8
as ■-%V M >-■ 4 a K< ? - v ... Q @Seo3 Los Angeles City Ethics Commission November 30, 2018 The Honorable City Council c/o Holly Wolcott, City Clerk 200 North Spring Street City Hall - 3rd Floor Los Angeles CA 90012 Council File Number 11-0452-S8 Re: Selection of Frederick H. Picket as Executive Director of the Office of Public Accountability FOR COUNCIL CONSIDERATION Dear Councilmembers: On November 15, 2018, the Office of Public Accountability's (OP A) Citizen's Committee for the Selection of the Executive Director transmitted to the City Clerk a letter indicating their selection of Dr. Frederick H. Pickel as the executive director of OPA. The Ethics Commission received Dr. Pickel's pre-confirmation statement of economic interest on November 29, 2018. In compliance with Los Angeles Municipal Code § 49.5.10, a copy of Dr. Pickels financial disclosure statement is enclosed. If you have questions, please feel free to contact me at (213) 978-1960. Sincerely, Samantha Rodriguez Ethics Program Analyst Enclosures: Form 700 Form 60 Rafael Prieto cc: 200 North Spring Street, Suite 2410 Los Angeles CA 90012 phone (21S) 978-1960 fax (213) 978-1988 ethics.lacity.org

Los Angeles City Ethics Commissionclkrep.lacity.org/onlinedocs/2011/11-0452-S8_misc_11-30-2018.pdf · 30/11/2018  · Centurylink Inc CTL (foundation, Schedule A-2) Telecommunications

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Page 1: Los Angeles City Ethics Commissionclkrep.lacity.org/onlinedocs/2011/11-0452-S8_misc_11-30-2018.pdf · 30/11/2018  · Centurylink Inc CTL (foundation, Schedule A-2) Telecommunications

as■-%VM

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@Seo3

Los Angeles City Ethics Commission

November 30, 2018

The Honorable City Council c/o Holly Wolcott, City Clerk 200 North Spring Street City Hall - 3rd Floor Los Angeles CA 90012

Council File Number 11-0452-S8Re:Selection of Frederick H. Picket asExecutive Director of the Office of Public Accountability

FOR COUNCIL CONSIDERATION

Dear Councilmembers:

On November 15, 2018, the Office of Public Accountability's (OP A) Citizen's Committee for the Selection of the Executive Director transmitted to the City Clerk a letter indicating their selection of Dr. Frederick H. Pickel as the executive director of OPA. The Ethics Commission received Dr. Pickel's pre-confirmation statement of economic interest on November 29, 2018. In compliance with Los Angeles Municipal Code § 49.5.10, a copy of Dr. Pickel’s financial disclosure statement is enclosed.

If you have questions, please feel free to contact me at (213) 978-1960.

Sincerely,

Samantha Rodriguez Ethics Program Analyst

Enclosures: Form 700 Form 60

Rafael Prietocc:

200 North Spring Street, Suite 2410 • Los Angeles CA 90012 • phone (21S) 978-1960 ■ fax (213) 978-1988 • ethics.lacity.org

Page 2: Los Angeles City Ethics Commissionclkrep.lacity.org/onlinedocs/2011/11-0452-S8_misc_11-30-2018.pdf · 30/11/2018  · Centurylink Inc CTL (foundation, Schedule A-2) Telecommunications

Date Initial Filing ReceivedOfficial Use Only700 STATEMENT OF ECONOMIC INTERESTSCALIFORNIA FORM

FAIR POLITICAL PRACTICES COMMISSION

COVER PAGEA PUBLIC DOCUMENT

Please type or print in ink.

NAME OF FILER (LAST)

Pickel

(MIDDLE)

Hugh

(FIRST)

Frederick

1. Office, Agency, or CourtAgency Name (Do not use acronyms)

City of Los Angeles

Division, Board, Department, District, if applicable Your Position

Executive Director / Ratepayer AdvocateOffice of Public Accountability

► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)

Agency: Position:

2. Jurisdiction of Office (Check at least one box)

□ State □ Judge or Court Commissioner (Statewide Jurisdiction)

□ County of_____________________________________

□ Other_________________________________________

□ Multi-County

Los Angeles0 City of

3. Type Of Statement (Check at least one box)

□ Annual: The period covered is January 1, 2017, through December 31, 2017.

