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020417 Stars of the Valley Agency Report of: Ceremonial Role Events and TickeUPass Distributions A Public Document 1. Agency Name Date Stamp . . . ' City of Temecula • � Division,Department,or Region (i/applicab�e) For�cial Use Only City Clerk's Office Designated Agency Contact(Name,Title) Randi Johl, City Clerk ❑ AmentlmeM (MustProNtleExplanafioninPart3.J Area CodelPhone Number E-mail (951)694-6421 randi.johl@temeculaca.gov Date of Original Filing; 02/07/17 (month,tlag year) 2. Function or Event Information Does the agency have a ticket policy? Yes� No❑ Face Value of Each TickeUPass $ �00.00 Event Description: Stars of the Valley Date(s)� 04 � 17 �_J_ ProNde TGe/Ezplanafion Ticket(s)/Pass(es) provided by agency? Yes❑ No� If no: Charity for Charity Name ol Sou(ce Was ticket distribution made at the behest Yes❑ No� If yes: of agency official? O/ficia/'s Nama�Last,First) 3. Recipients •Use Seclion A to identify ihe agenty's deparlmenl or unit •Use Section B lo identify an individual. •Ose Section C to identify an oulside organization. Number � A. Name ofAgency,Department or Unit ot7ickeqsl/ Describe the�public purpose made purauantto the agency's policy Paseea ' t Number' B, Name of Individual of Tickerye)/ Identity one of the tollowing: ' � (L85t,First) � Passes - I EdW8fd5, Maryann Ceremonial Role 0 Other ❑ Income ❑ 2 llchecking'Ceremonlal Rde"or'Ot�eC tlescnDe Delow: Present City Sponsored Award/Advertise and promote the Cit of Temecula Naggar, Mike Ceremonial Role ❑ Other X❑ Income ❑ � uchecking'Ceremonia�Rde'or'Othe/tlescnDebelow: Advertise and promote the Ciry of Temecula Name of-Oubide Organization Numoar - - i C'' .(include address and deacription) � o(Tiekaqe�/ Describe tha puhlic purpose made purauant to the agency's policy � Passea � 4. Verification 1 have read and understand FPPC Regulations 18944.1 and 18942. 1 have verified that the distribution set/orth above, is in accordance with Y e re uirements. Randi Johl City Clerk 02/07/17 Si ure of cy Head or Designee Pnnt Name 7tle (monfh,tlay,yea�J Comment: FPPC Form 602(Y/2016) FPPC Toll•Free Helpline:8661ASK-FPPC(86612753772)