Event Description: Sharks Hockey Game Date(S) L J

Agency Report of: Ceremonial Role Events and Ticket/Pass Distributions A Public Document 1. Agency Name ' - Date Stamp Galifornia City of San Jose Form Division, Department, or Region (if applicable) For Official Use Only L rr;: I Environmental Services Department, Integrated Waste Management Designated Agency Contact (Name,Title) Kerrie Romanow, Director I I Amendment (Must Provide Explanation in Part 3.) Area Code/Phone Number E-mail

408-535-8550 Date of Original Filing: [email protected] (month, day, year)

2. Function or Event Information 240 Does the agency have a ticket policy? YesS NoD Face Value of Each Ticket/Pass $ 10 19 19 Event Description: Sharks Hockey Game Date(s) L J. J. j. Provide Title/ Explanation Ticket(s)/Pass(es) provided by agency? Yes El No □ If no: Name of Source Was ticket distribution made at the behest Yes □ No 0 Official's Nome (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.

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

Number Name of Individual B. of Ticket(s)/ Identify one of the following: (Last, First) Passes Ceremonial Role CH Other [HI Income I I See attached list If checking "Ceremonial Role" or "Othef describe below: 20 Employee recognition

Ceremonial Role CH Other EH Income I I It checking "Ceremonial Role" or "Olhef describe below:

Number Name of Outside Organization c. of Ticket{s)/ Describe the public purpose made pursuant to the agency’s policy (include address and description) Passes

4. Verification I have read and understand FPPC Regulations 18944.1 and 18942. 1 have verified that the distribution set forth above, is in accordance with the rt irements.

Kerrie Romanow Director Signa^re 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) Attachment to form 802/ Ticket Distribution for event on 10/19/19

City Employee Name # of tickets Role: Other Osmond Valerie 2 Employee Recognition Anderson Jeff 2 Employee Recognition Romanazzi Lauren 2 Employee Recognition Horning Peggy 2 Employee Recognition Gire Jon 2 Employee Recognition Vroman Junko 2 Employee Recognition Rios Cecilia 2 Employee Recognition Lowrie Alana 2 Employee Recognition Vanni Mark 2 Employee Recognition Romanow Kerrie 2 Employee Recognition Agency Report of: Ceremonial Role Events and Ticket/Pass Distributions A Public Document

1. Agency Name Date Stamp : California qaa uuli v U 3 ?_• i/!i V K_ City of San Jose Form OUZ Division, Department, or Region (if applicable) For Official Use Only 28I8MR-7 SHII ): 40 Environmental Services Department Designated Agency Contact (Name,Title) Kerrie Romanow, Director I I Amendment (Must Provide Explanation in Part 3.) Area Code/Phone Number E-mail

Date nf Original Filing- 408-535-8550 [email protected] (month, day, year) 2. Function or Event Information Does the agency have a ticket policy? Yes M No □ Face Value of Each Ticket/Pass $ 86"225 Event Description: Sharks Hockey Game______Date(s) 01 / 20 , 18 ____ Provide Title/Explanation Ticket(s)/Pass(es) provided by agency? Yes H No □ If no:______Name of Source Was ticket distribution made at the behest Yes □ No H If yes:______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.

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

Number B, Name of Individual of Ticket(s)/ Identify one of the following: (Last, First) Passes

See Attached list Ceremonial Role d Other [HI Income d If checking "Ceremonial Role" or "Other" describe below: staff recognition

Ceremonial Role d Other d Income d If checking “Ceremonial Role" or "Other" describe below:

Number p Name of Outside Organization of Ticket(s)/ Describe the public purpose made pursuant to the agency s policy (include address and description) Passes

4. Verification

I havpteadVU [Ud and understand FPPC Regulations 18944.1 and 18942. I have verified that the distribution set forth above, is in accordance with therequirements.

Kerrie Romanow Director 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) January 20, 2018 Sharks Hockey Game Ticket Distribution

Employee Name Ticket Qty Value Each Anna Szabo 2 $225 Robert Herrera 2 $225 Valerie Osmond 2 $86 Napp Fukuda 2 $225 Ed Ramirez 2 $225 Woody Hassman 2 $86 Kate Ziemba 2 $225 Nora Cibrian 2 $86 Agency Report of: Ceremonial Role Events and Ticket/Pass Distributions A Public Document 1. Agency Name Da California OAQ M!SrvH- Form OUZ City of San Jose San Jflso Citv CI Division, Department, or Region (if applicable) 0)C CT — For Official Use Only Environmental Services Department 2011 MAY !2 PH I 20 Designated Agency Contact (Name,Title) Kerrie Romanow, Environmental Services Director I I Amendment (Must Provide Explanation in Part 3.) Area Code/Phone Number E-mail

nato nf Original Filing- (408) 535-8100 [email protected] (month, day, year) 2. Function or Event Information 20.00 Does the agency have a ticket policy? Yes 13 No • Face Value of Each Ticket/Pass $

Event Description: San Jose Barracuda's Games Date(s) _JL_/__!L_/ ^ 31 17 Provide Title/Explanation I ii H / ( 3 / m Ticket(s)/Pass(es) provided by agency? Yes 0 NoQ If no: Name of Source Was ticket distribution made at the behest Yes • No 13 lf ^es: 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.

Number A„ Name of Agency, Department or Unit of Ticket(s)/ Describe the public purpose made pursuant to the agency's policy Passes Environmental Services Department Employee Recognition 86

Number 0, Name of Individual of Ticket(s)/ Identify one of the following: (Last, First) Passes

See Attached List of Employees Ceremonial Role ED Other [3 Income I I If checking "Ceremonial Role" or "Other describe below: Employee Recognition

Ceremonial Role ED Other ED Income ED If checking "Ceremonial Role" or "Other" describe below:

Number p Name of Outside Organization of Ticket(s)/ Describe the public purpose made pursuant to the agency's policy (include address and description) Passes N/A

4. Verification I have read and understand FPPC Regulations 18944.1 and 18942.1 have verified that the distribution set forth above, is in accordance with the requirements. •'

" iSignature of Agency Head or Designee (montl, day, bear)

Comment:

FPPC Form 802 (2/2016) FPPC Toil-Free Helpline: 866/ASK-FPPC (866/275-3772) CSJ Environmental Services Employee Recognition San Jose Barracuda's Games

March 11,2017 Last Name First Name Qty of Tickets Camarena Carolina 2 Martin Scott 2 Prakash Megha 2 Cline Mandi 2 Dominguez Eddie 2 Luong Andrew 2 Burke Laura 2 Loft Jennie 2 Lowes Stephen 2 Heresa Cheyna 2 Gupta Shikha 2 Cravens Tony 2 Sinclar Jeff 2 Jimenez Maggie 2 Benabente Julie 2

March 31,2017 Williams Peter 2 Layman John 2 Villa Joshua 2 Preto Gomes Jose 2 Schat Amber 2 Laxamana Rina 2 Szabo Anna 2 Spencer Novim 2 Amorim David 2 Torres Rick • 2 CSJ Environmental Service - Employee Recognition - Barracuda's Games - Cont.

April 9, 2017 Vandergriff Rocky 2 Cloutier Scott 2 Moreno Joe 2 Samatua Robert 2 Garcia Carlos 2 Osmond Valerie 2 Sasscer Matt 2 Fontes Brian 2 Gonterman Tina 2 Whig Anju 2 Hildebrand Steven 2 Danko Bill 2 Prange Paul 2

April 13,2017 Zeintek Joe 2 Kellet April 2 Pham Tina 2 Carpenter Ariel 1 Leonis Amanda 1 Romanazzi Lauren 2 Agency Report of: Ceremonial Role Events and Ticket/Pass Distributions A Public Document 1. Agency Name RECfeMjifamp California OAO City of San Jose ^dli Jose City Clerk Form O UZ For Official Use Only Division, Department, or Region (if applicable) \AuD oJtL

Environmental Services Department 2017 IIAR-6 AH lb 10

Designated Agency Contact (Name,Title) Kerrie Romanow, Environmental Services Director f~l Amendment (Must Provide Explanation in Part 3.) Area Code/Phone Number E-mail Date of Original Filing: (408)535-8100 [email protected] (month, day, year)

2. Function or Event Information 222 00 Does the agency have a ticket policy? Yes • No • Face Value of Each Ticket/Pass $ J__

Event Description: San Jose Sharks Hockey Game Date(s). 01 17 Provide Title/Explanation Ticket(s)/Pass(es) provided by agency? Yes SI No • If no: Name of Source Was ticket distribution made at the behest Yes • No ® ^es' Official's Name (Last, First) of agency official?

3. Recipients • Use Section A to identify the agency's department or unit. • Use SectionB to identify an individual. • Use Section C to identify an outside organization.

Number Name of Agency, Department or Unit of Ticket(s)/ Describe the public purpose made pursuant to the agency's policy Passes City of San Jose Environmental Services Employee Recognition 24 Department

Number B_ Name of Individual of Ticket(s)/ Identify one of the following: " (Last, First) - , Passes

Ceremonial Role CD Other [El Income CD See attached list of employees If checking "Ceremonial Role" or "Other" describe below: Employee Recognition

Ceremonial Role CD Other CD Income CD If checking "Ceremonial Role" or "Other" describe below:

Number p Name of Outside Organization of Ticket(s)/ Describe the public purpose made pursuant to the agency's policy (include address and description) Passes

4. Verification I have read and understand FPPC Regulations 18944.1 and 18942.1 have verified that the distribution set forth above, is in accordance with thejsquirements.

..'Signature of Ageniffiead or Designee Print Name • ' ' Titie w (month, pay, year) / Comment:

FPPC Form 802 (2/2016) FPPC Toil-Free Helpline: 866/ASK-FPPC (866/275-3772) CSJ Environmental Services

Employee Recognition

San Jose Sharks vs. Edmonton Oilers Game, 1/26/17

Last Name First Name Qty of Tickets Osmond Valerie 2 Urban Shellyne 2 Lasat Darwin 2 Cacal Melrose 2 Ruiz Ray 2 Price Casey 2 Perhach Robert 2 Matos Luis 2 Boland Carol 2 Guerrero Cheryl 2 Hansen Anne 2 Alba Alicia 2 Agency Report of: Ceremonial Role Events and Ticket/Pass Distributions A Public Document 1. Agency Name Date Stamp California QAO City of San Jose Form OUZ Division, Department, or Region (if applicable) Environmental Services Department Designated Agency Contact (Name, Title) ' Kerrie Romanow, Environmental Services Director l~~l Amendment (Must Provide Explanation in Pari 3.) Area Code/Phone Number E-mail Date of Original Filing: - (408)535-8100 [email protected] (month, day, year)

2. Function or Event Information 23.00 . Does the agency have a ticket policy? Yes 13 No • Face Value of Each Ticket/Pass 16 Event Description: SJSU/Hawaii Homecoming Game Date(s) 10 J- J_ • Provide Title/Explanation Ticket(s)/Pass(es) provided by agency? Yes 0 NoQ If no: Name of Source Was ticket distribution made at the behest Yes • No I If yes: 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.

Number Name of Agency, Department or Unit of Ticket(s)/ Describe the public purpose made pursuant to the agency's policy Passes City of San Jose Environmental Service Dept. Employee Recognition 34

Number Name of Individual of Ticket(s)/ Identify one of the following: " (Last, First) ! Passes

Ceremonial Role d] Other 0 Income [ZH See attached list of employeees If checking "Ceremonial Role" or "Other" descn'be below: Employee Recognition

Ceremonial Role • Other n Income D if checking "Ceremonial Role" or "Other" describe below:

Number Name of Outside Organization of Ticket(s)/ Describe the public purpose made pursuant to the agency's policy (include address and description) Passes

N/A

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

Comment:

FPPC Form 802 (2/2016) FPPC Toil-Free Helpline: 866/ASK-FPPC (866/275-3772) CSJ Environmental Services Employee Recognition Football Game Spartan vs. Elawaii Elomecoming Game

Last Name First Name Qty of Tickets Morales Christina 2 Heresa Cheyna 2 Gonzales Michael 2 Burke Laura 2 Moreno Renato 2 Leu Alex . 2 Mulleniux Diana 2 Lovewell Joe 2 Alvarado Luis 2 Hernandez Luis 2 Hernandez Hugo 2 Spencer Novim 2 Bernade Sandra 2 Pereira Raymond 2 Tran Catherine 2 Chautian Guman 2 Gille Rayjinder 2 Ohara Kia 2 Agency Report of: Ceremonial Role Events and Ticket/Pass Distributions A Public Document

1. Agency Name ' Date Stamp California QHO Form City of San Jose OUZ For Official Use Only Division, Department, or Region (If Applicable)

Environmental Services Department Designated Agency Contact (Name,Title)

Linda Charfaurous l~l Amendment (Must provide explanation in Part 3.) Area Code/Phone Number E-mail nate nf Original Filing- 408/535-8553 [email protected] (Month, Day, Year) 2. Function or Event Information 165.50 Does the agency have a ticket policy? Yes I NoD Face Value of Each Ticket/Pass $. Harlem Globetrotters Event Description. Date(s) —^1 / 22 / 16 Provide Title/Explanation

Ticket(s)/Pass(es) provided by agency? Yes El No • If no: Name of Source

Was ticket distribution made at the behest n0 El Yes • If yes:. of agency official? Official's Name (Last, First)

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. Number of A. Name of Agency, Department or Unit Ticket(s)/ Describe the public purpose made pursuant to the agency's policy Pass(es) Environmental Services Department Recognition of direct involvement in City-related projects/ 24 Employees programs

Number of B Name of Individual Ticket(s)/ identify one of the following: " (Last, First) Pass(es)

Ceremonial Role tH Other El Income El If checking "Ceremonial Role" or "Other' describe below:

Ceremonial Role El Other HH Income El If checking "Ceremonial Role" or "Other' describe below:

Number of Q Name of Outside Organization Ticket(s)/ Describe the public purpose made pursuant to the agency's policy " (include address and description) Pass(es)

4, Verification I have read and uot 'PC Regulations 18944.1 and 18942. i have verified that the distribution set forth above, is in accordance with the requirements.

Kerrie Romanow Director / • t L -

Signature of Agency Head or Designee Print Name Title (Month, Day, Year)

Comment: FPPC Form 802 (4/12) FPPC Toil-Free Helpline: 866/ASK-FPPC (866/275-7772) Agency Report of: Ceremonial Role Events and Ticket/Pass Distributions A Public Document

1. Agency Name JrtJate Stafnp California QAO Form wwfc City of San Jose , For Official Use Only ,rJw.J Division, Department, or Region (If Applicable) ?[ l u Hub ? O i" n '"!• Hi

Environmental Services Department Designated Agency Contact (Name, Title)

Linda Charfauros ("I Amendment (Must provide explanation in Part 3.) Area Code/Phone Number E-mail Date of Original Filing: 408-535-8553 [email protected] (Month, Day, Year) Function or Event Information 30.00 Does the agency have a ticket policy? yes |x] No • Face Value of Each Ticket/Pass $.

.H , ... San Jose Earthquakes Soccer Game Event Description _ Date(s) 08 / 14 I 15 Provide Title/Explanation

Ticket(s)/Pass(es) provided by agency? Yes El No • If no:. Name of Source

Was ticket distribution made at the behest N0 |X] Yes • If yes:. of agency official? Official's Name {Last, First)

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. Number of A. Name of Agency, Department or Unit Ticket(s)/ Describe the public purpose made pursuant to the agency's policy Pass(es) Environmental Services Department Recognition for direct involvement in City-related 100 Employees projects/programs

Number of Q Name of Individual Ticket(s)/ Identify one of the following: " (Last, First) Pass(es)

Ceremonial Role d Other [H Income El If checking "Ceremonial Role" or "Other" describe below:

Ceremonial Roie CD Other CD Income CD If checking "Ceremonial Role" or "Other" describe below:

Number of Q Name of Outside Organization Ticket(s)/ Describe the public purpose made pursuant to the agency's policy " (include address and description) Pass(es)

4. Verification I have read and understand FPPC Regulations 1 and 18942.1 have verified that the distribution set forth above, is in accordance with the requirements. Kerrie Romanow Director 6 Signaturd of Agency Head or Designee Print Name (Month, Day, Year)

Comment: FPPC Form 802 (4/12) FPPC Toil-Free Helpline: 866/ASK-FPPC (866/275-7772) Agency Report of: Ceremonial Role Events and Ticket/Pass Distributions California QAQ Form Continuation Sheet A Public Document

Agency Name City of San Jose

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.

