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460 Pena 2020 from 07/01 to 12/31COVER PAGE Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from 7/1/2020 through 12/31/2020 1. Type of Recipient Committee: All Committees —Complete Parts 1, 2, 3, and 4. 8ff miceholder, Candidate Controlled Committee ElPrimarily Formed Ballot Measure State Candidate Election Committee O Recall ommittee Controlled (Also Complete Part 5) (((�� Sponsored (Also Complete Pad 6) ❑ General Purpose Committee O Sponsored O Small Contributor Committee O Political Party/Central Committee ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Pad 7) 3. Committee Information I.D. NUMBER 1370057 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) COMMITTEE TO ELECT JOHN PENA CITY COUNCIL 2018 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE LA QUINTA CA 92253 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREACODE/PHONE LA QUINTA CA 92253 OPTIONAL: FAX / E-MAIL ADDRESS 4. Verification Date Stamp MCEIVED Date of election if applicable: age % of 5 (Month, Day, Year) FEB U 12021 For Official Use Only CITY OF LA QUINTA CITY CLERK DCPARTMF 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement m Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER ANDREA OLIVER-GILMORE MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE LA QUINTA CA 92253 NAME OF ASSISTANT TREASURER, IF ANY SHERRY LOVE-PENA MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE LA QUINTA CA 92253 OPTIONAL: FAX/E-MAIL ADDRESS have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the infom"M. contained herein and in tpt3 attached ales is true and complete certify under penalty of perjury under the laws of the State of California that the foregoing Is true a corn ct. / Executed on VSi' 202 By r lip 7 r� Sig o ur or s sWrit Treasurer Executed on k'�L! WZ I By 114 'A pate Signature of Cuntroliing Officeh PJ der, te. SRI M sure rtant or 12sspon5lh a Officer of Sponsor Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on Date By Signature of Controlling Officeholder. Candidate, State Measure Proponent FPPC Form 496 (Feb/2019) 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 JOHN PENA OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) CITY COUNCIL CITY OF LA QUINTA RESIDENTIALIBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP LA QUINTA CA 92253 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 AREACODEIPHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO R0. BOX) CITY STATE ZIP CODE AREACODEIPHONE COVER PAGE - PART 2 1 Page L of 5 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT I i ❑ 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 officeholders) 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 7/1/2020 SUMMARY PAGE SEE INSTRUCTIONS ON REVERSE through 12/31/2020 Page 3 of Jr NAME OF FILER I.D. NUMBER COMMITTEE TO ELECT JOHN PENA CITY COUNCIL 2018 1370057 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 1. Monetary Contributions................................................... Schedule A, Linea $ 0 $ 12093 1/1 through 6/30 7/1 to Date 0 750 2. Loans Received................................................................ Schedule B, Line 3 0 12843 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2 $ $ Received $ $ 0 6290 4. Nonmonetary Contributions ............................................ Schedule C, Line 3 21. Expenditures 0 19133 Made $ $ 5. TOTAL CONTRIBUTIONS RECEIVED................................Add Lines 3+4 $ $ Expenditures Made 6. Payments Made................................................................ Schedule E, Line 4 $ 0 $ 12073 7. Loans Made....................................................................... Schedule H, Line 3 0 0 8. SUBTOTAL CASH PAYMENTS ....................................... Add Lines 6+7 $ 0 $ 12073 9. Accrued Expenses (Unpaid Bills) .......................................... schedule F Line 3 0 0 10. Nonmonetary Adjustment......................................................... schedule C, Line 3 0 0 11. TOTAL EXPENDITURES MADE....................................Add Lines 8+9+10 $ 0 $ 12073 Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 209 13. Cash Receipts ......... ............... ».. Column A, Line 3 above 0 14. Miscellaneous Increases to Cash .................................. Schedule 1, Line 4 0 15. Cash Payments......................................................... Column A, Line 8 above 146 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 63 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule B, Part $ 750 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 0 19. Outstanding Debts... ........................... Add Line 2 + Line 9 in Column B above $ 750 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). 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) *Amounts in this section may be different from amounts reported in Column B. FPPC Form 496 (Feb/2019) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov .AsA SCHEDULE B - PART 1 Schedule B — Part 1 ""'�""'" '"' "" " to whole dollars. Statement covers period Loans Received from 7/1/2020 . - through 12/31/2020 Page 4' of 5 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER COMMITTEE TO ELECT JOHN PENA CITY COUNCIL 2018 1370057 FULL NAME, STREETADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER a OUTSTANDING (b) AMOUNT ° AMOUNT PAID OUTSTANDING e► INTEREST ORIGINAL ¢ CUMULATIVE OF LENDER 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- EOFTHIS CLOPER PERIOD LOAN TO DATE NAME OF BUSINESS) PERIOD OD [3 PAID CA N AR YEAR JOHN PENA JOHN PENA ASSOC s 750 � $ 750 750 51405 LA QUINTA, CA 92253 ❑ FORGIVEN RATE PER ELECTIaNt* $ 750 $ 0 $ 12/31/21 $ 9/2018 $ 750 t ® IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED PAID CALIENDAR YEAR ❑ FORGIVEN PER ELECTION" RATE $ $ $ $ DATE DUE t ❑ IND ❑ COM ❑ OTH El PTY ❑SCC $ DATE INCURRED ❑ PAID CALENDARYEAR ❑ FORGIVEN PER ELECTION- RATE $ S S $ $ t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED SUBTOTALS $ $ $ $ 71 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. *Amounts forgiven or paid by another party also must be reported on Schedule A. *" If required. 750 (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 496(Feb/2019) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE COMMITTEE TO ELECT JOHN PENA CITY COUNCIL 2018 Amounts may be rounded to whole dollars. Statement covers period from 7/4/2020 through 12/31/2020 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. SCHEDULE E Page 5_ of 5 1370057 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 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) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.)............................................................................................................. $ 2. Unitemized payments made this period of under$100........... ........... .......................................................................--......................................... $ 146 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.)........................... TOTAL $ 146 FPPC Form 496(Feb/2019) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov