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2012 Humana Challenge - Dinner EventAgency Report of: Ceremonial Role Events and Ticket/Admission Distributions 1- Agency Name City of La Quinta Division, Department, or Region (if applicable) rens 78-495 Calle Tampico, La Quinta, CA 92253 Designated Agency Contact (Name, Title) Mark Weiss, Interim City Manager Area Code/Phone Number I E-mail 780-777-7100 1mweiss@la-quinta.org 2. Function,vent, or Cera „ E Ceremonial Role Information Title 2012 Humana Challenge .._ Description Dinner Event A Public Document D4tL- tl , FEB 1 3 2012 I I r}IY G! LA t' 50A �,1� ],SM1IJ :S f'L n'C RF Pi For Official use Only ❑ Amendment (Must provide explanation in Part 3.) Date of Original Filing: (month, day, year) Face Value of Each Admission $ 750 Date(s)0118( 12 l�J Tickets)/Admission(s) provided by agency? Yes ❑ No El 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 recipients) and the explanation: Name • Check the Income box If the agency official claims admission as (Last, First) Number of Agency taxable Income, If the agency ofnclaI performed a ceremonial role, or Admission(s)l 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 organization. Yes p Income Adolph, Don 2 No © sec attached ❑ Yes [j Income Franklin, Kristy 2 No see attached ❑ Yes p Income Henderson, Terry 2 No ❑ did not use ❑ Yes p Income Evans, Linda 2 No [I❑ see attached Yes p Income Osborne, Lee 2 No 1:1see attached ❑ 3. Verification 1 have read and understand FPPC Regulations 18944.1 and 18942. l have verified that the distribution of admissions, set forth above, is in accordance with the provisions. 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 802 (2111) FPPC Toll -Free Helpline: 8681ASK-FPPC (8661275-3772) California Form 802 — Attachment (2012 Humana Challenge Dinner Event January 18, 2012) No income. Public purpose for the distribution was for the promotion of The Humana Challenge; City recognition, growth and development; and tourism,