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

Number of R_ Name of Individual Ticket(s)/ Identify one of the following: " (Last, First) Pass(es)

Ceremonial Role CD Other CD Income CD If checking "Ceremonial Role" or "Other" describe below:

Ceremonial Role CD Other CD Income CD If checking "Ceremonial Role" or "Other"' describe below:

Number of Q Name of Outside Organization Ticket(s)/ Describe the public purpose made pursuant to the agency's policy " (include address and description) Pass(es)

FPPC Form 802 (4/12) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-7772) Earthquakes Tickets August 14 2015 Name EMAIL Abigail Shull abigail.shull(5)sanioseca.eov Adriana Marquez adriana.marauez(®sanioseca.gov Andrea Case andrea.case(Sisanioseca.gov Anju Whig aniu.whig(S)sanioseca.gov AnnaSzabo anna.szabo(S)sanioseca.gov Behilma Magday behilma.magdav(S>sanioseca. gov Brandon Massey brandon.massev(S>sanioseca.gov Brianna Guillory brianna.guillorv(S)sanioseca.gov Cathy Hoang-Mendoza cathv.hoang-mendoza(S)sanioseca.gov Cecilia Rios cecilia.rios(S)sanioseca.gov Diana Mulleiux diana.mulleiux(S)sanioseca.gov Ed Ramirez ed.ramirezfSsanioseca.gov Eddie Dominguez eddie,dominguez(S> sanioseca.gov Erica Colunga erica.colunga (S)sanioseca.gov Giang Pham giang.Dham(S)sanioseca.gov Jaime Avalos iaime.avalos(5)sanioseca.gov Jeff Krump ieff.krumpPsanioseca.gov ' - r - |'oanna.desa(S>sanioseca.gov

|Jon Gire ion.gire(® sanioseca.gov e' ' - :errie,romanowiSisanioseca.gov Kort Jackson kort.iackson(S>sanioseca.gov Laura Burke laura.burke(S)sanioseca.gov Laura Markel laura.markel(®sanioseca.gov Lauren Romanazzi lauren.romanazzi(a)sanioseca.eov Leanna Huynh leanna.huvnh(5)sanioseca. gov Leslie Martin leslie.martinPsanioseca.gov Linden Skjeie linden.skieie(a)sanioseca. gov Lindy Stankov lindv.sankovfaisanioseca.gov Mary Taylor marv.tavlor^sanioseca.gov Michale Gonzales michael.gonzales(5)sanioseca.gov Michele Young michele.voung(S>sanioseca.gov Jordan Queensbury iordan.aueensburvffflsanioseca.gov Julia Nguyen iulia.nguvenfSsanioseca.gov Lam Castillo lani.castilloffflsanioseca.gov Linda Duong , j ' Long Vu ^ ,>• Long.vufSsanioseca.gov Matt Sasser j'J matt.sasserffflsanioseca.gov Michael Demissie i 'i michael.demissieffflsanioseca.gov Novim Spencer novim.soencerffflsanioseca.gov Paul Krukar Daul.krukarffflsanioseca.gov iSandra Bernabe sandra.bernabeffflsanjoseca.gov Shirley Mata shirlev.mata (fflsanioseca. gov Stephanie Garcia steDhanie.garciafSsanioseca.gov Led Williams ted.williamsffflsanioseca.gov Megha Prakash megha.DrakashfSsanioseca.gov Tom Martinez Wm tom.martinezfSsanioseca.gov Rami Hijazeen J i, [email protected] Cheyna Heresa chevna.heresaffflsanioseca.gov Adrian Calderon-Flores adrian,calderon-floresfSsanioseca.gov Jonathan Chavez |ionathan.chavezffflsanioseca.gov Leo Valdez leo.vaidezffflsanioseca.gov Agency Report of: Ceremonial Role Events and Ticket/Pass Distributions A Public Document 1. Agency Name Date Stamp California QAO Form OUA City of San Jose tt'l I . ™ | Af Division, Department, or Region (If Applicable)

Environmental Services Department 0 Designated Agency Contact (Name,Title)

Linda Charfauros [~l Amendment (Must provide explanation in Part 3.) Area Code/Phone Number E-mail Date of Original Filing: . 408 535-8553 [email protected] (Month, Day, Year) 2. Function or Event Information 42.00 Does the agency have a ticket policy? Yes 13 No • Face Value of Each Ticket/Pass $. San Jose Earthquakes Soccer Game Event Description. Date(s) 08 / 30 / 14 Provide Title/Explanation

Ticket(s)/Pass(es) provided by agency? yes 13 No • If no: Name of Source

Was ticket distribution made at the behest |\]0 g] Yes • If yes:. of agency official? Official's Name (Last, First)

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. Number of A. Name of Agency, Department or Unit Ticket(s)/ Describe the public purpose made pursuant to the agency's policy Pass(es) Environmental Services Department Recognition for direct involvement in City-related Employees 100 projects/programs.

