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110116 Our Kids Rock Monster Mash Agency Report of: Ceremonial Role Events and Ticket/Pass Distributions A Public Document 1. Agency Name Date Stamp . ' City of Temecula Division, Department, or Region (if applicable) For OfBaal use Only City Clerk's Office Designated Agency Contact(Name.Title) Randi Johl, City Clerk ❑ Amendment (Must Provide Explanation in Part 3) Area Code/Phone Number E-mail (951) 694-6421 randi.johl@temeculaca.gov Date of Original Filing: 11/01/16 (month day.year) 2. Function or Event Information Does the agency have a ticket policy? Yes® No❑ Face Value of Each Ticket/Pass$ 54 Event Description. Our Kids Rock Monster Mash Date(s) 10 l 29 ) 16 Provide Tile/Explanation Ticket(s)/Pass(es) provided by agency? Yes❑ No EI If no: Boys& Girls Clubs of Southwest County Name of Source Was ticket distribution made at the behest Yes❑ No® If yes: O of agency official? Official Name(Last First) 3. Recipients •Use section A to identify the agency's department or unit. •Use Sedion s to identify an individual. •Use Section C to identify an outside organization. Number A. Name of Agency,Department or Unit of Tlcket(sp Describe the public purpose made pursuant to the agency's policy Peasas Number B. Name of Individual of Ticket(slf Identify one of the following: (Last,First) Passes Edwards, Maryann eeremonaf Note ❑ Other ® Income ❑ 2 ll checbrp'Ceremon,al Rae or Omerae.,,ce Below To advertise and promote the City of Temecula McCracken, Michael Cerennnial Role ❑ Other ❑% Inwme ❑ 2 d checbng Ceremonial Rae"or-Other deuni a below To advertise and promote the City of Temecula Name of Outside Organization Nanbw Ce' (include address and description) of Ticket(ap Describe the Public purpose made pursuant to the agency's policy PasNs 4. Verification 1 hav and understand FPPC Regulations 18944.1 and 18942 1 have verified that the distribution set forth above, is in accordance wit the gwements. Randi Johl City Clerk 11/01/16 4=igsmy or Designee Pnnt Name Ttle (month,day year) Comment. FPPC Form 602(2/2016) FPPC Toll-Free Helpline:6661ASK.FPPC(8661275-3772)