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Home My Public Portal AboutForm 460 (July 1, 2018 - Jan 20, 2019)Recipient Committee Campaign Statement Cover Page Statement covers period from 07/01/2018 SEE INSTRUCTIONS ON REVERSEthrough 01/30/2019 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure O State Candidate Election Committee Committee Q Recall O Controlled (Also Complete Parr s) O Sponsored (Also Complete Part 6) ❑ General Purpose Committee O Sponsored ❑ Primarily Formed Candidate/ O Small Contributor Committee Officeholder Committee O Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1400500 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Committee to Elect Sam Pedroza STREET ADDRESS (NO P.O. BOX) 580 Cinderella Drive CITY STATE ZIP CODE AREA CODEIPHONE Claremont CA 91711 909-964-2047 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my certify under penalty of perjury under the laws of the State of California that the foregoing is true pny Executed on�/ O� By V Date / COVER PAGE LEVE 460 Date of election if applicable: JAN J 1 209 Page 1 of 5 (Month, Day, Year) For Official Use Only CITY CLERK 11/06/18 ( ITY OF CLAREMOAT 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement Semi-annual Statement ❑ Special Odd -Year Report Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Brian Teuber MAILING ADDRESS 553 Redlands Avenue CITY STATE ZIP CODE AREACODE/PHONE Claremont CA 91711 909-802-4596 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL: FAX/ E-MAIL ADDRESS information contained herein and in the attached schedules is true and complete. I of TreasurerkgAssistant Treasurer Executed on By Date Sign re,priontrolling O iceho der, Candi b, S117 Measure Proponent or Responsible Officer of Sponsor Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Sam Pedroza OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Claremont City Council RESIDENTIALBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP 580 Cinderella Drive Claremont, CA 91711 Related Committees Not Included in this Statement: List any committees not included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER COMMITTEE ADDRESS CITY COMMITTEE NAME NAME OF TREASURER COMMITTEE ADDRESS CITY CONTROLLED COMMITTEE? ❑ YES ❑ NO STREET ADDRESS (NO P.O. BOX) STATE ZIP CODE AREA CODE/PHONE I.D. NUMBER CONTROLLED COMMITTEE? ❑ YES ❑ NO STREET ADDRESS (NO P.O. BC>:) STATE ZIP CODE AREA CODE/PHONE COVER PAGE - PART 2 CALIFORNIA 1 . .1 - Page 2 of 5 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD IDISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee Is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE Attach continuation sheets if necessary FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Elect Sam Pedroza 2018 Contributions Received 1. Monetary Contributions................................................... Schedule A, Line 3 $ 2. Loans Received................................................................ Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2 $ 4. Nonmonetary Contributions ............................................ Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED ................................... Add Lines 3 + 4 $ Expenditures Made Amounts may be rounded to whole dollars. Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) 0.00 0.00 0.00 0.00 0.00 6. Payments Made................................................................ Schedule E, Line 4 $ 7. Loans Made. ............... ...................................................... Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS ............................:............. Add Lines 6 + 7 $ 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F Line 3 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE........ ................................ Add Lines 8 + 9 + 10 $ Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 13. Cash Receipts........................................................... Column A, Line 3 above 14. Miscellaneous Increases to Cash .................................. Schedule 1, Line 4 15. Cash Payments......................................................... Column A, Line 8 above 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract tine 15 $ tf this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 19. Outstanding Debts .............................. Add Lhre 2 + Line 9 in Column B above $ 1897.00 0.00 1897.00 0.00 0.00 1897.00 1897.00 0.00 0.00 1897.00 0.00 1 11 ONO SUMMARY PAGE Statement covers period CALIFORNIA from 07/01/2018 FORM • through 01/30/2019 Page 3 of 5 I.D. NUMBER 1400500 Column B Calendar Year Summary for Candidates CALENDARYEAR TOTAL TO DATE Running in Both the State Primary and 600.00 General Elections $ 0.00 1/1 through 6/30 711 to Date 600.00 20. Contributions $ Received $ $ 0.00 21. Expenditures $ 600.00 Made $ $ Expenditure Limit Summary for State $ 1999.00 Candidates 0.00 199900 22• Cumulative Expenditures Made* . $ (If Subject to Voluntary Expenditure Limit) 0.00 Date of Election Total to Date 0.00 (mm/dd/yy) $ 1999.00 $ To calculate Column B, add amounts in Column A to the corresponding *Amounts in this section may be different from amounts amounts from Column B reported in Column B. of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). FPPC Form 460 (1an/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Elect Sam Pedroza 2018 Amounts may be rounded to whole dollars. Statement covers period from 07/01/201 ji through 01/30/2019 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. SCHEDULE E Page 4 of 5 I.D. NUMBER 1400500 CMP campaign paraphemalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR Dan C. Holznecht 501 Wayland Court RFD Claremont, CA 91711 Ophelia's Jump 2009 Porterfield Way, Ste H CVC Upland, CA 91786 Rotary Club of Claremont PO Box 357 CVC Claremont, CA 91711 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Schedule E Summary DESCRIPTION OF PAYMENT Returned Contribution Donation Donation AMOUNT PAID 100.00 500.00 1000.00 SUBTOTAL $ 1600.00 1. Itemized payments made this period. (Include all Schedule E subtotals.)............................................................................................................. $ 2. Unitemized payments made this period of under $100.......................................................................................................................................... $ 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column(e).)............................................................................. $ 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ........................... TOTAL $ 1720.0 177.00 JW 1897.00 FPPC Form 460(1an/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E (Continuation Sheet) Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Elect Sam Pedroza 2018 Amounts may be rounded to whole dollars. SCHEDULE E (CONT.) Statement covers period from 07/01/2010 • through 01/30/2019 Page 5 I.D. NUMBER 1400500 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment of 5 CMP campaign paraphemalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)' OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)" POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Claremont Police Department 570 W Bonita Avenue Claremont. CA 91711 CODE OR DESCRIPTION OF PAYMENT CVC * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Donation AMOUNT PAID 120.00 SUBTOTAL $ 120.00 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov