2017-04-22 Animal Shelter Faux Fur BallAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name
i Y SP-WQM �e i
City of Palm Springs
Division, Department, or Region (if applicable) 2017 MAY -2 PM 5 3 or Official Use Only
Designated Agency Contact (Name, Title) FFICE O I IL GI i LLkI;
Cindy Cairns, Executive Services Administrator ❑Amendment (Must Provide Explanation in Part 3.)
Area Code/Phone Number E-mail
l Filing:
i i f O Date oOriginal ng:
760-322-$362 cindy.cairns@palmspringsca.gov Da(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: PS Animal Shelter Faux Fur Ball Date(s) 41 22 1 17 _J 1
Provide Title/Explanation
Ticket(s)/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.
A. Name of Agency, Department or Unit
Number
of TickegsN
Describe the public purpose made pursuant to the agency's policy
Passes
B. Name of Individual
Number
ofTicket(s)(
Identify one of the following:
(Last, First)
passes
Ceremonial Role ❑ other ® Income ❑
Moon, Robert
If checking"Ceremonial RoWor"Ocher'dsscdbebelom
Public Purpase as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other X❑ Income ❑
Roberts, J.R.
if checking Temmonial RcWor"Other' describe below:
Public Purpose as defined by PS Resolution No. 22454
Name of Outside Organization
C.
Number
ofTlcket(ey
Describe the public purpose made pursuant to the agency's policy
{include address and description)
Passes
4. Verification
I have read and understan PC Regulations 18944.1 and 18942. 1
have verified that the distribution set forth above, is in accordance
with the requirements.
David Ready
City Managed
Signature of Agency ead or signee Print Name
Title (month, day, year)
Comment:
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 8661ASK-FPPC (3661275-3772)