700 Radi 2015 from 01/01 to 12/31QLIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
A PUBLIC DOCUMENT
Please type or print in ink.
STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
Date Initial Filing Received
caa; Use Only
rE OFFICE
NAME OF FILER (LAST)
Radi
(FIRST) ' t F, r: z.
T} = t = -- - .� _ (MIDDLEY
Robert D..
%
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of La Quinta
Division, Board, Department, District, if applicable
City Council
Your Position
Council Member
► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
1. Riverside County Transportation Commission Commissioner
Agency: 2. Coachella Valley Association of Governments Position Transportation Committee Member
2. Jurisdiction of Office (Check at least one box)
❑ State ❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Multi -County ❑ County of
❑ Other
L City of La Quinta
3. Type of Statement (Check at least one box)
R Annual: The period covered is January 1, 2015, through
December 31, 2015.
-or-
The period covered is i_o/ , through
December 31, 2015.
❑ Assuming Office: Date assumed / /
❑ Leaving Office: Date Left
(Check one)
Q The period covered is January 1, 2015, through the date of
leaving office.
-Or-
• The period covered is ®1 , through
the date of leaving office.
❑ Candidate: Election year and office sought, if different than Part t
4. Schedule Summary (must complete) ► Total number of pages including this cover page:
Schedules attached
Q Schedule A-1 - Investments -- schedule attached
[Schedule A-2 - Investments- schedule attached
Schedule B • Real Property - schedule attached
-or
❑ None • No reportable interests on any schedule
5. Verification
®'iSchedule C - Income, Loans, & Business Positions- schedule attached
'`Schedule D • Income - Gifts - schedule attached
0 Schedule E - Income - Gifts - Travel Payments -schedule attached
MAILING ADDRESS STREET
(Business or Agency Address Recommended - Public Document)
79405 Hwy 111 Ste 9-318
CITY
La Quinta
STATE
CA
ZIP CODE
92253
DAYTIME TELEPHONE NUMBER
E-MAIL ADDRESS
(
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained
herein and in any attached schedules is true and complete. I acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that the foregoi, , true and co
Date Signed 2/25/2016
(month, day, year)
Signature
(File the engin
ned statement with your filing official.)
FPPC Form 700 (2015/2016)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE A-2
Investments, Income, and Assets
of Business Entities/Trusts
(Ownership Interest is 10% or Greater)
► 1. BUSINESS ENTITY OR TRUST
Integral Advantage
Name
79405 Hwy 111 Ste 9-318 La Quinta, CA 92253
Address (Business Address Acceptable)
Check one
❑ Trust, go to 2 ■ Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR
•
■
[$10,001
1
NATURE
.1
MARKET VALUE
$0 - $1,999
$2,000 - $10,000
- $100,000
$100,001 - 81,000,000
Over $1,000,000
OF INVESTMENT
Partnership
IF APPLICABLE, LIST DATE:
/__J 155 / 1 15
ACQUIRED DISPOSED
a Sole Proprietorship
YOUR
Other
BUSINESS POSITION
2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA
SHARE OF THE GROSS INCOME ] THE ENTITY/TRUST)
•
•
1
$0 - $499 • $10,001 - $100,000
$500 - $1,000 ❑ OVER $100,000
$1,001 - $10,000
► 2.
IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA
II
SHARE OF THE GROSS INCOME IQ THE ENTITY/TRUST)
1
•
[1,001
$0 - $499 fl $10,001 - $100,000
$500 - $1,000 ❑ OVER $100,000
- $10,000
la 3.
LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF
INCOME OF $10,000 OR MORE (Attach a separate sheet if necessary.)
•
None or ❑ Names fisted below
4.
INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR
LEASED BY THE BUSINESS ENTITY OR TRUST
Check
❑
one box:
INVESTMENT 0 REAL PROPERTY
Name
Assessor's
of Business Entity, if Investment, pi
Parcel Number or Street Address of Real Property
► 4.
INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR
LEASED BY THE BUSINESS ENTITY OR TRUST
Check
®
one box:
INVESTMENT J REAL PROPERTY
Name
Assessor's
of Business Entity, if Investment, or
Parcel Number or Street Address of Real Property
Description
City
FAIR
[]
■
of Business Activity of
or Other Precise Location of Real Property
MARKET VALUE IF APPLICABLE, LIST DATE:
$2,000 - $10,000
$10,001 - $100,000 / / 15 / / 15
E
II
NATURE
•
a
8100,001 - $1,000,000
Over $1,000,000
OF INTEREST
Property Ownership/Deed of Trust
Leasehold
ACQUIRED DISPOSED
• Stock • Partnership
• Other
Yrs. remaining
• Check box if additional schedules reporting Investments or real property
are attached
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Name
I. 1. BUSINESS ENTITY OR TRUST
Name
Address (Business Address Acceptable)
Check one
0 Trust, go to 2 ❑ Business Entity, complete the box, then go to 2
GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
II $0 - $1,999
■ $2,000 - $10,000 15 / 15
_/-/ _/
E $10,001 - $100,000 ACQUIRED DISPOSED
• $100,001 - $1,000,000
• Over $1,000,000
NATURE OF INVESTMENT
• Partnership II Sole Proprietorship II
Other
YOUR BUSINESS POSITION
2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA
SHARE OF THE GROSS INCOME ] THE ENTITY/TRUST)
•
•
1
$0 - $499 • $10,001 - $100,000
$500 - $1,000 ❑ OVER $100,000
$1,001 - $10,000
3.
LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF
INCOME OF $10,000 OR MORE (Attach a separate sheet it necessary.)
II
None or D Names listed below
4.
INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR
LEASED BY THE BUSINESS ENTITY OR TRUST
Check
❑
one box:
INVESTMENT 0 REAL PROPERTY
Name
Assessor's
of Business Entity, if Investment, pi
Parcel Number or Street Address of Real Property
Description
City
FAIR
III
■
of Business Activity or
or Other Precise Location of Real Property
MARKET VALUE IF APPLICABLE, LIST DATE:
$2,000 - $10,000
$10,001 - $100,000 / / 15 / /-1_§._
■
•
NATURE
0
a
$100,001 - $1,000,000
Over $1,000,000
OF INTEREST
Property Ownership/Deed of Trust
Leasehold
i♦ Other
ACQUIRED DISPOSED
■ Stock ❑ Partnership
Yrs. remaining
• Check box if additional schedules reporting investments or real property
are attached
Comments'
FPPC Form 700 (2015/2016) Sch. A-2
FPPC Advice Email: advice@fppc.ca.gov
FPPCToII-Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE B
Interests in Real Property
(Including Rental Income)
ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
773325005-8
CITY
La Quinta
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
$2,000 - $10,000
i $10,001 - $100,000 _/ /AL / /_1_5__
[$100,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
[.Ownership/Deed of Trust IIS Easement
0 Leasehold ❑
Yrs. remaining Other
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
❑ $0 - $499 ❑ $500 - $1,000 • $1,001 - $10,000
$10,001 - $100,000 0 OVER $100,000
SOURCES OF RENTAL INCOME: If you own a 10% or greater
interest, list the name of each tenant that is a single source of
income of $10,000 or more.
❑ None
Lisa & Mat Gawn
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Name
► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
773282008-9
CITY
I a Quinta
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
❑ $2,000 - $10,000
❑ $10,001 - $100,000 -I -t-15 / / 15
[100,001 - $1,000,000 ACQUIRED DISPOSED
❑ Over $1,000,000
NATURE OF INTEREST
E wnership/Deed of Trust ❑ Easement
❑ Leasehold
Yrs. remaining Other
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
❑ $0 - $499 ❑ $500 - $1,000 ❑ $1,001 - $10,000
10,001 - $100,000 0 OVER $100,000
SOURCES OF RENTAL INCOME: If you own a 10% or greater
interest, list the name of each tenant that is a single source of
income of $10,000 or more.
❑ None
Brandon & Denise Marley
You are not required to report loans from commercial lending institutions made in the lender's regular course of
business on terms available to members of the public without regard to your official status. Personal Ioans and
Ioans received not in a lender's regular course of business must be disclosed as follows:
NAME OF LENDER*
N/A
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM (Months/Years)
[❑ None
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
0 $10,001 - $100,000
® Guarantor, if applicable
0 si.00i - $10,000
OVER $100,000
NAME OF LENDER*
N/A _
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM (Months/Years)
°% 0 None
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $10,001 - $100,000
❑ Guarantor, if applicable
0 si.00i - $10,000
0 OVER $100,000
Comments'
FPPC Form 700 (2015/2016) Sch. 8
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www,fppc.ca.gov
SCHEDULE B
Interests in Real Property
(Including Rental Income)
ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
5087018032
CITY
Los Angeles
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
• $2,000 - $10,000
• $10,001 - $100,000/ 15 / / 15
_/-J
• $100,001 - $1,000,000 ACQUIRED DISPOSED
M Over $1,000,000
NATURE OF INTEREST
• Ownership/Deed of Trust • Easement
• Leasehold
Yrs. remaining Other
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
• $0 - $499 • $500 - $1,000 • $1,001 - $10,000
M $10,001 - $100,000 • OVER $100,000
SOURCES OF RENTAL INCOME: If you own a 10% or greater
interest, list the name of each tenant that is a single source of
income of $10,000 or more.
• None
Marcy Kelly
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Name
► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
774213032-3
CITY
La Quinta
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
• $2,000 - $10,000
• $10,001 - $100,000 15 / / 15
_/-J
M$100,001 - $1,000,000 ACQUIRED DISPOSED
• Over $1,000,000
NATURE OF INTEREST
M Ownership/Deed of Trust • Easement
• Leasehold
Yrs. remaining Other
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
• $0 - $499 • $500 - $1,000 II $1,001 - $10,000
• $10,001 - $100,000 • OVER $100,000
SOURCES OF RENTAL INCOME: If you own a 10% or greater
interest, list the name of each tenant that is a single source of
income of $10,000 or more.
II None
N/A
* You are not required to report loans from commercial lending institutions made in the lender's regular course of
business on terms available to members of the public without regard to your official status. Personal loans and
loans received not in a lender's regular course of business must be disclosed as follows:
NAME OF LENDER*
Chase
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM (Months/Years)
❑ None
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $10,001 - $100,000
❑ Guarantor, if applicable
❑ $1,001 - $10,000
❑ OVER $100,000
NAME OF LENDER*
N/A
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM (Months/Years)
❑ None
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $10,001 - $100,000
❑ Guarantor, if applicable
❑ $1,001 - $10,000
❑ OVER $100,000
Comments'
FPPC Form 700 (2015/2016) Sch. B
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE B
Interests in Real Property
(Including Rental Income)
ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
774065007-4
CITY
La Quinta
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
$2,000 - $10,000
• $1o,001 - $100,000 / / 15 / / 15
• $100,001 - $1,000,000 ACQUIRED DISPOSED
In Over $1,000,000
NATURE OF INTEREST
• Ownership/Deed of Trust • Easement
• Leasehold i
Yrs. remaining Other
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
• $0 - $499 • $500 - $1,000 • $1,001 - $10,000
M $10,001 - $100,000 • OVER $100,000
SOURCES OF RENTAL INCOME: If you own a 10% or greater
interest, list the name of each tenant that is a single source of
income of $10,000 or more.
