HomeMy WebLinkAboutSt. Patrick's Day Gala - Signed Form 802Agency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
1. Agency Name
City of Dublin
or Region (if applicable)
(Name,
Marsha Moore, City Clerk
Date Stamp
A Public Document
For Official Use Only
❑ Amendment (Must Provide Explanation in Part 3.)
(925) 833-6644
marsha.moore@dublin.ca.gov
Date of Original Filing:
I
(month, day, year)
I
2. Function or Event Information
Does the agency have a ticket policy? Face Value of Each Ticket/Pass $ 50
9 Y p Y� Yes No
Event Description: St. Patrick's Day Gala Date(s) 03 / 17 1 20
Provide Ttle/Explanation
Ticket(s)/Pass(es) provided by agency? Yes N No ❑ If no:
Name of Source
Was ticket distribution made at the behest Yes ❑ No E 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 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 Ticket(s)l
Identify one of the following:
(Last, First)
Passes
Ceremonial Role ❑ Other Q Income ❑
Hernandez, Melissa
1
If checking `Ceremonial Role" or'Other" describe below:
Promotion of City -sponsored activities - Sister City
Ceremonial Role ❑ Other E Income ❑
Josey, Jean and one guest per FPPC 18942(13)
2
If checking 'Ceremonial Role" or'Other" describe below:
Promotion of City -sponsored activities - Sister City
Name of Outside Organization
C. (include address and description)
Number
of Ticket(s)/
Describe the public purpose made pursuant to the agency's policy
Passes
4. Verification
1 have read and understand FPPC Regulations 18944.1 and 18942. l have verified that the distribution set forth above, is in accordance
w'th a requireme t .
Linda Smith City Manager ho 23
ignature of Agency Head or Designee 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: California 802
Ceremonial Role Events and Ticket/Pass Distributions Form
Continuation Sheet A Public Document
Agency Name
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)/
Passes
Describe the public purpose made pursuant to the agency's policy
B. Name of Individual
(Last, First)
Number
of Ticket(s)/
Passes
Identify one of the following:
Hu, Sherry
1
Ceremonial Role ❑ Other ® Income ❑
If checking 'Ceremonial Role" or 'Other" describe below:
Promotion of City -sponsored activities - Sister City
Mccorriston, Michael and one guest per FPPC 18942(13)
2
Ceremonial Role Q Other ❑ Income ❑
If checking "Ceremonial Role" or'Other' describe below:
Had a speaking role in the program.
Qaadri, Kashef
1
Ceremonial Role ❑ Other ® Income ❑
If checking 'Ceremonial Role" or "Other' describe below:
Promotion of City -sponsored activities - Sister City
Ceremonial Role ❑ Other ❑ Income ❑
If checking 'Ceremonial Role" or 'Other" describe below:
Name of Outside Organization
C.
(include address and description)
Number
of Ticket(s)/
Passes
Describe the public purpose made pursuant to the agency's policy
FPPC Form 802 (212016)
FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)