HomeMy Public PortalAboutForm 700 (Economic Interest Statements, SEI) Ted Mertens 2022CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Please type or print in ink.
STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
A PUBLIC DOCUMENT
Date Initial Filing Received
riling Official Use Cn;y
NAME OF FILER (LAST)
Mertens
(FIRST) (MIDDLE)
Ted J
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of Indian Wells
Division, Board, Department, District, if applicable Your Position
City Council Candidate
► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency: Position -
2. Jurisdiction of Office (Check at least one box)
U State _I Judge, Retired Judge, Pro Tem Judge, or Court Commissioner
(Statewide Jurisdiction)
Multi -County County of
Other
1 City of Indian Wells
3. Type of Statement (Check at least one box)
7 Annual: The period covered is January 1, 2021, through
December 31, 2021.
The period covered is through
December 31, 2021.
n Assuming Office: Date assumed _/_/
-or-
] Leaving Office: Date Left
(Check one circle.)
The period covered is January 1, 2021, through the date of
leaving office.
-or-
The period covered is —J_J through
the date of leaving office.
ILI Candidate: Date of Election 11 /08/2022 and office sought, if different than Part 1:
4. Schedule Summary (must complete) ► Total number of pages including this cover page:
Schedules attached
(it Schedule A•1 • Investments - schedule attached
E Schedule A-2 - Investments - schedule attached
• Schedule B • Real Property schedule attached
-or- n None - No reportable interests on any schedule
5. Verification
n Schedule C - Income, Loans, & Business Positions - schedule attached
Schedule D - Income - Gifts - schedule attached
U Schedule E • Income - Gifts - Travel Payments - schedule attached
MAILING ADDRESS STREET
(Business or Agency Address Recommended - Public Document)
DAYTIME TELEPHONE NUMBER
CITY
Indian Wells
STATE ZIP CODE
CA 92210
(
EMAIL ADDRESS
1 have used all reasonable diligence in preparing this statement. 1 have reviewed this statement and to the best of my knowledge the information contained
herein and in any attached schedules is true and complete. I acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date Signed
8/17/2022
(month. day. year)
Signature
Ming official.)
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FPPC Form 700 - Cover Page (2021/2022)
advice@fppc.ca.gov • 866-275.3772 • www.fppc.ca.gov
Page - 5
SCHEDULE A-1
Investments
Stocks, Bonds, and Other Interests
(Ownership Interest is Less Than 10%)
Investments .must be itemized.
Do not attach brokerage or financial statements.
► NAME OF BUSINESS ENTITY
Costco
GENERAL DESCRIPTION OF THIS BUSINESS
Reatiler
FAIR MARKET VALUE
• $2,000 - 510,000
[� $100,001 - 51,000,000
L 510,001 - $100,000
Over $1,000,000
NATURE OF INVESTMENT
`� Stock 'J Other
(Describe)
Partnership !� Income Received of 50 - 5499
;J Income Received of 5500 or More (Report on schedule C)
IF APPLICABLE, LIST DATE:
_/_/21
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
IBM
GENERAL DESCRIPTION OF THIS BUSINESS
Business Services
FAIR MARKET VALUE
[� $2,000 - $10,000
L $100,001 - 51,000,000
510,001 - $100,000
L Over 51,000,000
NATURE OF INVESTMENT
• Stock C Other
(Describe)
Partnership ❑ Income Received of SO - $499
❑ Income Received of 5500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
Chevron
GENERAL DESCRIPTION OF THIS BUSINESS
Oil, Gas
FAIR MARKET VALUE
�J $2,000 - $10,000
r i $100,001 - $1,000,000
NATURE OF INVESTMENT
111 Stock J Other
U 510,001 - 5100,000
1 Over 51,000,000
;Uescnhe)
P Partnership El Income Received of SO - $499
❑ Income Received of 5500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
—J21 —l—J2i
ACQUIRED DISPOSED
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Name
► NAME OF BUSINESS ENTITY
Royal Caribbean Cruise Line
GENERAL DESCRIPTION OF THIS BUSINESS
Leisure
FAIR MARKET VALUE
$2,000 - $10,000
7 $100,001 - $1,000,000
J 510,001 - 5100,000
7 Over 51,000,000
NATURE OF INVESTMENT
Stock In, Other
(Describe)
7 Partnership [ Income Received of 50 - 5499
L Income Received of 5500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
_/_/21 / /21
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
J $2,000 - $10,000
— $100,001 - $1,000,000
7 $10,001 - $100,000
J Over 51,000,000
NATURE OF INVESTMENT
Stock ❑ Other
(Describe)
J Partnership L Income Received of S0 - $499
❑ Income Received of 5500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
► NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE
J $2,000 - $10,000
7 $100,001 - $1,000,000
NATURE OF INVESTMENT r J Stock Other
510,001 - $100,000
7 Over $1,000,000
(uescnbe)
-1 Partnership ( Income Received of 50 - 5499
L Income Received of 5500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE:
ACQUIRED DISPOSED
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FPPC Form 700 - Schedule A-1 (2021/2022)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page - 7
SCHEDULE B
Interests in Real Property
(Including Rental Income)
I. ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
75640 Painted Desert
CITY
Indian Wells
FAIR MARKET VALUE
n 52,000 - 510,000
❑ $10,001 - $100,000
•ii $100,001 - $1,000,000
n Over 51,000,000
NATURE OF INTEREST
' Ownership/Deed of Trust
IF APPLICABLE, LIST DATE:
_/_/21
ACQUIRED DISPOSED
Easement
J Leasehold U
Yrs. remaining Other
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
1 7$o-5499
7 $500 - $1,000 n $1,001 - S1o,o00
' 510.001 - 5100,000 OVER $100,000
SOURCES OF RENTAL INCOME: if you own a lD% or greater
interest, list the name of each tenant that is a single source of
income of $10,000 or more.
None
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Name
I. ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
CITY
FAIR MARKET VALUE
j $2,000 - 510,000
J $10,001 - $100,000
7 5100,001 - S1,000,000
J Over $1,000,000
NATURE OF INTEREST
Ownership/Deed of Trust
IF APPLICABLE, LIST DATE;
ACQUIRED DISPOSED
Easement
Leasehold L
Yrs. remaining Other
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
-1 $0 - 5499
n $500 - 51,000 n $1,001 - $10,000
510,001 - 5100,000 OVER $100,000
SOURCES OF RENTAL INCOME: If you own a 10% or greater
interest, list the name of each tenant that is a single source of
income of $10,000 or more.
Li None
* You are not required to report loans from a commercial lending institution made in the lender's regular course of
business on terms available to members of the public without regard to your official status. Personal loans and
loans received not in a lender's regular course of business must be disclosed as follows:
NAME OF LENDER'
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM (Months/Years)
None
HIGHEST BALANCE DURING REPORTING PERIOD
G 5500 - 51,000
lI $10,001 - 5100,000
U Guarantor, if applicable
P1 51,001 - 510.000
L OVER $100,000
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM (Months/Years)
%
None
HIGHEST BALANCE DURING REPORTING PERIOD
nl $500 - 51,000
LI 510,001 - 5100,000
L i Guarantor, if applicable
51,001 - 510,000
OVER $100,000
Comments -
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FPPC Form 700 - Schedule B (2021/2022)
advice@fppc.ca.gov • 866-275-3772 • www.fppc.ca.gov
Page -11