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HomeMy Public PortalAbout01. Form 460 (Jan. 1- June 30, 2021)Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from 1/1/21 through 6/30/21 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. Z Officeholder, Candidate Controlled Committee 0 State Candidate Election Committee O Recall (Also Complete Part 5) ❑ General Purpose Committee O Sponsored 0 Small Contributor Committee O Political Party/Central Committee 3. Committee Information ❑ Primarily Formed Ballot Measure Committee O Controlled O Sponsored (Also Complete Part 6) ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) Im Committee to Elect Sal Medina GV tAc. %, L_ 20 21 C STREET ADDRESS (NO P.O. BOX) 257 E. Green St. CITY STATE ZIP CODE AREA CODE/PHONE Claremont CA 91711 6268330170 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/ E-MAIL ADDRESS Date Stamp CEIVE Date of election if applicable: (Month, Day, Year) NOV 2 9 2029 COVER PAGE Page _ of For Official Use Only November 3, 2020 1 CITY CLERK I - CITY OF CLAREMONT 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement © Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Lindsey Shiomi MAILINGADDRESS 3016 Knollwood Ave CITY STATE ZIP CODE AREA CODE/PHONE La Verne CA 91750 7145194085 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/ E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my 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 tru nd correct. �' Executed on 11/23/21 By Date Signature Of Tr urer or Assistant Treasurer _1 Executed on 11/23/21 By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officer of Sponsor Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE 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 ADDRESS STREETADDRESS (NO P.O. B CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURERrCONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (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 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 SUMMARY PAGE SummaPa a to whole dollars. Statement covers period - , g 1/1/21 • from SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Elect Sal Medina for City Council 2020 Expenditures Made 6. Payments Made................................................................ Schedule E, Line 4 $ 1,054.26 7. Loans Made....................................................................... Schedule H, Line 3 0 8. SUBTOTAL CASH PAYMENTS ....................................... Add Lines 6+7 $ 0 9. Accrued Expenses (Unpaid Bills Schedule F, Line 3 0 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 0 11. TOTAL EXPENDITURES MADE....................................Add Lines 8+9+1p $ 1,054.26 Current Cash Statement 12. Beginning Cash Balance ............................ Previous summary Page, Line 16 $ 1,582.07 13. Cash Receipts ........................................................... Column A, Line 3 above 250 14. Miscellaneous Increases to Cash .................................. Schedule 1, Line 4 493.57 15. Cash Payments......................................................... Column A, Line 8 above 1,054.26 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 1,271.38 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule s, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ through 6/30/21 Page -3 of 7_ Column B CALENDAR YEAR TOTAL TO DATE $ 250 0 $ 250 0 $ 250 $ 1,054.26 0 $ 0 0 0 $ 1,054.26 To calculate Column B, add amounts in Column Ato 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). I.D. NUMBER 143397 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 111 through 6/30 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates 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 Column A Contributions Received TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) 1. Monetary Contributions................................................... Schedule A, Line 3 $ 250 2. Loans Received................................................................ Schedule a, Line 3 0 3. SUBTOTAL CASH CONTRIBUTIONS .......................... Add Lines 1 +2 $ 250 0 4. Nonmonetary Contributions ............................................ Schedule C, Line 3 250 5. TOTAL CONTRIBUTIONS RECEIVED................................Add Lines 3+4 $ Expenditures Made 6. Payments Made................................................................ Schedule E, Line 4 $ 1,054.26 7. Loans Made....................................................................... Schedule H, Line 3 0 8. SUBTOTAL CASH PAYMENTS ....................................... Add Lines 6+7 $ 0 9. Accrued Expenses (Unpaid Bills Schedule F, Line 3 0 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 0 11. TOTAL EXPENDITURES MADE....................................Add Lines 8+9+1p $ 1,054.26 Current Cash Statement 12. Beginning Cash Balance ............................ Previous summary Page, Line 16 $ 1,582.07 13. Cash Receipts ........................................................... Column A, Line 3 above 250 14. Miscellaneous Increases to Cash .................................. Schedule 1, Line 4 493.57 15. Cash Payments......................................................... Column A, Line 8 above 1,054.26 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 1,271.38 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule s, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ through 6/30/21 Page -3 of 7_ Column B CALENDAR YEAR TOTAL TO DATE $ 250 0 $ 250 0 $ 250 $ 1,054.26 0 $ 0 0 0 $ 1,054.26 To calculate Column B, add amounts in Column Ato 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). I.D. NUMBER 143397 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 111 through 6/30 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates 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 Schedule A Amounts may be rounded SCHEDULE A Monetary Contributions Received to whole dollars. Statement covers period . - , 1 from 1/1/21 - � through 6/30/21 Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER- Committe to Elect Sal Medina 4;Y(�O d I.D. NUMBER 1433397 (tiC�n FULL NAME, STREET ADDRESS AND ZIP CODE OF IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR OCCUPATION AND EMPLOYER R RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 1/28/21 California Real Estate Political Action Committee ❑ IND 250.00 250.00 ❑ COM 515 S. Figueroa Stte. 1110 ❑ OTH Los Angeles, CA 90071 ❑ PTY ❑✓ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC El IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL$ 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.). $ 250.00 0 TOTAL $ 250.00 *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 Amounts may be rounded to whole dollars. Campaign to Elect Sal Medina Fo 2 G-t'T i C` -o u sC.111— 2 V 2� Statement covers period from 1/1/21 through 6/30/21 SCHEDULE E 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) Nationbuilder, PO Box 811428, Los Angeles, CA CA 90081 I WEB I Janaury 2021 invoice 195.00 Nationbuilder, PO Box 811428, Los Angeles, CA CA 90081 I WEB I February 2021 Invoice 195.00 Nationbuilder, PO Box 811428, Los Angeles, CA CA 90081 I WEB I March 2021 Invoice 195.00 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 285.00 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.) ........................... 1,054.26 ............ $ o.00 $ 0.00 TOTAL $ 1,054.26 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 Statement covers period 1/1/21 from through 6/30/21 SCHEDULE E (CONT.) Page of - NAME OF FILER I.D. NUMBER Committee to Elect Sal Medina P O 0- C I t I C v U jJGI' L Zo Z 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 (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Verafide Designs 310 Indian Hill Blvd #414, Claremont, CA 91711 CMP Campaign Mailer Designs (2/25/21 Invoice) 269.26 Verafide Designs 310 Indian Hill Blvd #414, Claremont, CA 91711 CMP Campaign Mailer Designs (3/1/21 Invoice) 500.00 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 769.26 FPPC Form 460 (Jan 2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov eclWe I A--+. mw he --A-A SCHEDULEI iscellaneous Increases to Cash to whole dollars. SEE INSTRUCTIONS ON REVERSE Statement covers period from 1/1/21 through 6/30/21 • . .1 • ' Page of NAME OF FILER Commitee to Elect Sal Medina v R c 7 ✓ L.� . e 11r 2 Z 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 4/2/21 City of Claremont 207 Harvard Ave. Claremont, CA Reimbursement for Election Fees 493.57 Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 493.57 c e u e ummary 1. Itemized increases to cash this period............................................................................................................................$ 493.57 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).) .. 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Line 14.) ............$ 0 TOTAL $ 493.57 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov