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081015 Abbott United Way GolfAgency Report of: Ceremonial Role Events and Ticket/Pass Distributions 1. Agency Name City of Temecula Division, Department, or Region (If Applicable) City Council/City Manager Designated Agency Contact (Name, Title) Sue Steffen, Executive Assistant Date Stamp A Public Document California Q A f>t Form Q V JIL For Official Use Only Area Code/Phone Number 951-506-5100 E-mail sue.steffen@cityoftemecula.org ❑ 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? Yes El No 11 Face Value of Each Ticket/Pass $ 200.00 Event Description Abbott United Way Golf Tournament Date(s) 08 / 10 f 15 Provide Title/Explanation Ticket(s)/Pass(es) provided by agency? Was ticket distribution made at the behest of agency official? Yes ❑ No El If no: Abbott Vascular Name of Source No x❑ Yes ❑ If yes: Official's Name (Last, First) 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. A. Name of Agency, Department or Unit Number of Ticket(s)/ Pass(es) Describe the public purpose made pursuant to the agency's policy City Manager 2 Advertise/Promote City. Employee morale. Community Development 1 Advertise/Promote City. Employee morale. B. Name of Individual (Lest, First) Number of Ticket(s)/ Pass(es) Identify one of the following: Ceremonial Role ❑ Other ❑ If checking "Ceremonial Role" or "Other' describe below: Income ❑ Ceremonial Role ❑ Other ❑ If checking "Ceremonial Role" or "Other' describe below: Income ❑ C. Name of Outside Organization (include address and description) Number of Ticket(s)/ Pass(es) Describe the public purpose made pursuant to the agency's policy 4. Verification I have read and understand FPPC Regulations 18944.1 and 18942. 1 have verified that the distribution set forth above, is in accordance with the requirements. -- Signature of Agency Comment: e or Designee Sue Steffen Print Name Executive Assistant Title 8/18/15 (Month, Day, Year) FPPC Form 802 (4/12) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-7772) Agency Report of: Ceremonial Role Events and Ticket/Pass Distributions Continuation Sheet California 802 Form A Public Document Agency Name City of Temecula 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 of A. Name of Agency, Department or Unit Ticket(s)/ Describe the public purpose made pursuant to the agency's policy Pass(es) Public Works 1 Advertise/Promote City. Employee Morale. B. Name of Individual (Last, First) Number of Ticket(s)/ Pass(es) Identify one of the following: Ceremonial Role ❑ Other ❑ If checking "Ceremonial Role" or "Other" describe below: Income ❑ Ceremonial Role ❑ Other ❑ If checking "Ceremonial Role" or "Other deschbe below: Income ❑ Ceremonial Role ❑ Other 0 If checking "Ceremonial Role" or "Other" descnbe below: Income ❑ Ceremonial Role ❑ Other ❑ If checking "Ceremonial Role" or "Other" describe below: Income ❑ C. Name of Outside Organization (include address and description) Number of Ticket(s)/ Pass(es) Describe the public purpose made pursuant to the agency's policy FPPC Form 802 (4/12) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-7772)