Ceremonial Role Events and TicketJPass Distributions ~ A Public Document ~~----~----------------------------------------~~~----------- - 1. 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 E-mail (626) 744-6936 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 18944. 1 and 18942. 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 (866/275-3772)
. 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 91107 Ability First 201 S Kinneloa Ave, Pasadena, CA 91107 Abode Communities 235 E Holly St. Pasadena, CA 91101 Armory Center 145 N Raymond Ave, Pasadena, CA 91103 30 rendered by non-profit orgs benefitting Pasadena resident FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
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 91101 Door of Hope 669 N Los Robles Ave, Pasadena, CA 91101 Journey House 1232 N Los Robles Ave, Pasadena,CA 91104 Friends In Deed 444 E Washington Blvd, Pasadena, CA 91114 30 rendered by non-profit orgs benefitting Pasadena resident FPPC Toll-Free Helpline: 866/ASK-FP.PC _(866/275-3772)
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 91101 LSSSC/ Avanti 60 N Daisy Ave, Pasadena, CA 91107 Mother's Club 980 N Fair Oaks Ave, Pasadena, CA 91103 New Macedonia Baptist Church 455 E Washington Blvd, Pasadena, CA 91104 rendered by non-profit orgs benefitting Pasadena resident FPPC 802 (212016) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
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 91103 Union Station Homeless Services 825 E Orange Grove BI,Pasadena,CA 91104. Young & Healthy P.O. Box 93397, Pasadena, CA 91109 Borne Group Home 2980 Santa Anita Ave, Altadena, CA 91001 20 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 (866/275-3772)
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 91109 For The Kids 400 W Peoria Street, Pasadena, CA 91103 AJ Jackson and Otis Triplett 241 E Washington Blvd, Pasadena, CA 91104 20 21 10 rendered by non-profit orgs benefittiog Pasadena resident FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
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 91107 201 S Kinneloa Ave., Pasadena Non-profit CA 91107 235 E Holly St.. Pasadena CA Non-profit 91101 145 N Raymond Ave., Non-profit Pasadena CA 91103 175 N Euclid Ave., Pasadena, Non-profit CA 91101 669 N Los Robles Ave., Non-profit Pasadena CA 91101 1232 N Los Robles Ave., Non-profit Pasadena CA 91104 444 E Washington Blvd.. Non-profit Pasadena CA 91114 712 E Villa St., Pasadena CA Non-profit 91101 60 N Daisy Ave., Non-profit Pasadena CA 91107 980 N Fair Oaks Ave., Non-profit Pasadena CA 91103 455 E Washington Blvd., Non-profit Pasadena CA 91104 892 N Fair Oaks Ave., #D Non-profit Pasadena CA 91103 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
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 20 18 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 37 825 E Orange Grove Blvd., Non-profit Pasadena CA 91104 PO Box 93397, Pasadena CA Non-profit 91109 2980 Santa Anita Avenue, Non-profit Altadena, CA 91001 P.O. Box 94871, Pasadena, CA Non-profit 91109 400 W. Peoria Street, Non-profit Pasadena, CA 91103 241 E. Washington Blvd., Non-profit Pasadena, CA 91 104 1081 N. Fair Oaks, Pasadena, Non-profit CA 91103 363 E Villa St., Pasadena, CA Non-profit 91101 2575 Paloma Street, Pasadena, Non-profit CA 91107 1081 N. Fair Oaks, Pasadena, Non-profit CA 91103 1081 N. Fair Oaks, Pasadena, Non-profit CA 91103 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 1000 2