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100717 Our Kids Rock Fundraiser Agency Report of: Ceremonial Role Events and TickeUPass Distributions A Public Document 1. Agency Name Dale Slamp . � . ' City of Temecula ' � Divislon,Department,or Regfon/ifapp�icabk) ForpfGcial Use Only City Clerk's Office Designated Ageacy ConUct(Name,7rtb) Randi Johl, City Clerk ❑ Amendment (Musf ProNda Explanetian in Pert 3.) Area CodelPhone Number E-mall 951-694-6421 randi.'ohl temeculaca. ov DateofOrlglnalFlling: �0/19/17 1 @ 9 rmo�m.aey.Yea.� 2. Function or Event Information Does the agency have a ticket policy? Yes� No❑ Face Value of Each TickeVPass$ �25 Event Description: Our Kids Rock Fundraiser Date(s)���� ��_ Provida Tfle�Explanation Ticket(s)/Pass(es) provided by agency? Yes O No� If no: Boys and Girls Club Name a/Saurce Was ticket distribution made at the behest Yes O No� If yes: of agency official? Olficial's Neme(Lasf,FirsfJ 3. Recipients •Uc<Se<�lon A lo identify lhe egmcy4 deparlment or unit. •Use Section B to idenli(y an individual. •Use Section C lo identify en outside argani�ation. Numlwr (+, Neme o(Agen�y,Dapartment or Unit of 7lckat(.)I Des�riEe tha publl�purpose made punuant to[he agency's pollcy Pas�as Number B. Nama of IndNidual of Tick�q�y Identify one of tha following: (Last.Firsf) Paasn Maryann Edwards Ceremonim Rda � Omer ❑ inmme ❑ ,2 tlNreckrp'CeremomalRde"oi'ONei OesrnceOe�ow Advertise and Promote lhe City Ceremonial Rde ❑ ONar ❑ Income ❑ P Mxking'Ceremoniai Rde"oi'ONe�'0.^trnDe De�ow. Nama ol Outslda Organization Number C' (Inclutle atlEress antl deacription) °�T�k°u'u Des�riba the public purpose made punuant to the agency's policy Pesaas 4. VeriTication I have d and understand FPPC Regulations 18944.1 and 18942. 1 have venfied that the distribution set/orth above, is in accordance with e quiremenls. Randi Johl City Clerk 10/19/17 Si nq HaaO or Despnee Pnnt Name Titla (monM,dag year) Comment: FPPC Form 802(212016) FPPC Totl-Free Helpllne:E681ASN•FPPC(8661275-3772)