2016-06-10 Splash HouseAgency Report of:
Ceremonial Role Events and TicketlPass
Dis�r�1 tw�lY D
A L H SPRING', Public Document
1. Agency Name
Dal stamp
PH 3: �i4Division,
JUN 20
City of Palm SpringsZ616
, 1+IMP
Department, or Region (if Applicable)
JAHES T
CITY
LEft
LER
Designated Agency Contact (Name. Title)
Jennifer Nelson, Executive Asst. to Mayor/Council
ent (Must provide explanation in Part 3.)
LDateof
Area CodeiPhone Number
E-mail
760-323-8200
jennifer.nelson@palmspdngsca.gov
nal Filing:
(Month, Day, Year)
2. Function or Event Information
Does the agency have a ticket policy? Face Value of Each Ticket/Pass $ 150.00
9 Y P cY Yes ® No ❑
Event Description Splash House
Date(s) 61 10 t 16 61 12 f 16
Provide Trllw/Explanalion
Ticket(s)/Pass(es) provided by agency? Yes ❑ No ® If no- McLean Company Rentals
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 Identify the agency's department or unit. • Use Section 8 to identify an Individual. a Use Section C to identify an outside organisation.
A. Name of Agency, Department or Unit
Number of
Ticket{s)1
Describe the public u
p purpose made pursuant to the agency's policy
Pass(es)
Name of Individual
B. n.K di
Number of
Ikket(s)l
Identify one of the following-
Pass(es)
Ceremonial Role ❑ Other ® Income ❑
Roberts, J.R.
ircbeckiap'CerernwtWRde•or-OMerdaswbebelow-
2
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ® Income ❑
Ready, David
m NcbeckkV'CemnialRafe'or'OtMr'deraibebelaw,
2
Public Purpose as defined by PS Resolution No. 22454
C. Name of Outside Organizatlon
{Include address and description)
Number of
TIcket(s)l
Describe the public purpose made pursuant to the agency's policy
Passles)
4. Verification
i have read and understand FPPC as 18944.1 and 18942. t have verified that the distribution set forth above, is in accordance with the requ,remamts
David H. Ready City Manager __t, /)", //�
sipnatme otAp nee Print Nam* PTM fm :n, &dY. ear)
Comment:
FPPC Form 802 (4112)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-7772)
Agency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
Fin
Continuation Sheet `
A Public Document
Agency Name
City of Palm Springs
3. Recipients
a Use Section A to Iderift the agency's department or unit *Use Section 8 to identify an individual. a Use Section C to Identify an outside organization.
A. Noma of Agency, Department or Unit
Number ofTicksgs)l
Pass(n)
Describe the public purpose made pursuant to the agency's policy
Name of Individual
B. r� �
Number of
7lckagsy
Pass(es)
Identify one of the following;
Mician, Michele
2
Ceremonial Role ❑ Other ® InmrnM ❑
lydwcJunp�Cen:rmrrFaiRwa or�ornelaesaiheoerow
Public Purpose as defined by PS Resolution No. 22454
Richards, Tabitha
2
Ceremonial Role ❑ Other ® Income ❑
ItcheckrVTebrm„WRue-or-Other'de=bebebw
Public Purpose as defined by PS Resolution No. 22454
DeCastro, Mike
2
Ceremonial Role ❑ Other ® Income ❑
J1Chedinp'Cere=WalRaWor'Orher+'daswbebebw
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ❑ inmr,e ❑
N checkng'Ceremoniar Role- ar'Ofher desedhe hebw
Name of Outside Organization
C. tlnclude address and description)Zicket(s)i
Number of
Pass(es)
Describe the public purpose made pursuant to the agency's policy
FPPC Form 802 (4112)
FPPC Toll -Free Halpllne: 8661ASK-FPPC (8661276-7772)