman's Club Luncheon
Provide Trdef Explanation
Tickets)/Pass(es) provided by agency? Yes ® No ❑
Was ticket distribution made at the behest Yes ❑ No
of agency official?
A Public Document
I� e?I`N E D 'ntornia r 84
T Y OF PALM S P R For Official Use Only
ill APR 24 PM 5: 43
t'lP1: (ice T14i 7 r'IT :` f` t:I'
❑ Amendment (Must Provide Explanation in Part 3.)
Date of Original Filing:
(month, day, year)
Face Value of Each Ticket/Pass $ 100.00
Date(s) 31 24 t 17
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 TickagaY Describe the public purpose made pursuant to the agency's policy
Passes
B.
Moon, Robert
Foat, Ginny
Name of Individual
(Last First)
of Tk ketlsy ! identify one of the following:
Passes 1
Ceremonial Role ❑ Other ® Income ❑
1 !f checking `Ceremonial Role" or "Other" describe below.
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other 9 Income ❑
1 If checking `Ceremonial Rote" or "Other' describe below:
Public Purpose as defined by PS Resolution No. 22454
C.Name of Outside Organization I of Tlekt(sy Describe the public purpose made pursuant to the agency's policy
(include address and description) Passes
4. Verification
1 have read and understand
with the requirements. Y
Signature of Agency H
Comment:
Regulations 16944.1 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 (2120161
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)
Agency Report of:
Ceremonial Role Events and Ticket/Pass 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 Unft
of TickegsN
Passes
Describe the public purpose made pursuant to the agency's policy
B.
Name of Individual
(Last, First)
Number
of Ticket(sy
Passes
Identify one of the following:
Roberts, J.R.
Ceremonial Role ❑ Other El Income
If checking "Ceremonial Role"or"Othw'descnbebelow:
Public Purpose as described by PS Resolution No. 22454
❑
Ceremonial Role ❑ Other ❑ Income
H checking "Ceremonial Role' or "Other" describe below
❑
Ceremonial Role ❑ Other ❑ Income
If checking "Ceremoniai Role' or -Othe> ' describe below:
❑
Ceremonial Role ❑ Other ❑ Income
if checking "Cemmonfal Rote"ar'Othef describe below.
❑
C.
Name of Outside Organization
(include address and description)
Number
of Tickegay
paste
Describe the public purpose made pursuant to the agency's policy
FPPC Form 802 (2f2016)
FPPC Toll -Free Helpline: 866fASK-FPPC (8661275-3772)