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Home My Public Portal AboutForm 460 (July 1 - Sept. 19, 2020)Recipient Committee D8 COVER PAGE Campaign Statement �' ' • 1 Cover Page CETV SEE INSTRUCTIONS ON REVERSE Statement covers period from 7/1/20 through 9/19/20 1. Type of Recipient Committee: All committees - complete Parts 1, 2, 3, and 4. m 8 fficeholder, Candidate Controlled Committee State Candidate Election Committee O Recall (Aho Corapleft, Part 5) ❑gneral Purpose Committee Sponsored Small Contributor Committee Political Party/Central Committee 3. Committee Information Committee to Elect Sal Medina ❑ Primarily Formed Ballot Measure ommittee Controlled mmSponsored vi-carapkf i Pans) ❑ Primarily Formed Candidate/ Officeholder Committee (AJ.Pat n I.D. NUMBER STREET ADDRESS (NO P.O. BOX) 257 E Green St CITY STATE ZIP CODE AREACODE/PHONE Claremont CA 91711 6268330170 MAILING ADDRESS OF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL: FAX/E-MAIL ADDRESS Date of election If applicable: (Month, Day, Year) SEP 2 4 2020 Page of For Official Use CA 91750 7145194085 NAME OF ASSISTANT TREASURER, IF ANY November 3, 2020 g �j A g0 CLE 4y `s 2. Type of Statement 1 1- A. Milyll koro p m Preelection Statement ❑ Quarterly Statement ❑ Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) STATE Treasurer(s) NAME OF TREASURER Lindsey Shiomi MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE La Verne CA 91750 7145194085 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL: FAX/E-MAIL ADDRESS 4. Verification 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 an correct. - •- P'F .ZLIL � (iltitdJ Executed on 4. to ey $(gn or Treasurer orAssistant Treasurer Executed on ate By Signature of Contr9 —cerolder, candidate, State Measure Proponent or Responsible Of icer of Sponsor Executed on Data By Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on Date By Signature of Controlling Officeholder, Candidata, State Measure Proponent FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ce.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 Sal Medina OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Claremont City Council, District 5 RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP 257 E Green St 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 AREACODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE Page 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE COVER PAGE - PART 2 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 ANY 7. Primarily Formed Candidate/Officeholder Committee last 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 j ❑ OPPOSE Attach continuation sheets if necessary FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Cam ai n Disclosure Statement p g Amounts may be rounded SUMMARY PAGE Statement covers period , 1 to whole dollars. Summary Page from 7/1/20 • through 9/19/20 Pagerof SEE INSTRUCTIONS ON REVERSE NAME OF FILER COMMITTEE TO ELECT SAL MEDINA Column A Column B Calendar Year Summary for Candidates Contributions Received TOTAL THIS PERIOD CALENDAR YEAR (FROM ATTACHED SCHEDULES) TOTAL TO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions................................................... schedule A, Line 3 $ 10075 $ 10075 0 0 Try through 6/30 7/1 to Date 2. Loans Received ............................................................ schedule 8, Line 3 10075 10075 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 +2 $ $ Received $ $ 4. Nonmonetary Contributions ............................................ schedule C, Line 3 0 0 21. Expenditures 10075 10075 Made $ $ 5. TOTAL CONTRIBUTIONS RECEIVED...............................Add Lines 3+4 $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made................................................................ schedule E, Line 4 $ 5646.42 $ 5646.42 Candidates 7. Loans Made....................................................................... schedule H cine 3 0 0 5646.42 5646.42 22. Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS ....................................... Add Lines 6+7 $ $ (d Subject to Voluntary Expenditure Limes) 9. Accrued Expenses (Unpaid Bills) .......................................... schedule F, Line 3 0 0 Date of Election Total to Date 10. Nonmonetary Adjustment......................................................... schedule C, Line 3 0 0 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE....................................Add Lines 8+9+10 $ 5646.42 $ 5646.42 $ $ Current Cash Statement 12. Beginning Cash Balance ............................ Previous summary Page, Line 16 $ 0 To calculate Column B, 13. Cash Receipts........................................................... Column A, Line 3 above 10075 add amounts in Column 0 A to the corresponding *Amounts in this section may be different from amounts 14. Miscellaneous Increases to Cash .................................. schedule r, Line 4 amounts from Column B reported in Column B. 15. Cash Payments......................................................... Column A, Line 8 above 5646.42 of your last report. Some amounts in Column A may 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 4428.58 be negative figures that should be subtracted from If this is a termination statement, Line 16 must be zero. 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 17. LOAN GUARANTEES RECEIVED ................................ schedule e, Pad 2 $ 0 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ seelnshuctionsonreverse 0 $ any). 19. Outstanding Debts .............................. Add Line 2 +Lime 9 in Column a above $ 0 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 Statement covers period CALIFORNIA I , • from 7/1/20 FORM SEE INSTRUCTIONS ON REVERSE through 9/19/20 Page of NAME OF FILER I.D. NUMBER COMMITTEE TO ELECT SAL MEDINA 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 QF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE QF SELF-EMPLOYED, ENTER NAME PERIOD (JAN.t-DEC. 31) (IF REQUIRED) []IND 9/18/20 4C's Finecraft Jewelers ® COM 200 200 307 Yale Avenue ❑ OTH Claremont, CA 91711 ❑ PTY ❑ SCC ® IND 9/17/20 Joan Bunte ❑COM Retired 200 200 326 De Paul Rd. ❑ OTH Claremont, CA 91711 ❑ PTY ❑ SCC ® IND 9/9/20 Adam Sauceda ❑ COM Mail Services, Grifols 250 250 15466 Wild Onion Rd ❑ OTH Perris, CA 92570 ❑ PTY ❑ SCC ® IND 9/2/20 Paul Mylott ❑ COM Consultant, The Mylott 100 100 21384 Paseo Montana ❑ OTH Group Murietta, CA 92562 ❑ PTY ❑ SCC ❑ IND 8/29/20 G.O. Rodriguez Trucking, Inc. ® COM 250 250 16155 E 1st ❑ OTH Irwindale, CA 91706 ❑ PTY ❑ SCC SUBTOTAL $ 1000 Schedule A Summary 1. Amount received this period — itemized monetary contributions. 9575 (Include all Schedule A subtotals.).........................................................................................................$ — 2. Amount received this period — unitemized monetary contributions of less than $100 ...........................$ 500 3. Total monetary contributions received this period. 10075 (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)......................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 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Mrww.fppc.w.gov Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULE A (CONT) Monetary Contributions Received to Whole dollars. Statement covers period _ from 7/1/20 through 9/19/20 ll.!D!N ofNAME !UM6!.1 OF FILER R COMMITTEE TO ELECT SAL MEDINA DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION 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 8/29/20 George Rodriguez ❑ COM Owner, G.O. Rodriguez 250 250 3560 Padua Ave ❑ OTH Trucking, Inc Claremont, CA 91711 ❑ PTY ❑ SCC ® IND 8/27/20 Deborah Hargrave ❑ COM Office Manager, Apex 200 200 336 Notre Dame Rd ❑ OTH Imaging Services Claremont, CA 91711 ❑ PTY ❑ SCC ® IND 8/27/20 Diann Ring ❑ COM Retired 200 200 816 Peninsula Ave ❑ OTH Claremont, CA 91711 ❑ PTY ❑ SCC ® IND 8/25/20 Roger Auerbach ❑ COM Retired 150 