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052017 Denim & Diamonds 15th Anniversary Agency Report of: Ceremonial Role Events and TickeUPass Distributions A Public Document 1. Agency Name Date Stamp . . . ' City of Temecula • � Division, Department,or Region (ifapplicable) Forotfcial use only City Clerk's Office Designated Agency Contact(nlame,Tine) Randi Johl, City Clerk ❑ Amendment (MustProvideExplanafioninPart3J Area Code/Phone Number E-mail (951)694-6421 randi.johl@temeculaca.gov Date otOriginal Filing; 05/30/17 (month,day,year) 2. Function or Event information Does the a enc have a ticket olic � Face Value of Each TickeUPass $ 125.00 9 Y P Y Yes� No❑ Event Description: Denim & Diamonds 15th Anniversary Date(s)���� _�J_ Provide Ttle/Explanation Ticket(s)/Pass(es) provided by agency? Yes❑ No� If no: SAFE Alternatives for Everyone Nameo/Somce Was ticket distribution made at the behest Yes❑ No 0 If yes: O�ficial's Name(Last,First) of agency official? 3. Recipients •Ose Section A to identify the agency's department or unit •Use Section B to identify an indlvidual. •Use Section C to identify an outside organiza[ion. Number ' � � � � I A. Name ot Agency,Department or Unit of Tickeys�/ Describe the public purpose made pursuant to the agency's policy � Passes � � ' . Number . � � ' . � ' B. ,Nameoflntlivitlual ofTlcket�s)/� .Itlentifyoneofthetollowing:. . .. ' (Last,First)� Passes ' . . ' . � . . � EdWBfdS, Maryann Ceremonial Role ❑ ONer ❑X Income ❑ ,Z IlchecWhg'CeremonialRda'or'OtheY'tlentn6ebelow: Advertise and Promote the City of Temecula Ceremonial Role ❑ Other ❑ Income ❑ II checkbg'Ceremonial Rde'or'Otl�el'c§ttn6e below: � Name of Outside Organization . . Numner � +�.. � - . �. � �.; �� � C• (inciutle atltlress and description) - of Tickeqsp Describe.the public purpose made purauant to the ageney'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 uirements. Randi Johl City Clerk 05I30/17 Si a Agency Heatl or Designee Print Name Ttla (month,day year) Comment: � FPPC Form 602(2I2016) FPPC Toll-Free Helpline:866IASK-FPPC(86612753772)