2016-02-06 Steve Chase Humanitarian AwardsAgency Report of: RECEIVED
Ceremonial Role Events and Ticket/Pass DistributjW s OF PALM S P R I NG � ubiic Document
1. Agency Name 2816 g I I I) tS P53 ` a i
City of Palm Springs
02
Division, bepartment, or Region (if Applicable) jTmts Y H 0 M P s 0
Far official Use Only
C TY CLERK
Jennifer Nelson, Executive Asst. to Mayor/Council
❑ Amendment (Must provide explanation in Part 3.)
Area Code/Phone Number
E-mail
760-323-8200
jennifer.nelson@palmspringsca.gov
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 $ 475.00
Event Description Steve Chase Humanitarian Awards Date(s) 2 1 6 1 16 1 1
Provide Titld Explanation
Ticket(s)IPass(es) provided by agency? Yes ❑ No ® If no: Desert AIDS Project
Name of Source
Was ticket distribution made at the behest No ® Yes ❑ If yes
of agency official? Orrraars Name (Last, First)
3. Recipients
*Use Section A to Identify the agency's department or unit a Use section B to Identify an Individual. *Use Section C to Identify an outside organization.
A. Name of Agency, Department or Unit
Number of
TkkeMsp
Describe the public purpose made pursuant to the agency's policy
Pass(es)
Name of Individual
B. r+ r
Number of
TickegaN
Identify one of the following:
Passles)
Ceremonial Rde ❑ other ® Incame ❑
Moon, Rob
nchwkrq'CemmaniarRde'a'OtMfdauWbebelow-
2
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ® Incvma ❑
Roberts, J.R.
acheMnp ceremonlalRde'or'OfherdesatbebeMw-
2
Public Purpose as defined by PS Resolution No. 22454
C.Name of Outside Organization
{Include address and description)
Number of
Ticket(all
Describe the public purpose made pursuant to fhe agency's policy
Pass(es)
4. Verification
I have read and understand FPPC Ragu1 09" 1 and 18942. 1 have verified that the distribution set forth above, is in accordance with the regtnremvr s
David H. Ready City Manager
VgmtweafApencyHand a• FhrgName nns (Month Day, Year)
Comment:
FPPC Form 802 (4112)
FPPC Tall -Free Helpline: 8661ASK-FPPC (8661276-7772)
Agency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
Continuation Sheet
A Public Document
Agency Name
City of Palm Springs
3. Recipients
• Use section A to Identify the agency's department or unit. a Use Section 9 to Identify an Individual, s Use Section C to identify an outside organization.
A. Name of Agency, Department or Unit Tlekestielf I Describe the public purpose made pursuant to the en policy agency's po' y
Name of Individual Number of
B. Incket(s)l Identify one of the following-
Pasa{es)
❑ Other ® :ncome ❑
Foat, Ginny 2 tare' or-Odwr'desodbe below
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ® Income ❑
Fuller, Marcus 2 1
rlcheckln0•CeremonWRore or -rherdesWbebelow
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Rde ❑ Other ® Income ❑
Ready, David 1 lrchet"'CommmWRole'or'OrhePdeswbebePow
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ❑
rrcheckrV'Cem=nralRole or'Orher'desaibeberow
Income ❑
C. Name of Outside Organization Number of
{Include address and description) 7pleeek`e1Mu Describe the public purpose made pursuant to the agency's policy
FPPC Form 802 (4112)
FPPC Toll -Free Helpline: 886/A$K-FPPC (B661276-7772)