2012 Humana Challenge - Dinner & Concert EventAgency Report of:
Ceremonial Role Events and
Ticket/Admission Distributions
1. Agency Name
City of La Quinta
Division, Department, or Region (if applica.t
Street Aaa ress
78-495 Calle Tampico, La Quinta, CA 92253
Designated Agency Contact (Name, Title)
Mark Weiss, Interim City Manager
Area Code/Phone Number E-mail
760-777-7100 mweiss@la-quinta.org
2. Function, Event, or Ceremonial Role Information
Title 2012 Humana Challen
Description Dinner and Concert Event
A Public Document
Date stamp
For Official Use only
I
❑ Amendment (Most provide explanation in Part 3.)
Date of Original Filing:
(month, day, year)
Face Value of Each Admission $ 750
Date(s)
01 2� 12
f�
Tickets)/Admission(s) provided by agency? Yes ❑ No I] If no: Humana Challenge
Name of Source
Was the distribution to persons identified below made at the behest of an agency official?
Yes ❑ No ❑ If yes:
Official's Name (Last. First) and Title
The identity of recipient(s) and the explanation:
Name
• Check the income box If the agency official claims admission as
(Last, First)
Number of .:
.'Agency
taxable Income. if th a agency.ofRclal.perforrned a ceremonial role,
or
Admission(s)/
Official
also provide a description. .
Organization
Ticket(s)
If not Income, describe the public purpose, including
(Name, Address, Description)
ceremonial roles, performed by an agency official, Individual, or
or anlzation.
Yes d
Income
Adolph, Don
2
No [j
see attached ❑
Yes I]
Income
Franklin, Kristy
2
No ❑
see attached ❑
Yes 0
Income
Henderson, Terry
2
No ❑
see attached ❑
Yes d
Income
Evans, Linda
2
No ❑
see attached
Yes El
Income
Osborne, Lee
2
No ❑
see attached ❑
3. Verification
1 have read and understand FPPC Regulations 18944.1 and 98942, 1 have verified that the distribution of admissions, set forth above,
is in accordance with the provisions.
6 Mark Weiss Interim City Manager 02/13/2012
Signature of Agency Head or Designee Print Name Title (month, day, year)
Comment: (Use this space or an attachment for any additional information including amendment explanation.)
FPPC Form 842 (2191)
FPPC Toil -Free Helpline: 866/ASK-FPPC (866/275-3772)
California Form 802 — Attachment (2012 Humana Challenge (Dinner and Concert Event January 21, 2012)
No income. Public purpose for the distribution was for the promotion of The Humana Challenge; City
recognition; growth and development; and tourism.