2021-11-24 Justin Clifton (2)Agency Report of:
Ceremonial Role Events and Ticket/Pass DistributiQ s - A Public Document
1. Agency Name CITY 0 f tpi S f'�d"p i
City of Palm Springs
or
Designated Agency Contact (Name, Title)
Llubi Rios, Executive Services Administrator
Area Code/Phone Number E-mail
760-322-8632 1 Llubi.rios@palmpspringsca.gov
2. Function or Event Information
Does the agency have a ticket policy? Yes ® No ❑
Event Description: BGCPS Halloween Bash
Provide Title/Explanation
Ticket(s)/Pass(es) provided by agency? Yes ❑ No El
AN
7• 24
I For Official Use Only
;� `1TY CL
❑ Amendment (Must Provide Explanation in Part 3.)
Date of Original Filing:
(month, day, year)
Face Value of Each Ticket/Pass $ 100.00
Date(s) 10 /31 1 21 101 31 / 21
If no: PS Boys & Girls Club
Name of Source
Was ticket distribution made at the behest Yes ® No ❑ If yes:
of agency official?
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
B. Name of Individual
Number
of Tickegs►i
Identify one of the following:
(Last, First)
Passes
Ceremonial Role ❑ Other ❑x Income ❑
Garner, Grace
1
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
1
If checking "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
C.
Number
of Ticket(s)t
Describe the public purpose made pursuant to the agency's policy
(include address and description)
Passes
4. Verification
I have read and understand FPPC Regulations 18944.1 and 18942. l have verified that the distribution set forth above, is in accordance
Justin Clifton City Manager
Print Name Title (month, day, year)
Comment:
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)