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Home My WebLink About2023-08-Form 802 - PDACC Business Installation AwardsOo c uS ign Envelope ID : A 119B070-6081-450 D-9780-04AD057 4 0 570 Agency Keport ot: Ceremonial Role Events and Ticket/Pass Distributions Public Document ----------------------------.---IM~~ ......... -1. Agency Name CJ'f '/ ~€£:~~ Off CITY OF PALM DESERT P;, H DE RT . C California 802 Division , Department, or Region (if applica ble) Designated Agency Contact (Name, Title) ANTHONY J. MEJIA Area Code/Phone Number 760-346-06 11 E-mail amej ia@palmdesert.gov 2. Function or Event Information Does the agency have a ticket pol icy? Yes IZI No D E t D . t· PDACC -Insta ll ation Dinner & Awards ven escnp I0n : _______________ _ Provide Title/ Explanation Form 1 13 OCT -3 PM L: • 2 For Officia l Use On ly D Amendment (Must Provide Explana tion in Part 3.) Date of Original Filing : -...,...---,,~---,--- (mo nth, day, year) 96.38 Face Value of Each Ticket/Pass $ ________ _ Date(s) ~~ 2023 ___/___/ __ Ticket(s)/Pass(es) prov ided by agency? Yes IZI No D If no : _________________ _ Was ticket distribution made at the behest Yes IZ) No □ of agency official? 3. Recipients Name of Source If Hileman , Todd yes : __________________ _ Official's Na me (Last. First) • Use Secti o n A t o id entify the agency's depart ment or unit. • Use Sec t ion B t o ide ntify an ind ividu al. Use Sect ion C to identify an outside organizat ion. Number A. Name of Agency, Department or Unit of Ticket(s)I Describe the public purpose made pursuant to the agency's policy Passes Number B. Name of Individual of Ticket(s)/ Identify one of the following: (Last, F irst) Passes t Ceremonial Role D Other D Income D KELLY .KATHLEEN 2 If checking •ceremonial Role " or "Other" describe below: PD Resolut ion No. 2019-70 Section 6-C -17 Ce remonial Role D Other D Income D QUINTAN ILLA , KARINA 2 If checking •ceremonial Role " or "Other" describe below: PD Resolutio n No . 2019-70 Section 6-C-17 Name of Outside Organization Number C. ofTicket(s)I Describe the public purpose made pursuant to the agency's policy (include address and description) Passes 4. Verification I have read and understan d FPPC Re g ula tion s 18944 . 1 and 1894 2. I have verified th at the distrib ution set forth above, is in accordan ce with 6SfiJNIJflfltS. I/A, AN THONY MEJIA CITY CLERK 10/03/202 3 Si Print Name Ti tl e (month, day, year) Commen t:------------------------------------------- Print Clear FPPC Form 802 (2/2016) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) DocuSign Envelope ID : A 119B070-608 1-450D -9780-04AD057 4 D57D Agency Report of: Ceremonial Role Events and Ticket/Pass Distributions California 802 Form This form is for use by all state and local government agencies . The form identifies persons that receive admission tickets and passes and describes the public purpose for the distribution . This form was prepared by the Fair Political Practices Commission (FPPC) and is available at www.fppc .ca .gov. General Information FPPC Regulation 18944.1 sets out the circumstances under which an agency 's distribution of tickets to entertainment events , sporting events , and like occasions would not result in a gift to individuals that attend the function . In general , the agency must adopt a policy which identifies the public purpose served in distributing the admissions. The Form 802 serves to detail each event and the public purpose of each ticket distribution . FPPC Regulation 18942 lists exceptions to reportable gifts , including ceremonial events , when listed on this form . When the regulation procedures are followed , persons , organizations , or agencies who receive admissions are listed on a Form 802 . Agency officials do not report the admissions on the official's Statement of Economic Interests , Form 700 , and the value of the admission is not subject to the gift limit. The Form 802 also informs the public as to whether the admissions were made at the behest of an agency official and whether the behested tickets were provided to an organization or to specific individuals . Exception FPPC This form is not required for admission provided to a school or university district official , coach , athletic director, or employee to attend an amateur event performed by students of that school or university. Reporting and Public Posting Ticket Distribution Policies: An agency must post its ticket policy on its website