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Home My Public Portal AboutForm 460 Amendment (July 1 - Sept. 19, 2020)Recipient Committee Campaign Statement Cover Page 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. (� Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also Complete Part 5) 0 Sponsored (Also Complete Part 6) ❑ General Purpose Committee 0 Sponsored ❑ Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1424182 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Nicole Wirick for Claremont City Council 2020 STREET ADDRESS (NO P.O. BOX) 495 Notre Dame Rd CITY STATE ZIP CODE AREACODE/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 Date Stamp CCT ? 2%20 COVER PAGE Page 1 of 7 For Official Use Only 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement ❑ Semi-annual Statement ❑ Special Odd -Year Report ® Termination Statement (Also file a Form 410 Termination) W1 Amendment (Explain below) Correcting a total on Page 3, Column A, Line 11. The orieinal was filed on 9/19/20. Treasurer(s) NAME OF TREASURER Jim Keith MAILINGADDRESS 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 ;2!!� Executed on 10/26/20 By Dale Sigrlature of Treasurer or Assistant Treasurer Executed on 10/26/20 Date Executed on Date Executed on Date BY or By Signature of Controlling Officeholder, Candidate, Slate 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 5. 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 RESIDENTIAL/BUSINESS ADDRESS (NO.ANDSTREET) 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 NAME OF TREASURER I.D. NUMBER ❑ YES ❑ NO MITTEEADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURERI CONTROLLED COMMITTEE? ❑ YES ❑ NO ESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE COVER PAGE - PART 2 Page 2 of 7 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 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 be rounded to whole dollars. Summary Page Statement covers period from 7/1/20 SUMMARY PAGE Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 1,079 13. Cash Receipts........................................................... Column A, Line 3 above -414 14. Miscellaneous Increases to Cash .................................. schedule /, Line 4 none 15. Cash Payments......................................................... Column A, Line 8 above 665 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 0 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ schedule e, Part 2 $ none I Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ none $ none 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). `Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 ()an/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov through 9/19/20 Page 3 of 7 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Nicole Wirick for Claremont City Council 2020 1424182 Column A Column B Calendar Year Summary for Candidates Contributions Received (FROM TOTALTHIS PERIOD ATTACHED SCHEDULES) CALENDAR YEAR TOTAL TO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions................................................... schedule A, Line 3 $ 250 $ 1,700 111 through 6/30 7/1 to Date 2. Loans Received................................................................ Schedule a, Line 3 -664 0 -414 1,700 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2 $ $ Received $ $ 59 327 4. Nonmonetary Contributions ............................................ schedule c, Line 3 21, Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED..:? ............................Add Lines 3+4 $ -355 $ 2,027 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made................................................................ Schedule E, Line 4 $ 665 $ 1,700 Candidates 7. Loans Made....................................................................... schedule H, Line 3 none none 665$ 1,700 i 22. Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS ....................................... Add Lines 6+7 $ (if Subject tVoluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F Line 3 none none Date of Election Total to Date 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 59 327 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE .................................... Add Lines 8+9+ 10 $ 724 $ 2,027 J $ Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 1,079 13. Cash Receipts........................................................... Column A, Line 3 above -414 14. Miscellaneous Increases to Cash .................................. schedule /, Line 4 none 15. Cash Payments......................................................... Column A, Line 8 above 665 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 0 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ schedule e, Part 2 $ none I Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ none $ none 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). `Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 ()an/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A Amounts may be rounded SCHEDULE A to wnoie aoiiars. Monetary Contributions Received Statement covers period • , � from 7/1/20 � � through 9/19/20 4 of 7 Page 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 7/8/20 Mac McLoughlin El COM Consultant $250 $250 2074 Gatun St. ❑ OTH No separate business name Del Mar, CA 92014 ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL $ 250? ti ,- 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.). 250 ................... $ $ none *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 $ 250 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Amounts ma be rounded SCHEDULE B - PART 1 Schedule B — Part 'I to whole dollars. Statement covers period CALIFORNIA Loans Received460 from 7/1/20 FORM Page 5 of 7 through 9/19/20 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Nicole Wirick for Claremont City Council 2020 1424182 FULL NAME, STREETADDRESS 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 COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER BEGINNING THIS PERIOD THISPERIOD- CLOPERIOD HIS PERIOD LOAN TO DATE NAME OF BUSINESS) PERIOD ® PAID CALENDAR YEAR Nicole Wirick Deputy Public Defender $ 664 $ None $ 664 $ 664 495 Notre Dame Rd County of San Bernardino RATE ❑ FORGIVEN PER ELECTION Claremont, CA 91711 664 $ None $ $ p 11/3/20 $ 0 1/6/20 664 $ DATE DUE DATE INCURRED t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ PAID CALENDAR YEAR $ $ % $ $ RATE ❑ FORGIVEN PER ELECTION" t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR ❑ FORGIVEN PER ELECTION" RATE DATE DUE DATE INCURRED t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTALS $ None $ 664 $ None $ 0z to errsG' " 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. el 'Amounts forgiven or paid by another party also must be reported on Schedule A. `" If required. $ None ........................... $ NET $ 664 -664 (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 C Amounts may be rounded SCHEDULE C Nonmonetary Contributions Received to whole dollars. Statement covers period CALI • - , from 7/1/20 , FbRM "'Wr60 Page 6 of 7 through 9/19/20 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Nicole Wirick for Claremont City Council 2020 1424182 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. 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. SUBTOTAL $ None f x; Schedule C Summary Amount received this period — itemized nonmonetary contributions. (Include all Schedule C subtotals.)..................................................... 2. Amount received this period — unitemized nonmonetary contributions of less than $100 3. Total nonmonetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) TOTAL $ None 59 59 *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 E Payments Made SEE INSTRUCTIONS ON REVERSE Nicole Wirick for Claremont City Council 2020 Amounts may be rounded to whole dollars. Statement covers period from 7/1/20 through 9/19/20 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. SCHEDULE E ;ALIFUKNIA 460 FORM I.D. NUMBER 1424182 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) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. 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.). SUBTOTAL $ None $ None 665 $ None .................. TOTAL $ 665 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov