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2023 Riverside County Fair & National Date FestivalAgency Report of: Ceremonial Role Events and Ticket/Pass Distributions A Public Document 1. Agency Name HEWUMED, City of La Quinta Division, Department, or egion (if applicable) FEB 2 8 2023 For Ortldai Use Only Designate Agency Contact (Name, rue) CITY OF LA QUINTA Cl Jan McMillen, City Manager [] Amendment (Must Vmvide Explanarlon in Parr 3.) Area o hone Number mail 760-777-7030 jmcmillen@laquintaca.gov Date of Original Filing: (month. day, year) 2. Function or Event Information BEENEENEWN Does the agency have a ticket policy? Face Value of Each Tlcket/Pass $ 15.00 g Y P Y - Yes ■ No ❑ Event Description: Riverside County Fair Date(s) _ 1 18 i 23 2 16 23 Provide Truer Explanarion Ticket(suPass(es) provided by agency? Yes ■ No ❑ If no: Name of Sornse Was ticket distribution made at the behest Yes 0 No ■ If yes: arsfcWs Name (r_asr, First) of agency official? 3. Recipients .Use Section A to identify the agency's department or unit. • Use Section 9 to identify an individual. Use Section C to identify an outside organization q. Wwe ofAgwicr. Depwiirneft er Ursk of viakwqw)f D"Claw e rAft vdqw" Mok punretrttnt to" vawy Name of IndMdd"I 04 ✓ r of Ticks Passes i%Mtly once or the lailon dnW Caremomal Role Omer ❑ Income ❑ Mendez, Martha 4 9 c w+ wg 'ce,arrmud Rok' c(vnwr dowte below_ LQ Resolution No. 2009-15 Section 4 Ceremonial Rore Other ❑ Incane ❑ Mignogna, Julie 4 ,r�ne<arw crw,ror�, �r onr �ros�o.ber�w LQ Resolution No. 2009-15 Section 4 Now of Gu%Wle Orgenb atkm C. (Mtelrrde addr"s and descApHwr} thookbor of Twwqay > Donor" a* pubKe punpo"Mode pursuant to the agency's ParAy 4. Verification I have read and understand FPPC Regulations 18944,1 and 1894Z I have verified that the distribution set forth above, is in accordance ith the requirements. Jon McMillen City Manager 2128123 s rc ofAgency 4ead or Designee Print game rule (—rh, day. rear) Comment: FPPC Form 802 (212016) FPPC Toll -Free Helpline: 866iASK-FPPC 18661275-3772) Agency Report of: California . 0 Ceremonial Role Events and TicketlPass DistributionsForm� Continuation Sheet A Public Document Agency Name - - 3. Rec rents ,Use Section A to identify the agency's department or unit. *Use Section 8 to identify an individual. tJse Section C to identifyan outside organization - Number A. Dame of Agency. Department or Unit of Ticksf{a)i Passes Dascfte the public purpose made pursuant to tha agency's policy B. Name of individual ilaSF, Firstl Number of Tickegfi)r Pamsas Identify ono of the following; Molina, Elizabeth 2 Cerfernonial Role ® Other ❑ interne ❑ �f Zh&ckv,g 'Ceremanw pore'nr T*w'dasc?Ate lMeiaw: LQ Resoludon No. 2009-15 SecUon 4 Delgado, Jessica 4 Commonlal Rule Olh®r ❑ InParn@ ❑ �f checkJ`ng '�sfer:nwniaJ RoPe'ur'4Na��' desrn�e below: LQ Resolution No. 2009-15 Section 4 Ortega, Virginia 4 Csremrmial Role Other [] Incc:.7rt ❑ 7r fh9C.flYl� L"LJ12f7k,\wi¢i ii0119 ur 'IifYl�: �'' [�'xtliCle tJ�luw LQ Resolution No. 2009-15 Section 4 Cabrera, Armandr) 2 Ceremonial Role Dther © income �] +f C+16CkJftg `;,dfir'rIMFJAJ ROPB'Or'4,'h9�'' ��dCIJl� Jic>'DW' LQ Resolution No. 2009-15 Secflan 4 Name &Outside Organlzation C. (Include address and deserlpNan) Number of Tleket(s)l paste Oescrtbe the public qurposa made pursuoul to the mgancy's policy FPPC Form 802 (Wuir3) FPPC Toll-Frae Halpline: 8661ASK-FPPC (815361275 3772) Agency Report of: Catifornia ., 0 Ceremonial mole Events and Ticket/Pass Distributions �' Continuation Sheet A Public Document Agency Narne City of La Quinta - Riverside Co. Fair 3. Recipients • Use Sectl4n A tv identify the agerpcy' department or unit. • USe Se{tion B to Identify ark Individual. Cie Section C to Identlfyr an outside organi:zatlon. Number A. !Marne of Agency, Department or Unit OF Tickq�tjsjf patt&% DeArribe the public pur;%eksn anode pursuant t© the agency's poIley Name of Individual (Lass. Fre&s of Tiplcst{sy Pansen Identffy one of the fvlfuwing: li afde: Manuel 2 Cerernonlal Roles other ❑ Ins rf rfk9ckihv 1Ceramruuuer .` or 'Y�'her' Qe�+ibc laeftxw LQ Resolution No. 2009-15 Section 4 ❑ CL,rerngnial R61e ❑ Other ❑ InGwe Pchaciru+p'Cermmoreaa Rafe`otr a e*Srrnbe✓ Womr ❑ Cerernonlal Role ❑ 171he:r ❑ Ino ne Ir cl`-'ckua9 `C�r�txrsxn� RoftFa' or'QNr� dsaraliae below_ ❑ Ceremonial Rcle ❑ Other El ircarne K chacRNr9 "�eretnrarlief Rash" or "C¢he� destriYse 8gdpw. ❑ C. Name of Oulside organization (include address and door- `iptian) Numbar of T[ckeS(s)F Paa5g9 [tescrfbe the public purposernatEe pursuant is theagency's poky FPPC Form 80 {212U16) FPPC -toll-Free MOM 8661ASK-FPPC (BGW275-3772)