Fillable Form 802: CeremoniaIRole Events and Ticket/Pass Distributions A (City of San Pablo)

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Form 802: CeremoniaIRole Events and Ticket/Pass Distributions A (City of San Pablo)

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The Form 802: CeremoniaIRole Events and Ticket/Pass Distributions A (City of San Pablo) form is 32 pages long and contains:

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File type: PDF

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Agency Report of :
CeremoniaIRole Events and Ticket/Pass Distributions
A Public Document
1. Agency Name
CITY OF SAN PABLO
Division, Department, or Region (ff app/flab/eJ
California
802
Form
For OfftcialUse Only
esignated Agency Contact (Name,TFf/eJ
Lehny M. Corbin, Deputy City C.lerk
LehnyC@SanPabloCA.gov
8/28/19
Date of OriginaIFiling
(month, day, year)
2 Function or Event Information
Does the agency have a ticket policy? Yesj8 No []
Event Description: Salesman Boys & Girls Club Golf Tourn
Provide Title/ Explanation
Ticket(s)/Pass(es) provided by agency? Yes E] No []
Face Value of Each Ticket/Pass $ .Zl9=9o
Date(s) 08 / 26 / 19
If no:
Ifyes:
Name of Source
Was ticket distribution made at the behest Yes B] No []
ofagency official?
Ofhciaf's Name (Last, First)
3.
Recipients
Use Section A to identify the agencfs department or unit. ' Use Section B to identif)r an individual. ' Use Section C to identify an outside organization
4. Verification
shave read and understand FPPC Regulations 18944. land {8942. shave verified that the distribution set forth above, is in accordance
Matt Rodriguez
Print Name
City Manager
Htle
U/2W19
(month. day, year)
Comment
FPPC Form 802 (2/2016)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275 3772)
A. Name of Agency, Department or Unit
Number
ofTicket(s)/
Passes
Describe the public purpose made pursuant to the agency's policy
B. Name oflndividual
blast, Fin!)
Number
of Ticket(s)/
Passes
Identify one of the following;
Matt Rodriguez. Ron Raman, Greg Dwyer.
Alex Gregg
4
CeremoniaIRoleE] Other 181 Income[.
If checking 'Ceremonial Role ' ar 'Qthef descHbe below
CeremoniaIRoleE] Other [] Income [
f checldng 'CeremattiaIRole ' ar 'cher describe below
C. ,:.ET.qf.!!!:FE.!gl:B!:l
Number
ofTicket(s)/
Passes
Describe the public purpose made pursuant to the agency's policy
Promotion of City on a local. regional, state or national
scale. Promotion of open government by participation
of public officials at business or community events
Encouraging or rewarding significant academic. athletic
Agency Report of:
CeremoniaIRole Events and Ticket/Pass Distributions
Continuation Sheet
A Public Document
Agency Name
CITYOFSANPABLO
3. Recipients
Use Section A to identify the agenc/s department or unit. Use Section B to identify an individual. Use Section C to idaitify an outside organization
Number
FPPC Form 802 (2/2016)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
A. Name of Agency, Department or Unit afTicket(s)/
Passes
Describe the public purpose made pursuant to the agency's policy
B. Name oflndividual
blast, Firsts
Number
ofTicket(s)/
Passes
IdentiQ one of the following:
CeremoniaIRoleE] OtherE] Incomes'
If checnng 'CeremaniaIRoie ' Qr 'Other describe below
CeremoniaIRoleE] OtherE] Income [
If checking 'CenmoniaIRole ' Qr 'Other describe below
CeremoniaIRolet] OlherE] Income [
f chechng 'CeremaniaIRate ' or 'Other describe below
CeremoniaIRolet] OtherE] Incomes'
it checldng 'Ceremonial Role ' or 'Other describe below
C. .. Name of Outside Organization
Number
ofTicket(s)/
Passes
Describe the public purpose made pursuant to the agency's policy
(continued) or public or volunteer service achievements by
city students, residents or businesses.
Agency Report of:
CeremoniaIRole Events and Ticket/Pass Distributions A Public Document
1. Agency Name
City of San Pablo
Division, Department, or Region fif app/scab/eJ
California
802
Form
For OfficialUse Only
Designated Agency Contact (Name,T#fe;
Lehny Corbin. Deputy City Clerk
'Phone Number
'ea
[] Amendment (Must Provide E)p/anal/on/n Part 3.)
(510) 215-3005 le hnyc@sanpa bloca .gov
l0/31/18
Date of OriginaIFiling:
B,da)cyear]
2. Function or Event Information
Does the agency have a ticket policy? Yes 18 No []
Event Description: .j==!!ton Casino Golf Tournament
Provide Title/ Explanation
'ncket(s)/Pass(es) provided by agency? Yes E] No []
Face Value of Each 'Rcket/Pass $ .£99=gO
Date(s) ]9 / 29 / 18
If no:
If yes:
Name of Source
Was ticket distribution made at the behest Yes [] No B]
ofagency ofHcial?
Official's Name (Last. First)
3
Recipients
Use Section A to identiQ the agency's department or unit. ' Use Section B to identify an individual. ' Use Section C to identify ' an outside organization
4. Verification
shave read and understand FPPC Regulations 18944.land 18942. shave verified that the distribution set forth above, is in accordance
q.
ofAgency Head or Desi
Matt Rodriguez
Print Name
City Manager
Title
l0/31/18
(mann. day, year)
Comment
FPPC Form 802 (2/2016)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
A. Name of Agency, Department or Unit
Number
of Ticket(s)/
Passes
Describe the public purpose made pursuant to the agenc/s policy
B. Name oflndividual
blast, First)
Number
of Ticket(s)/
Passes
Identify one of the following:
Adams. Greg
l
CeremoniaIRoleE] OtherE] }ncomeE '
f checking 'CeremoniaIRole ' or 'Other descHbe below
Dwyer. Greg
l
CeremaniaIRoleE] OtherE] Income[.
f checking 'CeremoniaIRole ' Qr 'Other describe below
C. ,: Nam ' 'f.glee O'g?l:i"!!«
Number
of Ticket(s)/
Passes
Describe the public purpose made pursuant to the agency's policy
Promotion of City on a local, regional. state or national
scale. Promotion of open government by participation of
public officials at business or community events.
Agency Report of :
CeremoniaIRole Events and Ticket/Pass Distributions
Continuation Sheet
A Public Document
Agency Name
City of San Pablo
3. Recipients
Use Section A to identify the agency's department or unit. Use Section B to identif)r an individual ' (Jse Section C to identify an outside organization
Number
FPPC Form 802 (2/2016)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
A. Name of Agency, Department or Unit
of Ticket(s)/
Passes
Describe the public purpose made pursuant to the agency's policy
B. Name oflndividual
blast, First)
Number
ofTicket(s)/
Passes
Identify one of the following:
Raman. Ron
l
CeremoniaIRoleE] Other EI Income[.
f checldng 'CeremQniaIRQle ' Qr 'other describe below
Rodriguez, Matt
l
CeremoniaIRoleE] Other Ea Incomes'
If checHng 'CeremoniaIRote' or 'Other describe below
CeremoniaIRoleE] Oher]] Income [
If checking 'CeremaniaIRole ' or 'Other describe below
CeremoniaIRoleE] OtherE] Income [
f chechng 'Cenmonia} Role ' or 'ethel" describe below
C. .. Name of Outside Organization
Number
ofTicket(s)/
Passes
Describe the public purpose made pursuant to the agency's policy
Agency Report of :
CeremoniaIRole Events and Ticket/Pass Distributions
A Public Document
1. Agency Name
CI'TYOFSANPABLO
Division, Department, or Region r/f 4pp/icao/eJ
Date Stamp
802
California
Form
For OfhcialUse Only
Designated Agenif Contact (7Vame J7ffeJ
Lehny M. Corbin, Deputy City Clerk
Area Code/Phone Number
E-ma
LehnyC @SanPabloCA .gov(510) 215-3005
[] Amendment rMust provide explanaffon fn Part 3.J
.--..a (#2'11f,g......
Date of OriginaIFiling
(Month. DaZ Y
2. Function or Event Information
Does the agency have a ticket policy? Yes181 No []
Event Description Salesian Boys & Girls Club Golf Tourn
Provide Title/Explanation
Face Value of Each Ticket/Pass $
250.00
Oate(s) --.!
27 , 18
Ticket(s)/Pass(es) provided by agency?
Yes B[ No []
If no:
Ifyes:
Name of Source
Was ticket distribution made at the behest
of agency official?
No 81 Yes []
OfRcial's Name (Last, First)
3. Recipients
B Use Section A to identify the agency's department or unit. e Use Section B to identify an individual. e Use Section C to identify an outside organization
4. Verification
Ihavereadand
Agency Head ar Designee
18944.1 and t8942. shave verified that the distribution set forth above, is in accordance with the requirements.
Matt Rodriguez City Manager 8/30/18
Print Name Title(Month, Day, Year)
Comment
FPPC Form 802 (4/12)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-7772)
A. Name of Agency, Department or Unit
Number of
Ticket(s)/
Pass(es)
Describe the public purpose made pursuant to the agency's policy
B. Name oflndividual
jLest, FhU)
Number of
Ticket(s)/
Pass(es)
Identify one of the following:
Matt RodriguezIDwyer. Gregg
Gregg, AlexlSoungpanya, Leck
CeremoniaIRolel] Other ]!g IncomeE]
f checking 'Ceremonial Role ' or 'Other descHbe below:
CeremoniaIRoleE] OtherE] IncomeE]
f checking 'CeremoniaIRole ' or 'other describe below
C . Name of Outside Organization
(include address and description)
Number of
Ticket(s)/
Pass(es)
Describe the public purpose made pursuant to the agency's policy
Promotion of City on a local, regional, state or nationalscale.
Promotion of open government by participation of public officials
at business or community events/
Agency Report of:
CeremoniaIRole Events and Ticket/Pass Distributions
Continuation Sheet
A Public Document
Agency Name
CITYOFSANPABLO
3. Recipients
e Use Section A to identify the agency's department or unit. e Use Section B to identify an individual. e Use Sects on C to identify an outside organization
FPPC Form 802 (4/12)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-7772)
A. Name of Agency, Department or Unit
Number of
Ticket(s)/
Pass(8s)
Describe the public purpose made pursuant to the agency's policy
B. Name oflndividual
jtast Filet)
Number of
Ticket(s)/
Pass(es)
Identify one of the following:
CeremoniaIRole l:] OtherE] IncomeE]
f checking 'CenmoniaIRole ' or 'Other' describe below
CeremoniaIRaleE] Other [] IncomeE]
i checking 'Ceremonial Role ' or 'Other describe below
CeremoniaIRaleE] OtherE] Income []
f checking 'Ceremonial Role ' or 'Other' descHbe bek)w
Ceremonial RoleE] OtherE] IncomeE]
f checking 'CeremQniaIRQle ' or 'Other describe below
Ci. Name of Outside Organization
(include address and description)
Number of
Ticket(s)/
Pass(w)
Describe the public purpose made pursuant to the agency's policy
(continued) of public officials at business or community events.
Encouraging or rewarding significant academic, athletic or
public or volunteer service achievements by city students,
residents orbusinesses.
Name of Outside Organization
(include address and description)
C.
Describe the public purpose made pursuant to the agency’s policy
Identify one of the following:
FPPC Form 802 (4/12)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-7772)
A Public Document
Name of Agency, Department or Unit
Number of
Ticket(s)/
Pass(es)
Number of
Ticket(s)/
Pass(es)
Number of
Ticket(s)/
Pass(es)
Describe the public purpose made pursuant to the agency’s policy
Agency Report of:
Ceremonial Role Events and Ticket/Pass Distributions
Continuation Sheet
3. Recipients
Name of Individual
(Last, First)
● 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.
A.
B.
Ceremonial Role
Ceremonial Role
Ceremonial Role
Ceremonial Role
Other
Other
Other
Other
Income
Income
Income
Income
If checking “Ceremonial Role” or “Other” describe below:
If checking “Ceremonial Role” or “Other” describe below:
If checking “Ceremonial Role” or “Other” describe below:
If checking “Ceremonial Role” or “Other” describe below:
California
Form
802
Agency Name
Reset Page
Print Form
City of San Pablo
(continued) of public officials at business or community events.
Encouraging or rewarding significant academic, athletic or
public or volunteer service achievements by city students,
residents or businesses.
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Form 802: CeremoniaIRole Events and TicketPass Distributions A (City of San Pablo)

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Completed 26 February 2021

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