HomeMy WebLinkAbout2023-10 Form 802-Palm Desert Rotary AnniversaryOocuSign Envelope ID : 1AD6B974-B289-4655-930F-334FFCB3CA78
Agency Keport ot:
Ceremonial Role Events and Ticket/Pass Distributions A Public Document
1. Agency Name
CITY OF PALM DESERT
Division , Department, or Region (if applicable)
Designated Agency Contact (Name, Title)
ANTHONY J. MEJIA , CITY CLERK
Area Code/Phone Number
760-346-06 11
E-mail
amejia@palmdesert.gov
: California 802
Form
For Official Use Only
AH 9: 21
D 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? 25.00 Yes ■ No □ Face Value of Each Ticket/Pass $ _______ _
Event Description: Palm Desert Rotary Anniversary
Provide Title/ Explanation
Date( s) ~ ~ ~ ___J___J __
Ticket(s)/Pass(es) provided by agency? Yes D No ■ If no : _P_a_lm_D_e_s_ert_R_o_ta_ry ___________ _
Name of Source
Was ticket distribution made at the behest Yes ■ No □
of agency official?
If yes : Hileman, Todd
Official's Name (Last, First)
3. Recipients
• Use Section A to identify the agency's department or un it. • Use Section B to identify an i nd ividual. Us e Sec tion C to identify an outside organization .
Number
A. Name of Agency, Department or Unit of Ticket(s)I Describe the public purpose made pursuant to the agency's policy
Passes
City Manager's Department 2 PD Resolution No . 2019-70 Section 6-C-21
Economic Development 4 PD Resolution No . 2019-70 Section 6-C-21
Number
I B. Name of Individual of Ticket( s )I Identify one of the following :
(Last, First) Passes
Ceremonial Role D Oth er D Income D
Quintanilla , Karina 1 If checking "Ceremonial Role " or "Other" describe below:
PD Resolution No . 2019-70 Section 6-C-21
Ceremonial Role D Other D Income D
If checking "Ceremonial Role · or "Other" describe below:
Name of Outside Organization Number
C. of Ticket(s)I 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. I have verified that the distribution set forth above, is in accordance
with the r, Fm-M~_hy :
a~ ANTHONY J. MEJIA
11/6/2023
CITY CLERK
Signature o Designee Print Name Title (mon th , day, year)
Comment:-------------------------------------------
Print Clear FPPC Form 802 (2/2016)
FPPC Toll-Free Helpline: 866IASK-FPPC (8661275-3772)