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Tickets Provided by <br />w6z~~ TICKETS PROVIDED BY <br />Agency Report A PUbIIC Document <br />AGENCY REPORT <br />Agency Name <br />City of Riverside <br />Development Dept. <br />or Region (if applicable) <br />3944 Main St., Riverside, CA 92522 <br />951-826-5769 I phogan@riversideca.gov <br />Agency Contact (name and title) <br />Pamela Hogan <br />2. Event For Which Tickets Were Distributed <br />Date ~Stap,fl <br />_ w <br />i .i <br />❑ Amendment (Must explain in Part 5.) <br />Use Only <br />Date of Original Filing: <br />(month, day, year) <br />Date(s) of Event: 06 1 05 1 10 Description of Event: Bill Cosby Concert at Fox Performing Arts Center <br />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: <br />Ticket(s) Provided to Agency: El Gratuitously ❑ Pursuant to Contract <br />3. Agency Official(s) Receiving TlCket(s) (use a continuation sheet for additional names) <br />Name of Official Number State Whether the Distribution is Income to the Official or <br />(Mast, First) of Tickets Describe the Public Purpose for the Distribution <br />Please see attached sheet <br />5 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: Number of Tickets: <br />Description of Organization: <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 h determined that the distribution of tickets set forth above is in accordance with the provisions of FPPC 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 />FPPC Form 802 (Feb/09) <br />FPPC Tall-Free Helpline: 866/ASK-FPPC (86612753772) <br />