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2016-10-29 AIDS Assistance Program Dine and DishAgency Report of: Ceremonial Role Events and Ticket/Pass Distributions 1. Agency Name R4CEIyVjqs,amp City of Palm Springs 17 y OF rtLM SPRING - or Cindy Cairns, Executive Services Administrator Area Code/Phone Number E-mail 760-322-8362 1 cindy.cairns@palmspringsca.gov 2. Function or Event Information Does the agency have a ticket policy? Yes ® No ❑ Event Description: AIDS Assistance Prog. Dine & Dish Provide Trtle/Expianation Ticket(s)/Pass(es) provided by agency? Yes ® No ❑ Was ticket distribution made at the behest Yes ❑ No 99 of agency official? 2617 APR 126 AM 10, 4 OFFICE Or Fri C IJ Y 1E A Public Document Official Use Only Amendment (Must Provide Explanation in Part 3.) Date of Original Filing: (month, day, year) Face Value of Each Ticket/Pass $ 500.00 Date(s) 10 r29 1 16 J_ 1 Iran !Name of Source If yes: 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. Number A. Name of Agency, Department or Unit of Tickagey Describe the public purpose mad* pursuant to the agency's policy Passes B. Foat, Ginny Name of Individual (Last, First) of Tlcket(su I Identify one of the following: Passes Ceremonial Role ❑ Other © Income ❑ if checking 'Ceremonial Rote" or'Other" describe below: Public Purpose as defined by PS Resolution No. 22454 Ceremonial Role ❑ Other 0 Income ❑ If checking 'Ceremoniai Role"or'Other' descnbe below: Name of Outside Or anization Number C. g of Ticket(s)r Describe the public purpose made pursuant to the agency's policy (include address and description) Pam 4. Verification i have read and with the reauirel Comment: Regulations 18944.1 and 18942. l have verified that the distribution set forth above, is in accordance David Ready City Manager as 1-7- Print Name Title (month, day, }rear) FPPC Form 802 (212016) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)