2016-09-15 United Way LuncheonAgency Report of:
Ceremonial Role Events and TicketlPass Distributions A Public Document
1. Agency Name . I I r OF PA
M S fa p Wficial
City of Palm SpringsDivision, Department, or Region (if applicable) AM 10: 45 se Only
Designated Agency Contact (Name,Title)
CI I Y GLL t �
Cindy Cairns, Executive Services Administrator
❑ Amendment (Must Provide Explanation in Part 3.)
Area CodelPhone Number E-mail
:inal Filin i f O Date oOriginal g
760-322-8362 cindy.cairns@palmspringsca.gov Da(month, day, year)
2. Function or Event Information
Does the agency have a ticket policy?
Yes ® No ❑ Face Value of Each Ticket/Pass $ 35.00
Event Description: United Way of the Desert Luncheon Date(s) 09 j 15 1 16 _ J 1
Provide Title/Expianation
Ticket(s)/Pass(es) provided by agency?
Yes ® No ❑ If
no:
Name of Source
Was ticket distribution made at the behest
Yes ❑ No ® If
yes:
Official's Name (Last, First)
of agency official?
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 Tickegs)l
Describe the public purpose made pursuant to the agency's policy
Passes
B. Name of Individual
Number
of Tickegsy
Identify one of the following:
(Last, First)
Passes
Ceremonial Role ❑ Other ® Income ❑
Moon, Robert
1
it checking 'Ceremonial Role" or"Ofher"descdbebelow;
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other Q Income ❑
if checking °Ceremonial Role" cr °Ocher' describe below.
Name of Outside Organization
C.
Number
of Tloket(a)/
Describe the public purpose made pursuant to the agency's policy
(include address and description)
Passes
4. Verification
I have read and underst Regulations
18944.1 and 18942. 1
have verified that the distribution set forth above, is in accordance
with the requirements.
fi
David Ready
City Manager 4/as 7
Signature ofAgen sect or a nee
Print Name
Title (month, day, year)
Comment:
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 8681ASK-FPPC (8661275-3772)