2017-09-26 Mizell Senior Center Installation LunchAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name 17 C F P L H i
City of Palm Springs
13
JUL 1 g 71OX.F'rJale Only
Division, Department, or Region (if applicable) AM �;
Designated Agency Contact(Narne,rrtle) F THE CITY l;i,i
Christina Chartier, Executive Assistant to Mayor and Council
❑ Amendment (Must Provide Exp(anah'on in Part 3.)
760-322-8366
chdstina.chartier@palmspdngsca.gov
I Date of Original Filing: (month, day, year)
2. Function or Event Information
Does the agency have a ticket policy? Yes ® No ❑ Pace Value of Each Ticket/Pass $ 50.00
Event Description: 2017 Mizell Board Installation Lunch Date(s) 09 ) 26 ) 17
ProWde rrBe/Expranadan
Tickets)/Pass(es) provided by agency? Yes ❑ No ® If
no: Mizell Center
Name of source
Was ticket distribution made at the behest Yes ❑ No ® If
yes:
of agency official?
otraars Name (Last: First)
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 Ticket(sy
Describe the public purpose made pursuant to the agency's policy
Passes
B. Name of Individual.
Number
of Tieksgs)l
Identify one of the following;
(Lest, First}
Pam
Moon, Robert
Ceremonial Role ❑ Other ® Income ❑
1
it checidng Temmanlal Role' or •Other describe below
Public Purpose as defined by PS Resolution No. 22454,
Section 1 d vii
Ginny Foat
Ceremonial Role ❑ other Q Income ❑
1
Bcheckng'Cemmonlal Role' or'Other' describe below
Public Purpose as defined by PS Resolution No. 22454,
Section 1 d vii
Name of Outside Organization
C.
Number
of Tieket(s)l
Describe the public purpose made pursuant to the agency's policy
(include address and description)
Pashas
4. Verification
t have read and undo F egulations 18944.1 and 18942. 1 have venfred that the distribution set forth above, is in accordance
with the requirements
David Ready
City Manager
Signature of Agency ead a Print Name
TNe f month. day. year)
Comment:
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)
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 71clu4su
Passes
Describe the public purpose made pursuant to the agency's policy
Name of individual
B. {�� ��
Number
ofP �s1r
Identify one of the following:
Geoff Kors
Ceremonial Role ❑ Other ED Irimme ❑
lrcheckinp'CommonlalRde'cr'Other cbs=bebelow
Public Purpose as defined by PS Resolution No_ 22454,
Section I(d)(vii)
J.R. Roberts
1
Ceremonial Role ❑ Other ® Income ❑
ltcheck ngTeran Mat Rde'or rorher^ de=tw brow
Public Purpose as defined by PS Resolution No. 22454,
Section 1 d vil
Ceremonial Role ❑ Other ❑ Income ❑
HCheckBig'f:nmmonialRde or Other desenbe below
Ceremonial r ole ❑ Other ❑ Income ❑
it checlung medal Role or %Wher describe below
Name of Outside Organization
C. Include address and description)
( Pti )
Number
of TicksgaN
Passes
describe the public purpose made pursuant to the agency's policy
FPPC Form 802 (W2016)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3T72)