The period covered is _December 31, 2017.

□ Assuming Office: Date assumed

□ Leaving Office: Date Left (Check one)

O The period covered is January 1, 2017, through the date of leaving office.

O The period covered is__the date of leaving office.

1 J.

-or-J______ I. through

-or-J. throughJ.J_____ I.

11/15/2018[3 Candidate: Date of Election and office sought, if different than Part 1:

54. Schedule Summary (must complete) ^ Total number of pages including this cover page: Schedules attached

|x] Schedule C - Income, Loans, & Business Positions - schedule attached

□ Schedule D - Income - Gifts - schedule attached

□ Schedule E - Income - Gifts - Travel Payments - schedule attached

[x] Schedule A-1 - Investments - schedule attached

0 Schedule A-2 - Investments - schedule attached

□ Schedule B - Real Property - schedule attached

-or-□ None ■ No reportable interests on any schedule

5. VerificationMAILING ADDRESS STREET CITY ZIP CODESTATE

DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS

[email protected]

I have used ail 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 foregoing is true and correct. t

11/29/2018Date Signed Signature

(month, day, year) (File the originally signed statement with your filing official.)

FPPC Form 700 (2017/2018)FPPC Advice Email: [email protected]

FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov

Page 3: Los Angeles City Ethics Commissionclkrep.lacity.org/onlinedocs/2011/11-0452-S8_misc_11-30-2018.pdf · 30/11/2018  · Centurylink Inc CTL (foundation, Schedule A-2) Telecommunications

700SCHEDULE A-1CALIFORNIA FORM

Investments

Stocks, Bonds, and Other Interests (Ownership Interest is Less Than 10%)

Do not attach brokerage or financial statements.

FAIR POLITICAL PRACTICES COMMISSION

Name

Pickel, Frederick H.

<BLUE> is a required field

IF APPLICABLE, LIST DATE (mm/dd/2017)

ACQUIRED DISPOSED

NATURE OF INVESTMENT (Select from drop down list.

If "other," describe)

GENERAL DESCRIPTION OF THIS BUSINESS ACTIVITY

FAIR MARKET VALUE (Select from drop down list)NAME OF BUSINESS ENTITY

$100,001 -$1,000,000 Stock

Stock

TelecommunicationsAT&T, T (in foundation, Schedule A-2)$10,001 - $100,000Centurylink Inc CTL (foundation, Schedule A-2) Telecommunications

$10,001 -$100,000 $10,001 -$100,000

Financial service StockAXP AIMER EXPRESS COMPANY

AXAHY AXA -SPONS ADR Financial service Stock

$10,001 - $100,000 $100,001 -$1,000,000 Stock

Stock

BAC BANK OF AMERICA CORP Financial service Stock

BA BOEING COMPANY Defense

$10,001 - $100,000CVX CHEVRON CORP Energy

$10,001 - $100,000CSCO CISCO SYSTEMS INC COM Electronics Stock

$100,001 -$1,000,000 StockKO COCA COLA COM Food

$10,001 -$100,000 StockDEO DIAGEO PLC SPSD ADR NEW Food

$2,000-$10,000FCX FREEPORT-MCMORAN INC

GE GENERAL ELECTRIC

StockMining

$10,001 -$100,000Manufacturing, financial service Stock

$10,001 -$100,000GSK GLAXOSMITHKLINE PLC ADR Pharma Stock

$10,001 -$100,000INTC INTEL CORP

IBM INTL BUSINESS MACHINES CORP IBM

JNJ JOHNSON AND JOHNSON COM

Electronics

Computer systems and services

Stock

$10,001 -$100,000 Stock

$10,001 -$100,000Medical devices Stock

$10,001 - $100,000 $100,001 - $1,000000 Stock

$2,000-$10,000

Consumer products

Software

Consumer products

StockPHG KONINKL PHIL NV SH NEW

MSFT MICROSOFT CORP

PCRFY PANASONIC CORP SHS Stock

$10,001 -$100,000Pharma

RDSA ROYAL DUTCH SHELL PLC SPONS ADR A Energy

RHHBY ROCHE HLDG LTD SPN ADR Stock

$2,000-$10,000 Stock

$10,001 - $100,000 $2,000 - $10000

$10,001 - $100,000 $10,001 - $100,000

SIEGY SIEMENS AG SNE SONY CORP ADR NEW TOT TOTAL S.A.TM TOYOTA MOTOR CORP ADR

ManufacturingConsumer products, entertainmentEnergyManufacturing

StockStock

ADR

StockSP ADRStock

FPPC Form 700 (2017/2018) Sch. A-1FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov

Page 4: Los Angeles City Ethics Commissionclkrep.lacity.org/onlinedocs/2011/11-0452-S8_misc_11-30-2018.pdf · 30/11/2018  · Centurylink Inc CTL (foundation, Schedule A-2) Telecommunications

SCHEDULE A-1 700CALIFORNIA FORMInvestments

Stocks, Bonds, and Other Interests (Ownership Interest is Less Than 10%)

Do not attach brokerage or financial statements.

FAIR POLITICAL PRACTICES COMMISSION

Name

Pickel, Frederick H.

<BLUE> is a required field

IF APPLICABLE, LIST DATE (mm/dd/2017)

ACQUIRED DISPOSED

NATURE OF INVESTMENT (Select from drop down list.

If "other," describe)

GENERAL DESCRIPTION OF THIS BUSINESS ACTIVITY

FAIR MARKET VALUE (Select from drop down list)NAME OF BUSINESS ENTITY

$10,001 -$100,000 StockWFC WELLS FARGO & CO NEW DEL WFCPRL WELLS FARGO & CO NEW 7.5% PERP Financial service CONV PFD STK

Financial service$10,001 - $100,000 Stock

$10,001 -$100,000Energy Demand Monitoring StockMach Energy (private placement)$10,001 - $100,000BANK OF AMERICA CORP 6.2%-CC Rate: 1.550%, Financial service

BAC.C, PFD STKStock

$10,001 - $100,000CORNING INC, GLWGOLDMAN SACHS GROUP INC 6.3%-N Rate: 1.575%, GS.N, PFD STK

Manufacturing Stock$10,001 -$100,000 StockFinancial service

$10,001 - $100,000VERIZON COMMUNICATIONS, VZ VODAFONE GROUP PLC, VOD

StockTelecommunicationsTelecommunications $10,001 - $100,000 Stock

$100,001 -$1,000,000 StockAT&T INC 5.35% CPN: 5.350% Due : 11/1/2066 Callable, corporate fixed income, TBB

Telecommunications 9/18/2018

$10,001 - $100,000 StockTORCHMARK CORP CPN: 6.125% Due : 6/15/56,corp fixed income, TMK.CBANK OF AMERICA CORP 6%-GG Rate: 1.500%

Financial service

$10,001 -$100,000 Stock 5/7/2018Financial service

$100,001 - $1,000,000 StockJPMORGAN CHASE & CO 5.75-DD Rate: 1.438% 9/17/2018Financial service

$10,001 - $100,000WELLTOWER INC Healthcare Stock 1/8/2018$10,001 -$100,000 $10,001 - $100,000

Stock 1/8/2018CENTURYLINK INC DOMINION ENERGY INC

TelecommunicationsStock 1/8/2018Utility

$10,001 -$100,000 Stock 1/8/2018PPL CORPORATION Utility$100,001 -$1,000,000 Stock

$10,001 -$100,000 $10,001 - $100,000

1/8/2018 1/8/2018

AT&T INC BB & T CORP

Telecommunications Financial service Manufacturing Telecommunications

StockStock 1/8/2018CATERPILLAR INC

COMCAST CORP (NEW)~CLASS A $10,001 - $100,000 1/8/2018Stock$10,001 - $100,000

$2,000- $10,000 $100,001 - $1,000,000 Stock

$10,001 - $100,000

ManufacturingTelecommunicationsPharmaTelecommunications

Stock 1/8/2018EMERSON ELECTRIC CO FRONTIER COMMUNICATIONS CORP NEKTAR THERAPEUTICS VERIZON COMMUNICATIONS

Stock 1/8/20181/8/20181/8/2018Stock

FPPC Form 700 (2017/2018) Sch. A-1FPPC Toll-Free Helpline: 866/ASK-FPPC www.fppc.ca.gov

Page 5: Los Angeles City Ethics Commissionclkrep.lacity.org/onlinedocs/2011/11-0452-S8_misc_11-30-2018.pdf · 30/11/2018  · Centurylink Inc CTL (foundation, Schedule A-2) Telecommunications

700SCHEDULE A-2Investments, Income, and Assets

of Business Entities/Trusts(Ownership Interest is 10% or Greater)

CALIFORNIA FORMFAIR POLITICAL PRACTICES COMMISSION

Name

Pickel, Frederick H.

► 1. BUSINESS ENTITY OR TRUST► 1. BUSINESS ENTITY OR TRUST

Wilshire Energy Consulting Group Inc. The Chilk Family Charitable Foundation Inc.Name Name

%Band Gates Dramis,Pasadena, CA 91109 iRingling, Sarasota FL34237Address (Business Address Acceptable)

Check one□ Trust, go to 2

Address (Business Address Acceptable)

Check one□ Trust, go to 20 Business Entity, complete the box, then go to 2 0 Business Entity, complete the box, then go to 2

GENERAL DESCRIPTION OF THIS BUSINESS

Market research consulting, owned by spouseGENERAL DESCRIPTION OF THIS BUSINESS

Private Foundation, 501 (c)3

IF APPLICABLE, LIST DATE:IF APPLICABLE, LIST DATE: FAIR MARKET VALUE□ $0-$1,999□ $2,000 - $10,000 □ $10,001 - $100,000 X] $100,001 -$1,000,000 □ Over $1,000,000

FAIR MARKET VALUE□ $0 -$1,999□ $2,000 - $10,000 X\ $10,001 -$100,000 □ $100,001 - $1,000,000 □ Over $1,000,000

JSL jJlJSL jSL j. J.J. LDISPOSEDDISPOSED ACQUIREDACQUIRED

NATURE OF INVESTMENT|~1 Partnership Q Sole Proprietorship [x]

NATURE OF INVESTMENT Q Partnership Q) Sole Proprietorship jx]

unpaid VP Admin

Florida non-profit corpCalif, close corp. ST5tFeFOther

unpaid Secy/TreasurerYOUR BUSINESS POSITION YOUR BUSINESS POSITION

► 2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA SHARE OF THE GROSS INCOME JO THE ENTITY/TRUST)

► 2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA SHARE OF THE GROSS INCOME TO THE ENTITY/TRUST)

0 $0 - $499 □ $10,001 - $100,000 □ OVER $100,000

□ $10,001 - $100,000 □ OVER $100,000

□ $0 - $499□ $500 - $1,0000 $1,001 - $10,000

□ $500 - $1,000□ $1,001 - $10,000

► 3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF INCOME OF $10,000 OR MORE (Attach a separate sheet if necessary.)

► 3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF INCOME OF $10,000 OR MORE (Attach a separate sheet if necessary.)

0 None Q Names listed below[x) None □ Names listed below oror

► 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR LEASED BY THE BUSINESS ENTITY OR TRUST

► 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR LEASED BY THE BUSINESS ENTITY OR TRUST

Check one box:

[x] INVESTMENT

stock detail shown on Schedule A-1: AT&T, Centurylink

Check one box:

□ INVESTMENT □ REAL PROPERTY□ REAL PROPERTY

Name of Business Entity, if Investment, qtAssessor’s Parcel Number or Street Address of Real Property

Name of Business Entity, if Investment, orAssessor’s Parcel Number or Street Address of Real Property

telecom stocksDescription of Business Activity qtCity or Other Precise Location of Real Property

FAIR MARKET VALUE □ $2,000 - $10,000 □ $10,001 - $100,000 □ $100,001 -$1,000,000 □ Over $1,000,000

NATURE OF INTERESTProperty Ownership/Deed of Trust

Description of Business Activity qt

City or Other Precise Location of Real Property

FAIR MARKET VALUE □ $2,000 - $10,000 □ $10,001 - $100,000 3 $100,001 - $1,000,000 □ Over $1,000,000

NATURE OF INTEREST | | Property Ownership/Deed of Trust

IF APPLICABLE, LIST DATE: IF APPLICABLE, LIST DATE:

Jjl jSL jSL jSLL J. ]_ J.ACQUIRED DISPOSED ACQUIRED DISPOSED

□ Stock |~] Partnership [x] Stock Q Partnership

n Leasehold □ Other I | Leasehold □ OtherYrs. remaining

l~~l Check box if additional schedules reporting investments or real property are attached

Yrs. remaining

[Xl Check box if additional schedules reporting investments or real property are attached

FPPC Form 700 (2017/2018) Sch. A-2FPPC Advice Email: [email protected]

FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov

Comments:.

Page 6: Los Angeles City Ethics Commissionclkrep.lacity.org/onlinedocs/2011/11-0452-S8_misc_11-30-2018.pdf · 30/11/2018  · Centurylink Inc CTL (foundation, Schedule A-2) Telecommunications

700SCHEDULE CIncome, Loans, & Business

Positions(Other than Gifts and Travel Payments)

CALIFORNIA FORMFAIR POLITICAL PRACTICES COMMISSION

Name

Pickel, Frederick H.

► 1. INCOME RECEIVED ► 1. INCOME RECEIVED

NAME OF SOURCE OF INCOME

Sempra / SoCalGas

NAME OF SOURCE OF INCOME

Nestle USAADDRESS (Business Address Acceptable)

jghth Ave, San Diego, CA 92101

ADDRESS (Business Address Acceptable)

^H^orth Brand Blvd, Glendale, CA 91203BUSINESS ACTIVITY, IF ANY, OF SOURCE

Energy and utility services

BUSINESS ACTIVITY, IF ANY, OF SOURCE

Food productsYOUR BUSINESS POSITION

retiree

YOUR BUSINESS POSITION

Spouse: market research (retired Nestle 3/30/2018)

Q No Income - Business Position Only

□ $1,001 - $10,000

□ OVER $100,000

CONSIDERATION FOR WHICH INCOME WAS RECEIVED

Q Salary Q Spouse’s or registered domestic partner's income (For self-employed use Schedule A-2.)

CH Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.)

□ Sale of _______

Q Loan repayment

| | Commission or Rental Income, list each source of $10,000 or more

Q No Income - Business Position Only

□ $1,001 -$10,000

□ OVER $100,000

GROSS INCOME RECEIVED

□ $500 - $1,000

® $10,001 -$100,000

GROSS INCOME RECEIVED

□ $500 - $1,000

[x] $10,001 - $100,000

CONSIDERATION FOR WHICH INCOME WAS RECEIVED

Q Salary [X| Spouse's or registered domestic partner’s income (For self-employed use Schedule A-2.)

O Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.)

□ Sale of _______

Q Loan repayment

Q Commission or

(Real property, car, boat, etc.)(Real property, car, boat, etc.)

| | Rental Income, list each source of $10,000 or more

(Describe)

Qualified pension begun 2017, left SCG1993(Describe)

Qualified pension income post 3/30/18Ixl Other □ Other(Describe)(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* INTEREST RATE TERM (Months/Years)

|~l None.%ADDRESS (Business Address Acceptable)

SECURITY FOR LOAN

□ None I | Personal residenceBUSINESS ACTIVITY, IF ANY, OF LENDER

□ Real PropertyStreet address

HIGHEST BALANCE DURING REPORTING PERIOD

n $500 - $1,000

□ $1,001 - $10,000

□ $10,001 -$100,000

□ OVER $100,000

City

□ Guarantor

□ Other(Describe)

Comments:

FPPC Form 700 (2017/2018) Sch. CFPPC Advice Email: [email protected]

FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov

Page 7: Los Angeles City Ethics Commissionclkrep.lacity.org/onlinedocs/2011/11-0452-S8_misc_11-30-2018.pdf · 30/11/2018  · Centurylink Inc CTL (foundation, Schedule A-2) Telecommunications

Ethics Commission 200 N Spring Street City Hall — 24th Floor Los Angeles, CA 90012 (213) 978-1960 ethics.lacity.org

EmiCS COMMISSION Restricted Source Financial Disclosure Statement

Form 60Elected City officials, general managers and chief administrative officers of City agencies, members of City boards and commissions, and individuals nominated to positions subject to City Council approval must file this form in conjunction with the state Form 700. Please refer to the attached instructions for additional information.

13 Original Filing □ Amended Filing (original filed on / 720_____)o

Total Pages: _

Name:(Last, First, Middle)

Pickel, Frederick H.Agency: Position:■ Office of Public Accountability Executive Director / Ratepayer Advocate

Email:Phone:

11 15 18Type of Statement: 0 Pre-confirmation Date of nomination:

□ Assuming Office First day in position:

□ Annual

□ Leaving Office

/ 20.18/ 20.

