CA Form 410 South Bay Women's Project, Sponsored by UNITE HERE Local 11 •
Statement of Organization C= ��
� CALIFORNIA 41 0
Recipient Committee :TY OF RANCHO PALOS VER FORM
Statement Type ❑Initial ® Amendment ❑ Termination—See Part 5 AUG 1 3 2019 For Official Use Only
Q Not yet qualified
or 04 13 2018
0 Date qualified as committee
Date qualified as committee Date of terminationCITY CLERK'S O
1. Committee Information I.D. Number 1404950 2. Treasurer and Other Principal Officers
(if applicable)
NAME OF COMMITTEE NAME OF TREASURER
South Bay Women's Project, Sponsored by UNITE HERE Local 11 Ada Briceno
STREET ADDRESS(NO P.O.BOX)
464 S. Lucas Avenue, Suite 201
STREET ADDRESS(NO P.O.BOX) CI I Y STATE ZIP CODE AREA CODE/PHONE
464 S. Lucas Avenue, Suite 201 Los Angeles CA 90017 (213)481-8530
CITY STATE ZIP CODE AREA CODE/PHONE NAME Of ASSISTANT TREASURER,IF ANY
Los Angeles CA 90017 (213)481-8530 Susan Minato
MAILING ADDRESS(IF DIFFERENT) STREET ADDRESS(NO P.O BOX)
777 S. Figueroa Street, Suite 4050, Los Angeles, CA 90017 464 S. Lucas Avenue, Suite 201
E-MAIL ADDRESS(REQUIRED)/FAX(OPTIONAL) CITY STATE ZIP CODE AREA CODE/PHONE
sshin@kaufmanlegalgroup.com/(213)452-6575 Los Angeles CA 90017 (213)481-8530
COUNTY OF DOMICILE IURISUIICTION WFIEIIF COMMITTEE IS AC LIVE NAME OF PRINCIPAE.OFFICER(S)
Los Angeles City of Rancho Palos Verdes Ada Briceno
STREET ADDRESS(NO P.O.Elox)
464 S. Lucas Avenue, Suite 201
CITY STATE ZIP CODE AREA CODE/PHONE
Attach additional information on appropriately labeled continuation sheets.
Los Angeles CA 90017 (213)481-8530
3. Veri kation
I have used all reasonable diligence in preparing this statement and to the - of my knowledge the l ormation contained herein is true and complete. I certify under
penalty of perjury un er th- laws of the State of California that the fore;o is true and corre
Executed on ())'
' By
IIAIE SIGNATURE OF TREASURER OR ASSISTANT TREASURER
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
FPPC Form 410(February/2018)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
•
Statement of Organization CALIFORNIA 41 0
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Page 2
COMMITTEE NAME 1.0.NUMBER
South Bay Women's Project, Sponsored by UNITE HERE Local 11 1404950
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER
California Bank&Trust (213)228-1700 5794357979
ADDRESS CITY STATE ZIP CODE
550 S. Hope Street,Suite 100 Los Angeles CA 90071
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Controlled Committee
• List the name of each controlling officeholder,candidate,or state measure proponent. If candidate or officeholder controlled,also list the elective office sought or held,and
district number,if any,and the year of the election.
• List the political party with which each officeholder or candidate is affiliated or check"nonpartisan." Stating"No party preference"is acceptable.
• If this committee acts jointly with another controlled committee,list the name and identification number of the other controlled committee.
ELECTIVE OFFICE SOUGHT OR HELD YEAR OF PARTY
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION
CHECK ONE
Nonpartisan Partisan (list political party below)
o a
Nonpartisan Partisan (list political party below)
Primarily Formed Comrtlittee Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CANDIDATE(S)NAME OR MEASURE(S)FULL TITLE(INCLUDE BALLOT NO.OR LETTER) CANDIDATE(S)OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION
IF A RECALL,STATE"RECALL"IN FRONT OF THE OFFICEHOLDER'S NAME. (INCLUDE DISTRICT NO.,CITY OR COUNTY,AS APPLICABLE) CHECK ONE
SUPPORT OPPOSE
Hospitality Working Conditions Ordinance City of Rancho Palos Verdes
SUPPORT OPPOSE
FPPC Form 43.0(February/2018)
FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Statement of Organization CALIFORNIA 41 0
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Page 3
COMMITTEE NAME I.D.NUMBER
South Bay Women's Project, Sponsored by UNITE HERE Local 11 1404950
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Genera!Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee 0 COUNTY Committee 0 STATE Committee 0 Political Party/Central Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Sponsored Committee List additional sponsors on an attachment.
NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR
UNITE HERE Local 11 Labor Organization
STREET ADDRESS NO.AND STREET CITY STATE ZIP CODE AREA CODE/PHONE
464 S. Lucas Avenue, Suite 201 Los Angeles CA 90017 (213)481-8530
Small Contributor Committee ❑
Date qualified
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• This committee has ceased to receive contributions and make expenditures;
• This committee does not anticipate receiving contributions or making expenditures in the future;
• This committee has eliminated or has no intention or ability to discharge all debts,loans received,and other obligations;
• This committee has no surplus funds;and
• This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions.
-- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government
Code Section 89519.
-- Leftover funds of ballot measure committees may be used for political,legislative or governmental purposes under Government Code Sections 89511-89518,and are
subject to Elections Code Section 18680 and FPPC Regulation 18521.5.
Print FPPC Form 410(February/2018)
Clear Page _ FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov
Attachment to California Form 410--Statement of Organization
South Bay Women's Project, Sponsored by UNITE HERE Local 11
Part 2. Additional Principal Officer
Name: Susan Minato
Street Address: 464 S. Lucas Avenue, Suite 201
City, State, Zip Code: Los Angeles, CA 90017
Phone: (213) 481-8530
Name: Kurt Petersen
Street Address: 464 S. Lucas Avenue, Suite 201
City, State, Zip Code: Los Angeles, CA 90017
Phone: (213) 481-8530