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Home My Public Portal AboutForm 460 (Sept. 20 - Oct. 17, 2020)Recipient Committee Caimpaigrn ;Statement Cover Page Statement covers period from -9/20/20 SEE INSTRUCTIONS ON REVERSE I through 10/1.7/20 1. Type -of Recipient Committee: All CorFimittees— Complete: Parts1, 2,' 3, -and 4. 1 Off ceholder,,.Candidate Controlled.Carnmittee ❑ Primarily Formed Ballot Measure. 0 State Candidate,,Election<Committee Committee O RecallQ Controlled A_� c«rpr_.e pads 8 Sp nsored ❑ General Purpose Committee O Sponsored 8 Small Contributor Committee Political Party/Central Committee 3. Committee Information COMMITTEE NAME (OR -CANDIDATES f Comniittee;to Elect Sal Medina ❑ Primarily Formed Candidate/ Officeholder Committee ifc_? C -sNfeta Part 7,; in COMMITTEE) STREET:ADDRESS (NO P.O. BOX) 257 E Green St CITY STATE ZIP CODE .AREA£ODE/PHONE Claremont _ CA. 91711 "6268330170. MAILING ADDRESS (IF`DIFFERENT)'NO. AND STREET OR P.O. BOX ` 3016 Knollwood:Aye CITY STATE ZIP CODE AREA ,COMPHONE OPTIONAL: FAX'! E-MAIL ADDRESS COVER PAGE O C T C 2 2020 Date of election if applicable: Page, of - — (Month,.bay,Year) MY r�Fi ERRpp�a Fc (.idalUse Oniy -ITY OF �•L EM()NT November;:; 3, 2020: 2. Type of:Statementt z Preelection Statement ❑ Ouai erly Statement ❑ Semi-annual Statement ❑Special Odd=Year Report .❑ 1pirmination'Statement (Also flea Form 410 Termination) ❑ Amendment (Explain belotiv)' Treas u re r(s) NAtlE OF -TREASURER )✓in&ey Shi.omi MAILING ADDRESS 3016 Kn'ollwood •Ave. 77 CITY" STATE ZIP CODE AREACODE;PHCNF. La Verne CA 91750 7145194085 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS :CITY STATE ZIP CODE AREACOD&PHONE OPTIONAL' F.AX;&..14AILADDRESS 4. Verification I have used all reasonable diligence in prepaniig:and revi6wing this statement and to the best of my knowledge the information conlained lier6in and in theattachpd schedules is true and COMP1ete: I certify under penalty of perjury under thetawsof the State of California that the foregcing.ls tru sand correct. 10/22/20 �- 11 i Z s�. , Executed on u By Executed on 10/22/20 Date Executed an Executed on By rM By FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppC.Ca.gav 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: Listany 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 CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURERI CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COVER PAGE - PART 2 Page of 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTERI JURISDICTION I ElSUPPORT ❑ 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 Listnames 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 Amounts may of rounded to whole dollars. Summary Page Statement covers period from 9/20/20 SUMMARY PAGE Expenditures Made 6. Payments Made................................................................ Schedule E, Line 4 $ 3386.86 7. Loans Made....................................................................... Schedule H, Line 3 0 8. SUBTOTAL CASH PAYMENTS ....................................... Add Lines 6+7 $ 3386.86 9. Accrued Expenses (Unpaid Bills ........................ Schedule F Line 3 0 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 0 11. TOTAL EXPENDITURES MADE....................................Add Lines a+9+10 $ 3386.86 Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 4428.58 13. Cash Receipts........................................................... Column A, Line 3 above 1048 14. Miscellaneous Increases to Cash .................................. Schedule 1, Line 4 0 15. Cash Payments......................................................... Column A, Line a above 3386.86 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 2089.72 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule 8, Part 2 $ 0 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 0 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column a above $ 0 $ 9033.28 0 $ 9033.28 0 0 $ 9033.28 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 .andidates 22. Cumulative Expenditures Made` (If Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) _ I $ 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 through 10/17/20 Page of SEE INSTRUCTIONS ON REVERSE I.D. NUMBER NAME OF FILER COMMITTEE TO ELECT SAL MEDINA 1433397 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTAL THIS PERIOD CALENDAR YEAR Running in Both the State Primary and (FROM ATTACHED SCHEDULES) TOTAL TO DATE General Elections 1048 $ 11123 1. Monetary Contributions................................................... Schedule A, Line 3 $ 1/1 through 6/30 7/1 to Date 0 0 2. Loans Received................................................................ Schedule e, Line 3 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 +2 $ 1048 $ 11123 Received $ $ 4. Nonmonetary Contributions ............................................ Schedule C, Line 3 0 0 21. Expenditures 1048 11123 Made $ $ 5. TOTAL CONTRIBUTIONS RECEIVED................................Add Lines 3+4 $ $ Expenditures Made 6. Payments Made................................................................ Schedule E, Line 4 $ 3386.86 7. Loans Made....................................................................... Schedule H, Line 3 0 8. SUBTOTAL CASH PAYMENTS ....................................... Add Lines 6+7 $ 3386.86 9. Accrued Expenses (Unpaid Bills ........................ Schedule F Line 3 0 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 0 11. TOTAL EXPENDITURES MADE....................................Add Lines a+9+10 $ 3386.86 Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 4428.58 13. Cash Receipts........................................................... Column A, Line 3 above 1048 14. Miscellaneous Increases to Cash .................................. Schedule 1, Line 4 0 15. Cash Payments......................................................... Column A, Line a above 3386.86 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 2089.72 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule 8, Part 2 $ 0 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 0 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column a above $ 0 $ 9033.28 0 $ 9033.28 0 0 $ 9033.28 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 .andidates 22. Cumulative Expenditures Made` (If Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) _ I $ 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 Cr-hnrli lln A Amounts may be rounded SCHEDULE A VV 11VM- r- to whole dollars. Monetary Contributions Received Statement covers period CALIFORNIA .1 from 9/20/20FORM • - through 10/17/20 Page of SEE INSTRUCTIONS ON REVERSE I.D. NUMBER NAME OF FILER COMMITTEE TO ELECT SAL MEDINA 1433397 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) Z INDEl 10/11/20 Philip Garcia COM Retired 150 200 2131 E 1st St, #303 ❑ OTH Long Beach, CA 90803 ❑ PTY ❑ SCC W] IND 10/3/20 Alfonso T Villanueva ❑ COM Retired 100 200 1411 N Cambridge Ave ❑ OTH Claremont, CA 91711 ❑ PTY ❑ SCC D INDEl 10/1/20 Ben Wirick COM Development, Altamed 250 250 495 Notre Dame Rd ❑ OTH Health Services Claremont, CA 91711 ❑ PTY ❑ SCC m INDEl 10/1/20 Eduardo Rivas COM Business Affairs Executive, 100 100 611 S Indian Hill Blvd D ❑ OTH Warner Bros Studio Claremont, CA 91711 ❑ PTY ❑ SCC ®IND 9/23/20 Damien Alarcon El COM Sales, Lifesource Water 200 250 413 S. Angeleno Ave ❑ OTH Systems Azusa, CA 91702 ❑ PTY ❑ SCC SUBTOTAL $ 800 Schedule A Summary Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.).........................................................................................................$ 800 2. Amount received this period — unitemized monetary contributions of less than $100 ...........................$ 248 3. Total monetary contributions received this period. 1048 (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) www.fppc.ca.gov Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULE (CONT.) Monetary Contributions Received to whole dollars. Statement covers period CALIFORNIA , ' from 9/20/20FORM through 10/17/20 Page of NAME OF FILER I.D. NUMBER COMMITTEE TO ELECT SAL MEDINA 1433397 FULL NAME, STREET ADDRESS AND ZIP CODE OF IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR CONTRIBUTOR *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. 1 -DEC. 31) (IF REQUIRED) ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY SCC SUBTOTAL $ *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 B - PART 1 Amounts may De rummeu Schedule B — Part 1 to whole dollars. Statement covers period CALIFORNIA ' Loans Received from 9/20/20 FORM Page of through 10/17/20 SEE INSTRUCTIONS ON REVERSE I.D. NUMBER NAME OF FILER COMMITTEE TO ELECT SAL MEDINA 1433397 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING INTEREST ORIGINAL CUMULATIVE OF LENDER OCCUPATION AND EMPLOYER BALANCE RECEIVED THIS OR FORGIVEN BALANCE AT PAID THIS AMOUNT OF CONTRIBUTIONS (IF SELF-EMPLOYED, ENTER BEGINNING THIS PERIOD THIS PERIOD: CLOSE OF THIS PERIOD LOAN TO DATE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAME OF BUSINESS) PERIOD PERIOD ❑ PAID CALENDAR YEAR RATE ❑ FORGIVEN PER ELECTION $ $ $ $ $ DATE DUE DATE INCURRED t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC PAID CALENDAR YEAR ❑ FORGIVEN PER ELECTION" RATE $ g $ $ DATE DUE DATE INCURRED t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC $ ❑ PAID CALENDAR YEAR ❑ FORGIVEN PER ELECTION" RATE $ $ $ $ $ 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 $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 3. Net change this period. (Subtract Line 2 from Line 1.) .................................................... Enter the net here and on the Summary Page, Column A, Line 2. —`Amounts forgiven or paid by another party also must be reported on Schedule A. If required. .................$ ....... NET $ (May be a negative number) (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 B - PART 2 Schedule B — Part 2 Amounts may be rounded to dollars. Statement covers period CALIFORNIA , whole Loan Guarantors 9/20/20 • ' from throu g h 10/17/20 Page of SEE INSTRUCTIONS ON REVERSE I.D. NUMBER NAME OF FILER COMMITTEE TO ELECT SAL MEDINA 1433397 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER LOAN AMOUNT GUARANTEED CUMULATIVE BALANCE OUTSTANDING CONTRIBUTOR CODE* (IF SELF-EMPLOYED, ENTER THIS PERIOD TO DATE TO DATE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAME OF BUSINESS) LENDER CALENDAR YEAR F1 IND ❑ COM $ ❑ OTH DATE PER ELECTION ❑ PTY (IF REQUIRED) ❑ SCC s LENDER CALENDAR YEAR ❑IND ❑ COM 3 ❑ OTH DATE PER ELECTION ❑ PTY (IF REQUIRED) ❑ SCC s CALENDAR YEAR LENDER ❑ IND $ ❑ COM ❑ OTH PER ELECTION DATE (IF REQUIRED) ❑ PTY ❑ SCC s LENDER CALENDAR YEAR ❑ IND ❑ COM $ ❑ OTH PER ELECTION ❑ PTY DATE (IF REQUIRED) ❑ SCC s Enter on SUBTOTAL $ 0 Summary Page, vq� p m s ' Line 17 only. _.•; 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 to wnoie sonars. Statement covers period CALIFORNiA from 9/20/20 .1 FORM through 10/17/20 Page of SEE INSTRUCTIONS ON REVERSE VAME OF FILER I.D. NUMBER COMMITTEE TO ELECT SAL MEDINA 1433397 DATE FULL NAME, STREET ADDRESS AND CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF AMOUNT/ FAIR MARKET CUMULATIVE TO DATE PER ELECTION TO DATE RECEIVED ZIP CODE OF CONTRIBUTOR * CODE (IF SELF-EMPLOYED, ENTER GOODS OR SERVICES VALUE CALENDAR YEAR (IF REQUIRED) (IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAME OF 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. SUBTOTALS 0 = v' Schedule C Summary Amount received this period — itemized nonmonetary contributions. (Include all Schedule C subtotals.)......................................................................................................................$ 0 2. Amount received this period — unitemized nonmonetary contributions of less than $100 ..................................$ _ 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 $ — *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 D SCHEDULED Summary of Expenditures Amounts may be rounded Statement covers period CALIFO_NIA to whole dollars. I • , Supporting/Opposing Other 9/20/20 • - Candidates, Measures and Committees from through 10/17/20 Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER COMMITTEE TO ELECT SAL MEDINA 1433397 NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR DESCRIPTION AMOUNT THIS CUMULATIVE TO DATE PER ELECTION DATE MEASURE NUMBER OR LETTER AND JURISDICTION, TYPE OF PAYMENT PERIOD CALENDAR YEAR TO DATE OR COMMITTEE (IF REQUIRED) (JAN. 1 -DEC. 31) (IF REQUIRED) ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent support O p ose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent Support O ose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure SUBTOTAL $ 0 Schedule D Summary 1. Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.)....................................................... $ 2. Unitemized contributions and independent expenditures made this period of under $100.................................................................................... $ 0 3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enter on the Summary Page.) .......... TOTAL.. $ FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule D (Continuation Sheetl Amounts may be rounded SCHEDULE D (CONT.) Summary of Expenditures to whole dollars. Statement covers period CALIFORNIA I 60 Supporting/Opposing Other 9/ao/ao from . - Candidates, Measures and Committees through 10/17/20 page of NAME OF FILER I.D. NUMBER COMMITTEE TO ELECT SAL MEDINA 1433397 NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR DESCRIPTION AMOUNT THIS CUMULATIVE TO DATE PER ELECTION DATE MEASURE NUMBER OR LETTER AND JURISDICTION, TYPE OF PAYMENT (IF REQUIRED) PERIOD CALENDAR YEAR TO DATE OR COMMITTEE (JAN. 1 - DEC. 31) (IF REQUIRED) ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure SUBTOTAL $ 0 r' FPPC Form 460 (Jan/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 SAL MEDINA Amounts may be rounded to whole dollars. SCHEDULE E Statement covers period from 9/20/20 through 10/17/20 I Page of 1433397 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 (internet, e-mail) NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Verafide DesignsI CMP I Design Costs for Fliers I 150 310 N Indian Hill Blvd #414, Claremont, CA 91711 Agent Booster Videos CMP Campaign Video 800 2120 S State College Blvd. #2033 A-_L_:� �A nen Printing Works I CMP I Printing Campaign Fliers and Postage I 1554.48 679 E Foothill Blvd O I POL n ____ ! A �1"l/"9 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 2504.48 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.) ................. 2624.49 762.37 ....................... $ 0 .......... TOTAL $ 3386.86 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Amounts may be rounded (Continuation Sheet) to whole dollars. Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER COMMITTEE TO ELECT SAL MEDINA Statement covers period 9/20/20 from SCHEDULE E (CONT.) through 10/17/20 Page of I.D. NUMBER 1433397 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 FIND 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 (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID FedEx 112 Harvard Ave, Claremont, CA 91711 CMP Printing and Postage of Campaign Mailer 120.01 " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 120.01 FPPC Form 460 (Jan 2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule F Accrued Expenses (Unpaid Bills) SEE INST r1N RFVFRSF NAME OF FILER COMMITTEE TO ELECT SAL MEDINA Amounts may be rounded to whole dollars. Statement covers period from 9/20/20 through 10/17/20 SCHEDULEF Page of I.D. NUMBER 1433397 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 FIND 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 (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 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 on the 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 Schedule F (Continuation Sheet) Accrued Expenses (Unpaid Bills) Amounts may be rounded to whole dollars. Statement covers period from 9/20/20 SCHEDULE F (CONT.) NAME AND ADDRESS OF CREDITOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT (a) OUTSTANDING BALANCE BEGINNING OF THIS PERIOD through 10/17/20 Page of NAME OF FILER I.D. NUMBER COMMITTEE TO ELECT SAL MEDINA 1433397 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 (internet, e-mail) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. 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 SUBTOTALS $ 0 $ 0 $ 0 $ 0 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule G SCHEDULE G Payments Made by an Agent or Independent Amounts may be rounded Statement covers period _ , • ' Contractor (on Behalf of This Committee) to whole dollars. from 9/20/20 ..ITI through 10/17/20 pa a of 9 SEE INSTRUCTIONS ON REVERSE I.D. NUMBER NAME OF FILER COMMITTEE TO ELECT SAL MEDINA 1433397 NAME OF AGENT OR INDEPENDENT CONTRACTOR 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, e-mail) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Attach additional information on appropriately labeled continuation sheets. TOTAL* $ 0 * Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or FPPC form 460 (Jan/2016)) independent contractor as reported on Schedule 5-3772 E. FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULE H Schedule H Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 9/20/20 • Loans Made to Others* from FORM 10/17/20 through Page of SEE INSTRUCTIONS ON REVERSE I.D. NUMBER NAME OF FILER COMMITTEE TO ELECT SAL MEDINA 1433397 FULL NAME, STREET ADDRESS AND ZIP CODE ENTER IF AN INDIVIDUAL ENTER OCCUPATION AND E (a) OUTSTANDING ) AMOUNT ° REPAYMENT OR OUTSTANDING e INTEREST (f) ORIGINAL 9 CUMULATIVE OF RECIPIENT (IF SELF-EMPLOYED, ENTER BALANCEBALANCE BEGINNING THIS LOANED THIS FORGIVENESS AT CLOSE OF THIS RECEIVED AMOUNT OF LOAN LOANS TO DATE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAME OF BUSINESS) PERIOD THIS PERIOD' ❑ PAID CALENDAR YEAR RATE ❑ FORGIVEN PER ELECTION" S S S S S DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR ❑ FORGIVEN PER ELECTION„` RATE s s $ s s DATE INCURRED DATE DUE "Loans that are contributions to another candidate or committee must also be summarized on Schedule D. Loans forgiven must also be $ $ reported on Schedule E. SUBTOTALS $$ (Enter (e) on Schedule I, Line 3) Schedule H Summary Loansmade this period....................................................................................................................................................$ (Total Column (b) plus unitemized loans of less than $100.) 2. Payments received on loans......................................................................... (Total Column (c) plus unitemized payments of less than $100.) 3. Net change this period. (Subtract Line 2 from Line 1.) .................................. (Enter the net here and on the Summary Page, Column A, Line 7.) ................................................................$ ...................................................... NET $ *'If Required (May be a negative number) FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov e•_L_A..�.. 1 SCHEDULEI ✓V..VMM.V . f1111V YIIW Py v uuv..r Miscellaneous Increases to Cash to whole dollars. SEE INSTRUCTIONS ON REVERSE Statement covers period from 9/20/20 through 10/17/20 CALIFORNIA , ' • FORM page of NAME OF FILER COMMITTEE TO ELECT SAL MEDINA I.D. NUMBER 1433397 DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF COMMITTEE. ALSO ENTER I.D. NUMBER) DESCRIPTION OF RECEIPT AMOUNT OF INCREASE TO CASH Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 1. Itemized increases to cash this period............................................................................................................................$ o 2. Unitemized increases to cash of under $100 this period.................................................................................................$ 0 3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).) .......................................$ 0 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the 0 SummaryPage, Line 14.)............................................................................................................................. TOTAL $ — FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov