2016-03-12 Art Museum GalaAgency Report of: RECEIVED
Ceremonial Role Events and Ticket/Pass Distributibills OF PALH SP �, Public Document
City of Palm Springs
1. Agency Name 2016 �Official R 22 �aAP! Stamp 9 � 8 �
For Oal Use Only
Division, Department, or Region (if Applicable) JAM S T H O H p S U P
C TY CLER11
Designated Agency Contact (Name Title) t
Jennifer Nelson, Executive Asst. to Mayor/Council
❑Amendment (Must provide explanation in Part 3 )
760-323-8200
I jennifer.nelson@palmspdngsca.gov
I Date of Original Filing: I
(Month, Day, Year)
2. Function or Event Information
Does the agency have a ticket policy? Yes ® No ❑ Face Value of Each Ticket/Pass $ 750.00
Event Description PS Art Museum Gala Date(s) � 216 ��
Provide rtfe/Explanalion
Ticket(s)IPass(es) provided by agency? Yes ❑ No ® If no: PS Art Museum
Hama of Source
Was ticket distribution made at the behest No ® Yes ❑ If yes:
of agency official? Olhcial's 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(s)l
Describe the public purpose made pursuant to the agency's policy
Pass(es)
B. Name of Individual
Number of
Tickagoll
Identify one of the following:
,, }d
pass(es)
Ceremonial Role ❑ other ® Income ❑
Foat, Ginny
lfchecrano•CommonialRoo'or'Ortarde=bebelow
2
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ® Income ❑
Robert, J.R.
HehecfdfigTeremonialRole'or'Otherdoxmbebelow
2
Public Purpose as defined by PS Resolution No. 22454
C.Name of Outside Organization
pnelude address and description)
Number of
Ticket(s)l
Describe the public purpose made pursuant to the agency's policy
Pass(es)
4. Verification
understand FPPC Regulations 18944. t and 18942, 1 have verified that the { r,c;! cation set forth ?bom is in accordance with the requirements.
(, # David H. Ready City Manager
ncy Head er OeSq I Print Name Tide (Month Day. Year)
Comment:
FPPC Form 802 (4112)
FPPC Toll -Free Helpllne: 8661ASK-FPPC (8661276 7772)
Agency Report of:
Ceremonial Role Events and Ticket/Pass Distributions e13021
Continuation Sheet e
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.
A. Name of Agency, Department or Unit
Number of
Mckegs)I
Describe the public purpose made pursuant to the agency's policy
Pass(es)
B. Name of Individual
Number of
Tic"s)r
Identify one of the following:
Passes)
Ceremonial Role ❑ Other ® Income ❑
Moon, Robert
2
IfchecM 'Camrnonim;Ravar•Other'a smb•bekw-
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ® Income ❑
Ready, David
1
NeheckirVTaremonlalRoWor,Orherdesedbebelow
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ® Income ❑
Edmondson, Josh
2
flchecking'CammonlarR&e'or'Otberdeswbebelow
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ® Income ❑
Sheffer, Ann
1
ftchecra'ng'CemmonialRore or-Orher'descrlbebefaw
Public Purpose as defined by PS Resolution No. 22454
Name of Outside Organization
C. (include address and description)
Number of
Tickegs)!
Describe the public purpose made pursuant to the agency's policy
passles)
FPPC Form 802 (4112)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-7772)