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Agency Report of:Ceremonial Role Events and Ticket/Pass Distributions A Public Document
California Form 1. Agency Name
Designated Agency Contact (Name,Title)
Date Stamp
E-mail
Division, Department, or Region (if applicable)
802
(month, day, year)
For Official Use Only
Area Code/Phone Number
Date of Original Filing:
Amendment (Must Provide Explanation in Part 3.)
2. Function or Event Information
Does the agency have a ticket policy? Yes Face Value of Each Ticket/Pass $
Event Description:
No
Date(s) / / / /Provide Title/ Explanation
Ticket(s)/Pass(es) provided by agency? Yes If no:No Name of Source
If yes:Was ticket distribution made at the behest Yes No Official’s Name (Last, First) of agency official?
3. Recipients
• 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.
If checking “Ceremonial Role” or “Other” describe below:
If checking “Ceremonial Role” or “Other” describe below:
Name of Agency, Department or Unit
Name of Outside Organization (include address and description)
Name of Individual
(Last, First)
Number of Ticket(s)/ Passes
Number of Ticket(s)/ Passes
Number of Ticket(s)/ Passes
Describe the public purpose made pursuant to the agency’s policy
Identify one of the following:
Describe the public purpose made pursuant to the agency’s policy
IncomeOther
Other
Ceremonial Role
Ceremonial Role Income
A.
B.
C.
4. Verification
I have read and understand FPPC Regulations 18944.1 and 18942. I have verified that the distribution set forth above, is in accordance
with the requirements.
Signature of Agency Head or Designee Print Name Title (month, day, year)
Comment:
FPPC Form 802 (2/2016) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
A.
B.
Name of Individual Number of Tickets Identify one of the following: Ceremonial Role, Other or Income and Describe
Tony Alanis 2 Other: Police Foundation Raffle
Peter Morales 2 Other: Employee Engagement and Wellness Committee Raffle
Michael Lafferty 2 Other: Employee of the Month
Jimmy Talamantes 2 Other: Employee of the Month
Cynthia Barba 2 Other: Employee of the Month
Name of Agency Number of Tickets Describe the Public Purpose Made Pursuant to the Agency’s
Policy
City of Chula Vista Police Foundation 2 Benefits local police. City Policy #161-01 III.A.2.a.c.h.
City of Chula Vista Animal Services
Foundation
2 Benefits abandoned animals. City Policy #161-01 III.A.2.a.c.h.
City of Chula Vista Recreation Department
Foundation
2 Benefits public parks. City Policy #161-01 III.A.2.a.c.h.
City of Chula Vista Library Foundation 2 Benefits local libraries and residents. City Policy #161-01 III.A.2.a.c.h.
City of Chula Vista Employee Engagement Committee 2 Benefits City employees through events and outreaches. City Policy #161-01 III.A.2.a.c.h.
City of Chula Vista Fire Foundation 2 Benefits local fire fighters and their families. City Policy #161-01 III.A.2.a.c.h
C.
Name of Outside Organization Number of Tickets Describe the Public Purpose Made Pursuant to the Agency’s Policy
The Living Coast Discovery Center 2 A public forum to discuss City issues. City Policy #161-01 III.A.2.a.c.h.