150 1105 N College Ave ❑ OTH Claremont, CA 91711 ❑ PTY ❑ SCC ® IND 8/24/20 Nick Van Der Wende ❑ COM Supervisor, )et Propulsion 250 250 2859 Frances Ave ❑ OTH Laboratory La Crescenta, CA 91214 ❑ PTY El SCC SUBTOTAL $ 1050 71 *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.ra.gov Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULE A (CONT) Monetary Contributions Received to whole dollars. Statement covers period CALIFORNIA from 7/1/20 FORM � 4.1 through 9/19/20 Page of NAME OF FILER I.D. NUMBER COMMITTEE TO ELECT SAL MEDINA FULL NAME, STREET ADDRESS AND ZIP CODE OF IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR CONTRIBU *OR 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. 7 -DEC. 31) (IF REQUIRED) W] IND 8/21/20 Charlene Gregg Bolton ❑ COM Real Estate Agent, Coldwell 100 100 1888 Abilene Way ❑ OTH Banker Claremont, CA 91711 ❑ PTY ❑ SCC ® IND 8/16/20 Manan Gerecke ❑ COM Retired 150 150 333 S Villanova Dr ❑ OTH Claremont, CA 91711 ❑ PTY ❑ SCC ® IND 8/15/20 Russell Riehl ❑ COM Healthcare Executive, 250 250 2415 Shadyridge Ave ❑ OTH Palomar Health Escondido, CA 92029 ❑ PTY ❑ SCC ® IND 8/14/20 August Gerecke ❑ COM Retired 150 150 333 S Villanova Dr ❑ OTH Claremont, CA 91711 ❑ PTY ❑ SCC ® IND 8/14/20 John Faranda ❑ COM College Administrator, 250 250 410 West 11th Street ❑ OTH Claremont McKenna Claremont, CA 91711 ❑SCC College I SUBTOTAL $ 900 '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 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule (Continuation Sheet) Amounts may be rounded SCHEDULE (CONT.) Monetary Contributions Received to whole dollars. Statement covers period CALIFORNIA • from 7/1/20 FORM through 9/19/20 Page of NAME OF FILER I.D. NUMBER COMMITTEE TO ELECT SAL MEDINA FULL NAME, STREETADDRESS 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 8/13/20 Richard Chute ❑ COM Fundraiser, The Planetary 100 250 467 Georgia Ct ❑ OTH Society Claremont, CA 91711 ❑ PTY ❑ SCC ❑ IND 8/12/20 Jim and Sue Keith ❑ COM Site Supervisor, Claremont 150 1550 337 Marygrove Rd ❑ OTH After -School Program Claremont, CA 91711 ❑ PN ❑ SCC ® IND 8/12/20 Becky Sauceda ❑ COM Real Estate Appraiser, HUD 250 250 1231 W Payson ❑ OTH San Dimas, CA 91773 ❑ PN ❑ SCC ® IND 8/12/20 Mara Watkins ❑ COM Attorney, FSC Lighting 250 250 645 W 9th St ❑ OTH Claremont, CA 91711 ❑ PN ❑ SCC ® IND 8/12/20 John Watkins ❑ COM Entrepreneur, FSC Lighting 250 250 645 W 9th St ❑ OTH Claremont, CA 91711 ❑ PN -ELSCC SUBTOTAL $ 1000 '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 (Jan/2016)) FPPC Advice: advice@fppc.w.gov (866/275-3772) www.fppc.ca.gov Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULE A (CONT) Monetary Contributions Received to whole dollars. Statement covers period from 7/1/20 • - through 9/19/20 Page of NAME OF FILER I.D. NUMBER COMMITTEE TO ELECT SAL MEDINA FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE,ALSO ENTER I.D. NUMBER) CODE OF SELF-EMPLOYED, ENTER NAME) PERIOD (JAN. 7 -DEC. 31) (IF REQUIRED) ® IND 8/11/20 KhatcherAgopian ❑COM Sales, SGWS 250 250 7049 Yarmouth Avenue ❑ OTH Reseda, CA 91335 ❑ PTY ❑ SCC ® IND 8/11/20 Paul Mahoney ❑ COM Attorney, Mahoney & Soll 250 250 688 Valparaiso Drive ❑ OTH LLP Claremont, CA 91711 ❑ PTY ❑ SCC ® IND 8/11/20 Victor Lau ❑COM Retired 250 250 1528 Hollencrest Drive ❑ OTH West Covina, CA 91791 ❑ PTY ❑ SCC m IND 8/11/20 Ivan Ayro ❑ COMEducation Administration, 100 100 8729 Cedar Point Ct. ❑ OTH Charter Oak Unified Rancho Cucaonga, CA 91730 ❑ PT`/ ❑ SCC ® IND 8/10/20 Ed Leavell ❑ COM Retired 100 100 464 Cinderella Drive ❑ OTH Claremont, CA 91711 ❑ PTY Fl SCC I SUBTOTALS 950 _771 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 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULE (CONT) Monetary Contributions Received to whole dollars. Statement coversperiod 0. from 7/1/20 FORM ' • 1 through 9/19/20 Page of NAME OF FILER I.D. NUMBER COMMITTEE TO ELECT SAL MEDINA 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) Z IND 8/7/20 Christopher Perez ❑ COM Attorney, AECOM 150 150 2540 Stonehill Ct ❑ OTH Claremont, CA 91711 ❑ PTY ❑ SCC ® IND 8/7/20 Mary Vu ❑ COM Manicurist, Unemployed 250 250 4015 Esmeralda Ave ❑ OTH EI Monte, CA 91731 ❑ PTY ❑ SCC ® IND 8/7/20 Henry Sauceda ❑ COM Retired 250 250 505 E Jefferson Ave ❑ OTH Pomona, CA 91767 ❑ PTY ❑ SCC ® IND 7/30/20 Hal Hargrave ❑ COM Contractor Owner, Apex 250 250 720 Indigo Ct ❑ OTH Imaging Pomona, CA 91767 ❑ PTY ❑ SCC ® IND 7/30/20 Grant Schmidt ❑ COM Executive Vice Social Chair, 100 100 6052 Barbara St ❑ OTH Cal Rho Chino, CA 91710 ❑ PTY SCC SUBTOTAL $ 1000 '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 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULE (CONT) Monetary Contributions Received to wnoie collars. Statement covers period ----I CALIFORNIA from 7/1/20 FORM - • through 9/19/20 Page of NAME OF FILER I.D. NUMBER COMMITTEE TO ELECT SAL MEDINA FULL NAME, STREET ADDRESS AND ZIP CODE OF IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOROCCUPATION CONTRIBUTOR + ' AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) QF SELF-EMPLOYED, ENTER NAME) PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) ® IND 7/29/20 Wendy Lau ❑ COM Risk Management Lead, 250 250 1765 Lordsburg Court ❑ OTH AECOM La Verne, CA 91750 ❑ PTY ❑ SCC ® IND 7/29/20 Evan Rutter ❑COM Higher Education 250 250 670 Blanchard PI ❑ OTH Administrator, Claremont Claremont, CA 91711 ❑ PTY McKenna College ❑ SCC 8 ® IND 7/29/20 Mario Guerrero ❑ COM Legislative Director, Ca1HR 150 150 1062 56th Street ❑ OTH Sacramento, CA 95819 ❑ PTY ❑ SCC Z IND 7/29/20 Jaime Riley ❑ COM Strategy Project Manager, 250 250 1773 Lordsburg Court ❑ OTH Carrington Mortgage La Verne, CA 91750 ❑ PTY Services ❑ SCC 0 ® IND 7/29/20 Kimbley Craig ❑ COM President & CEO, Monterey 100 100 2402 N. Main St Unit B ❑ OTH County Business Council Salinas, CA 93906 ❑ PTY OFl SCC SUBTOTAL $ 1000 *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 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULE A (CONT.) Monetary Contributions Received to wnoie a°Bars• — - Statement covers period CALIFORNIA from 7/1/20 FORM 46Cr through 9/19/20 Page of 71 NAME OF FILER 1 I.D. NUMBER COMMITTEE TO ELECT SAL MEDINA DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED CONTRIBUTOR * CODE OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE BF COMMITTEE.ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER NAME) PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) ® IND 7/28/20 Veronica Freeman ❑ COM FM, ) LL 100 100 705 Oakford Drive ❑ OTH Los Angeles, CA 90022 ❑ PTY ❑ SCC ® IND 7/27/20 Richard Chute ❑ COM Fundraiser, The Planetary 100 250 467 Georgia Court ❑ OTH Society Claremont, CA 91711 ❑ PTY ❑ SCC ® IND 7/27/20 Angela Sauceda ❑ COM Unemployed 100 100 1231 W Payson St ❑ OTH San Dimas, CA 91773 ❑ PTY 0 ❑ SCC ® IND 7/27/20 Thomas Andersen ❑ COM Financial Advisor, Morgan 250 250 417 E Green St ❑ OTH Stanley Claremont, CA 91711 ❑ PTY ❑ SCC ® IND 7/24/20 Manuel Escalante ❑ COM Owner & Business Coach, 100 100 8343 W 90th P1 ❑ OTH Leadership and Leads Westminster, CO 80021 ❑ PTY Business Coaching SCC SUBTOTAL $ 650 '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 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov z O U E Q _ N 2 V � E .O N N o o U. c E o E�> > 0 a. .0 a U C c oca ow (DC) Ua fl ccU— O> t L o E So o" =}U 000 FF0 UZU OILcn • z Q O W L w Q D J ❑ C7 o W 0 w of W d — w m W d Z LU �} w W ❑ i Q Q Z O LU Z Q O Ln N N N d O O O ~ o 0 .O EE W a N 7 E o Q w un o 0 0 0 O t K N Lr'> N K 'O UA C LU } ?.