/ 2017 through December 31, 20.1Z.

Last day in office: /____ / 20.

I had the following interests associated with restricted sources during this reporting period:

□ 1. REAL PROPERTY —section attached.Interests in real property leased from or to, co-owned by, purchased from, or sold to a restricted source.

□ 2. INVESTMENTS — section attached.Investments (other than real property) co-owned by, purchased from, or sold to a restricted source.

0 3, INCOME — section attached.Income received from a restricted source.

□ 4. GIFTS section attached.Gifts, cumulatively valued at $50 or more, received from a restricted source.

□ 5. BOARD POSITIONS —section attached.Positions held on the board of a restricted source.

- Or-

II] 6. NO INTERESTSI had no interests in real property, investments, income, gifts, or board positions associated with restricted sources during this reporting period.

Certification

I declare under penalty of perjury under the laws of the City of Los Angeles and the state of California that Iand complete.have read the instructions for this form and the informatioi

ll/afj/st&i £

Date Signature

January 2016 Los Angeles Municipal Code §§ 49.5.2, 49.5.9, 49.5.10

Page 8: Los Angeles City Ethics Commissionclkrep.lacity.org/onlinedocs/2011/11-0452-S8_misc_11-30-2018.pdf · 30/11/2018  · Centurylink Inc CTL (foundation, Schedule A-2) Telecommunications

^mmission .

illlfr 24th ^ioor' f,-,.’

(MraMBiMiSl

fifaisiKi

;~a:Sr ,t r1.gnticscoMMsaoN

£fi?jrr--Tjc' wsi|rhfAl 1i ;,y If*li-w >u.*=P

j/'f.KIP 'tiPiiipfc,

MB ||y.il

'■>m -m “.iii

!*i« ;!!! mmmmwa r > M.iy,j-i,. i-’

-:’"r:r'> "1‘ m•* Iy MillilI

Name:(Last, First, Middle)

Pickel, Frederick H.The following income was received from a restricted source.

Name of restricted source: Sempra / SoCalGas

Name of restricted source: Nestle USA

Address of restricted source:ighth Ave, San Diego, CA 92101

Address of restricted source:^^North Brand Blvd, Glendale, CA 91203

Business activity of restricted source:Food products

Business activity of restricted source: Energy and utility services

Position title: retiree

Position title:Market research (retired Nestle 3/30/2018)

Income received by:□ Me □ My spouse/registered domestic partner□ My dependent child

Value of income:□ $500—$1,000 □ $1,001-$10,000□ $10,001-$100,000 □ Over $100,000

Income received by:□ Me □ My spouse/registered domestic partner□ My dependent child

Value of income:□ $500—$1,000 □$1,001—$10,000□ $10,001—$100,000 □ Over $100,000

Income was:□ Salary/Commission □ Loan repayment

□ Rental income □ Sale of____________

Income was:□ Salary/Commission □ Loan repayment

□ Rental income □ Sale of____________(e.g., car, boat, etc.)

m Other: Qualified pension income post 3/30/18 to 11/16/18

(e.g., car, boat, etc.)

□ Other: Qualified pension begun 2017, left SoCalGas1993

Name of restricted source: Name of restricted source:

Address of restricted source:Address of restricted source:

Business activity of restricted source: Business activity of restricted source:

Position title: Position title:

Income received by:□ Me □ My spouse/registered domestic partner□ My dependent child

Value of income:□ $500—$1,000 □$1,001—$10,000□ $10,001—$100,000 □ Over $100,000

Income received by:□ Me □ My spouse/registered domestic partner□ My dependent child

Value of income:□ $500—$1,000 □ $1,001—$10,000□ $10,001—$100,000 □ Over $100,000

Income was:□ Salary/Commission □ Loan repayment

□ Rental income □ Sale of____________

Income was:□ Salary/Commission □ Loan repayment

□ Rental income □ Sale of____________(e.g., car, boat, etc.) (e.g., car, boat, etc.)

□ Other: □ Other:

January 2016 Los Angeles Municipal Code §§ 49.5.2, 49.5.9, 49.5.10