2016-02-13 Black History Awards GalaAgency Report of: RECEIVED
Ceremonial Role Events and Ticket/Pass Dist�ltfg t#tf, LH SPRING:.- „; � �A Public Document
1. Agency Name C��v FEB 23 �� IU• Date Stamp krFor
- . l
City of Palm Springs 10 0 r
rdal Use Only
Division, Department or Region pfApplicable) JAHES TFi Hlz� �;',
CITY C ERK 9
rloeinn�4ne1 Annnns C�nhna rhrr,.na T.'deal
Jennifer Nelson, Executive Asst. to Mayor/Council
❑ Amendment (Must provide explanedon in Part 3.)
Area Code/Phone Number
E-mail
760-323-8200
jennifer.nelson@paimspdngsca.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 $ 55.00
Event Description PS Black History Gala
Date(s) 21 13 1 16 _ f�
Provide Trtle/Explanedon
Ticket(s)IPass(es) provided by agency? Yes ❑ No ®
If no: Black History Committee
Name of Source
Was ticket distribution made at the behest
No ® Yes ❑
If yes.
of agency official?
Official's Name (Last. First)
3. Recipients
*Use section A to ldentify the agency's department or unit. a Use section B to identify an individual. a Use Section C to Identify an outside organization.
A. Name of Agency, Department or Unit
Number of
Tlcksgs)l
Describe the public purpose made pursuant to the agency's policy
Passles)
Individual
B. Noma of Idi
Number of
TicksIay
Identify one of the folbwing:
Pass(es)
Ceremonial Role ❑ C'ther ® Income ❑
Moon, Rob
itcNar.1riV T&remorria1Rore or Other* dascabe below
2
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ® Income ❑
Mills, Chris
Other desWbebekw'
2
Public Purpose as defined by PS Resolution No. 22454
C.Name of Outside Organization
(include address and description)
Number of
Ticket(sy
Describe the public purpose made pursuant to the agency's policy
Pass(es)
4. Verification
I have read and understand F equladons 16944.1 and
1894Z , have verified that
the drstnbudon set forth above is in accordance with die requirements.
David H. Ready
City Manager
Slpnarure + spree
=Tint Name
Tine (Month, Day rear
Comment:
FPPC Form 802 (4i12J
FPPC Toll -Free Helpline: 866)ASK-FPPC (8661276 77721
Agency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
Continuation Sheet
A Public Document
Agency Name
City of Palm Springs
3. Recipients
e 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 of
A. Name of Agency, Department or Unit TIcWs)1 Describe the public purpose made pursuant to the agency's policy
Pass{es)
Name of Individual Mumvsr yr
B. a,,,, di Tiekegs)l Identify one of the following:
Passlesl
Ceremonial Role ❑ Other ® Income ❑
Crawford, Jarvis 2 lloneeking CeremonlalRole'or'0tWdescrlbebelow
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ® Income ❑
Ready, David ilrcWkino-CommoniarRore'ar'orherdesWboberaw,
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ❑ Income ❑
l/checkft Tammonial Role' or ,01tw' describe below
Ceremonial Roie ❑ Other ❑ Income ❑
if checking Telemonial Rate or Olher describe below-
C
. Name of Outside Organization rrumuer or
(include address and description) Tk:ketts)l Describe the public purpose made punsuant to the agency's policy
Passles)
FPPC Form 802 (4112)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661276-7772)