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Tickets Provided by <br />Agency Report <br />1. Agency Name <br />City of Riverside <br />Division, Department, or Region <br />Development Department <br />3900 Main Street, Riverside, CA 92522 <br />krea Code /Phone Number I E -mail <br />A Public Document <br />951- 826 -5769 1 phogan @riversideca.gov <br />Agency Contact (name and title) <br />Pamela Hogan, D Coordinator <br />2. Event For Which Tickets Were Distributed <br />MAR - Z4 lU <br />TICKETS PROVIDED BY <br />AGENCY REPORT <br />For Official Use Only <br />® Amendment (Must explain in Part 5 ) <br />Date of original Filing: 2/1/10 <br />(month, day, year) <br />Date(s) of Event: 01 / 15 1 10 Description of Event: Fox Foundation Inaugural Gala <br />/ Face Value of Ticket: $ 150.00 <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: ❑ Gratuitously ❑ Pursuant to Contract <br />3. Agency Official(s) Receiving Tickets) (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 I Describe the Public Purpose for the Distribution <br />See attached list <br />17 1 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: <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 />! h2va determined that the distribution of tickets set forth above is in accordance with the provisions of FPPC Regulation 18944.1. <br />Deanna Lorson Development Director 03/04/10 <br />Signature of Agency Head or Print Name Tltle (month. day year) <br />Comment: (Use this space or an attachment for any additional information including amendment explanation.) <br />The City distributed only one ticket to each person listed on the attached list. <br />FPPC Form 802 (Feb/09) <br />FPPC Tall -Free Helpline: 866 /ASK -FPPC (8661276 -3772) <br />