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460 Pena 2022 from 07/01 to 09/24Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from 7/1/2022 through 9/24/2022 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. m ffceholder, Candidate Controlled Committee 8 State Candidate Election Committee 0 Recall (Also Complete Pad 5) ❑ gneral Purpose Commtttee Sponsored Small Contributor Committee O Political Party/Central Committee 3. Committee Information ❑ Primarily Formed Ballot Measure ommittee Controlled O Sponsored (Also Complete Part fi) ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 1) I.D. NUMBER yOMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) COMMITTEE TO ELECT JOHN PENA CITY COUNCIL 2022 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 ZIP CODE AREACODE/PHONE Date of election if applicable: (Month, Day, Year) Date Stamp RECEIVED SEP 2 9 2022 COVER PAGE Page ► of — For Official Use Only 11/8/2022 CITY OF LA QUINTA I ATY CLERK DEPARTMEN 2. Type of Statement: Ia 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 SHERRY LOVE-PENA MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE LA QUINTA CA 92253 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADD CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS 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 per'u �u]nder t e laws of the State of California that the foregoing is true and Executed on `^� By Da Assistant Troasurer Executed on f Q By ate Signature of CortlroAing O holds n Meesp asure Proponent or Ronsi We Officer of Sponwr Executed on By ate Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on By Date Signature of Controlling Officeholder, Cantlitlete, Stele 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 JOHN PENA OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IFAPPLICABLE) CITY COUNCIL RESIDENTIALIBUSINESS ADDRESS (NO.ANDSTREET) CITY STATE ZIP LA QUINTP 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 AREACODE/PHONE 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 COVER PAGE - PART 2 Page -2-- 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) orcandidatels) 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 7/1/2022 SUMMARY PAGE through 9/24/2022 Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER COMMITTEE TO ELECT JOHN PENA CITY COUNCIL 2022 1370057 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHIS PERIOD CALENDARYEAR Running in Both the State Primary and (FROM ATTACHED SCHEDULES) TOTAL TO DATE General Elections 1. Monetary Contributions.. ............ __ ......... ............ Schedule A, Line 3 $ 6173 $ 25306 ........... 0 1100 111 through 6/30 7/1 to Date 2. Loans Received..-... .......................................................... schedule B, Line 3 6173 26406 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS ............................... Add Lines 1 +2 $ $ Received $ $ 4. Nonmonetary Contributions ............................................ Schedule C, Line 3 0 6290 21. Expenditures 6173 32696 Made $ $ 5. TOTAL CONTRIBUTIONS RECEIVED ................................ Add Lines 3 + 4 $ $ Expenditures Made 6. Payments Made............................................................. .. Schedule E, Line 4 $ 1563 7. Loans Made..................................................................... Schedule H, Line 3 0 8. SUBTOTAL CASH PAYMENTS ....................................... Add Lines 6+7 $ 1563 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule 1, Line 3 0 10. Nonmonetary Adjustment........,.........::...:..:::..............._....... Schedule C, Line 3 0 11. TOTAL EXPENDITURES MADE....................................Add Lines 8+9+10 $ 1563 Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 250 13. Cash ................ Receipts ............................... . ........ Column A, Line 3 above . 6173 14. Miscellaneous Increases to Cash..... . . ................ Schedule 1, Line 4 0 15. Cash Payments ............................ . Column A, Line 8 above 1563 16. ENDING CASH BALANCE ................Add Lines 12 + 13 + 14, then subtract Line 15 $ 4610 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule B, Part 2 $ 0 Cash Equivalents and Outstanding Debts 18. Cash Equivalents.............................................1. See instructions on reverse $ 19. Outstanding Debts...... .................... Add Line 2 + Line 9 in Column B above $ 1100 $ 13696 0 $ 13696 0 0 $ 13696 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) � 1 $ *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 Lo wnow uonars' Statement covers period CALIFORNIA from 7/1/2022 FORM Page of through 9/24/2022 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER COMMITTEE TO ELECT JOHN PENA CM COUNCIL 2022 1370057 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 OF BUSINESS) PERIOD (JAN.1-DEC. 31) (IF REQUIRED) 8/2/22 E COLE BURR ® IND PRESIDENT 750.00 ❑ COM ❑ OTH BURRTEC WASTE TEMECULA, CA 92592 ❑ PTY ❑ SCC 8/2/22 TRACY BURR ® IND RETIRED 750.00 ❑ COM ❑ OTH TEMECULA, CA 92592 ❑ PTY ❑ SCC 8/12/22 FORTUN'S KITCHEN + BAR ❑ IND 500.00 ❑ coM ® OTH KIRKLAND, WA 98033 ❑ PTY ❑ SCC 9/6/22 RCS POINT HAPPY, LLC ❑ IND 250.00 ❑ COM ® OTH LOS ANGELES, CA 90010 ❑ PTY ❑ SCC 9/6/22 DONNA BLACK ®IND RETIRED 500.00 ❑ CoM ❑ OTH LA QUINTA, CA 92253 ❑ PTY ❑ ScC SUBTOTAL $ 2750 Schedule A Summary Amount received this period — itemized monetary contributions. 