agency name m13 stmppm i i t city of pomona timber)/ · 2016. 2. 18. · etheridge r. michelle...

RECEIVEDAgency Report of: CITY CLERKCeremonial Role Events and Ticket/Pass Distributions A Public Document

1. Agency Name M13 Qefle"STmppM I i tCity of Pomona For Oficial Use OnlyDivision, Department, or Region ( 6Appficable)

Human Resources Department

Designated Agency Contact( Name, Title)

Chris Millard, Acting Human Resources/ Risk Management Director Amendment ( Must provide explanation in Part 3.)

Area Code/ Phone Number E- mail

909- 620-2280 chris millard ci. omona. ca. us Date of Original Filing:p Month, Day, Year)

2. Function or Event Information

Does the agency have a ticket policy? Yes® No Face Value of Each Ticket/Pass$ 12 17

Event DescriptionLos Angeles County Fair

Date(s) 08

130 I 13 09 / 29 / 13

Provide Title/Explanation

Ticket(s)/ Pass( es) provided by agency? Yes No® If no: Los Angeles County FairName of Source

Was ticket distribution made at the behest No Yes® If yes:

of agency official? Official's Name( Last, First)

3. RecipientsUse 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.

Number of

A. Name of Agency, Department or Unit Ticket(s)/ Describe the public purpose made pursuant to the agency's policy

Passes)

Name of IndividualNumber of

B.

Timber)/ ` Identify one of the following.

ri isl Fm)passlesl

Ceremonial Role Other Income

Refer to attached list of individuals ecxmg° caemouialRae" nr•ome. de bahemw

1400

Ceremonial Role Other Income

If oheckir7q" Ceremonial Rnle" or" Olhs/ detalhe eatow:

Name of Outside OrganizationNumberof

Ci.

Timber)/ Describe the public purpose made pursuant to the agency's policy

include address and description) Passles)

4. Verifical" n1 have rea Antl unde

7d F PC a0 89441 and 18942. 1 have verified that the distribution set forth above, is in accordance with the requirements.d 9

Chris Millard Acting HR/ Risk Mgmt Director 10/ 01/ 13

Signature ofAOancy Head or Designer- Pour Name MA, dvonlh, Deg Year)

Comment: FPPC Form 802( 4112)

FPPC Toll-Free Helpline: 866/ASK-FPPC( 866/275-7772)

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PoliceOfficer

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RICH

JANE

Principal

Accountant

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RICHARDSONDANIEL

WaterUtility

WorkerII

RICHARDSONJAMES

WaterUtility

WorkerII

RICO

ANDREA

Youth &

FamilyServicesManager

RIDEAU

DAMON

Heavy

EquipmentMechanic

RILLORAZA

ALEXANDROPolice

Lieutenant

2

C! (

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RIOS

ERNESTOPoliceOfficer

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3

RIVERA

CESAR

PoliceOfficer

7

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RIVERA

RALPH

PoliceOfficer

RIZZO

MARY

Police

DispatcherII

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ROBLEDO

MARK

ManagementAnalyst

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ROCHA

CARRIE

Police

DispatcherII

ROCHA

GENOVEVAPolice

RecordsSpecialistII

ROCHA

LUIS

AssociatePlanner

ROCHA

ROGER

RehabilitationSpecialist

RODRIGUEZ

ADRIAN

PoliceOfficer

LA

COUNTYFAIR

TICKET

DISTRIBUTION

Employeesare

I

ROJAS

JASMINE

CommunityService

SpecialistI

ROJAS

VERONICAAideI

2

ROMAN

TIMOTHYSolid

WasteDriver

ROMERO

DANIEL


ROSAS

RITA


ROSS

KIUESHA

SchoolCrossingGuard

RYAN-

FLUKER

BAMBI

CustomerService

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FRANCESCOPoliceOfficer, CHRP

SALAS

RENE

PublicWorksDirector

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SALCIDO

ALBERT

Fleetand

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ALMA


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YESENIA


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SALVESON

HEATHERPolice

RecordsSpecialistII

SAMPSON

MATTHEWFacilities

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SAMSON

ROSAMARIA

libraryClerkII

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SAMUELS

TODD

Police

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SANCHEZ

ALAN

CommunityService

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SANCHEZ

DAVID

AssociatePlanner

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HUMBERTOPolice

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SANCHEZ

JEFFREY

GraffitiRemovalWorker, Limited-Term

Assignment

SCHEPPMANNDAVID

Rangemaster

SCHEPPMANNROBERT

PoliceOfficer

SCHMIDT

ROBERT


SCHNEIDERII

ROBERT

WaterUtility

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SCHUSTER

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Code

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CommunityService

SpecialistI

SEAVEY

ROBERTA

Propertyand

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LA

COUNTYFAIR

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SMITH

PHILIP

Water

OperationsCrewChief

SMITH

SSYLVIA

Police

RecordsSpecialistI

SMITH

TONY

Solid

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SPILL

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SPRAGUE

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PATRICE

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STEPHENS

KARA


STEVENSON

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STIRES

GLENN

PoliceOfficer

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Police

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Fair Tickets Sign-Out Sheet

Commissioners

Name of Tickets Date Si atu e

Adriana Robledo 2 q//-T

Andi Campognone- Couwenberg 2

AnthonyGuild 2

Antonia Brookshire 2

Carlos Go tia 2

Carole Pelton 2

Daniel Kelly 2

UI ) Danielle Soto 2 2

Daryl Beans 2

Demecio " Mitch" Elias 2 rfi g z f3

Dena Davis- Island 2

Denton Mosier 2

Diana E. Butcher 2

Douglass Dorado 2r 17- 13

l

Fair Tickets Sign-Out Sheet

Commissioners

Name of Tickets

DatedSignature

Joy McAllister 2

Juan Carlos Garcia 2

Kathleen M. Jones 2 V/1 13

Kenneth E. Coble 2

Larry Taylor 2

Linda Garner 2 r

Lorraine Canales 2

Manuel Castille' os 2

d

Maricruz Hernandez 2

Mario " Mike" Suarez 2

Mary Hurtado 2 i

Nancy Leanos 2 l

Nancy Ramos 2

Oscar Ixco 2C/

til I_

Pamela Lynn 2 5

Paul Robinson 2

Rebecca Ramos 2

Rubio Gonzalez 2

Sara Mondra on

Stephanie E. Marin 2 24 t

Veronica Michalowski 2

Page 2 of 2

AUTHORIZATION TO RECEIVE L. A. COUNTY FAIR TICKETS

The below Planning Commissioner authorizes Nancy Ramos to pick up their allottedFair tickets from the City Clerk's Office.

Oscar Ixco

Print Name)

I understand that I am responsible for the safekeeping and distribution of Fair ticketsdesignated for the above Commissioner. I accept full responsibility if these tickets arelost before I am able to deliver them to the

Date: 0

AUTHORIZATION TO RECEIVE L.A. COUNTY FAIR

K'

AIRR TICKETS

The below Police Department personnel authorize 1,11 1u-15F

to pick up their allotted Fair tickets from the Human Resources Department.

7' IfIgf //c C-2

I understand that I am responsible for the safekeeping and distribution of Fair ticketsdesignated for the above personnel. I accept full responsibility if these tickets are lostbefore I am able to deliver them to the above employees.

Print Name)

C, Date:

AUTHORIZATION TO RECEIVE L.A. COUNTY FAIR TICKETS

The below Police Department personnel authorize - v'\- c vVw;- ...


Print Name)

Print Name) Signature)







Print Name)

Date: `\ - A - \ 3

AUTHORIZATION TO RECEIVE €_.A. COUNTY FAIR TICKETS

0 Q s' 1"' o r

The below f Department personnel authorize


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Print Name)








Print Name)

Date: _

AUTHORIZATION TO RECEIVE L.A. COUNTYFAIR TICKETS

The below Police Department personnel authorize Afl / S ff/ e


Print Name)



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Date: l / _ /3


The below Police Department personnel authorize COJWokiSi.,


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Print Name)

Date: nt l


TICKETSrThe below Police Department personnel authorize k' Tc Qj2to pick up their allotted Fair tickets from the Human Resources Department.

Print Name)





zPrint Name)

Date: 4 t


The below Police Department personnel authorize Td2p 72t(a lto pick up their allotted Fair tickets from the Human Resources Department.

Print Name)


Print Name)

Date: ct JcP?


The below Police Department personnel authorize 4L-- i-0,/-z l -

to pick up their allotted Fair tickets from the


A 457

Date: I (-4 ( t ;,


The below Police Department personnel authorize E Zc 2( {" O'J2 E,to pick up their allotted Fair tickets from the Human Resources Department.

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Print Name)

Date: q


The below Police Department personnel authorize /( UV/M Q 6to pick up their allotted Fair tickets from the Human Resources Departent.

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Print Name)

Dater( 1 E


The below Police Department personnel authorize` i U4 4 tJto pick up their allotted Fair tickets from the Human Resources Department.

Print Name)

I understand that I am responsible for the safekeeping and distribution of Fair ticketsdesignated for the above personnel. I accept full tickets are lostbefore I am able to djeliliver them to the above employees.

Print Name)

Date: ro I


The below Police Department personnel authorize s AgAe-C- ER--d

to pick up their allotted Fair tickets from the Human Resdurces Department.

Print Name)






I understand that I am responsible for the safekeeping d distribution of Fair tickets

designated for the above personnel. I accept full are lostbefore/Mmren able to/deliver them to the above employees .

X,3 11 L

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Date: 0S1,12 g 3


The below Police Department personnel authorize ,g v10 47Lv

to pick up their allotted Fair tickets from the Human ResourcesDeaprtment.

Y`

I understand that I am responsible for the safekeeping and distribution of Fair ticketsdesignated for the above personnel. I accept full if these tickets are lostbefore I am able to deliver them to the above employees.

Mly10y Zu oLPrint Name)

Date: 6- 2.9/-- 13


The below Police Department personnel authorize


I understand that I am responsible for the safekeeping and distribution of Fair ticketsdesignated for the above personnel. I accept full responsibilit if these tickets are lostbefore I am able to deliver them to the above

Date: 46 I-4 /3


The below Police Department personnel authorize i2 )to pick up their allotted Fair tickets from the Human Resources Department.

7

Print Name)

I understand that I am responsible for the safekeeping and distribution of Fair ticketsdesignated for the above personnel. I accept full responsibility if these tickets are lostbefore II am able to deliver them to the above employees.

Print Name)

Date: GD k—1 3


The below Police Department personnel authorize 24to pick up their allotted Fair tickets from the Human Resources D artment.

C 5 IN



I understand that I am responsible for the safekeeping and distribution of Fair ticketsdesignated for the above personnel. I accept full responsibility if these tickets are lostbefore 1 am able to deliver them to the above employees.

rint Name)

Date: g - Zl? —/ 3


The below Public Services Department personnel authorize Sam Lama, Supervisor to

pick up their allotted Fair tickets from the Human Resources Department.

A(/ F CIGPrint Name)


Print Name)

Date: z


The below Public Services Department personnel authorize Sam Lama, Supervisor to

pick up their allotted Fair tickets from the Human Resources Department.

Z OrPrint Name)


ij 1 L fair

Print Name)

Date:


The below Public Services Department personnel authori Sam Lama, Supervisor to

pick up their allotted Fair tickets from the Human Res rces e artme

Date- I


The below Public Services Department personnel authorize Sam Lama, Supervisor topick up their allotted Fair tickets from the Human Resources Department.









Print Name)

Date:


I

The below Police Department personnel authorize I ) ( 4. r ' 1( ll7ll0to pick up their allotted Fair tickets from the Human Resources Department.

Print Name)








Print ame)

Date: v

AUTHORIZATION TO RECEIVE L.A. COUNTYFAIRTICKETS

The below Police Department personnel authorize1

to pick up their allotted Fair tickets from the Human Resourcesi Department.

Print Name)


CC-r0t y, ( ;, err LPrint Name)

Date: ' 56 — 2-56 I


The below Police Department personnel authorize`°- `"`21 v* t: u- , L-W-.-


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Print Name)






Print Name)

Date:




Print Name)


IAm nCCPrint Name)

Date: CCy


The below Police Department personnel authorize L e L ( U C Vto pick up their allotted Fair tickets from the HumanResources artment.

Print Name)


Print Name)

Date: 2 /


The below Police Department personnel authorize CPL.J,


AL4-4A $.-.FTP i.

Date: F'Z P> 3


The below Police Department personnel authorize <:f49Lj' r-LcO


4VU.0 Z6-60Print Name) //

I understand that I am responsible for the safekeeping and distribution of Fair ticketsdesignated for the above personnel. I accept full responsibility if these tickets are lostbefore I a'm able to deliver them to the above employees.

