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2017-10-22 Friends of Palm Springs Mountains BrunchAgency Report of: Ceremonial Role Events and Ticket/Pass Distributio s A Public Document I. Agency Name CITY OF F LM SP"4wP I ' - e j City of Palm Springs Division, bepartment or Region (if applicable) Christina Chartier, Executive Assistant to Mayor and Council 760-322-8366 1 chdstina.chartier@paimspdngsca.gov AM 9: 57 1 For Ofriclal Use Only CITY CLERK Amendment (Must Provide Explanation in Part 3.) Date of Original Filing: (month, day, year) 2. Function or Event Information Does the agency have a ticket policy? Yes ® No ❑ Face Value of Each Ticket/Pass $ 100.00 Event Description: Donation of Chino Cone Brunch Date(s) 10 1 22 r 17 J� Provide TrltalExplanabon Ticket(s)IPass(es) provided by agency? Yes ❑ No El If no: Friends of Palm Springs Mountains 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 8 to Identify an individual. • Use Section C to identify an outside organisation. Number A. Name of Agency, Department or unit of Tloket(s)1 Describe the public purpose made pursuant to the agency's policy Passes B. Foat, Ginny Name of individual (Lest, Fiat) of Tk:kettsy I Identify one of the following; Passes Ceremonial Role ❑ Other © Income ❑ Kch hM—Cemmonlal Rafe or Othef descrtbe below Public Purpose as define by PS Resolution No.22454 Ceremonial Role ❑ other ❑X Income ❑ Kors, Geoff lrcheckng CommonlalRole'or'OtWolescrtbeWow Public Purpose as define by PS Resolution No.22454 Section 1 (d) (vii) C. Name of Outside enbadon (include address andd description) Passaa I ofpi:Ear-y I Describe the public purpose made pursuant to the agency's policy 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 with the reauirements.— L. David Ready City Manager Print Name Title (month, day, year) FPPC Form 802 (212016) FPPC Toll -Free Helpllne: 8661ASK-FPPC (8661275-3772) Agency Report of:California Ceremonial Role Events and TicketlPass Distributions I 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 Tkkegs}! Passes Describe the public purpose made pursuant to the agency's policy B. Name of Individual (Lost, First) Number of Tickagayl Passes Identify one of the following: Roberts, J.R. 1 Ceremonial Rote ❑ Other ® Income ❑ Nchecking'CematonialRole or Other describe below Public Purpose as define by PS Resolution No.22454 Section 1 (d) (vii) Ceremonial Role ❑ Other ❑ Income ❑ it checking 'Ceremonial Role' or'&W describe below Ceremonial Role ❑ Other ❑ In aria ❑ If cheGdng'Ceremonial Role- or Ocher describe below Ceremonial Role ❑ Other ❑ Income ❑ 11 checking 'Ceremonial Role' or'Other describe below Name of Outside Organization C• (include address and description) Number of Tlcket(sy Pam Describe the public purpose made pursuant to the agency's policy FPPC Form $02 (212016) FPPC TM -Free Helpline: 8661ASK-FPPC (8661275-3772)