2016-04-15 Womens Club Scholarship LuncheonAgency Report of: R C E I V E D
Ceremonial Role Events and Ticket/Pass Wtjribp ' # 'I SPRINGS
1. Agency Name 2016 MAY -9 Al9: 24atestamp
City of Palm Springs
or
JES
CITYTHOM
CLE K r
Public Document
For Official Use Only
Jennifer Nelson, Executive Asst. to Mayor/Council
❑Amendment (Must pmvide explanation 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? Face Value of Each Ticket/Pass $ 250.00
9 Y P cY Yes ® No ❑
Event Description PS Women's Club Scholarship lunch pates) � 516 1 1
Provide Title/Explanation
Ticket(s)/Pass(es) provided by agency? Yes ❑ No ® If no: PS Women's Club
Name of Source
Was ticket distribution made at the behest No ® Yes ❑ If yes -
of agency official? offrrdal•s Name (Last. First)
3. Recipients
• Use Section A to Identify the agency's department or unit. • Use Section B to identify an Individual. v Use section C to Identify an outside organization.
A. Name of Agency, Department or Unit
Number of
Tkketla)1
Describe the public purpose made
P P rp pursuant to the agency's policy
Passles)
Name of Individual
B. y�d i
Number of
Ticket(s)l
Identify one of the following:
Pass{es)
Ceremonial Role ❑ Other ® Income ❑
Kors, Geoff
If checrdrg Teremonrar Rde or other desc ibe Wow
1
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ® Income ❑
Middleton, Lisa
ifctwiangToremmlalROO or 'Other desmbe bebw
1
Public Purpose as defined by PS Resolution No. 22454
C. Name of Outside Organization
{Include address and description)
Number of
Tlcket(s)l
Describe the public purpose made pursuant to the agency's policy
Pass{es)
4. Verification
I have read and understand FPPC Regulations 18944.1 and 18942. 1 have verified that the distribution sat forth above, is in accordance with the nquiremerits.
_ David H. Ready _ City Manager ps 4{ f
Signature ofAgee.vjhead orDe4nee V Prtnt Name ride (month. Day, Year)
Comment:
FPPC Form $02 (4112)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-7772)
Agency Report of:
Ceremonial Role Events and Ticket/Pass DistributionsCalifornia
Form 802
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 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
Ticket(s)1
Passes)
Describe the public purpose made pursuant to the agency's policy
B. Name of Individual
,qA,w cn1.
Number of
Tickat(s)!
paaslK)
Identify one of the following:
Moon, Robert
2
Ceremonial Role ❑ Other ® Income ❑
+tchwking'CommorMRue'w-onrerve=beeercw
Public Purpose as defined by PS Resolution No. 22454
Foat, Ginny
1
Ceremonial Role ❑ Other ® Income ❑
I/checkmgVemamialRcle orOrherdesenbebelow-
Public Purpose as defined by PS Resolution No. 22454
Hart, Kathi
1
Ceremonial Role ❑ Other ® Income ❑
lrchedung'CommmialRcM' or'Olherde=bebelow,
Public Purpose as defined by PS Resolution No. 22454
Nelson, Jennifer
1
Ceremonial Rote ❑ Other ® Income ❑
Rchecking 'Ceremonial Role'or'01herdeseihebelow,
Public Purpose as defined by PS Resolution No. 22454
C Name of Outside Organization
C. (include address and description)
Number of
Ticketls)l
Passes)
Describe the public purpose made pursuant to the agency's policy
FPPC Form 802 (4112)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-7772)
Form 802 — PS Women's Club Scholarship lunch — 4/15/16
Blaisdell, Amy. 3, - Public Purpose as described by PS Resolution No. 22454