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092819 TEDx Temecula 2019: Eleva TEDxperience Agency Report of: Ceremonial Role Events and Ticket/Pass Distributions A Public Document 1. Agency Name Date Stamp California 802 City of Temecula Form Division,Department,or Region (if applicable) For Official Use Only City Clerk Designated Agency Contact(Name,Title) Randi Johl, Director of Legislative Affairs/City Clerk ❑ Amendment (Must Provide Explanation in Part 3.) Area Code/Phone Number E-mail 951 694-6421 dihl tl ov Date of Original Filing: 10/01/19 ( ) ran .o emecuaca.g (month,day,year) 2. Function or Event Information Does the agency have a ticket policy? Yes® No❑ Face Value of Each Ticket/Pass$ 60 Event Description: TEDx Temecula 2019: Eleva TEDxperience Date(s)�� 19 Provide Title/Explanation Ticket(s)/Pass(es) provided by agency? Yes® No❑ If no: City of Temecula Name of Source Was ticket distribution made at the behest Yes❑ No® 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 Number B. Name of Individual of Ticket(s)/ Identify one of the following: (Last,First) Passes Ceremonial Role ❑ Other El Income ❑ Matt Rahn 2 If checking"Ceremonial Role"or"Other"describe below: Advertise and Promote the City of Temecula Ceremonial Role ❑ Other ❑ Income ❑ If checking"Ceremonial Role"or"Other'describe below: Name of Outside Organization Number C. (include address and description) of Ticket(s)/ Describe the public purpose made pursuant to the agency's policy 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 th j'irements. Director of Legislative Affairs/ Randi Johl City Clerk 10/01/19 Signature• •-ncy 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)