2016-09-27 Mizell Board Installation LuncheonAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name
•
�iTY OF P1',L Wpm w- M � �
City of Palm Springs
Division, Department, or Region (if applicable) oe ` qpj AP 2 AM ��: 45 For Official Use Only
Designated Agency Contact (Name, Title) r 1 HIE. Ci i Y CL}.l i
Cindy Cairns, Executive Services Administrator ❑Amendment (Must Provide Explanadon in Part 3.)
760-322-8362 I cindy.cairns@palmspringsca.gov I Date of Original Filing:
(month, day, year)
2. Function or Event Information
Does the agency have a ticket policy? Yes ® No ❑
Event Description: Mizell Board Installation Luncheon
Face Value of Each Ticket/Pass $ 50.00
Date(s) 09 1 27 r 16 ___J____J
Provide Title/Explanafion
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.
Number
A. Name of Agency, Department or Unit of Tickegay Describe the public purpose made pursuant to the agency's policy
Passes
Number
B. Name of Individual of Tickel(sy Identify one of the following:
(Last, First) I Passes
Moon, Robert
Kars, Geoff
Ceremonial Role ❑ Other ® Income ❑
1 if checking -Ceremonial Role" or °Other" describe below.
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other iJ Income ❑
1 if checking "Ceremonial Role" or 'Other' dwcrbe below
Public Purpose as defined by PS Resolution No. 22454
Name of Outside Organization I o NuTilckeet(S)f I Describe the public purpose made pursuarrt to the agency's policy
C. (include address and description) Passes
4. Verification
l have read and understand
with the requirements. /
Comment:
yulations 18944.1 and 18942. 1 have verified that the distribution set forth above, is in accordance
David Ready City Manager + 1-(
Print Name Title (month, day, year)
FPPC Form 802 (2I2016)
FPPC Toll -Free Helpline: 8661ASK-FPPC 18661276-3772)
Agency Report of: - • • V
Ceremonial Role Events and Ticket/Pass Distributions
Continuation Sheet A Public Document
Agency Name
City of Palm Springs
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.
Number
A. Name of Agency, Department or Unit
of TICketlsy
Passes
Describe the public purpose made pursuant to the agency's policy
B. Name of Individual
{Last, First}
Number
of Tickst(sq
Passes
Identify one of the following:
Reyes, Bryan
Ceremonial Role ❑ Other ® Income ❑
gcheckng"ceremonial Role" or-Othar' dascnbe below'
Public Purpose as defined by PS Resolution No. 22454
Nalder, Kevin
1
Ceremonial Role ❑ Other ® Income ❑
ifchecklng"CereM0WatRole" or"Other'descrrbebelow"
Public Purpose as defined by PS Resolution No. 22454
Blaisdell, Amy
Ceremonial Role ❑ other El Income ❑
lfchecking 'CeremonfalRole'or"Other"descRbebelow:
Public Purpose as defined by PS Resolution No. 22454
Fuller, Marcus
Ceremonial Role ❑ Other ® Income ❑
it checking `CeretnonlatRole"or°Other describe below.
Public Purpose as defined by PS Resolution No. 22454
Name of Outside Organization
C. r9
(include address and description)
Number
of Tlekei(sy
Passes
Describe the public purpose made pursuant to the agency's policy
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)