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Home My Public Portal About05. Form 460 (Jan. 1 - June 30, 2023).4 Recipient Committee Campaign Statement Co ve r Page SEE INSTRUCTIONS ON REVERSE Statement cov ers period from 1/1/23 through 6/30/23 Date of election if applicable: (Month, Day, Year) Nov. 8, 2024 K For Official Use Only CITY CLER CITY OF CLAREM ONT COVER PAGE 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. WI Officeholder, Candidate Controlled Committee O State Candidate Election Committee O Recall (Also Complete Part 5) ❑ General Purpose Committee O Sponsored O Small Contributor Committee O Political Party/Central Committee Primarily Formed Ballot Me asure Committee O Controlled O Sponsored (Also Complete Part 6) Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 2. Type of Statement: ❑ Preelection Statement ❑d Semi-annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) ❑ Quarterly Statement ❑ Speci al Odd -Year Report ; • 3. Committee Information I. D. NUMBER COMMITTEE NAM E (OR CANDIDATE'S NA ME IF NO COM MITTEE) Committee to Elect Sal Medin a for City Council 2024 STREET A DDRESS (NO P. O. BOX) 257 E. Green St. CITY STATE ZIP CODE AREA CODE/PHONE Claremont CA 91711 M AILING ADDRESS (IF DIFFERENT) NO. A ND STREET OR P.O. BOX 3016 Kn ollwoo d Av e. CITY STA TE 626-833-0170 ZIP CODE AREA CODE/PHONE OPTIONA L: FA X / E-M AIL ADDRESS Treasurer(s) NA ME OF TREASURER Lindsey Shiomi MAILING ADDRESS 3016 Kn ollwood A ve . CITY La Verne STATE ZIP CODE& •:-AREA CODEIPH0NF�. CA 9170 • '714-519-4085 . NAME OF ASSISTANT TREASURER, IF ANY • . MAILING ADDRESS CITY STATE ZIP CODE . ,—AIVEA CODE/PHONE , ye _ .. OPTIONAL: FAX / E- MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and rev ie wing this statement and to the best of my knowledge the information contained h erein and in th e attached schedul es is true and compl ete. • I. certify under penalty of perjury under the laws of the State of Califomia that the foregoing is ue and correct . . Exe cuted on 7/31/23 ., ic.4-t Date By Exe cuted on 7/31/23 By Date Executed on By Ex ec uted on By Date Date at o ' easureror AssistantTreasurer Signature o Controlling Officeh der, andidate, State Measure Proponent or Responsible Officer of Spons or Signature of Controlling Officeholder, Candidat e, St ate Measure Proponent Signature of Controlling Officeholder, Candidat e, State Measure Proponent FPPC Form 460 (Jan/2016)) .. FPPC Advice: advice@fppc.ca:gov (866/275-3772) www.fppc.ca .g ov ewe COVER PAGE - PART 2 Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeho lder or Candidate Contro lled Co mmittee 6. Primarily Fo rmed Ballo t M easure Committee NAME OF OFFICEHOLDER OR CANDIDATE Sal Medina OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Claremont City Co uncil, D istrict 5 NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT ❑ OPPOSE RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP Identify the controllin g offic eholder, candidate, or state rneasure.pr oponent, if any. • . _ ' 257 E. Green St. Claremo nt CA 91711 Related Committees No t Included in this Statement: List an y committees n ot included in this statement that are controlled by you or are primarily formed to receiv e contributions or make expenditures on behalf of you r 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 TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMM ITTEE ADDRESS STREET ADDRESS (NO P. O. BOX) CITY STATE ZIP CO DE AREA CODE/PHONE NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT • OFFICE SOUGHT OR HELD DISTRICT NO. IF. ANY • 7. Primarily Formed Candidate/Officeholder Committee List names of, o fficeholder(s) or candidate(s) for whi ch thi s committ ee fs primarily f ormed'_. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ° SUPPORT II OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE S OUGHT OR.HELD - • . '• •'. .c ®.SUPPORT . .