2016-11-15 Chamber Police and Fire Appreciation LuncheonAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name F t,�i t �` i»p
City of Palm Springs 30
For Official Use Only
Division, Department, or Region (if applicable) ull tM
Designated Agency Contact (Name, Title) � r
Joanne Bruggemans, Executive Assistant to Mayor/Council
❑ Amendment (Must Provide Explanadon in Part3.)
Area Code/Phone Number E-mail
760-323-8200 joanne.bruggemans@paimspringsca.gov Date of Original Filing:
gg @palms rin sca. p g gov (month, day, year)
2. Function or Event Information
Does the agency have a ticket policy? Face Value of Each Ticket/Pass $ 60.00
g y p Y • Yes ® No ❑
Event Description: Peace Officer & Public Safety Awards Date(s) 11 1 15 r 16 —J.
Provide Ttle/Explanation
Ticket(s)/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 idenflfy 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 Ticket(sy Describe the public purpose made pursuant to the agency's policy
Passes
B. Name of Individual
of Tickai(sN
Identify one of the following:
(Last, First)
Passes
Ceremonial Role ❑ Other 0 Income ❑
Moon, Robert
2
11 checking Temmonial Role" or "Other descr/tte below.
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other X❑ Income ❑
Kors, Geoff
if checking "Cammonial Role" or -Other' desca6e below.
Public Purpose as defined by PS Resolution No. 22454
Name of Outside Organization
C.
Number
ofTickagay
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.
re of Agency
Comment:
Regulations 16944.1 and 18942. 1 have verified that the distribution set forth above, is in accordance
David Ready City Manager 5 Q0 1 1
Print Name Title (month, day, year)
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)
Agency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
Continuation Sheet
Agency Name
A Public Document
City of Palm Springs
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 Tlck"ay
Passes
Describe the public purpose made pursuant to the agency's policy
B. Name of Individual
(Last, First)
Number _
of Tickskey
Passes
Identify one of the following:
Roberts, J.R.
Ceremonial Role ❑ Other El Income ❑
Nchedung'CeremoniaJRda'or'Other'descnbebelow:
Public Purpose as defined by PS Resolution No. 22454
Ready, David
1
Ceremonial Role ❑ Other ® Income ❑
lfchecking'CeremonfsJRole" or"Other'descHbebelow:
Public Purpose as defined by PS Resolution No. 22454
Reyes, Bryan
1
Ceremonial Role ❑ Other ® Income ❑
Jf checking "Ceremonial Role" or "Other' describe below.
Public Purpose as defined by PS Resolution No. 22454
Nalder, Kevin
Ceremonial Role ❑ Other ® Income ❑
Jt checking`Commonial RoWor°Ofher'descnbs below:
Public Purpose as defined by PS Resolution No. 22454
Name of Outside Organization
C. �
(include address and description)
Number
of Tk;kegsy
Passes
Describe the public purpose made pursuant to "agency's policy
FPPC Form 802 (2l2016)
FPPC Toll -Free Helpline: 8661ASK-FPPC 18661275-3772)
Form 802 — Additional Tickets for 20th Annual Peace Officer & Public Safety Lunch
November 15, 2016
Smith, Mike —1, Public Purpose as described by PS Resolution No. 22454