CA Form 410 UNITE HERE Local 11 for Working Families - Amendment No. 2 (Name change) a
Statement of Organization Date Stam CALIFORNIA
RECEIVED Recipient Committee _ FORM 410
Statement Type 0 Initial ® Amendment 0 Termination—See Part 5
CITY OF RANCHO PALOS V For Official Use Only
Q Not yet qualified JAN 0 7 2020
or 04 / 13 / 2018 /
O Date qualified as committee
Date qualified as committee Date of termination
/ / CITY CLERK'S OFFICE
I.D. Number
1. Committee Information . Treasurer and Other Principal Officers
1404950 N�M
>. i'° (if applicable) z>, °s f � •�`$;�.�s, <s,°Y��° o.° s
NAME OF COMMITTEE NAME OF TREASURER
UNITE HERE Local 11 for Working Families Ada Briceno
STREET ADDRESS(NO P.O.BOX)
464 S. Lucas Avenue, Suite 201
STREET ADDRESS(NO P.O.BOX) CITY 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 1 JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(S)
Los Angeles :County of Los Angeles Ada Briceno
STREET ADDRESS(NO P.O.BOX)
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
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I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under
penalty of perjury under the laws of the State of California t .'th- oregoin: is true and correct.
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Executed on 416 By Iv. 1
DATE 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 I.D.NUMBER
UNITE HERE Local 11 for Working Families 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
4
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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)
Nonpartisan Partisan (list political party below)
Primarily Formed Committee 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
SUPPORT OPPOSE
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 3
I.D.NUMBER
TTEE NAME
11 for Working HERE Local Families 1404950
4. Type of Committee (Continued)
General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
❑ CITY Committee ® COUNTY Committee❑ STATE Committee❑ Political Party/Central Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
Sponsored Committee List additional sponsors on an attachment.
INDUSTRY GROUP OR AFFILIATION OF SPONSOR
NAME OF SPONSOR
UNITE HERE Local 11 Labor Organization
CITY STATE ZIP CODE AREA CODE/PHONE
STREET ADDRESS NO.AND STREET
464 S. Lucas Avenue, Suite 201 CA 90017
Los Angeles (213)481-8530
Small Contributor Committee ❑
Date qualified
5. Termination Requirements By signing the verification,the treasurer,assistant treasurer and/or candidate,officeholder,or proponent certify that all of the following conditions have been met.
• 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.
-- the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government
There are restrictions on p p
Code Section 89519.
-- Leftover funds of ballot measure committees political,maybe used for legislative or governmental purposes under Government Code Sections 89511-89518,and are
subject to Elections Code Section 18680 and FPPC Regulation 18521.5.
FPPC Form 410(February/2018)
Clear Page Print FPPC Advice:advice@fppc.ca.gov(866/275-3772)
www.fppc.ca.gov