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Tickets Provided by <br />Agency Report <br />1. Agency Name <br />City of Riverside <br />Division, Department. or F <br />Development Department <br />3900 Main Street, Riverside, CA 92522 <br />-Pa S tawp <br />~ r. <br />HE 3 2 2,L" !;I <br />TICKETS PROVIDED BY <br />AGENCY REPORT <br />For Official Use Only <br />171 Amendment (Must explain in Part 5.) <br />951-826-5769 <br />phogan@riversideca.gov <br />1 2/2/10 <br />Agency Contact (name and title) Date of Original Filing: (month, day <br />day year) <br />Pamela Hogan, Development Coordinator <br />2, Event For Which Tickets Were Distributed <br />Date(s) of Event: 01 1 15 l 10 Description of Event: Fox Foundation Inaugural Gala <br />-J Face Value of Ticket: $ 150.00 <br />Agency Event Z 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: ❑ Gratuitously ❑ Pursuant to Contract <br />3. Agency Official(s) Receiving Ticket(s) (use a continuation sheet for additional names) <br />Name of Official Number State Whether the Distribution is Income to the Official or <br />(Last, First) of Tickets Describe the Public Purpose for the Distribution <br />See attached list <br />A Public Document <br />25 Promotion of City Facility and 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 />P rpose for Distribution: (Describe the public purpose for the distribution to the organization.) <br />5. Vurification <br />l have determined that the distribution of tickets set forth above is in accordance with the provisions of FPPG Regulation 18944.1. <br />Deanna Lorson Development Dept. Director 02/15/10 <br />Signature of Agen Head or Designee Print Name Tide (month, day, year) <br />Comment: (Use this space or an attachment for any additional information including amendment explanation.) <br />FPPG Form 602 (Febt09) <br />FPPG Toll-Free Helpline: 866/ASK-FPPG (866/275-3772) <br />