2016-12-02 ACBCI Golf TournamentAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name r, •
City of Palm Springs
Division, Department, or Region (if applicable) ��� AP 24 PM 5: 44 For Official Use Only
Designated Agency Contact (Name, Title)
i .i 10E r� i Y
Cindy Cairns, Executive Services Administrator
❑ Amendment (Must Provide Explanation in Part 3.)
Area Code/Phone Number E-mail
l Filing:
i i f Original ng:
760-322-8362 cindy.cairns@palmspringsca.gov Date o(month, day, year)
2. Function or Event Information
Does the agency have a ticket policy? Face Value of Each Ticket/Pass $ 750.00
9 Y P Y� Yes® No
Event Description; ACBCI 7th Annual Charity Golf Tourn, Date(s) 12_ 1— 02 1 16 1 1
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 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 Tickeksjl Describe the public purpose made pursuant to the agency's policy
Passes
Number
B. Name of Individual of Tickei{sN Identify one of the following:
(Last, First) I Peeves
Nalder, Kevin
Kleindienst, Will
Ceremonial Role ❑ Other ❑X Income ❑
1 if checking 'Ceremonial Role" or "Other' describe below:
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other 0 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) °fPe ;su Describe the public purpose made pursuant to the agency's policy
4. Verification
I have read and understand
with the requirements. /)
Comment:
Regulations 18944.1 and 18942. 1 have verified that the distribution set forth above, is in accordance
David Ready City Manager 4 --x) [ 1
Print Name Title (month, day, year)
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)
Agency Report of: - -
Ceremonial Role Events and Ticket/Pass Distributions 'Form 802,
Continuation Sheet A Public Document
Agency Name
City of Palm Springs
3. Recipients
• Use Section A to identify the agency's department or unit. • Use Section S to identify an individual. • Use Section C to identify an outside organization.
Number
A. Name of Agency, Department or Unit
of Tlckst(ay
Passes
Describe the public purpose made pursuant to the agency's policy
B. Name of Individual
(Last, First)
Number
of Ticket(s)!
pores
Identify one of the following:
Fontana, Mike
Ceremonial Role ❑ Other ® Income ❑
Itchecking 'CeremonialRae" or"OtherdescaDabelow:
Public Purpose as defined by PS Resolution No. 22454
Cairns, Greg
1
Ceremonial Role ❑ Other El Income ❑
It checking "Commonial Role of `other' describe below
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ® Income ❑
It checking 'Ceremonial Role- or "Other' desonbe below_
Ceremonial Role ❑ other ® Income ❑
It checking 'Ceremonial Role" or "Other' describe below.
Name of Outside Organization
C. •
(include address and description)
Number
of Tlckegsy
paw
Describe the public purpose made pursuant to the agency's policy
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772)