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2016-10-28 Eisenhower Center State 2016Agency Report of: Ceremonial Role Events and Ticket/Pass Distributions 1. Agency Name s" City of Palm Springs Division, Department, or Region (If Applicable) FF14 OF ,i'11E ci i Y OL.Lo. Designated Agency Contact (Name,Title) Joanne Bruggemans, Executive Asst. to Mayor/Council Area Code/Phone Number E-mail 760-323-8200 joanne.bruggemans@paimspringsca.gov 2. Function or Event Information RCCEIVFD 26 AM 10: 45 A Public Document For Official Use Only ❑ Amendment (Must provide explanation in Pan 3.) Date of Original Filing: (Month, Day, Year) Does the agency have a ticket policy? Yes © No ❑ Face Value of Each Ticket/Pass $ Event Description Eisenhower's Center Stage 2016 Date(s) .10 1 28 1 16 195.00 Provide Trtle/Explanahon Ticket(s)/Pass(es) provided by agency? Yes ❑ No ® If no: LGBT Community Center of the Desert Name of Source Was ticket distribution made at the behest No ® Yes ❑ If yes: of agency official? Official's Name (Last, First) 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 Ticket(s)l Describe the public purpose made pursuant to the agency's policy Passes) Name d B. of Individual Number of Ticket(sy Identify one of the following: least i) Pass(esi Ceremonial Role ❑ Other ® Income ❑ Moon, Robert tfchscking"CeremcnialRole"or"Othe/'desenbebelow 2 Public Purpose as defined by PS Resolution No. 22454 Ceremonial Role ❑ Other N Income ❑ Foat, Ginny ffchecking'CeremonialRole" or"Other"descnbebelow, 2 Public Purpose as defined by PS Resolution No. 22454 Name of Outside Organization C. Number of Ticket(sU Describe the public purpose made pursuant to the agency's policy (include address and description) Passes) 4. Verification I have read and understand FP R ns 16944.1 and 18942. l have verified that the distribution set forth above, is in accordance with the requirements. David H. Ready City Manager Signature of Agency Head or a Print Name Tibe (Monih, oay. Year) Comment: FPPC Form 802 (4112) FPPC Toll -Free Helpline: 8661ASK-FPPC (866/275-7772) Agency Report of: � California Ceremonial Role Events and Ticket/Pass Distributions Form 802 Continuation Sheet A Public Document Agency Name City of Palm Springs 3. Recipients a 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. A. Name of Agency, Department or Unit Number of Ticke4sy Describe the public purpose made pursuant to the agency's policy Passes) B. Name of Individual Number of Tickst(s}I Identify one of the following: (Lear, Firar) Pass(B8) Ceremonial Role ❑ Other © Income ❑ Roberts, J.R. rechecking "Ceremonial Role" or'Other'descnbebelow, Public Purpose as defined by PS Resolution No. 22454 Ceremonial Role ❑ Other ® Income ❑ Ready, David tfchecking "Ceremonial Role" or"Other'describebelow, Public Purpose as defined by PS Resolution No. 22454 Ceremonial Role ❑ Other ® Income ❑ Fuller, Marcus 2 ifchecking"Ceremonial Role"or'Other'descdbe below: Public Purpose as defined by PS Resolution No. 22454 Ceremonial Role ❑ Other ® income ❑ Lampert, Dr. Barbara 1 Ifcheckirig"CeremontaiRole" or"Other describe below: Public Purpose as defined by PS Resolution No. 22454 Name of Outside Organization C. Numberof Ticket(aN Describe the public purpose made pursuant to the agency's policy (include address and description) Passes) FPPC Form 802 (4/12) FPPC Toll -Free Helpline: 866IASK-FPPC (866/275-7772) Form 802 — Additional tickets for Center Stage 2016 — October 28, 2016 Mr. Jack Newby - 1 Public Purpose as described by PS Resolution No. 22454