• MI opPosff NA ME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR4IELD . • • SUPPORT • OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE S OUGHT OR HELD ° • SUPPORT OPPOSE .• Att ach continuati on sheets if n ecessa ry FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc:ca.gov (866/275-3772) www.fppc .ca .gov Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE Amounts may be rounded to who le do llars. Statement covers period from 1/1/23 through 6/30/23 SUMMARY PAGE Page v of NAME OF FILER Committee to Elect Sal Medina for City Cou ncil 2024 I.D. NUMBER 143397 Contributions Received 1. M onetary Contributions 2. Loans Received 3. SUBTOTAL CASH CONTRIBUTIONS 4. Nonmonetary Contributions 5. TOTAL CONTRIBUTIONS RECEIVED Schedule A, Line 3 Schedu le B, Lin e 3 Add Lines 1 + 2 Schedule C, Line 3 Add Lines 3 + 4 Column A TOTAL THIS PERIOD (FROM ATTA CHED SCHEDULES) Column B CALENDAR YEAR TO TAL TO DATE 150. 00 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 20. Contributions Received $ 1/1'througth 6/30 • 7/1 to Date 21. Expenditures Made $ • ' Ex penditures Made 6. Payments Made Schedule E, Line 4 7. Loans Made Sche dule H, Lin e 3 8. SUBTO TAL CASH PAYMENTS AddLines6+ 7 9. Accrued Expenses (Unpaid Bills) Schedu le F, Line 3 10. Nonmonetary Adjustment Schedu le C, Line 3 11. TOTAL EXPENDITURES MADE Add Lines 8 + 9 + 10 $ iso.- 150. 00 $ $ Current Cash Statement 12. Beginning Cash Balance 13. Cash Receipts 14. M iscellaneous Increases to Cash 15. Cash Payments 16. ENDING CASH BALANCE Add Lines 12 + 13 + 14, then subtract Line 15 If this is a termination statement, Line 16 must be zero. Previous Summary Page, Line 16 Column A, Line 3 above Schedule 1, Line 4 Column A, Line 8 above 150._ $ 1071.38 1221.38 17. LOAN GUARANTEES RECEIVED Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents See instructi ons on r ever se $ 19. Outstanding Debts Add Line 2 + Line 9 in Column B abo ve $ 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 subtr acted from previous period amounts. If this is th e first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any) . Expenditure Limit Summary for State Candidates 22. Cumulative Expenditure s Made *. . ' (If Subject to V ol unt ary •Expenditure Lintit) .a,.x' i. Date of Election - •.Total to Dat e . - •' (mm/dd/yy) FPP.0 Form 460 (Jan/2016)) FPPC Ad vice: ad vice@fppc .ca .gov (866/275-3772) www.fppc.ca:gov Sche dule E Payments M ade SEE INSTRUCTIONS ON REVERSE NAME OF FILER Amo unts may be ro un ded to whole dollars. State ment cov ers period from 1/1/23 through 6/30/23 Co mmittee to Elect Sal Medina for City Coun cil 2024 CODES: If one of the following codes accurately describes the CMP CNS CTB CVC FIL FND IND LEG LIT campaign paraphernalia/misc. campaign consultants contribution (explain nonmonetary)* civic donations candidate filing/ballot fees fundraising events independent expenditure supporting/opposing others (explain)* legal defense campaign literature and mailings MBR MTG OFC PET PHO POL POS PRO PRT payment, you may enter the code. Otherwise, describe the payment. member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and me sse nger services professional services (legal, accounting) print ads RAD RFD SAL TEL TRC TRS TSF VOT WEB SCHEDULE E radio airtime and production costs returned contributions ` . campaign workers' salaries t.v. or cable airtime and production costs candidate travel, lodging, and meals staff/spouse travel, lodging, and meals. ' transfer between committees of the same candidate/sponsor voter registration • • - information techn ology. costs (4nternet, e-mail) . NAME AND ADDRESS OF PAYEE (IF CO MMITTEE. ALSO ENTER I.D. NUM BER) CODE OR DESCRIPTION OF PAYMENT • AMOUNT PAID SOS POLITICAL Fee FIL State Campaign Filing Fee * * Payme nts 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 .) T OTAL $ 150 .00 FPPC Form •460 (Jan/2016)) FPPC Advice: advice @fppc.ca.gov (866/275-3772) www.fppc .ca .gov