Passes. of Tlcket(s)/ Identify one of the following: Passes

Transcription

1 Ceremonial Role Events and TicketJPass Distributions ~ A Public Document ~~----~ ~~~ Agency Name r> ~te Stamp -...,... Fo rm <S> <..._ o:-:o For Official Use Only Division, Department, or Region (if applicable),... 0"1,.., :i ~ City Manager Department Designated Agency Contact (Name, Title) Steve Merrnell, City Manager Area Code/Phone (626) smermell@cityofpasadena.net 2. Function or Event Information 0 Amendment (Must Provide Explanation in Part 3.) Date of Original Filing: --:---::-~-= (month. day, year) Does the agency have a ticket policy? Yes~ No 0 Face Value of Each Ticket/Pass$ _ 1 _ 5 _ 0_ 0 Event Description: 91 st Annual 4rh of July America fest Provide Title/ Explanation Ticket(s)/Pass(es) provided by agency? Yes~ NoD Was ticket distribution made at the behest Yes eg No 0 of agency official? --'--'-- lf no: Name of Source If yes: Mermell, Steve Officiars Name (Last. First) A. Name of Agency, Department or Unit ofticket(s)/ Describe the public.purpose made pursuant to the agency's policy Human Services & Recreation Department 219 Attract or reward volunteer public service B. Name of Individual of Tlcket(s)/ Identify one of the following: 10 Ceremonial Role 0 Other (BI Income 0 If ch$cidng "Ceremonial Role' or "Other" describe below: A City employee in connection with a competition or drawing If checlang 'Ceremonial Role' or 'Other" describe below: c. of Tlcket(s)/ (include address and description) See attached. 781 Support and/or show appreciation for programs or services rendered by non-profit orgs benefiting Pasadena 4. Verification I have read and understand FPPC Regulations and I have verified that the distribution set forth above, is in accordance with the requirements. S~ Steve Mermell City Manager 12/20/17 Signature of Agency Head or Designee Print Name Title (month, day, year) Comment: FPPC Toll-Free Helpline: 866/ASK FPPC (866/ )

2 . Continuation Sheet Agency Name A Public Document Gity of Pasadena 'A. Name of Agency, Department or Unit of Ticket(s)l '.. B. Name of Individual of Tlcket(s)/ Identify one of the following: If checking 'Ceremonial Role' or 'Other' descril>e below: If checking 'Ceremonial Role' or 'Other' describe below: If Checking ceremonial Role' or 'Other' descril>e below: Ceremonial Role 0 Other 0 Income 0 If checking 'Ceremonial Role' or 'Other' describe below: c. of Ticket(s)l (Include address and description) A Step Ahead 1265 N Altadena Dr, Pasadena, CA Ability First 201 S Kinneloa Ave, Pasadena, CA Abode Communities 235 E Holly St. Pasadena, CA Armory Center 145 N Raymond Ave, Pasadena, CA rendered by non-profit orgs benefitting Pasadena resident FPPC Toll-Free Helpline: 866/ASK-FPPC (866/ )

3 Continuation Sheet A Public Documen.t. Agency Name A. Name of Agency, Department or Unit of Ticket(s)/ -.. B.. Name of lnl;llvldual. of Tlcket(s)/ ' Identify one of the following: Ceremonial Role D Oth~r D Income D.. If checking ceremonial Role" or "Other" describe below:.. \ Ceremonial Role D Other D Income D If checking ceremonial Role" or "Other" describe below: Ceremonial Role D Other D Income D If checking "Ceremonial Rote or "Other" describe below: ( Ceremonial Role D Other D Income D If checking ceremonial Rote or "Other" describe below: ' c. of Ticket(s)/ (include address and description) / Day One 175 N Euclid Ave, Pasadena. CA Door of Hope 669 N Los Robles Ave, Pasadena, CA Journey House 1232 N Los Robles Ave, Pasadena,CA Friends In Deed 444 E Washington Blvd, Pasadena, CA rendered by non-profit orgs benefitting Pasadena resident FPPC Toll-Free Helpline: 866/ASK-FP.PC _(866/ )

4 Continuation Sheet A Public Document Agency Name A. Name of Agency, Department or Unit. of Tlcket(s)l Describe the public purpose made pursuant.to the agency's policy B. Name of Individual of Ticket(s)l Identify one of the following: If checking 'Ceremonial Role' or 'Othe,. describe below: - C~remon ial Role 0 Other 0 Income 0 If checking 'Ceremonial Role' or 'Other" describe below: If checking 'Ceremonial Role' or 'Othe,. describe below: If checking 'Ceremonial Role' or 'Othe,. describe below: c. ofticket(s)/ (Include address and description) Lake Avenue Community Foundation 712 E Villa St, Pasadena, CA LSSSC/ Avanti 60 N Daisy Ave, Pasadena, CA Mother's Club 980 N Fair Oaks Ave, Pasadena, CA New Macedonia Baptist Church 455 E Washington Blvd, Pasadena, CA rendered by non-profit orgs benefitting Pasadena resident FPPC 802 (212016) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/ )