l• None
Tamara Fisher
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Name
► ASSESSOR'S PARCEL NUMBER OR STREET ADDRESS
774252016-0
CITY
La Quinta
FAIR MARKET VALUE IF APPLICABLE, LIST DATE:
• $2,000 - $10,000
• $10,001 - $100,000 -/ / 15 / 15
M$100,001 - $1,000,000 ACQUIRED DISPOSED
• Over $1,000,000
NATURE OF INTEREST
Mj Ownership/Deed of Trust • Easement
• Leasehold •
Yrs. remaining Other
IF RENTAL PROPERTY, GROSS INCOME RECEIVED
• $0 - $499 • $500 - $1,000 • $1,001 - $10,000
Mj $10,001 - $100,000 - • OVER $100,000
SOURCES OF RENTAL INCOME: If you own a 10% or greater
interest, list the name of each tenant that is a single source of
income of $10,000 or more.
l• None
Heather Merryman
* You are not required to report loans from commercial lending institutions made in the lender's regular course of
business on terms available to members of the public without regard to your official status. Personal loans and
loans received not in a lender's regular course of business must be disclosed as follows:
NAME OF LENDER*
N/A
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM (Months/Years)
❑ None
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $10,001 - $100,000
❑ Guarantor, if applicable
❑ $1,001 - $10,000
❑ OVER $100,000
NAME OF LENDER*
N/A
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
INTEREST RATE TERM (Months/Years)
OA
❑ None
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $10,001 - $100,000
❑ Guarantor, if applicable
❑ $1,001 - $10,000
❑ OVER $100,000
Comments"
FPPC Form 700 (2015/2016) Sch. B
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Name
► 1. INCOME RECEIVED
► 1. INCOME RECEIVED
NAME OF SOURCE OF INCOME
Pepperdine University
ADDRESS (Business Address Acceptable)
6100 Center Dr, Los Angeles, CA 90045
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
Ambassador/Ad iser
GROSS INCOME RECEIVED
0 $500 - $1,000 &$1,001 - $10,000
❑ $10,001 - $100,000 ❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
[Salary ❑ Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2.)
0 Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
❑ Sale of
(Real property, car, boat etc.)
O Loan repayment
❑ Commission or ❑ Rental Income, list each source of MOW or more
(Describe)
❑ Other
(Describe)
NAME OF SOURCE OF INCOME
Education Management Corporation
ADDRESS (Business Address Acceptable)
210 Sixth AVP. 33rd Finnr PittRhiirgh, PA 15277
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
Professor
GROSS INCOME RECEIVED
0 $500 - $1,000
$10,001 - $100,000
❑ $1,001 - $10,000
❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
[Salary ❑ Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
❑ Sale of
(Real property, car, boat etc.)
❑ Loan repayment
0 Commission or
❑ Rental Income, list each source of $10,000 or more
(Describe)
❑ Other
(Describe)
► 2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD
You are not required to report Loans from commercial lending institutions, or any indebtedness created as part of a
retail installment or credit card transaction, made in the lender's regular course of business on terms available to
members of the public without regard to your official status. Personal loans and loans received not in a lender's
regular course of business must be disclosed as follows:
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $1,001 - $10,000
0 $10,001 - $100,000
❑ OVER $100,000
INTEREST RATE TERM (Months/Years)
1 I None
SECURITY FOR LOAN
0 None ❑ Personal residence
❑ Real Property
Sheet address
City
0 Guarantor
❑ Other
(Describe)
Comments'
FPPC Form 700 (2015/2016) Sch. C
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www fppc.ca.gov
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Name
► 1. INCOME RECEIVED ► 1. INCOME RECEIVED
NAME OF SOURCE OF INCOME
China US Strategic Ventures
ADDRESS (Business Address Acceptable)
1029 Vermont Ave NW, 7F Washington DC 20005
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
President
GROSS INCOME RECEIVED
❑ $500 - $1,000
❑ $10,001 - $100,000
❑✓ $1,001 - $10,000
❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑✓ Salary ❑ Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
❑ Sale of
(Real property, car, boat, etc.)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
(Describe)
❑ Other
(Describe)
NAME OF SOURCE OF INCOME
Benedictine University
ADDRESS (Business Address Acceptable)
5700 College Rd Lisle, IL
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
Professor (Adjunct)
GROSS INCOME RECEIVED
❑ $500 - $1,000
✓❑ $10,001 - $100,000
❑ $1,001 - $10,000
❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
✓❑ Salary ❑ Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
❑ Sale of
