2016-03-13 Mizell Senior Center GalaAgency Report of: RECEIVED K
Ceremonial Role Events and TicketlPass DistributiorTY OF PALM SPRINt4lic Document
1. Agency Name 2�� � Ia Sip 9: 0 "Only
City of Palm Springs rnI For O(ri
Division, Department, or Region (if Applicable) J M E S T H O M P 5
CITY CLER
Designated Agency contact (Name. Title)
Jennifer Nelson, Executive Asst. to Mayor/Council
❑Amendment (Must provideexplanation inPart 3.)
Area CodelPhone Humber 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 $ 140.00
Event Description
Opera Arts When I Rise Gala Date(s) �� 3 13 16
..�....�;r�
Provide Titlw/Exptanation
Ticket(s)/Pass(es) provided by agency? Yes ❑ No ® If no: Opera Arts
Name of Source
Was ticket distribution made at the behest No ® Yes ❑ If yes
of agency official? Official's Name (Last, Firsq
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 ocgoisation.
Numbar of
A. Name of Agency, Department or Unit Zksgs)l Describe the public purpose made pursuant to the cy'sMblicy
Pass(es)
Name Number of
of Individual
B. rof rat Tickags)l Identify one of the following:
Pass(es)
Ceremonial Role ❑ Other ® Income ❑
Moon, Robert I ffcheC;diV CerenoniafRofe'or Or cedleunimbefow
Public Purpose as defined by P5 Resolution No. 22454
Ceremonial Rde ❑ Other ❑ Income ❑
If chedung 'Ceremontar Rote' or'�har describe below
C. Name of outside Organization Number of
pnelude address and description) Tickegsy Describe the public purpose made pursuant to the agency's policy
Passes}
4. Verification
1 have read and understand F fn..
bons 16944.1 and 18942. 1 have verifred that the distribuffon set forth above is in accordance with the requirements.
David H. Ready City Manager
Sfpnature o! AQenry t d ar Prtnf Nano rde (Month. Bey. Year)
Comment:
FPPC Form 802 (4112)
FPPC Toll -Free Heiplins: 8661ASK-FPPC/8661276 7772)