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Tickets Provided by <br />Agency Report <br />1. Agency Flame <br />City of Riverside <br />Division, Department, or Region (if applicable) <br />Development Dept. <br />A Public Document <br />C LIN <br />D <br />TICKETS PROVIDED BY <br />AGENCY REPORT <br />For Official Use Only <br />Ai 2 4 2 01 10 <br />3900 Main St., Riverside, CA 92522 <br />951-826-5769 <br />(name and title) <br />phogan@riversideca.gov <br />Pamela Hogan <br />2. Event For Which Tickets Were Distributed <br />❑ Amendment (Must explain in Fart 5.) <br />Date of original Filing: <br />(month, day, year) <br />Date(s) of Event: 03 f 14 f 10 Description of Event: Gladys Knight Concert at Fox Performing Arts Center <br />-J I Face Value of Ticket: $ 77.00 <br />Agency Event x❑ Yes ❑ No (Identify source of tickets below.) <br />Name of Outside Source of Ticket(s) Provided to Agency: <br />Number of Tickets Received: Ticket(s) Provided to Agency: x❑ Gratuitousiy ❑ Pursuant to Contract <br />3. Agency Official(s) Receiving Ticket(s) (use a continuation sheet for additional names) <br />Name of Official f Number State Whether the Distribution is Income to the Official or <br />(Last, First) I of Tickets Describe the Public Purpose for the Distribution <br />Davis, Paul <br />Gardner, Mike <br />1 Promotion of City Profile <br />1 1 Promotion of City Profile <br />4. Individual or Organization Receiving Ticket(s) (Provided at the behest of an agency official.) <br />Name of Behesting Agency Official: <br />Name of Individual or Organization: <br />Description of Organization: <br />Number of Tickets: <br />Address of Organization: <br />Number and Street city State Zip Code <br />Purpose for Distribution: (Describe the public purpose for the distribution to the organization.) <br />5. Verification <br />t have determined that the distribution of tickets set forth above is in accordance with the provisions of FPPG Regulation 18944.1. <br />Deanna Lorson Director <br />'Signature of Agency Head or Designee Print Name Title (month, day, year) <br />Comment: (Use this space or an attachment for any additional information including amendment explanation.} <br />FPPG Form 802 (Feb/09) <br />FPPG Toll-Free Helpline: 8661ASK-FPPG (866/275-3772) <br />