(Real property, car, boat, etc.)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
(Describe)
❑ Other
(Describe)
► 2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD
* You are not required to report loans from commercial lending institutions, or any indebtedness created as part of a
retail installment or credit card transaction, made in the lender's regular course of business on terms available to
members of the public without regard to your official status. Personal loans and loans received not in a lender's
regular course of business must be disclosed as follows:
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $1,001 - $10,000
❑ $10,001 - $100,000
❑ OVER $100,000
INTEREST RATE TERM (Months/Years)
❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
Street address
City
❑ Guarantor
❑ Other
(Describe)
Comments'
FPPC Form 700 (2015/2016) Sch. C
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Name
► 1. INCOME RECEIVED ► 1. INCOME RECEIVED
NAME OF SOURCE OF INCOME
California State University San Bernardino
ADDRESS (Business Address Acceptable)
5500 University Pkwy, San Bernardino, CA 92407
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
Professor (Adjunct)
GROSS INCOME RECEIVED
❑ $500 - $1,000
❑✓ $10,001 - $100,000
❑ $1,001 - $10,000
❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑✓ Salary ❑ Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
❑ Sale of
(Real property, car, boat, etc.)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
(Describe)
❑ Other
(Describe)
NAME OF SOURCE OF INCOME
City of La Quinta
ADDRESS (Business Address Acceptable)
78495 Calle Tampico, La Quinta, CA 92253
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
Council Member
GROSS INCOME RECEIVED
❑ $500 - $1,000
❑✓ $10,001 - $100,000
❑ $1,001 - $10,000
❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
✓❑ Salary ❑ Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
❑ Sale of
(Real property, car, boat, etc.)
❑ Loan repayment
❑ Commission or
❑ Rental Income, list each source of $10,000 or more
(Describe)
❑ Other
(Describe)
► 2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD
* You are not required to report loans from commercial lending institutions, or any indebtedness created as part of a
retail installment or credit card transaction, made in the lender's regular course of business on terms available to
members of the public without regard to your official status. Personal loans and loans received not in a lender's
regular course of business must be disclosed as follows:
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $1,001 - $10,000
❑ $10,001 - $100,000
❑ OVER $100,000
INTEREST RATE TERM (Months/Years)
❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
Street address
City
❑ Guarantor
❑ Other
(Describe)
Comments'
FPPC Form 700 (2015/2016) Sch. C
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Name
► 1. INCOME RECEIVED ► 1. INCOME RECEIVED
NAME OF SOURCE OF INCOME
Desert Sands Unified School District
ADDRESS (Business Address Acceptable)
47950 Dune Palms Rd La Quinta, CA 92253
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
Guest Teacher
GROSS INCOME RECEIVED
❑ $500 - $1,000
❑ $10,001 - $100,000
❑✓ $1,001 - $10,000
❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary ❑✓ Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
❑ Sale of
(Real property, car, boat, etc.)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
(Describe)
❑ Other
(Describe)
NAME OF SOURCE OF INCOME
Coachella Valley Unified School District
ADDRESS (Business Address Acceptable)
87225 Church St Thermal CA 92274
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
Teacher
GROSS INCOME RECEIVED
❑ $500 - $1,000
✓❑ $1o,001 - $100,000
❑ $1,001 - $10,000
❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary ❑✓ Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
❑ Sale of
(Real property, car, boat, etc.)
❑ Loan repayment
❑ Commission or ❑ Rental Income, list each source of $10,000 or more
(Describe)
❑ Other
(Describe)
► 2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD
* You are not required to report loans from commercial lending institutions, or any indebtedness created as part of a
retail installment or credit card transaction, made in the lender's regular course of business on terms available to
members of the public without regard to your official status. Personal loans and loans received not in a lender's
regular course of business must be disclosed as follows:
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $1,001 - $10,000
❑ $10,001 - $100,000
❑ OVER $100,000
INTEREST RATE TERM (Months/Years)
❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
Street address
City
❑ Guarantor
❑ Other
(Describe)
Comments.
FPPC Form 700 (2015/2016) Sch. C
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Name
► 1. INCOME RECEIVED ► 1. INCOME RECEIVED
NAME OF SOURCE OF INCOME
Riverside County Transportation Commision
ADDRESS (Business Address Acceptable)
4080 Lemon Street, 3rd Floor Riverside, CA 92501
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
Commisoner
GROSS INCOME RECEIVED
❑ $500 - $1,000
❑ $10,001 - $100,000
✓❑ $1,001 - $10,000
❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary ❑ Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
❑ Sale of
(Real property, car, boat, etc.)
❑ Loan repayment
❑ Commission or
❑ Rental Income, list each source of $10,000 or more
(Describe)
❑ Other
(Describe)
NAME OF SOURCE OF INCOME
Coachella Valley Association of Governments
ADDRESS (Business Address Acceptable)
73710 Fred Waring Drive Palm Deser, CA 92260
BUSINESS ACTIVITY, IF ANY, OF SOURCE
YOUR BUSINESS POSITION
Committee Member
GROSS INCOME RECEIVED
❑✓ $500 - $1,000
❑ $10,001 - $100,000
❑ $1,001 - $10,000
❑ OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
❑ Salary ❑ Spouse's or registered domestic partner's income
(For self-employed use Schedule A-2.)
❑ Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
❑ Sale of
(Real property, car, boat, etc.)
❑ Loan repayment
❑ Commission or
❑ Rental Income, list each source of $10,000 or more
(Describe)
❑ Other
(Describe)
► 2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD
* You are not required to report loans from commercial lending institutions, or any indebtedness created as part of a
retail installment or credit card transaction, made in the lender's regular course of business on terms available to
members of the public without regard to your official status. Personal loans- and loans received not in a lender's
regular course of business must be disclosed as follows:
NAME OF LENDER'
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF LENDER
HIGHEST BALANCE DURING REPORTING PERIOD
❑ $500 - $1,000
❑ $1,001 - $10,000
❑ sio,00i - $ioo,000
❑ OVER $100,000
Comments"
INTEREST RATE TERM (Months/Years)
❑ None
SECURITY FOR LOAN
❑ None ❑ Personal residence
❑ Real Property
Street address
City
❑ Guarantor
❑ Other
(Describe)
FPPC Form 700 (2015/2016) Sch. C
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov
SCHEDULE D
Income — Gifts
► NAME OF SOURCE (Not an Acronym)
United States Tennis Association
ADDRESS (Business Address Acceptable)
70 West Red Oak Lane White Plains New York 10604
BUSINESS ACTIVITY, IF ANY, OF SOURCE
BNP Paribas Open Tennis Tournament
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
3 / 20 /15 $ 150 Indian Wells Tennis
Tournament
// $
/ $
—/
► NAME OF SOURCE (Not an Acronym)
City of Palm Spring
ADDRESS {Business Address Acceptable)
3200 E. Tahquitz Canyon Way. Palm Springs, CA 92262
BUSINESS ACTIVITY IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
04 / 24/15 $ 52 Palm Springs Restaurant
Week 2015
1—/ $
$
_-_..1 _—/
► NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
$
®/—/
s
_./—/
/............. / ... s
CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Name
i NAME OF SOURCE (Not an Acronym) .
City of Indian Wells
ADDRESS (Business Address Acceptable)
44950 Eldorado Dr, Indian Wells, CA 92210
BUSINESS ACTIVITY, IF ANY, OF SOURCE
BNP Paribas_Open Tennis Toumament
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
3 / 18/ 15 $ 150 Indian Wells Tennis
Toumament
/ 1 $
/ / $
N. NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
1 $
/ $
-/
/ / $
O. NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
/ 1 $
/ $
-/
/ 1 $
Comments.
FPPC Form 700 (2015/2016) Sch. El
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll -Free Helpline: 866/275-3772 www.fppc.ca.gov