HomeMy WebLinkAbout2026 Wine Passport - Signed Form 802California
Form
Agency Report of:
1. Agency Name
Designated Agency Contact (Name,Title)
Date Stamp
E-mail
Division, Department, or Region (if applicable)
2. Function or Event Information
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.
Signature of Agency Head or Designee Print Name
Comment:
FPPC Form 802 (2/2016)
FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)
(month, day, year)
802
(month, day, year)
For Official Use Only
Area Code/Phone Number
Date of Original Filing:
Ticket(s)/Pass(es) provided by agency?
Was ticket distribution made at the behest
of agency official?
Title
Ceremonial Role Events and Ticket/Pass Distributions
Event Description:
Amendment (Must Provide Explanation in Part 3.)
Provide Title/ Explanation
Official’s Name (Last, First)
If checking “Ceremonial Role” or “Other” describe below:
If checking “Ceremonial Role” or “Other” describe below:
Name of Agency, Department or Unit
Name of Outside Organization
(include address and description)
Name of Individual
(Last, First)
Number
of Ticket(s)/
Passes
Number
of Ticket(s)/
Passes
Number
of Ticket(s)/
Passes
Describe the public purpose made pursuant to the agency’s policy
Identify one of the following:
Describe the public purpose made pursuant to the agency’s policy
Does the agency have a ticket policy?No
No
Income Other
Other
Ceremonial Role
Ceremonial Role Income
No
Yes
Yes
Yes
Face Value of Each Ticket/Pass $
Date(s)
If no:
Name of Source
If yes:
3.
A.
B.
C.
4.
A Public Document
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.• • •
City of Dublin
Marsha Moore, City Clerk
(925) 833-6644 marsha.moore@dublin.ca.gov
n
350
Livermore Valley Wine Community Wine Passports 02/03/2026 12/31/2026
n Livermore Valley Wine Community (City is Member)
Hu, Sherry 2
n
Public Purpose - Promotion of local and regional businesses and economic activities
Colleen Tribby City Manager
Print Clear
Docusign Envelope ID: 2867EB38-4805-4213-B698-2D1E30A77834
2/5/2026