5 Continuation Sheet A Public Document Agency Name A. Name of Agency, Department or Unit ofticket(s)l 1 B. Name of Individual of Ticket(s)l Identify one of the following: If checkjng "CeremotNal Role" or "Othel' desaibe bejqw; If checking 'Ceremonial Role' or 'Oihe,. desctibe below: If checking ceremonial Role" or "0 /he,. describe below: If checking ceremonial R(!le" or 'Othet" desctibe below: c. of Ticket(s)/ (Include address and description) Peace Over Violence 892 N Fair Oaks Ave,#D,Pasadena,CA Union Station Homeless Services 825 E Orange Grove BI,Pasadena,CA Young & Healthy P.O. Box 93397, Pasadena, CA Borne Group Home 2980 Santa Anita Ave, Altadena, CA rendered by non-profit orgs benefitting Pasadena resident Support and/or show appreciation for progra_ms or services FPPC Toll-Free Helpline: 866/ASK-FPPC (866/ )

6 Continuation Sheet. Agency Name A Public Document Use Section A to identify the agency's department or unit. Use Section B to identify an individual. Use Sect.ion C to identify an outside organization. A. Name of Agency, Department or Unit of Tlcket(s)J. B. Name of Individual of Tlcket(s)/ Identify one of the following: If checking 'Ceremonial Role" or "Other'" describe below: If checi<ing ceremonial Role' or 'Othel' describe beloo.i' If checking 'Ceremonial Role' or 'Other'" describe below: If checi<ing 'Ceremonial Role or 'Other'" describe below: c. of ncket(s)/ (include address and description) West Pasadena Little League P.O. Box 94871, Pasadena, CA For The Kids 400 W Peoria Street, Pasadena, CA AJ Jackson and Otis Triplett 241 E Washington Blvd, Pasadena, CA rendered by non-profit orgs benefittiog Pasadena resident FPPC Toll-Free Helpline: 866/ASK-FPPC (866/ )

7 AMERICAFEST TICKET DISTRIBUTION JULY 4, 2017 #of Organization Contact Tickets 1 A STEP AHEAD Jacques Bolton 30 2 ABILITY FIRST Michael Barkyoumb ABODE 3 COMMUNITIES Victoria Allen 4 ARMORY CENTER Tricia Garcia 5 DAY ONE Christy Zamani 6 DOOR OF HOPE Andrew Fike 7 JOURNEY HOUSE Jorge Camarena 8 FRIENDS IN DEED Marlene Martinez 30 LAKE AVENUE COMMUNITY 9 FOUNDATION Eric Johnson 10 LSSSC/AVANTI Martin Gordon 11 MOTHER'S CLUB Silvana Casalegno NEW MACEDONIA 12 BAPTIST CHURCH Beverly Bogar PEACE OVER 13 VIOLENCE. Elia Jasquez - Description of Organization ADDRESS 1265 N Altadena Dr., Pasadena. Non-profit CA S Kinneloa Ave., Pasadena Non-profit CA E Holly St.. Pasadena CA Non-profit N Raymond Ave., Non-profit Pasadena CA N Euclid Ave., Pasadena, Non-profit CA N Los Robles Ave., Non-profit Pasadena CA N Los Robles Ave., Non-profit Pasadena CA E Washington Blvd.. Non-profit Pasadena CA E Villa St., Pasadena CA Non-profit N Daisy Ave., Non-profit Pasadena CA N Fair Oaks Ave., Non-profit Pasadena CA E Washington Blvd., Non-profit Pasadena CA N Fair Oaks Ave., #D Non-profit Pasadena CA Purpose of Di!»tribution benefiting Pasadena residents. or services re ndered by non-profit organizations! benefiting Pasadena resjdents. or services rendered by non-profit orgc!nizations 1

8 AMERICAFEST TICKET DISTRIBUTION JULY 4, 2017 UNION STATION HOMELESS 14 SERVICES Joyce Miles 15 YOUNG & HEAL THY Ana Martinez 16 BORNE GROUP HOM Charles Phillips 20 WEST PASADENA 17 tittle LEAGUE Beverly Bogar FOR THE KIDS Georgia Halloway 21. AJ JACKSON AND 19 OTIS TRIPLETT 10 JRC COMMUNITY 20 MEMBERS leonardo Chavez 32 VILLA PARKE COMMUNITY 21 MEMBERS Maricela Galvez VICTORY PARK COMMUNITY 22 MEMBERS Kenny James ROBINSON PARK COMMUNITY 23 MEMBERS Darrell Walker 24 YOUTH COUNCIL Maricela Galvez E Orange Grove Blvd., Non-profit Pasadena CA PO Box 93397, Pasadena CA Non-profit Santa Anita Avenue, Non-profit Altadena, CA P.O. Box 94871, Pasadena, CA Non-profit W. Peoria Street, Non-profit Pasadena, CA E. Washington Blvd., Non-profit Pasadena, CA N. Fair Oaks, Pasadena, Non-profit CA E Villa St., Pasadena, CA Non-profit Paloma Street, Pasadena, Non-profit CA N. Fair Oaks, Pasadena, Non-profit CA N. Fair Oaks, Pasadena, Non-profit CA benefiting Pasadena residen,ts. Community members Community members 'Community members Community members Community members ' i Non-Profit 781 H~R Programs, Youth Council 219 TOTAL RECEIVED