V' vlca—

Print Name)

Date: glY-13


The below Department personnel authorize IJ4 crrin #Ljrl ','5to pick up their allotted Fair tickets from the Human Resources De

Print Name)


Print Name)

Date: X—


The below Department personnel authorize Dav Y1IA


Print Name)



I understand that I am responsible for the safekeeping and distribution of Fair ticketsdesignated for the above personnel. I accept full responsibility if these tickets are lostbefore I am able to deliver them to the above ern yees.

Print Name)

2Date: 5--


The below Police Department personnel authorize ( - VA N 11 VA- c-' A e- -to pick up their allotted Fair tickets from the Human esourc Department.

N( , -SPrint Name)

I understand that I am responsible for the safekeeping and distribution of Fair ticketsdesignated for the above personnel. I accept full responsibility if these tickets are lostbefore I am able to deliver them to the above employee

Date: 2 O





Print Name)

Date: C}


The below Police Department personnel authorize , 5(, 7f R (/ f3 0/ q ( Z f/(


Print Name)




Qzi L . j f Lv

Date:


TICKETSThe below Police Department personnel authorize I/"fy 2- to pick up their allotted Fair tickets from the Human Resources Department.

Print Name)





Print Name)

1Date: t

j


The below Police Department personnel authorize 4" Y1


Print Name)


Print Name)

Date:


The below Police Department personnel authorizeto pick up their allotted Fair tickets from the Human Resources Department.

AwyaPrint Name)


Print Name)

Date:


The below Police Department personnel authorize _ 64't'4i 0,4n"F( w Sto pick up their allotted Fair tickets from the Human Resources Department.

6ErG7 Di/ 6//i 2B-

1 understand that I am responsible for the safekeeping and distribution of Fair ticketsdesignated for the above personnel. I accept full responsibility if these tickets are lostbefore am able to deliver them to the above employees.

ePrint Name)

1Date:


The below Police Department personnel authorize ( tc t MAT7Qf-- Sto pick up their allotted Fair tickets from the Human Resources Department.

lamw e e:5


Print Name)

Date:


The below Police Department personnel authorize O'a 1A-012to pick uppttheir allotted Fair tickets from the Human Resoouurrcceess Department.

Print Name)



I understand that I am responsible for the safekeeping and distribution of Fair ticketsdesignated for the above personnel. I accept full responsibility it these tickets are lostbefore I am able to deliver them to the above employees.

Print Name)

Date: Lz- 3


The below Police Department personnel authorize l dl,/

to pick up their allotted Fair tickets from the Human ResourceDepart nt.

Print Name)



I understand that I am responsible for the safekeeping and distribution of Fair ticketsdesignated for the above personnel. I accept full responsibility if these tickets are lostbefore I am able to deliver them t the above employees.

Print Name)

Date:



to pick up their allotted Fair tickets from the Human Resourc s Department.

Print Name)

I understand that I am responsible for the safekeeping and distribution of Fair ticketsdesignated for the above personn I. I accept full responsibility if are lostbefore I am able to deliver them to the above employees.

Print Name)

Date: 2



to pick up their allotted Fair tickets from the Human Resources Depart ent.

Print Name)


Print Name)

Date: E)


I1 1The below Police Department personnel authorize afiiZVA koto pick up their allotted Fair tickets from the Human Resources Department.

Print Name)



bLiw eraPrint Name)

Date: S 2-4 5


The below Police Department personnel authorize IJESS/l/ to pick up their allotted Fair tickets from the Human Resources Department.

Print Name)





Print Name) v

Date:


The below Police Department personnel authorize ( 1 0 j / /o Vto pick up their allotted Fair tickets from the Human Resources Department.

k I CC7/ C ir9

Print Name)


Print Name)

Date: 0- t 13


The below Police Department personnel authorize CCDKT z-to pick up their allotted Fair tickets from the Human Resources Department.

Print Name)







I understand that I am responsible for the safekeeping and distribution of Fair ticketsdesignated for the above personnel. I accept full responsibility if these tickets are lostbefore I am able to deliver them to the above employ e.

Print Name)

Date: 1113 lz-, 1i-:!)


The below Water Department personnel authorize


W" wPrint Name)





Print Name)

Date:


The below Police Department personnel authorize T Ll 1M 1 /! I n 'on (r,v i rto pick up their allotted Fair tickets from the Human Resources Department.

Print Name)

I understand that I am responsible for the safekeeping and distribution of Fair ticketsdesignated for th ve personnel. I accept full responsibility if these tickets are lostbefore I am abl to liver the to the above employees.

4TPh6t Name)

Date: 0


The below Police Department personnel authorize &/ xi ' rx/ ex i0gdn5 to pick up theirallotted Fair tickets from the Human Resources Department.

Print Name)

I understand that I am responsible for the saf eepin nd distribution of Fair tickets

designated for the above personnel. I accept full responsibility if these tickets are lostbefore I am able to deliver them to the above employees.

P. 1- 59.J

Date: d z9/ 3


The below Police Department personnel authorizeto pick up their allotted Fair tickets from the Human Resources epart ' t.

Print Name)

I understand that I am responsible for the safekeeping an stribution of Fair ticketsdesignated for the above personnel. I accept full re o ity if these tickets are lostbefore I am able to d(eliver them to the above emplo ees

AA

Pant Name)

Date:


The below Police Department personnel authorize r— , Sto pick up their allotted Fair tickets from the Human Resources epart t.

Print Name)

I understand that I am responsible for the safekeeping an stribution of Fair tickets

designated for the above personnel. I accept full re o ity if these tickets are lostbefore I am able to deliver them to the above emplo ees

Pant Name)

Date: 2,c (i- 3


The below Ponce-Department personnel authorize ""& 4to pick up their allotted Fair tickets from the Human sources Department.

6

Print Name)









Date:




Frrint Name) s

T








Date: 7 ^ /

27


The below Police Department personnel authorize 3-b 2.- b;Wo ` SLto pick up their allotted Fair tickets from the Human Resources Department.

Prin Name)



Aia L̀tO Z, 2Print Name)

Date: z4 '

l Zs




9OnJ 2c ,v [/ L C ?





Print Name)

Date:


The below Police Department personnel authorize L 2c J2tcovL(topickup their allotted Fair tickets from the Human Resources Department.

C",,)

Print Name)


L G7' D L 1.10" t- l',

Date:


The below Police Department personnel authorize6LCtopick up their allotted Fair tickets from the Hu an Resource/ &,"Resources Department.

Print Name)

1 understand that I am responsible for the safekeeping and distribution of Fair ticketsdesignated for the above personnel. I accept full responsibility if these tickets are lostbefore I am able to deliver them to the above employees.

Date: nf-4 r 5


The below Police Department personnel authorize ' ip272 16< 1to pick up their allotted Fair tickets from the Human ResourcesDepartment.

Print Name)

I understand that I am responsible for the safekeeping and distribution of Fair ticketsdesignated for the above personnel. 1 accept full responsibility if these tickets are lostbefore I am able to deliver them to the above employees.

Print Name)

Date:


iThe below Police Department personnel authorize fto pick up their allotted Fair tickets from the Hu atiResources Departm nt.

Print Name)







I understand that I am responsible for the safekeeping and distribution of Fair ticketsdesignated for the above personnel. I accept full responsibility if these tickets are lostbefore I a (m_ able to deliver them to the above employees.

Print Name)

Date:

AUTHORIZATION TO RECEIVE L.A. COUNTY FAIR TICKETS/



rU+xC uc ncr T7/3



Date:


The below Police Department personnel authorize 0 ; qv—ccs Cj c, cam,to pick up their allotted Fair tickets from the Human Resources Department.—

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Print Name)







Print Name)

Date:


The below Police Department personnel authorize / lll u


5/4- CPrint Name)

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Date: Ftp P1




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Print Name)

Date: 7//-/ 13


The below Community Services personnel authorize _ Ilona Arendsto pick up their allotted Fair tickets from the Human Resources Department.

Aren Yeh








n 0 sPrint Name)

Date: I d 3


The below Police Department personnel authorize y y- ja, to pick up their allotted Fair tickets from the Human Resources Department.

Print Name)


f7i_7Print Name)

Date: 1 7- 13


The below Police Department personnel authorizeto pick up their allotted Fair tickets from the Human Resources Department.

Print Name)








Print Name)

Date: 1.3

agency name m13 stmppm i i t city of pomona timber)/ · 2016. 2. 18. · etheridge r. michelle...

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