2017-05-20 Palm Valley School Golf TournamentAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
1. Agency Name i
City of Palm Springs
or Region (if applicable)
Designated Agency Contact (Name,Title)
Christina Chartier, Executive Assistant to Mayor and Council
Area Code/Phone Number E-mail
760-322-8366 1 christina.chartier@paimspringsca.gov
2. Function or Event Information
Does the agency have a ticket policy? Yes ® No ❑
Event Description: Palm Valley School Golf Fundraiser
Provide Title/ Explanation
Ticket(s)/Pass(es) provided by agency? Yes ® No ❑
C iV EU KPtiblic Document
AUG 15 AM i. 32 - -
For Official Use Only
E C-
[] Amendment (Must Provide Explanaton in Part 3.)
Date of Original Filing:
{month, day, year}
Face Value of Each Ticket/Pass $ 200.00
Date(s) 05 t 20 1 17 1 y
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 I of ricket(sy I Describe the public purpose made pursuant to the apricy's policy
Passes
Number
B. Name of Individual of TICketilaY identify one of the following:
(Last First) pass"
Mills, Chris Ceremonial Role ❑ Other ® Income ❑
If checking "Ceremonial Rate- or'omeP des&be below:
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other I@ Income ❑
Smith, Bob 1 If checking 'CeremonialRole' or'Othe!'describebelow.'
Public Purpose as defined by PS Resolution No. 22454
Name of Outside Organization Number
of Tickrgay Describe the public purpose made pursuant to the agency's policy
C. (include address and description)
Passes
4. Verification
1 have read and understand FPPC Regulations 18944.1 and 18942. 1 have verified that the distribution set forth above, is in accordance
vz�h the requirerr�ents.
David Ready City Manager ��� ��
SignaWreofA a nee Print Name Title (month, day, year)
Comment:
FPPC Form 802 (212016)
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 Unit
of Tickegay
Passes
Describe the public purpose made pursuant to the agency's policy
B. Name of Individual
(Last, First)
Number
of Tickagau
Paste
Identify one of the following:
Preet, Bob
Caremonial Role ❑ Other ® Income ❑
llchecking'CeremonialRole-or'Ofhe/'describebelow
Public Purpose as defined by PS Resolution No. 22454
Becker, Ross
1
Ceremonial Role ❑ Other ® Income ❑
Irchacking'CeraiwwalRole"or°Ofher'descdbebelow:
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ❑ Income ❑
Irchecldng 'Ceremonial Role- or "Ofher" describe below
Ceremonial Role ❑ Other ❑ Income ❑
l/check/ng `Ceremonial Role" or `Ofher' describe below:
C. Name of Outside Organization
(include address and description)
Number
of Ttekegsy
Passes
Describe Me public purpose made pursuant to the agency's policy
FPPC Form 802 (2f2016)
FPPC Toll -Free Helpline: 8661ASK•FPPC 18661276- 772)