2021-11-24 Justin CliftonAgency Report of:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name ' � �
City of Palm Springs C T'r G�
Division, Department, or Region (if applicable) 021 NOV 24 AN 7. 24 For Official Use Only
Designated Agency Contact (Name, Tine) 10 F TFILE %!If `i' C
Llubi Rios, Executive Services Administrator
❑ Amendment (Must Provide Explanation in Part 3.)
Area Code/Phone Number E-mail
760-322-8632 1 Llubi.rios@palmpspringsca.gov Date of Original Filing: (month, day, year)
2. Function or Event Information
Does the agency have a ticket policy? Yes ® No ❑
Event Description: PS Modernism Show & Sale Fall Prev.
Provide Title/Explanation
Ticket(s)/Pass(es) provided by agency? Yes ❑ No El
Face Value of Each Ticket/Pass $ 75.00
Date(s) 10 / 15 / 21 101 15 t 21
If no: PS Modernism Week
Was ticket distribution made at the behest Yes ❑ No ® If yes:
of agency official?
Name of Source
Official's Name (Last, First)
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(s)/ Describe the public purpose made pursuant to the agency's policy
Passes
Name of Individual Number
B. of Ticket(s)/ Identify one of the following:
(Last, First) I Passes
Ceremonial Role ❑ Other Q Income ❑
Kors, Geoff 2 If checking "Ceremonial Role" or "Other"' describe below
Public Purpose as described by PS Resolution No. 22454,
Section lld vii viii xi
Ceremonial Role ❑ Other ❑X Income ❑
Woods, Dennis 2 Ifchecking"Ceremonial Role"or°Other' describe below.
Public Purpose as described by PS Resolution No. 22454,
Section 1(d)(vii)(viii)(xi)
Name of Outside Organization Number
of Ticket(s)/ Describe the public purpose made pursuant to the agency's policy
C. (include address and description)
Passes
4. Verification
l have read and understand FPPC Regulations 18944.1 and 18942. / have verified that the distribution set forth above, is in accordance
wit
Justin Clifton City Manager
Print Name Title (month, day, year)
Comment:
FPPC Form 802 (2/2016)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)
Agency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
Continuation Sheet
Agency Name
City of Palm Springs
3. Recipients
A Public Document
• 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(s)/
Passes
Describe the public purpose made pursuant to the agency's policy
B.
Name of Individual
(Last, First)
Number
of Ticket(s)l
Passes
Identify one of the following:
Holstege, Christy
2
Ceremonial Role ❑ Other El Income ❑
Itchecking"Ceremonial Role"or"Other" describe below.
Public Purpose as described by PS Resolution No. 22454,
Section 1(d)(vii)(viii)(xi)
Ceremonial Role ❑ Other ® Income
I/ checking "Ceremonial Role" or "Other" describe below
❑
Ceremonial Role ❑ Other ❑ Income
It checking "Ceremonial Role" or "Other" describe below.'
P
❑
Ceremonial Role ❑ Other ❑ Income
It checking "Ceremonial Role" or "Other" describe below:
❑
C.
Name of Outside Organization
include address and
( description) P )
Number
of Ticketlsy
Passes
Describe the public purpose made pursuant to the agency's policy
FPPC Form 802 (2/2016)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/2753772)