2016-10-01 Moderism Preservation AwardsAgency Report of:
Ceremonial Role Events and Ticket/Pass DistributionlK C E I V E D A Public Document
1. Agency Name Date Stamp
City of Palm Springs 2017 APR 6 Ate 10: 45 4FcrOfflcial Division, Department, or Region (IfApp0cable) Use Only
0I"FICE 0r �c Ci'i'f �i..t;k,=:
Designated Agency Contact (Name, Title)
Cindy Calms, Executive Services Administrator
❑ Amendment (Must provide explanation in Part 3.)
Area Code/Phone Number E-mail
760-322-8362 cindy.cairns@palmspringsca.gov Date of Original Filing: (Month, Day, Year)
2. Function or Event Information
Does the agency have a ticket polio Face Value of Each Ticket/Pass $ 100.00
9 Y Y? Yes ® No ❑
Event Description PS Modcom Preservation Awards Date(s) � 116 ��
Provide Tide/Expianation
Ticket(s)/Pass(es) provided by agency? Yes ® No ❑ If no: Palm Springs Modern Committee
Name of Source
Was ticket distribution made at the behest No ® Yes ❑ If yes:
of agency official? Official's Name (Last, First)
3. Recipients
e Use Section A to identify the agency's department or unit. • Use Section B to identify an individual. a Use Section C to identify an outside organization.
A. Name of Agency, De partmentor Unit
Number of
Tlcket(sy
Describe the public purpose made pursuant to the agency's policy
Passes)
B. Name of Individual
Number of
Tickegsp
Identify one of the following:
{Led, Rrd)
Passes)
Ceremonial Rolle ❑ Other ® Income ❑
If checking' Ceremonial Role"or-Other" describe below
Moon, Robert
1
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ® Income ❑
Foat, Ginny
ffchecking"Ceremonial Role"or"Othew descnbe below,
Public Purpose as defined by PS Resolution No. 22454
Name of Outside Organization
C.
Number of
Nust(sy
Tick
purpose made pursuant to the a enc s olio
Describe the public agency's policy
(include address and description)
Passes)
4. Verification
I have read and understandTut 'ons 18944.1 and 18942, 1 have verified that the distribution set forth above, is in accordance with the requirements.
David H. Ready City Manager LP.S I !
Signature ofAgency H or g Print Name Title (Month, Day. Year)
Comment:
All FPPC Form 802 (4112)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-7772)
Agency Report of:
rnia
Ceremonial Role Events and Ticket/Pass Distributions erm e 8021
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 8 to identify an individual. • Use Section C to identify an outside organization.
Number of
A. Name of Agency, Department or Unit Ticket(s)l Describe the public purpose made pursuant to the agency's policy
Passes)
Name of Individual Number of
N
B. Tick s Identify one of the following:
R-d, FA-0�e e�
Roberts, J.R.
Ready, David
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 ® Income ❑
1 if checking 'Ceremonial Role" or `Other' describe below:
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ❑ Income ❑
fr checkng 'Ceremonial Role" or "Other' descnbe below:
Ceremonial Role ❑ Other ❑ Income ❑
lFcbeclang 'Ceremonial Rae" or'Other dascnbe below.'
Name of Outside Organization Number of
C. Tlcket(sy Describe the public purpose made pursuant to the agency's policy
(include address and description) pass(es)
FPPC Form 802 (4112)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-7772)