2016-12-09 PSPOA Golf TournamentAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
1. Agency Name
City of Palm Springs
or Region (if
Designated Agency Contact (Name,TNe)
Cindy Cairns, Executive Services Administrator
Area Code/Phone Number E-mail
760-322-8362 1 cindy.cairns@palmspringsca.gov
A Public Document
Date StamtK C 41
'_1TY OF PA
2111 APR 2 41 W W 4it,se Only
OFFICE OF TH4 CI i Y CL Ui-,K
❑ Amendment (Must Provide Explanation in Part 3.)
Date of Original Filing:
(month, day, year)
2. Function or Event Information
Does the agency have a ticket policy? Face Value of Each Ticket/Pass $ 250.00
g y p Y� Yes® No
Event Description: PSPOA 19th Annual Golf Tournament Date(s) 12 t 09 t 16
Provide 7-itle/Explena5on
Ticket(s)/Pass(es) provided by agency? Yes ® No ❑ If no: Name or 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 Ticket(ay Describe the public purpose made pursuant to the agency's policy
Passes
B
Mills, Chris
Smith, Bob
Name of Individual
(Last, First)
of Ticket(sy I Identify one of the following:
Pass"
Ceremonial Role ❑ Other ® Income ❑
1 if checkng "Ceremonial Role" or `Otherdescribe below: -
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other X❑ Income ❑
1 11 checking °Ceremania! Role" or 'Other' describe below:
Public Purpose as defined by PS Resolution No. 22454
C.Name of Outside Organization I of Ticketis)1 Describe the public purpose made pursuant to the agency's policy
(include address and description) passes
4. Verification
1 have read and understand
with the requirements. /,N
Agency
Comment:
Regulations 18944.1 and 18942. 1 have verified that the distribution set forth above, is in accordance
David Ready City Manager
Print Name Tile (month, day, year)
FPPC Form 802 (212096)
FPPC Toll -Free Heipline: 8661ASK-FPPC (8661276-3772)
Agency Report of: QU&M
Ceremonial Role Events and Ticket/Pass Distributions `
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
of Ticket(sjl 1
Passes
Describe the public purpose made pursuant to the agency's policy
B. Name of Individual
(Lest, First)
Number
of Tickegs)l
Passes
Identify one of the following:
Ju rasky, Jeff
1
Ceremonial Role ❑ Other ® Income ❑
If checking -ceremonial Rota'or "0ther' describe below:
Public Purpose as defined by PS Resolution No. 22454
Fontana, Mike
Ceremonial Role ❑ Other ® Income ❑
if checking 'CemmoniaiRole" or'Other descdbebelow.
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other ® Income ❑
If checking 'Ceremoniai Role" or'Other' descilbe below:
Ceremonial Role ❑ Other ® Income ❑
if checking "Cemmonial Role -or "Orher' descnbe below
Name of Outside Organization
C. (include address and description)
Number
of Tickagey
Passes
Describe the public purpose made pursuant to the agency's policy
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/276-3772)