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042118 Birth Choice Centers 4th Annual Gala 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 Official 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: (month,day,year) 2. Function or Event Information Does the agency have a ticket policy? Yes® NO❑ Face Value of Each Ticket/Pass$ 80 Event Description: Birth Choice Centers 4th Annual Gala Date(s)4/ 21 / 18 Provide Title/Explanation Ticket(s)/Pass(es) provided by agency? Yes❑ No El If no: Birth Choice Centers Name of Source Was ticket distribution made at the behest Yes❑ No® If yes: Official's Name(Last,First) of agency official? 3. Recipients •Use Section A to identify the agency's department or unit. •Use Section B to identify an individual. •Use Section C to identify an outside organization. Number A. Name of Agency,Department or Unit of Ticket(s)/ Describe the public purpose made pursuant to the agency's policy Passes Number B. Name of Individual of Ticket(s)/ Identify one of the following: (Last First) Passes Mike Naggar Ceremonial Role ❑ Other Q Income ❑ 2 If checking'Ceremonial Role"or"Other'describe below: Advertise and Promote City of Temecula Ceremonial Role ❑ Other ❑ Income ❑ 1f checking"Ceremonial Role"or"Other'describe below: Name of Outside Organization Number C' (include address and description) of Ticket(s)/ Describe the public purpose made pursuant to the agency's policy Passes 4. Verification /haveFeV and understand FPPC Regulations 18944.1 and 18942. I have verified that the distribution set forth above, is in accordance with he r quirements. Randi Johl City Clerk 04/30/18 ure of Ag cy Head or Designee Print Name Title (month,day,year) Comment: FPPC Form 802(2/2016) FPPC Toll-Free Helpline:866/ASK-FPPC(866/275-3772)