5950 Include all Schedule A subtotals.....................................................................................$ — Amount received this period — unitemized monetary contributions of less than $100 ...........................$ 223 3. Total monetary contributions received this period. 6173 (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)......................TOTAL $ — 'Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY—Political Parry SCC — Small Contributor Committee FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULE A (CONT.) Monetary Contributions Received to whole dollars. Statement covers period from 7/1/2022 through 9/24/2022 5 of v F NAME OF FILER I.D. NUMBER COMMITTEE TO ELECT JOHN PENA CITY COUNCIL 2022 1370057 FULL NAME, STREETADDRESS 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) OF BUSINESS) PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 9/6/22 LUKE KUPERSMITH ® IND ENTREPRENUR 400.00 ❑ COM ❑ OTH LOJISTIC COSTA MESA, CA 92626 ❑ PTY ❑ SCC 9/6/22 TVANA STEELMEN ® IND A + R 500.00 ❑ COM ❑ OTH READ LABEL OAK PARK, CA 91377 ❑ PTY ❑ SCC 9/6/22 ANDREW LEBOWITZ ® IND PRESIDENT 200.00 ❑ COM ❑ OTH ALS HEALTH CARE SANTA MONICA, CA 90401 ❑ PTY p SCC 9/6/22 KASEY SURYAN ®IND MANAGING PARTNER 100.00 ❑ COM ❑ OTH LYON LIVING NEWPORT BEACH, CA 92663 ❑ PTY ❑ SCC 9/6/22 FRANK WEIGEL ®IND RETIRED 500.00 ❑ COM ❑ OTH LA QUINTA, CA 92253 ❑ PTY SCC SUBTOTAL $ 1700 *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 A (Continuation Sheet) Amounts may be rounded SCHEDULE A (CONT.) Monetary Contributions Received to whole dollars. Statement covers period CALIFORNIA from 7/1/2022 FORM through 9/24/2022 Page of NAME OF FILER I.D. NUMBER COMMITTEE TO ELECT JOHN PENA CITY COUNCIL 2022 1370057 FULL NAME, STREETADDRESS 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) OF BUSINESS) PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 9/14/22 E COLE BURR ® IND PRESIDENT 750.00 1500.00 ❑ COM ❑ OTH BURRTEC WASTE TEMECULA, CA 92592 ❑ PTY ❑ SCC 9/14/22 TRACY BURR ® IND RETIRED 750.00 1500.00 ❑ COM ❑ OTH TEMECULA, CA 92592 ❑ PTY ❑ ScC El IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY SCC SUBTOTAL $ 1500 "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 -a SCHEDULE B - PART 1 Schedule B — Part 1 ^� �Vto whole dollars. Statement covers period Loans Received from 7/1/2022 through 9/24/2022 Page of V SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER COMMITTEE TO ELECT JOHN PENA CITY COUNCIL2022 1370057 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER a OUTSTANDING (b) AMOUNT (c) 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 LD. NUMBER) (IF SELF-EMPLOYED, ENTER BEGINNING THIS PERIOD THISPERIOD. CLOPERIOD HIS PERIOD LOAN TO DATE NAME OF BUSINESS) PERIOD ❑ PAID CALENDAR YEAR JOHN PENA JOHN PENA & ASSOC s 0 $1100 0 $ 1100 51405 RATE LA QUINTA, CA 92253 ❑ FORGIVEN PER ELECTION 1100 $ 0 0 12/31/22 $ 0 s 1100 t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC s s DATE INCURRED DATE DUE ❑ PAID CALENDAR YEAR RATE ❑ FORGIVEN PER ELECTION- S $ S tEl IND ❑ COM ❑ OTH ❑ PTY ❑ SCC S S DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR PER ELECTION`S ❑ FORGIVEN RATE S S S S S DATE DUE t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE INCURRED SUBTOTALS $ $ $ $ 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. (May be a negative number) "Amounts forgiven or paid by another party also must be reported on Schedule A. If required. (En re•(v) on �7C1•e-�ule E LIna 31 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 E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER COMMITTEE TO ELECT JOHN PENA CITY COUNCIL 2022 Amounts may be rounded to whole dollars. Statement covers period from 7/1/2022 through 9/24/2022 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. Page A of v 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 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) CITY OF LA QUINTA FIL 600 78495 CALLE TAMPICO LA QUINTA, CA 92253 CITY OF LA QUINTA CMP SIGN PERMIT 543 78495 CALLE TAMPICO LA QUINTA, CA 92253 JORDAN WEIDNER - METEOR MEDIA WEB SITE DESIGN 400 CEDAR CITY, UT 84721 * 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.)............................................................... ,........................................... . $ 1543 2. Unitemized payments made this period of under$100................................................... ............ ......... ............................... ................................... $ 20 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).).......... 0 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.)........................... TOTAL $ 1563 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov