2017-03-28 Mambo ItalianoAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name
City of Palm Springs u I T Y OF P. I N G` i
Division, Department, or Region (if applicable) 2011 HAY -2 PM 5: 30 For Official Use Only
Designated Agency contact (Iiiarne,Title) Or or- i HE GI 1 'Y ru'LU.
Cindy Cairns, Executive Services Administrator
❑ Amendment (Must Provide Explanation in Part 3.)
Area Code/Phone Number E-mail
760-322-8362 1 cindy.cairns@paimspringsca.gov 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 $ 95.00
Event Description: Mambo Italiano with Gand Band Date(s) 31 28 t. 17 1
Provide Title/Expianation
Tickets)/Pass(es) provided by agency? Yes ® No ❑ 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 B to identify an individual. • Use Section C to identify an outside organization.
Number
A. Name of Agency, Department or Unit of Ticket(sy Describe the public purpose made pursuant to the agency's policy
Passes
Number
B. Name of Individual of Tlokegs)l Identify one of the following:
(Last, First) I passes
Roberts, J.R.
Ceremonial Role ❑ Other i] Income ❑
If checking 'Ceremonial Role" or "Other descrtbe below.
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other x❑ Income ❑
If checking 'Ceremonial Role" or'Ofher' describe below:
C. Name of Outside organization Number
of Ticket{sjl Describe the public purpose made pursuant to the agency's policy
{include address and description) passim
4. Verification
I have read and understand
with the requirements.
Signature of Agency
Comment:
Regulations 18944.1 and 16942. 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: 6661ASK-FPPC (8661275-3772)