2016-11-15 Sparrows Lodge PSPOA FundraiserAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
1. Agency Name
City of Palm Springs ,I ``,_
f OF P t L
Division, Department, or Region (if applicable) 211T APR 26
Designated Agency Contact (Name,Tltle) jr r ii.
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? Face Value of Each Ticket/Pass $ 200.00
g Y p Y� Yes® No
Event Description: Sparrows Lodge PSPOA Fundraiser Date(s) 11 t15 1 16
Provide TidelExplanadon
Ticket(s)/Pass(es) provided by agency? Yes ® No ❑ If no:
A Public Document
v p
5 F kRi ltn Stem '
N 10: 4 5 For Official Use Only
❑ Amendment (Must Provide Explanation in Part 3.)
Date of Original Filing:
(month, day, year)
Was ticket distribution made at the behest Yes ❑ No 29
of agency official?
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 8 to identify an individual. • Use Section C to identify an outside organization.
Number
A. Name of Agency, Department or Unit of TI0kWK$Y Describe the public purpose made pursuant to the agency's policy
Passes
Number
B• Name of Individual of TicketileY Identify one of the following:
(Last First) I Passes
Roberts, J.R.
Foat, Ginny
Ceremonial Role ❑ Other ® Income ❑
1 If checking "Ceremonial Role" or "Other' describe below.
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other x❑ Income ❑
1 It checking 'Ceremonial Role" or "Other' describe below:
Public Purpose as defined by PS Resolution No. 22454
Name of Outside Organization Number
C. (include address and description) of Tlcket(sy Describe the public purpose made pursuant to the agency's policy
Passes
4. Verification
1 have read and understand
with the requirements.
Comment:
18944.1 and 18942. 1 have verified that the distribution set forth above, is in accordance
David Ready City Manager �S F
Print Name Title (month, dap, year)
FPPC Form 802 (2/2016)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)