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093017 Temecula Tedx Event Agency Report of: Ceremonial Role Events and Ticket/Pass Distributions A Public Document 1. Agency Name Date Stamp . . . � , City of Temecula ' � Division,DepaRment,or Region (i�applicab�e) For OH¢ial llse Only City Clerk's Office Deafgnated Agency ConWct(Name,Tdle) Randi Johl, City Clerk ❑ Am90dm@nt (Mus!Provitle Esp/anaeon in Part 3) Area CodelPhone Num6er E-mail 951-694-6421 randi.'ohl temeculaca. ov �ateotOng�na�F���ng: 1D/D5l17 � @ 9 (monM,day.yeer) 2. Function or Event Information Does the agency have a ticket policy? Yes� No� Face Value of Each TickeUPass$ $35 Event Description: Temecula Tedx Event Date(s)���� ��_ Provide T/t/e/Exp/enefion Ticket(s)/Pass(es) provided by agency7 Yes❑ No� If no: �im McLaughlin -Tedx Facilitator Name o/Sourca Was ticket distribution made at the behest Yes❑ No� �f Yes: Dlficial's Name(LasL firsf) of agency official? 3. Recipients •U�e SeAion A lo idenli(y the agency's deparlment or unil. •Uce Section B lo idenlify an indiWdual. •Use Section C to identify an outside organi�ation. NumWr A, Name of Agency,Departmant or Unit of Tkkey�u Dettri6e tha publi[purposa mada punuant to tM agency's policy Puws City Clerk's Office 2 Enhance Employee Morale Community Services 2 Enhance Employee Morale NumMr B. Name of IndNidual o{7kp�y�y Identity ane of Na Following: (Last,Firsq paw� Cemmonial Role ❑ ONer ❑ Inwme ❑ ll cnBLkmq'Gerertro��al Rde'or'Otnei tlescnpe�elow Caremonial Role ❑ OUer ❑ Inwme ❑ !I clreckmg'Ceiamomal Rde'oi'Ol�e�tle5en0e 4elow� Name of Outaitle OrganireUon Numbar C' (in�luda address antl tlescNption) ol7kkayN Das�rl6a[ha public purpose made punuant to tha apency's Oolicy P�aat 4. Verification I have read and understand FPPC Regulations 18944.1 and 18942. /have ven(ed lhat the distrtbution sef forth above, is in accordance with th u ments. Randi Johl City Clerk 10/05/17 SiOnetum penq HeaC ar Desgnee Pnnt Nama TNe (marfh,tlag yeaiJ Comment: FPPC Form 802��M016) FPPC Toll-Free Helpline:866lASK-FPPC(866f275-3774)