Number of Name of Individual Ticket(s)/ Identify one of the following: " " (LastiWstl :• • . Pass(es)

Ceremonial Role CD Other CD Income CD If checking "Ceremonial Role" or "Other' describe below:

Ceremonial Role CD Other CD Income CD If checking "Ceremonial Role" or "Other" describe below:

Number of Q Name of Outside Organization Ticket(s)/ Describe the public purpose made pursuant to the agency's policy ' (include address and description) Pass(es)

4. Verification I have read and understand FPPC Regu&tions 18944.1 and 18942. I have verified that the distribution set forth above, is in accordance with the requirements. Kerrie Romanow Director 9/2/14 - v Signature of Agency —7—Header Designee (Month, Day, Year)

Comment: FPPC Form 802 (4/12) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-7772) Agency Report of: Ceremonial Role Events and Ticket/Pass Distributions California QAO Form Wfc Continuation Sheet A Public Document

Agency Name City of San Jose 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.

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

Number of Name of Individual Ticket(s)/ Identify one of the following: . " :/ " . (Last, First) ; . Pass(es)

Ceremonial Role El Other EH Income l~l If checking "Ceremonial Role" or "Other" describe below:

Ceremonial Role El Other El Income El if checking "Ceremonial Role" or "Other" describe below: •

Ceremonial Role El Other El Income I I If checking "Ceremonial Role" or "Other" describe below:

Ceremonial Role El Other El Income El if checking "Ceremonial Rote" or "Other' describe beiow:

Number of Q Name of Outside Organization Ticket(s)/ Describe the public purpose made pursuant to the agency's policy ' (include address and description) Pass(es)

FPPC Form 802 (4/12) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-7772) Soccer Game Ticket Recipients Albert Wong [email protected] Alice Ringer [email protected] Alma Zavala [email protected] Amado Valdez [email protected] Anna Szabo [email protected] Antonio Martinez [email protected] Arlene Tsang [email protected] Badaoui Mouderres [email protected] Brad Steinbach [email protected] Catherine Hoang Mendoza [email protected] Christina Pinedo [email protected] Darwin Lasat [email protected] Debbie Basher [email protected] Eddie Dominguez [email protected] Eloisa Tan [email protected] Eric Dunlavey [email protected] Erica Colunga [email protected] First Name Last Name Email Address Frank Chavez [email protected] Govan Hill [email protected] Gregory Missman [email protected] Ismael Parra [email protected] Jaime Avalos [email protected] James Powars [email protected] Jennie Loft [email protected] Jeondra Arrington [email protected] Jo Zientek [email protected] Joe Moreno [email protected] John Fosnaugh [email protected] John Navarra [email protected] John Mukhar [email protected] Jon Evans [email protected] Jonathan Chavez [email protected] Joshua Villa [email protected] Julie Benabente [email protected] Kerrie Romanow [email protected] Khara Joy Ramirez [email protected] Kort Jackson [email protected] Kristen Yasukawa [email protected] Kristina Clinton [email protected] Lauren Romanazzi [email protected] Liz Neves [email protected] Luis Alvarado [email protected] Maithi Nguyen [email protected] Mary Taylor [email protected] Matt Lambert [email protected] Soccer Game Ticket Recipients Matt Sasscer [email protected] Michael Gonzales [email protected] Michael Monelo [email protected] Michael Mitchell [email protected] Michele Young [email protected] Neli Avramova [email protected] Nick Garza [email protected] Nidia Gomez [email protected] Novim Spencer [email protected] Patrick Hansen [email protected] Paul Prange [email protected] Peter Williams [email protected] Phuong Pham [email protected] Ralph Rodriguez [email protected] Rene Eyerly [email protected] Rey Honrada [email protected] Robert Samatua [email protected] Robert Matz [email protected] Robert Cuellar [email protected] Roberto Gutierrez [email protected] Shadrack Nyambok [email protected] Shirley Mata [email protected] Simret Yigzaw [email protected] Stephanie Molloy [email protected] Stephen Lowes [email protected] Steven Osborn [email protected] Thomas Martinez [email protected] Tina Yu-Taylor [email protected] Varsha Patel [email protected] Victor Castellanos [email protected] Victoria Ribbs [email protected] Zuhayl Lambert [email protected] Agency Report of: Ceremonial Role Events and Ticket/Pass Distributions ..f, ,. A Public Document 1. Agency Name ~1 0~’ <.~&~ Date Stamp

