2016-12-15 College of the Desert FundraiserAgency 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, True)
Cindy Cairns, Executive Services Administrator
Area CodelPhone Number E-mail
760-322-8362 1 cindy.caims@palmspringsca.gov
A Public Document
Y OF PALM SPRi
For Official Use Only
11 APR 24 PM 5: 4
I
ICE 0 TE E CIT Y C ERK
❑ Amendment (Must Provide Explanation in Part 3.)
Date of Original Filing:
(month, day, year)
2. Function or Event Information
? Face Value of Each Ticket/Pass $ 100.00
Does the agency have a ticket policy. Yes ® No ❑
Event Description: COD Fundraiser Citizens/Distinction Date(s) 12 115 f 16 ____j ---- i
Provide Titie/Explanah'on
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 S to identify an individual. • Use Section C to identify an outside organization.
Number
A. Name of Agency, Department or Unit of Ticketisu Describe the public purpose made pursuaritto the agency's policy
Passes
Number
B. Name of Individual of Tloketlsy Identify one of the following:
(Last, First) I Passes
Moon, Robert
Ceremonial Role ❑ Other ❑yC Income ❑
1 !/checking "Ceremonial Role"Or "Oche/' deSCribe belOW:
Public Purpose as defined by PS Resolution No. 22454
Ceremonial Role ❑ Other X❑ Income ❑
I/ checking "Ceremonial Role" or "Other' describe below:
Name of Outside Organization Number
of Tlckegsa Describe the public purpose made pursuant to the agency's policy
C. (include address and description)
Passes
4. Verification
1 have read and understand
with the requirements. r\
gnature
Comment:
Regulations 18944.1 and 18942. 1 have verified that the distribution set forth above, is in accordance
David Ready City Manager
Print Name Title (month, day, year)
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772)