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Home My Public Portal AboutForm 460 (Jan 1 - June 30, 2020)Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from 1/1/20 through 6/30/20 1. Type of Recipient Committee: An committees -complete Parts 1, 2, 3, and 4. mSceholdei, Candidate Controlled Committee ElPrimarily Formed Ballot Measure State Candidate Election Committee�ommittee O Recall Controlled (Also Complete Part s) O Sponsored (Also Complete Pad 6) ❑ eneral Purpose Committee Sponsored ❑ Primarily Formed Candidate/ Small Contributor Committee Officeholder Committee Political Party/Central Committee (Also Complete Pad 7) 3. Committee Information I I.D. NUMBER Nicole Wirick for Claremont City Council 2020 STREET ADDRESS (NO P.O. BOX) 495 Notre Dame Rd CITY STATE ZIP CODE AREA CODE/PHONE Claremont CA 91711 909-407-2843 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX P.O. Box 504 CITY STATE ZIP CODE AREACODE/PHONE Claremont CA 91711 OPTIONAL: FAX/ E-MAIL ADDRESS Date of election if applicable: (Month, Day, Year) 11/3/20 2. Type of Statement: Date Stamp AUG 1 7 2020 CITY CLERK ❑ Preelection Statement W1 Semi-annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) COVER PAGE 1 of 8 For Official Use On ❑ Quarterly Statement ❑ Special Odd -Year Report Treasurer(s) NAME OF TREASURER Jim Keith MAILING ADDRESS P.O. Box 504 CITY STATE ZIP CODE AREA CODE/PHONE Claremont CA 91711 909-451-1913 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE- - OPTIONAL: FAX/ E-MAIL ADDRESS info@nicoleforclaremont.com jim.keith9@verizon.net 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correctl� , Executed on 8/13/20 Date Executed on 8/13/20 Date Executed on Date Executed on Date By By By Signature of Controlling Officeholder, Candidate, State Measure Proponent By 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 6. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Nicole Wirick OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Claremont City Council Member, District 5 RESIDENTIALIBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP 495 Notre Dame Rd 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 CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COVER PAGE - PART 2 Page 2 of 8 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 DISTRICT NO. IF 7. Primarily Formed Candidate/Officeholder Committee Listnamesof 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 Amounts may be rounded SUMMARY PAGE to whole dollars. Statement covers period . Summary Page 1/1/20 from Expenditures Made 6. Payments Made................................................................ h 6/30/20 through Page 3 of 8 SEE INSTRUCTIONS ON REVERSE Schedule H, Line 3 none 8. SUBTOTAL CASH PAYMENTS ....................................... Add Lines 6+7 $ 1,035 NAME OF FILER Schedule F Line 3 none 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 I.D. NUMBER Nicole Wirick for Claremont City Council 2020 Lines 8+9+10 $ 1,303 1424182 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) CALENDAR YEAR TOTAL TO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions................................................... Schedule A, Linea $ 1,450 $ 1,450 664 664 1/1 through 6/30 711 to Date 2. Loans Received................................................................ schedule e, Line 3 2,114 2,114 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add lines i +2 $ $ Received $ $ 4. Nonmonetary Contributions ............................................ Schedule C, Line 3 268 268 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED................................Add Lines 3+4 $ 2,382 $ 2,382 Made $ $ Expenditures Made 6. Payments Made................................................................ Schedule E Line 4 $ 1,035 7. Loans Made....................................................................... Schedule H, Line 3 none 8. SUBTOTAL CASH PAYMENTS ....................................... Add Lines 6+7 $ 1,035 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F Line 3 none 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 268 11. TOTAL EXPENDITURES MADE....................................Add Lines 8+9+10 $ 1,303 Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 0 13. Cash Receipts........................................................... Column A, Line 3 above 2,114 14. Miscellaneous Increases to Cash .................................. Schedule 1, Line 4 none 15. Cash Payments......................................................... Column A, Line 8 above 1,035 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 1,079 If this is a termination statement, line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule 8, Parte $ none Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ none 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column 8 above $ none $ 1,035 none $ 1,035 none 268 $ 1,303 To calculate Column B, add amounts in Column A to the corresponding amounts from 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). Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subject to Voluntary ExpendIture Umlt) Date of Election Total to Date (mm/dd/yy) *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A Amounts may be rounded SCHEDULE A Monetary Contributions Received to wnote aollars. Statement covers period CALIFORNIA , t from 1/1/20 through 6/30/20 Page 4 of 8 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Nicole Wirick for Claremont City Council 2020 FULL NAME, STREET ADDRESS AND ZIP CODE OF IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) ® IND 1/27/20 Jim Keith ❑COM P Site Supervisor $100 $100 337 Marygrove Rd ❑ OTH Claremont After -School Claremont, CA 91711 ❑ PTY Program ❑ SCC ® IND 2/27/20 RussellBelevick El COM Retired $100 $100 361 Marygrove Rd ❑ OTH Claremont, CA 91711 ❑ PTY ❑ SCC ® IND 3/2/20 Karen Wirick ❑ COM Fundraiser $250 $250 3909 Mayfield Ave ❑ OTH Children's Hospital of La Crescenta, CA 91214 ❑ PTY Los Angeles ❑ SCC Z IND 3/2/20 Wallace Wirick El COM Retired $250 $250 3909 Mayfield Ave ❑ OTH La Crescenta, CA 91214 ❑ PTY ❑ SCC ® IND 3/5/20 Dan Selmi ❑ COM $250 $250 106 Grand Canal ❑ OTH Balboa Island, CA 92662 ❑ PTY ❑ SCC SUBTOTAL $ 950 fi Schedule A Summary 1. Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.).................................................................................................. 2. Amount received this period — unitemized monetary contributions of less than $100 .................... 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)........... $ 1,400 50 *Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee .... TOTAL $ 1,450 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A (Continuation Sheet) Monetary Contributions Received WE OF FILER IF AN INDIVIDUAL, ENTER Nicole Wirick for Claremont City Council 2020 CONTRIBUTOR * FULL NAME, STREET ADDRESS AND ZIP CODE OF DATE CONTRIBUTOR RECEIVED PERIOD (� IND (IF COMMITTEE, ALSO ENTER I.D. NUMBER) 3/5/20 Ann Selmi professor 106 Grand Canal ❑ OTH Balboa Island, CA 92662 3/9/20 Bob Gerecke Dominguez Hills 333 Villanova Rd ❑ SCC Claremont, CA 91711 5/11/20 Kirith Dilley 247 N Bush St El COM Santa Ana, CA 92701 'Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee Amounts may be rounded SCHEDULE A (CONT.) to whole dollars. Statement covers period from 1/1/20 • .1 through 6/30/20 Page 5 of 8 ❑ IND ❑ COM ❑ OTH ❑ PTY SUBTOTAL $ 450 I.D. NUMBER 1424182 CUMULATIVE TO DATE PER ELECTION CALENDAR YEAR TO DATE (JAN. 1 - DEC. 31) (IF REQUIRED) $250 $100 $100 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov IF AN INDIVIDUAL, ENTER AMOUNT CONTRIBUTOR * OCCUPATION AND EMPLOYER RECEIVED THIS CODE (IF SELF-EMPLOYED, ENTER NAME) PERIOD (� IND ❑ COM professor $250 ❑ OTH Cal State University ❑ PTY Dominguez Hills ❑ SCC ® IND El COM Retired $100 ❑ OTH ❑ PTY ❑ SCC ® IND ❑ COM Nonprofit Leader $100 ❑ OTH Alta Med Health Services ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY SUBTOTAL $ 450 I.D. NUMBER 1424182 CUMULATIVE TO DATE PER ELECTION CALENDAR YEAR TO DATE (JAN. 1 - DEC. 31) (IF REQUIRED) $250 $100 $100 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULE B - PART 1 Schedule B — Part 1 to whole dollars. Statement covers period Loans Received 1/1/20 CALIFORNIA 460 from FORM through 6/30/20 Page 6 of 8 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Nicole Wirick for Claremont City Council 2020 1424182 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING INTEREST ORIGINAL CUMU9LATIVE OF LENDER BALANCE RECEIVED THIS OR FORGIVEN BALANCE AT PAID THIS AMOUNT OF CONTRIBUTIONS (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER BEGINNING THIS PERIOD THIS PERIOD. CLO HIS PERIOD LOAN TO DATE NAME OF BUSINESS) PERIOD PERIOD ❑ PAID CALENDAR YEAR Nicole Wirick Deputy Public Defender $ 0 $ 664 % $ 664 $ 664 495 Notre Dame Rd County of San Bernardino RATE ❑ FORGIVEN PER ELECTION Claremont, CA 91711 0 $ 664 $ 0 11/3/20 $ 0 1/6/20 664 t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC $ DATE INCURRED $ DATE DUE PAID CALENDAR YEAR ❑ FORGIVEN PER ELECTION' RATE t ❑ IND [ICOM ❑ OTH ❑PTY ❑SCC $_ $ $ $ $ DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR ❑ FORGIVEN PER ELECTION RATE $ $ $ $ $ DATE INCURRED t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE SUBTOTALS $ 664 $ 0 $ 664 $ 0 Schedule B Summary 1. Loans received this period....................................................................................................................$ (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period.........................................................................................................$ (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 3. Net change this period. (Subtract Line 2 from Line 1.).............................................................. NET $ Enter the net here and on the Summary Page, Column A, Line 2. "Amounts forgiven or paid by another party also must be reported on Schedule A. `* If required. 664 0 -664 (May be a negative number) (crani (tl� UI I J1:11tlUUltl C, lllltl Jf tContributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) 0TH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule C Amounts may be rounded Sr.wPnl IIF r Www uvuars. Nonmonetary Contributions Received Schedule Statement covers period • - from 1/1/20 , - , through 6/30/20 7 of 8 page SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Nicole Wirick for Claremont City Council 2020 1424182 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR * IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF AMOUNT! FAIR MARKET CUMULATIVE TO DATE PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) GOODS OR SERVICES VALUE CALENDAR YEAR (JAN 1 -DEC 31) (IF REQUIRED) m IND 1/7/20- Jim Keith El COM Site Supervisor Election Filing Fee $142 $142 1/10/20 337 Marygrove Rd ❑ OTH Claremont After -School and Post Office Claremont, CA 91711 ❑ PTY Program Box ❑ SCC [:1 IND ❑ COM ❑ OTH ❑ PTY ❑ SCC . ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 142 -RE 0�� M MAN Schedule C Summary 1. Amount received this period — itemized nonmonetary contributions. 142 (Include all Schedule C subtotals.)......................................................................................................................$ — 126 2. Amount received this period — unitemized nonmonetary contributions of less than $100 ..................................$ 3. Total nonmonetary contributions received this period. 268 (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.).....................TOTAL $ _ 'Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 460 ()an/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE Nicole Wirick for Claremont City Council 2020 Amounts may be rounded to whole dollars. covers period from 1/1/20 through 6/30/20 I Page 8 of 8 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. 1424182 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) E NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Open Hand Media, WEB $250 265 Termino Ave, Long Beach, CA 90803 Go Daddy WEB $295 14455 N Hayden Rd. #219, Scottsdale, AZ 85260 Nation Builder WEB $369 520 S Grand Ave, 2nd Floor, Los Angeles, CA 90071 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ $914 Schedule E Summary 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.) .......................... $ 914 121 $ none ........................ TOTAL $ 1,035 FPPC Form 460 (Jan/2016)) FPPC Advice. advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov