2016-05-06 United Way GalaAgency Deport of:
Ceremonial Role Events and Ticket/Pass Distribution4tECEIVED A Public Document
1. Agency Name `' ` T ` Dale Stamp California
City of Palm Springs �ei6 ,�� —6 AN 9: 59 '
02
Division, Department, or Region ()t'Applicable` For Official use only
aA Cl Y CLERK
Jennifer Nelson, Executive Asst. to Mayor/Council
Area Code/Phone Number E-mail ❑ Amendment (Must provide explanation in Part 3.)
760-323-8200 jennifer.nelson@paimspdngsca.gov Date of original Filing:
(Monet, say, Year)
2. Function or Event Information
Does the agency have a ticket policy? Yes ® No ❑
Event Description United Way Gala
Provide 'ritle/Explanation
Ticket(s)IPass(es) provided by agency? Yes ❑ No
Was ticket distribution made at the behest No ® Yes ❑
of agency official?
Face Value of Each Ticket/Pass $ 350.00
Date(s) — 5 1. 6 r 15 � I
If no- United Way of the Desert
Name of Source
If yes:
Official'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
Tickelfsp
Describe the public purpose made pursuant to the agency's policy
Pus(es)
B. Name of Individual
Number of
Ticket(sy
Identify one of the following:
aAkK RW.
Peas(esj
Ceremonial Role ❑ Other ® Income ❑
Moon, Robert
It checking 'Ceremonia) Role' or ,Othef de=be below
2
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ® Income ❑
Bruggemans, Joanne
dcheckrrgTemmorualRole- or*Other descObebebw
2
Public Purpose as defined by PS Resolution No. 22454
C. Name of Outside Organization
(include address and descHptlon►
Number of
Tickst(sy
Describe the public purpose made pursuant to the agency's policy
Pass(es)
4. Verification
l have read and untie F C Regulations 18944.1 and 18942 l have verified that the distribution set forth above, is in accordance with the requirements.
David H. Ready City Manager
5lpnatura OAg17,
Designee Prfnr Name fi (Month, flay, Year)
Comment:
FPPC Form sot (4112)
FPPC Toll -Free Helpline: SSSIASK-FPPC 186SM75T772)
Agency Report of: California
Ceremonial Role Events and Ticket/Pass Distributions 802
Continuation Sheet '
rm
A Public Document
Agency Name
City of Palm Springs
3. Recipients
*Use Section A to identify the agency's department or unit • Use Section S to identify an Individual. • Use Section C to Identify an outside organization.
a
A. Name of Agency, ncy, Department or Unit
Number of
Tickegsjl
pass(es)
describe the public purpose made pursuant to the agency's policy
vidual
Name of Individual
B. ,
Number of
Tic"sy
Passles)
Identify one of the following:
O'Neill, Roxanne
I
Ceremonial Role ❑ Other ® Income ❑
Nchecking'CommmnialRde'or'OtftrdosWb*balow
Public Purpose as defined by PS Resolution No. 22454
Wilson, Catherine
)
Ceremonial Role ❑ Other ® Income ❑
llchecldnp'CemmoniarRde'or'OMerdesalbabelow
Public Purpose as defined by PS Resolution No_ 22454
Min, Simon
2
Ceremonial Role ❑ Other ® ;nca^le ❑
llchecktV ComnwiarR&e•or'Otherdescrlbebelaw
Public Purpose as defined by PS Resolution No_ 22454
Combs, Walter
2
Ceremonial Role ❑ other ® Inoama ❑
Nchec*kV'CeremmiarRore'ar'O(Wdeswbebelaw
Public Purpose as defined by PS Resolution No. 22454
Name of Outside Organization
C. (include address and dascriptlon)
Number of
Ticksgsy
Pasaleaj
Describe the public purpose made pursuant to the agency's policy
FPPC Form 802 (41121
FPPC Toll -Free Helpllne: 8661ASK-FPPC (8661276 7TT2)