2017-04-17 Guide Dog DayAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name 'Oil
City of Palm Springs I F �; F' i e '
Division, Department, or Region (if applicable) O For Official Use Only
►�\ 1i MAY I $ PM 6�
Designated Agency Contact (Name,TiNe) v
iCE Gi= "i�-
Cindy Cairns, Executive Services Administrator
❑ Amendment (Must Provide ExpranaSon in Pen 3.)
Area Code/Phone Number E-mail
l Filing:
i i f Original ng:
760-322-8362 cindy.cairns@palmspringsca.gov Date o(month, day, year)
2. Function or Event Information
Does the agency have a ticket policy? Yes® No ❑
Face Value of Each Ticket/Pass $ 150.00
Event Description: Guide Dogs Dog Day Afternoon Date(s) 04 1 17 1 17 —J f
Provide Titte/Explanation
Tickets)/Pass(es) provided by agency? Yes ® No ❑ If no:
Name of Source
Was ticket distribution made at the behest Yes ❑ No ® If yes:
QflCiaPS 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
mber
B. Name of Individual of Tickegs)/ Identify one of the following:
(Last, First) Passes
Ceremonial Role ❑ Other ® Income ❑
Moon, Robert 1 trchecmng-Ceremonial Rde"or'Other'describebelow:
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other X❑ Income ❑
if checking 'Ceremonial Rate" or'Other' describe below
Number
C. Name of Outside Organisation of Tickegs►1 Describe the public purpose made pursuant to the agency's policy
(include address and description) Pass
4. Verification
I have read and
with the require)
Comment:
FPPC Regulations 18944.1 and 18942, I have verified that the distribution set forth above, is in accordance
David Ready City Manager 5110
Designee Print Name Title (month, day, year)
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)