within 30 days of adoption or amendment and e-mail a link of the website location to FPPC at form802@fppc .ca .gov. Form 802: The use of the ticket or pass under the policy must be reported on Form 802 and posted on the agency's website within 45 days of distribution . A link to the website location of the forms must be e-mailed to FPPC at form802@fppc.ca.gov. The FPPC will post on its website the link to each agency 's policy and completed forms. It is not necessary to send an e-mail each time a new Form 802 is posted . It is only necessary to submit the link if the posting location changes . A Public Document This form must be maintained as a public document. Privacy Information Notice Information requested by the FPPC is used to administer and enforce the Political Reform Act. Failure to provide information may be a violation subject to administrative , criminal , or civil penalties. All reports are public records available for inspection and reproduction. Direct questions to FPPC 's General Counsel. Instructions Part 1. Agency Identification : List the agency's name . Provide a designated agency contact person , their phone number, and e-mail address . Mark the amendment box if changing any .information on a previously filed form and include the date of the original filing . Part 2. Function or Event Information : Confirm that your agency has a policy for ticket distribution . Unless the ceremonial role or income box in Part 3 , Section B, is marked , this form is only applicable if your agency has a pol icy. Complete all of the other required fields tha t identify the ticket value , description of event , date(s) and whether the ticket was provided by the agency or an outside source . If an agency official behests the tickets , the official 's name is also required . Use the comment field or an attachment to explain in full. Part 3. Ticket Recipients : This part identifies who uses the tickets. The identification requirements vary depending upon who received the tickets and are categorized into three sections . Each section must list the number of tickets rece ived. Use the comment field or an attachment to explain in full. Section A. Report tickets distributed to agency staff, other than an elected official or governing board member, pursuant to the agency's policy. It is not necessary to list each employee 's name , but identify the uniUdepartment for which the employee works . The agency must describe the public purpose associated with the ticket distribution. A reference to the pol icy is permissible . Section B. Report : 1) any agency official who performs a ceremonial role ; 2) any agency official who reports the value as income ; or 3) tickets used by elected officials and governing board members (including those distributed pursuant to the agency's policy). Section C. Report tickets provided to an o rganization . The organization's name, an address (website url is permissible), and a brief description of the public purpose are required. FPPC Form 802 (2/2016) Docu Sig n Envelope ID: A 11 9 B070-6081-450 D-9780-04AD057 4D57D Agency Report of: Ceremonial Role Events and Ticket/Pass Distributions Continuation Sheet California 802 Form A Public Document Agency Name CITY OF PALM DESERT 3. Recipients • Use Sectio n A to identify the agency's d epartment or unit. • Use Section 8 to identify an indivi dual. lJ se Section C to identify an outside organization . A. Name of Agency, Department or Unit --- B. Name of Individual (Las t, Firs t) HARNIK , JAN NESTANDE, GINA TRUBEE ,EVAN C. Name of Outside Organization (include address and description) Print Number of Ticket(s)/ Passes Number of Ticket(s)/ Passes 1 1 1 Number of Ticket(s)/ Passes Clear Describe the public purpose made pursuant to the agency's policy Identify one of the following: I Ceremonial Role D Other D In come D If checking "Ceremonial Role " or "Other" describe below: PD Resolution No . 2019-70 Section 6-C-17 Ceremonial Ro le D Other D In co me D If checking "Ceremonial Role " or "Other" describe below: PD Resolution No. 2019-70 Section 6-C -17 Cere mon ia l Role D Other D In come D If checking "Ceremonial Role " or "Other" describe below: PD Resolution No. 2019-70 Section 6-C-17 Ceremon ia l Role D Other D In come D If checking "Ceremonial Role " or "Other" describe below: Describe the public purpose made pursuant to the agency's policy FPPC Form 802 (2/2016) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)