Division, Department, orC~’~-~( U ~(~g~’ Region For Official Use Only

Designated Agency Contact (Name, Title)

[] Amendment (Must provide explanation in Part 3.) Area Code/Phone Number E-mail Date of Original Filing: (Month, Day, Year) 2. Function or Event Information Does the agency have a ticket policy? Yes ~ No ~ Face Value of Each TickeUPass $ Event Description ~ 40£(~ 2gha,~t~ ~me Date(s) ~~ ~ ’ Provide ~tle~xp~ationt~

Ticket(s)/Pass(es) provided by agency? Yes[] No[] If no: Name of Source Was ticket distribution made at the behest No [] Yes [] If yes: of agency official? Official’s Name (Last, First) 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. Number of A. Name of Agency, Department or Unit Ticket(s)/ Describe the public purpose made pursuant to the agency’s policy Pass(es)

Number of B. Name of Individual Ticket(s)/ Identify one of the following: tLa~t, Fl~t) Pass(es) Ceremonial Role [] Other [] Income [] If checking "Ceremonial Rote" or "Other" descdbe below:

Ceremonial Role [] Other [] Income [] If checking "Ceremonial Rote" or "Other" descdbe below:

Number of C, Name of Outside Organization Ticket(s)/ Describe the public purpose made pursuant to the agency’s policy (include address and description) Pass(es)

4. Verificatk n I have r nderstand FPPC I; and 18942. I have verified that the distribution set forth above, is in accordance with the requirements.

Head or Designee Print Name Title (M~ont ~3ah, y, Year)

Comment: FPPC Form 802 (4112) FPPC Toll-Free Helpline: 8661ASK-FPPC (866/275-7772) California Form 802 - Attachment

City of San Jose, Environmental Services Department (Municipal Water System)

3. Recipients

The following staff received two tickets each to the event on 11/7/13:

1~ Carlos Barajas 2. VictorCarmona 3. Ray Ghasemi 4. Louie Gonzales 5. Nicole Harvie 6. Shirley Lu 7. Marcelo Mota 8. James Perez 9. JeffProvenzano 10. Alice Ringer 11. Ruben Torres 12. Amado Valdez n 1. Agency Nam~ ...... , ~at~S.tafr~p.. City of San Jose ~ 3 ~ ~=:~ For Official Use Only Division, Department, or Region (If Applicable)

Environmental Services Department Designated Agency Contact (Name, Title) Maryann Casorla [] Amendment (Must provide explanation in Part 3.) Area Code/Phone Number E-mail Date of Original Filing: 408 975-2541 maryann.casor [email protected] (Month, Day, Year) 2. Function or Event Information 179 Does the agency have a ticket policy? Yes [] No [] Face Value of Each Ticket/Pass $ Event Description Music Concert ~ (,~I~"¯ t~:~,(~’~,- .~ ~) Date(s) ~/ / ~, J. Provide Title/Explanation Ticket(s)/Pass(es) provided by agency? Yes[] No[] If no: Name of Source ~ . Was ticket distribution made at the behest No [] Yes [] If yes: Casorla, Maryann of agency official? Official’s Name (Last, First) 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. Number of A. Name of Agency, Department or Unit Ticket(s)/ Describe the public purpose made pursuant to the agency’s policy Pass(es) City of San Jose, Environmental Services Recognition of outstanding team performance De partment 16 Environmenta Services Recognition Committee Number of g. Name of Individual Ticket(s)/ Identify one of the following: (Last, First) Pass(es) Ceremonial Role [] Other [] Income [] If checking "Ceremonial Role" or "Othe¢’ descdbe below:

Ceremonial Role [] Other [] Income [] If checking "Ceremonial Role" or "OtheF’ desctfbe below:

Number of C ¯ Name of Outside Organization Tlcket(s)l Describe the public purpose made pursuant to the agency’s policy (include address and description) Pass(es)

4. Ver|f|catlonii’~ / I t)av~ reaj~and u~erst~l"d FPPC ~tu’latl~ns 18944.1 and 18942. I have verified that the distribution set forth above, is in accordance with the requirements. / /, .;.~’ /~"~/~’~ (’ ...... ~i,~,:/;, .... Maryann Casorla Senior Office Specialist 2/1/13 /" /~’~lg~turee~g~i~,):t~a-db~*Designee PdntName 7711e (Month, Day, Year)

Comment: FPPC Form 802 (4/12) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-7772)