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Agency Report of: <br />Ceremonial Role Events and Ticket/Pass Distributions <br />1. Agency Name <br />City of Riverside <br />Division, Department, or `'eglon (if applicable) <br />Public Utilities Department <br />Designated Agency Contact (Name, Title) <br />Justin Scott -Coe, Customer Engagement Manager <br />Area Code/Phone Number <br />951-826-8558 <br />E-mail <br />jscottcoe@riversideca.gov <br />2. Function or Event Information <br />Does the agency have a ticket policy? <br />Yes El No <br />Event Description: Unidos Celebrando Chicano Art Gala <br />Provide Title/ Explanation <br />Ticket(s)/Pass(es) provided by agency? Yes ® No 0 <br />Was ticket distribution made at the behest Yes ® No 0 <br />of agency official? <br />cav. <br />SEP 282018 <br />City of Riverside <br />City Clerk's Office <br />ublic Document <br />Form <br />For Official Use Only <br />0 Amendment (Must Provide Explanation in Part 3.) <br />Date of Original Filing: <br />01' 02e08 <br />(month, day, year) <br />Face Value of Each Ticket/Pass $ 150.00 <br />Date(s) <br />9 , 18 <br />If no' <br />Name of Source <br />If yes: Scott -Coe, Justin <br />Official's Name (Last, First) <br />3. Recipients <br />• 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. <br />AMI <br />A. Name of Agency, Department or Unit <br />Number <br />of Ticket(s)/ <br />Passes <br />Describe the public purpose made pursuant to the agency's policy <br />B. Name of individual <br />(Last, First) <br />Number <br />of Tlcket(s)I <br />Passes <br />identify one of the following: <br />Oceguerra, Larissa <br />1 <br />Ceremonial Role ■ Other Income MI <br />If checking "Ceremonial Role" or "Other describe below, <br />Ceremonial Role • Other ❑ Income ■ <br />If checking 'Ceremonial Role' or `Other describe below <br />Name of Outside Organization <br />C(Include address and description) <br />Number <br />Passes <br />Describe the public purpose made pursuant to the agency's policy <br />4. Verification <br />ave read and u <br />e <br />d FPP . Regulations 18944.1 and 18942. I have verified that the distribution set forth above, is in accordance <br />Sign: <br />Al Zelinka <br />ignee Print Name <br />City Manager <br />Title <br />9/28/18 <br />(month, day, year) <br />Comment: <br />FPPC Form 802 (2/2016) <br />FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) <br />