2017-05-07 White Party Circus T DanceAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name 't� E°ff:qt" D .. • 4 . e
City of Palm Springs i .I p ; t hi S 4' I~ 1 fa •
3
Division, Department, or Region (if applicable) For Official Use Only
J21 1 MAY 18 PM 6� 4
Designated Agency Contact (Name, Title) 0,
ICE Or-
Cindy Cairns, Executive Services Administrator
❑ Amendment (Must Provide Explanation in Part 3.)
760-322-83E2
cindy.cairns@palmspringsca.gov
l Filing:
i f Original
Date ognang:
Da(month, say. 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: White Party Circus T Dance Date(s) 05 J 07 1 17 1 1
Provide Title/Expianation
Ticket(s)/Pass(es) provided by agency? Yes ❑ No El If
no: White Party Entertainment, Inc.
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 TlckegsN
Describe the public purpose made pursuant to the agency's policy
Passes
B. Name of Individual
Number
of rick"a}I
identify one of the following:
(Last, First)
Passes
Ceremonial Role ❑ Other ® Income ❑
Roberts, J.R.
2
If checking "Ceremonial Role " ..'other" descnbe below:
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ❑X Income ❑
Gladders, Craig
4
lichecking'CeremoniaiRofie"or'0therdescribebelow.
Public Purpose as defined by PS Resolution No. 22454
Name of Outside Organization
C.
Number
of a}l
Describe the public purpose made pursuant to the agency's policy
(include address and description)
Posses
4. Verification
I have read and understand F egulations 18944.1 and 18942. 1
have verified that the distribution set forth above, is in accordance
with the requirements.
David Ready
City Manager
Signature of Agency Hea r D s e Print Name
Title (month, day, year)
Comment:
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 8661A5K-FPPC (8661275-3772)
Agency Report of: California 8021
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 Unit
of Ticksksy
Passes
Describe the public purpose made pursuant to the agency's policy
B. Name of Individual
(Last. Plra*
Number
of Ticket(sy
Passes
Identify one of the following:
Lyon, Ken
4
Ceremonial Role ❑ Other El Income ❑
lfcbecking "Ceremonial Role" or Othei descr be below:
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ❑ Income ❑
!/checking "Ceremonial Role"or "Othe/' describe below:
Ceremonial Role ❑ Other ❑ Income ❑
if checking 'Ceremonial Role" or "Other' describe below:
Ceremonial Role ❑ Other ❑ Income ❑
If checking `Ceremonial Role" or "Other' describe below:
Name of Outside Organization
C. g
(include address and description)
Number
of Tiakegsy
Pam
Describe the public purpose made pursuant to the agency's policy
FPPC Form 802 (212016)
FPPC Toll -Free Heipline: 66WASK-FPPC (8661275-3772)