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HomeMy WebLinkAboutJuly 2023 Interwinery Tasting - Signed Form 802California Form Agency Report of: 1. Agency Name Designated Agency Contact (Name,Title) Date Stamp E-mail Division, Department, or Region (if applicable) 2. Function or Event Information 9HUL¿FDWLRQ ,KDYHUHDGDQGXQGHUVWDQG)33&5HJXODWLRQVDQG,KDYHYHUL¿HGWKDWWKHGLVWULEXWLRQVHWIRUWKDERYHLVLQDFFRUGDQFH with the requirements. Signature of Agency Head or Designee Print Name Comment: FPPC Form 802 (2/2016) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) (month, day, year) 802 (month, day, year) )RU2ႈFLDO8VH2QO\ Area Code/Phone Number Date of Original Filing: Ticket(s)/Pass(es) provided by agency? Was ticket distribution made at the behest RIDJHQF\RႈFLDO" 7LWOH Ceremonial Role Events and Ticket/Pass Distributions )DFH9DOXHRI(DFK7LFNHW3DVV (YHQW'HVFULSWLRQ If no: If yes: Amendment (Must Provide Explanation in Part 3.) Provide Title/ Explanation Name of Source 2௻FLDO¶V1DPH /DVW)LUVW If checking “Ceremonial Role” or “Other” describe below: If checking “Ceremonial Role” or “Other” describe below: Name of Agency, Department or Unit Name of Outside Organization (include address and description) Name of Individual /DVW)LUVW Number of Ticket(s)/ Passes Number of Ticket(s)/ Passes Number of Ticket(s)/ Passes Describe the public purpose made pursuant to the agency’s policy Identify one of the following: Describe the public purpose made pursuant to the agency’s policy 'RHVWKHDJHQF\KDYHDWLFNHWSROLF\"No No Income Other Other &HUHPRQLDO5ROH &HUHPRQLDO5ROHIncome No Yes Yes Yes Date(s) //// 3. A. B. C. 4. A Public Document 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.• • • City of Dublin Marsha Moore, City Clerk (925) 833-6644 marsha.moore@dublin.ca.gov ■60 Interwinery Tasting 07 10 2023 ■Livermore Valley Wine Community (City is Member) ■ Josey, Jean and one guest per FPPC 18942(13)2 ■ Public Purpose - Promotion of local and regional businesses and economic activities Linda Smith City Manager Print Clear