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2017-06-26 CVAG General Assembly
Agency Report of: Ceremonial Role Events and Ticket/Pass Distributions 1. Agency Name City of Palm Springs Division, Department, or Region (if appiicabie) Christina Chartier, Executive Assistant to Mayor and Council Area Code/Phone Number E-mail 760-322-8366 1 christina.chartier@palmspringsca.gov 2. Function or Event Information Does the agency have a ticket policy? Yes ® No ❑ Event Description: CVAG General Assembly Provide Title/Explanation Tickets)/Pass(es) provided by agency? Yes ® No ❑ G 15 AM T 32 ublic Document For Official Use Only ❑ Amendment (Must Provide Explanation in Part 1) Date of Original Filing: (month, day, year) Face Value of Each Ticket/Pass $ 50.00 Date(s) 06 / 26 f 17 If no: Was ticket distribution made at the behest Yes ❑ No ® If yes: of agency official? Name of Source of oars Name (Last, First) 3. Recipients • Use Section A to identify the agency's department or unit. • Use Section S to identify an individual. • Use Section C to Identify an outside organization. Number A. Name of Agency, Department or unit of Tickat(sil Describe Use public purpose made pursuant to dw agency's policy Passes B. Moon, Robert Foat, Ginny Name of Individual (Last, First) of Ttcketisil I Identify one of the following: Passes I Ceremonial Role ❑ Other © Income ❑ ffcheckog "Ceremonial Ro/a"Or'Other-describe below Public Purpose as defined by PS Resolution No. 22454 Ceremonial Role ❑ Other ® Income ❑ .� flchecking "Ceremonial Role"or "Other' dsacdbe below: Public Purpose as defined by PS Resolution No. 22454 Name of Outside Organization Number C. (include address and description) of Tlckstlsit Describe the public purpose made pursuant to the agency's policy Passes 4. Verification I have read and understand FPPC Regulations 18944.1 and 18942. 1 have verirfed that the distribution set forth above, is in accordance irer"" David Ready City Manager Signature of Age .sign.. Print Name Title (month, day, year) Comment: FPPC Form $02 1212016) FPPC Toll -Free Helpline: 666/ASK•FPPC (866/275-3772) Agency Report of: California 802 Ceremonial Role Events and TicketlPass 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 Tickegsy Passes Describe the public purpose made pursuant to the agency's policy B. Name of Individual (Last, First) Number of Tickegs►! P"695 Identify are of the following: Kors, Geogg Ceremonial Role ❑ Other ® Income ❑ Irchecking'Ceremonial Rote"or'OIAdr'dwCobe below, Public Purpose as defined by PS Resolution No. 22454 Roberts, J.R. Ceremonial Role ❑ Other ® Income ❑ Ircheclung"Ceremonial Role"or°Ofher"deacdbebelow. Public Purpose as defined by PS Resolution No. 22454 Ready, David t Ceremonial Role ❑ other 0 Income ❑ rrchecking"CeremonialRo/e"cr"Other deccrlbeWow: Public Purpose as defined by PS Resolution No. 22454 Ceremonial Role ❑ Other ❑ Income ❑ If checking 'Ceremonial RaW or "0111eP daeeribe be10W: Name of Outside Organization C. (include address and description) Number ofPIcl�sN Describe the public purpose made pursuant to the agency's policy FPPC Form 802 (212016) FPPC Toll -Free Helpline: 8661ASK-FPPC (8681275-3772)