2016-10-05 State of Riverside County LuncheonAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name IFM
City of Palm Springs i OF PALM 5 P R I IRS ' Division, Department, or Region (if applicable) —. �� _ � f M For Use Only
Designated Agency Contact (Name, Title) E G F i HE C i T 1 G 4 k 4
Cindy Cairns, Executive Services Administrator
❑ Amendment (Must Provide Explanah'on in Part 3.)
760-322-8362 almsprin sca. cind .caim5 Date of original Filing:
y @p g gov (month, day, year)
2. Function or Event Information
Does the agency have a ticket policy? Yes ® No ❑ Face Value of Each Ticket/Pass $ 50.00
Event Description: State of the Riverside County Lunch Date(s) 10 1 05 i 16
Provide Tltla/Explanadon
Tickets)/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 Ticketlsu Describe the public purpose made pursuant to the agency's policy
Passes
B.
Moon, Robert
Name of Individual
(Last First)
of Tlckegsjl I Identify one of the following:
Passes
Ceremonial Role ❑ Other ❑X Income ❑
1 K checking 'Caseremondeial Role" or "Other'descrbe
Purpose below:
Public fined by PS Resolution No. 22454
Ceremonial Role ❑ Other ❑ Income ❑
If checking "Ceremonial Rote" or'Othef describe below:
C. Name of Outside organization I T1cke�sN I Describe the public purpose made pursuant to the agency's policy
(include address and description) Pages
4. Verification
I have read and understand
with the requirements. /
Signature of Agency
Comment:
18944,1 and 18942. 1 have verified that the distribution set forth above, is in accordance
David Ready City Manager 5 j
Print Dame Title (month, day year)
FPPC Form 802 (2/2016)
FPPC Toll -Free Helpline: 866fASK-FPPC (8661275-3772)