2016-10-08 ACBCI Dinner in the CanyonsAgency Report of:
Ceremonial Role Events and Ticket/Pass Distribution
1. Agency Name ! 17 y C
City of Palm Springs AR17 It
, Department, or Region (if applicable)
Designated Agency Contact (Name, Title)
Cindy Cairns, Executive Services Administrator
Area Code/Phone Number E-mail
760-322-8362 1 cindy.cairns@paimspringsca.gov
A Public Document
26 AM 10: 45 1 For Official Use Only
THE 13 i `I" Wri-Ki
❑ Amendment (Must Provide Explanation in Part 3.)
Date of Original Filing:
{month, day, year}
2. Function or Event Information
Face Value of Each Ticket/Pass $ 300.00
Does the agency have a ticket policy? Yes ® No ❑
Event Description: Agua Caliente Dinner in the Canyons Date(s) 10 1 08 i 16 1�d
Provide TtlelExpianafton
Ticket(s)/Pass(es) provided by agency? Yes El 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 Tickakay Describe the public purpose made pursuant to the agency's policy
Passes
B.
Moon, Robert
Name of Individual
(Last, First)
of Ticket(s)l Identify one of the following:
Passes
Ceremonial Role ❑ Other i] Income ❑
1 If checwng Ceremonial Role" or +Other' 67"'be below:
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other X❑ Income ❑
If checking 'Caremonial Role" or "Other" describe below:
C. Name of Outside Organization I of Tlcketis)I I Describe the public purpose made pursuant to the agency's policy
(include address and description) Passes
4. Verification
i have read and understand
with the requirements.
Signature of Agency Head
Comment:
Regulations 18944.1 and 18942. i have verified that the distribution set forth above, is in accordance
David Ready City Manager `t !as/ 1-1
Print Name Title (month, day, year)
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772)