� U z �o z -i W EL y z Q o W 00 x Gni a H w Z o ❑ Q un C nny M W W U o •ti p x .T o Z a ce C93w y Pa w z h d W y co s, LL U LN. y 10 O O �. a w E- cn v� x U 0 a w m 0 m ❑ z0I—�U z0H z0E—HU z0FHU 0 F- o z0HF-U ZU0ELcn zUOacn U Z UocL ? UOa.cn UOacn o ®OLIO❑ 51❑D0❑ ®❑OLID 51D❑00 510011 U _ LL O W O U � a m N � ❑ z 10 z d Q Of Q cp O w i •V W 00 Q � � N � z Q z Q W ° cz rA ^o U _ co d (� LL Q� o d V M P. r— N �, 07 V Q� fd Q p" N ¢ V) U CZ o CZ O U 4 cc U Q x U U c U z � U a cq �'" o cz non v d C w> 3 �� U O O E- o c v� d z o=° U w w 4.0 W J-- ❑ W > O CD N Q% LL Q W N N C4 � O w N � O Q U z _ N 2 V � E .O N N o o U. c E o E�> > 0 a. .0 a U C c oca ow (DC) Ua fl ccU— O> t L o E So o" =}U 000 FF0 UZU OILcn E Q N O oA Nen . u LM u cco N a 3 o w C 3 £ co 3 o0 U. u v a a LL a u m A a� U d E « (n N O 00 U c_ E} `o E F- 7N � o a m a a vim@� 0 m aciw�a�Oj Co E 00 OIC 2}U 0z0 HF -U U ?U 0CLw • O w H a D LU 0 o w O w w w CL - • w m w a R ^ N 0 Z 0 CL - O W M } w w O > a VQ O Z O 7 Za a e O. � j U v O O O O O N U N N N d O O U N y d o en ~ ~ E `C" j w 0 C O > w a in C E a o o � w w w w } s H OJ Z y EL Of W W M cOC W C a 0W Z Ln a w O Q v cC H > z O J 0 CL d� - W °' A o °' z w v i, O LL. U N vi y - H H �' cn cn 0 v � d 0 3 m Cl zOHF}--U z z OHF- U 0 OH�U F- o z0h---I}-U zUOdtn ?UOacn 0F= -FU ? UO�cn - UOacn - UOacn ®❑❑❑❑ 51❑11❑11 ®11❑❑❑ ®1111❑❑ 111111 El 0 U LLO w 0 O U � IL m N � z Z o a !Y - Q% •� Lu m w Q p 0 Q w ZO w cz �Q/i LL W w F � U O O R' 0 l� N 5 N i a pop N r, d� a) O 2 o o >; x Q cz 00 U _ cz cn U V) U a �G �-, ani �, O -WW w o `z o °J O W= � W O A a Q `�Lel cz U V W w (� +-' J_ -- w> LL. w W 0 0 N o N O N ai O a w D U N n M w z N O oA Nen . u LM u cco N a 3 o w C 3 £ co 3 o0 U. u v a a LL a u m A a� U d E « (n N O 00 U c_ E} `o E F- 7N � o a m a a vim@� 0 m aciw�a�Oj Co E 00 OIC 2}U 0z0 HF -U U ?U 0CLw Arnounts me be rounded SCHEDULE B - PART 1 Schedule B — Part 1 towholedollars. Statement covers period Loans Received CALIFORNIA 460 , ' 7/1/20 FORM from through 9/19/20 Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER COMMITTEE TO ELECT SAL MEDINA FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER ° OUTSTANDING AMOUNT c OUTSTANDING e INTEREST ORIGINAL 9 CUMULATIVE OF LENDER OCCUPATION AND EMPLOYER BALANCE RECEIVED THIS OR FOR IPAIDVEN 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 ❑ FORGIVEN PER ELECTION RATE S S f f f DATE DUE DATE INCURRED t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC PAID CALENDAR YEAR E ❑ FORGIVEN PER ELECTION- RATE f E f t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC E f DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR It S % f $ ❑ FORGIVEN PER ELECTION- RATE S E f E S DATE DUE DATE INCURRED t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTALS $ $ $ $ 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. (May be a negative number) 'Amounts forgiven or paid by another party also must be reported an Schedule A. If required. (Enter (e) on Schedule E, Line 3) tContributor 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 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule C Amounts may be rounded SCHEDULE C Nonmonetary Contributions Received Statement covers period CALIFORNIA I ' from 7/1/20 • through 9/19/20 Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER COMMITTEE TO ELECT SAL MEDINA DATE FULL NAME, STREET ADDRESS AND CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF AMOUNT/ CUMULATIVE TO DATE PER ELECTION RECEIVED ZIP CODE OF CONTRIBUTOR NUMBER) CODE • (IF SELF-EMPLOYED. ENTER GOODS OR SERVICES FAIR MARKET VALUE CALENDAR YEAR TO DATE (IF REQUIRED) (IF COMMITTEE,ALSO ENTER I.D. NAMEE OFF BUSINESS) (JAN 1 -DEC 31) ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑SCC ❑ IND ❑ COM ❑ OTH []PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY []SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 0 Schedule C Summary *Contributor Codes 1. Amount received this period — itemized nonmonetary.contributions.0 IND — Individual (Include all Schedule C subtotals. $ COM — Recipient Committee )...................................................................................................................... (other than PTY or SCC) 0 OTH — Other (e.g., business entity) 2. Amount received this period — unitemized nonmonetary contributions of less than $100 ..................................$ PTY—Political Party SCC — Small Contributor Committee 3. Total nonmonetary contributions received this period. 0 (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.).....................TOTAL $ FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Amounts may be rounded Payments Made to whole dollars. SEE INSTRUCTIONS ON REVERSE COMMITTEE TO ELECT SAL MEDINA covers from 7/1/20 through 9/19/20 I Page of CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/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, email) NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID OF COMMITTEE, ALSO ENTERLD. NUMBER) City of Claremont FIL Candidate Statement 800 207 Harvard Ave N, Claremont, CA 91711 Verafide Designs CMP Campaign logo, stickers, yard signs, tshirts 2328.83 310 N Indian Hill Blvd #414, Claremont, CA 91711 Political Data Inc, CMP Addresses for Mailer 271.04 PO Box 59570, Norwalk CA 90652 ' Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 3399.87 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.)............................................................................................................. $ 4870.44 2. Unitemized payments made this period of under $100.......................................................................................................................................... $ 775.98 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column(e).)............................................................................. $ o 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ........................... TOTAL $ 5646.42 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E (Continuation Sheet) Payments Made SEE INSTRUCTIONS ON REVERSE COMMITTEE TO ELECT SAL MEDINA Amounts may be rounded to whole dollars. 7/1/20 from covers SCHEDULE E (CONT.) through 9/19/20 I Page of I.D. NUMBER CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. 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 COMMRTEE,ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT I AMOUNT PAID Verafide Designs 310 N Indian Hill Blvd #414, Claremont, CA 91711 POS CMP Printing and Postage of Campaign Mailer 1350.56 FedEx 112 Harvard Ave, Claremont, CA 91711 CMP Printing Campaign Flyers 120.01 • Pavmontq that aro —trip, Binns nr independent emenditures must also be summarized on Schedule D. SUBTOTAL $ 1470.57 FPPC Form 460 Jan 2016 FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule F Amounts may be rounded Accrued Expenses (Unpaid Bills) to whole dollars. Statement covers period from 7/1/20 SCHEDULEF through 9/19/20 SEE INSTRUCTIONS ON REVERSE Page of NAME OF FILER I.D. NUMBER COMMITTEE TO ELECT SAL MEDINA CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. 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 Lv. 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 supportinglopposing 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 (internet, e-mail) NAME AND ADDRESS OF CREDITOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT (a) OUTSTANDING BALANCE BEGINNING OF THIS PERIOD (b) AMOUNT INCURRED THIS PERIOD (c) AMOUNT PAID THIS PERIOD (ALSO REPORT ON E) (d) OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD Payments that are contributions or independent expenditures must also be SUBTOTALS $ 0 $ 0 $ 0 $ 0 summarized on Schedule D. Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for 0 accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) ............................................INCURRED TOTALS $ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on 0 accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) .................................. PAID TOTALS $ 3. Net change this period. Subtract Line 2 from Line 1. Enter the difference here and 0 onthe Summary Page, Column A, Line 9.)................................................................................................................................................................................... NET $ May be a negative number FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov