2016-12-02 Chamber Athena Award LuncheonAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
1. Agency Name
City of Palm Springs
Division, Department, or Region (if applicable)
Designated Agency Contact (Name, Title)
Cindy Cairns, Executive Services Administrator
Area Code/Phone Number E-mail
760-322-8362 1 cindy.cairns@palmspringsca.gov
A Public Document
i _1 ._(.F..rr L M
2011 APR 24 P For Official Use Only
0' FiCC Jr I i "�
❑ Amendment (Must Provide Explanagon in Part 3.)
Date of Original Filing:
(month, day, year)
2. Function or Event Information
Does the agency have a ticket policy? Yes ® No ❑ Face Value of Each Ticket/Pass $ 80.00
Event Description: 2016 Athena Awards Luncheon Date(s) 12 ) 02 1 16 1
Provide TiHe/Explanation
Ticket(s)/Pass(es) provided by agency? Yes ❑ No El If no: PS Chamber of Commerce
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 TicksKeY Describe the public purpose made pursuant to the agency's policy
Passes
Number
B. Name of Individual of Tickat(s)✓ Identify one of the following:
(last, First) passes
Ceremonial Role ❑ Other ❑X Income ❑
Moon, Robert 1 It checking "Ceremonial ROle"or'Other"descnbebelow:
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other 121 income ❑
Foal, Ginny 1 l/cbecking'CeremoniafRoie"or°Ofher"desetibebelow:
Public Purpose as defined by PS Resolution No. 22454
Name of Outside Organization Number
C. of Tk:kegs)! 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
Comment:
Regulations 18944.1 and 18942. I have verified that the distribution set forth above, is in accordance
_ David Ready City Manager �+U
Print Name Title (month, day, year)
FPPC Form 802 (2/2016)
FPPC Toll -Free Helpllne: 866)ASK-FPPC (8661275-3772)
Agency Report of: Now
Ceremonial Role Events and Ticket/Pass Distributions 0
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 B to identify an individual. • Use Section C to identify an outside organization.
Number
A. Name of Agency, Department or Unit
ofTicket(sy
Passes
Describe the public purpose made pursuant to the agency's policy
B. Name of Individual
(Last First)
Number
of Ticket[sy
Passes
Identify one of the following:
Kors, Geoff
2
Ceremonial Role ❑ Other ® Income ❑
N checking "Ceremonial Role" or "Other' describe below
Public Purpose as defined by PS Resolution No. 22454
Roberts, J.R.
1
Ceremonial Role ❑ Other ® Income ❑
ifchecking"CeremonlatRote"or"Othw"describebelow.
Public Purpose as defined by PS Resolution No. 22454
Goolsby, Denise
1
Ceremonial Role ❑ Other ® Income ❑
if checking 'Ceremonia!Role" or"Cther'descdbe below:
Public Purpose as defined by PS Resolution No. 22454
Goodman, Ellen
1
Ceremonial Role ❑ Other ® Income ❑
if checking"CeremonialRoW or"Other'describebelow:
Public Purpose as defined by PS Resolution No. 22454
Name of Outside Organization
C.
(include address and description)
Number
of T�ket(su
Passes
Describe the public purpose made pursuant to the agency's policy
FPPC Form 802 1212016)
FPPC Toll -Free Helpline: 866IASK•FPPC 1866/275-3772)
Form 802 — Additional Tickets for Athena Awards Luncheon, 12/02 2016
Keller, Barbara —1, Public Purpose as described by PS Resolution No. 22454
Ahkami, Shayda —1, Public Purpose as described by PS Resolution No. 22454
Blaisdell, Amy —1, Public Purpose as described by PS Resolution No. 22454
Jones, Tee —1, Public Purpose as described by PS Resolution No. 22454
Kazmouz, Dallas —1, Public Purpose as described by PS Resolution No. 22454
Huskey, Kelley —1, Public Purpose as described by PS Resolution No. 22454
Patakas, Maria —1, Public Purpose as described by PS Resolution No. 22454
Voss, Nora —1, Public Purpose as described by PS Resolution No. 22454
Stein, Susan —1, Public Purpose as described by PS Resolution No. 22454
Goodsell, Lea —1, Public Purpose as described by PS Resolution No. 22454