...... ~ .l~ • emF' RNIA FORM 700 RE ECONOMIC INTEREST FAIR POLITICAL PRACTICES COMMISSION A PUBLIC DOCUMENT FEB 2 3 2016 C VER PAGE Please type or print in ink.
NAME OF FILER (LAST) Bloom Richard Q \ Office, Agency, or Court ® Agency Name (Do not use acronyms) California State Assembly Division, Board, Department, District, if applicable Your Position District 50 Assemblymember
~ If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
Agency: ______Position: ______
2. Jurisdiction of Offi ce (Check at least one box) [lJ State o Judge or Court Commissioner (Statewide Jurisdiction) o Multi-County ______o County of ______o City of ______o Other ______
3. Type of Statement (Check at least one box) [lJ Annual: The period covered is January 1, 2015, through o Leaving Office: Date Left ---1---1___ _ December 31 , 2015. (Check one) ·or· The period covered is ---1-----1____ , through o The period covered is January 1, 2015, through the date of leaving office. December 31, 2015. ·or· o Assuming Office: Date assumed ---1-----1___ _ o The period covered is ---1---1 , through the date of leaving office. o Candidate: Election year and office sought, if different than Part 1: ______
4. Schedule Summary (must complete) ~ Total number of pages including this cover: page: ~13~_.... Schedules attached [lI Schedule A·1 • Investments - schedule attached 12I Schedule C • Income, Loans, &Business Positions - schedule attached [Q] Schedule A·2 • Investments - scheoule attached [lJ Schedule 0 . Income - Gifts - schedule attached [11 Schedule B • Real Property - schedule attached [l] Schedule E • Income - Gifts - Travel Payments - schedule attached -or-
d herein and in any attached schedules is true and complete. I acknowledge this i
I certify under penalty of pe~ury under the laws of the State of California th
Date Signed 02/23/2016 Signat (month. day. year)
FPPC Form 700 (2015/2016) FPPC Advice Email: [email protected] FPPC TolI·Free Helpline: 866/275-3772 www.fppc.ca.gov ,.1 . , . ' SCHEDULE A-1 CALIFORNIA FORM 700 Investments FAIR POLITICAL PRACTICES COMMISSION Stocks, Bonds, and Other Interests Name (Ownership Interest is Less Than 10%) Richard Bloom Do not attach brokerage or financial statements.
~ NAME OF BUSINESS ENTITY ~ NAME OF BUSINESS ENTITY Activision, Inc. GENERAL DESCRIPTION OF THIS BUSINESS GENERAL DESCRIPTION OF THIS BUSINESS
Technology
FAIR MARKET VALUE FAIR MARKET VALUE o $2,000 - $10,000 III $10,001 • $100,000 o $2,000· S10,000 0$10,001 • $100,000 0$100,001 - $1 ,000,000 DOver Sl,OOO ,Ooo o S100,OOl • $1 ,000,000 DOver Sl ,OOO ,Ooo
NATURE OF INVESTMENT NATURE OF INVESTMENT III Stock 0 Olher ------o Stock 0 Other ------(Descnbe) (Descnbe) o Partnership 0 Income Received of SO - $499 o Partnership 0 Income Received of $0 • S499 o Income Received of $500 or More (Report on Schedule C) o Income Received of S500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE. IF APPLICABLE, LIST DATE:
~---.l~ ~~~ ~---.l~ DISPOSED ACQUIRED DISPOSED
~ NAME OF BUSINESS ENTITY ~ NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE FAIR MARKET VALUE 0$2,000 - $10,000 0 $10,001 • $100,000 o S2,OOO • S10,OOO o $10,001 - $100,000 o $100,001 • $1 ,000,000 DOver $1,000,000 0$100,001 • $1 ,000,000 DOver Sl ,OOO ,Ooo
NATURE OF INVESTMENT NATURE OF INVESTMENT o Stock 0 Other ------o Stock 0 Other ------IDescrlbe) (Descnbe) o Partnership 0 Income Received of $0 - S499 o Partnership 0 Income Received of SO • S499 o Income Received of $500 or More (Report on Schedule C) o Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE, LIST DATE. IF APPLICABLE, LIST DATE'
~~~ ~~~ ---.l~~ ~---.l~ ACQUIRED DISPOSED ACQUIRED DISPOSED
~ NAME OF BUSINESS ENTITY ~ NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE FAIR MARKET VALUE o S2,OOO - S10,OOO o S10,OOl . $100,000 o S2,OOO • $10,000 o $10,001 - $100,000 0$100,001 • $1 ,000,000 DOver Sl,OOO ,Ooo o S100,001 • $1,000,000 DOver $1 ,000,000
NATURE OF INVESTMENT NATURE OF INVESTMENT o Stock D Other ------o Stock 0 Other ------(Describe) (Descnbe) o Partnership 0 Income Received of $0 • S499 o Partnership 0 Income Received of $0 - S499 o Income Received of S500 or More (Report on Schedule C) o Income Received of $500 or More (Report on SChedule C)
IF APPLICABLE, LIST DArt: IF APPLICABLE, LIST DATE:
~~~ ~~~ ~~~ ---.l---.l~ ACQUIRED DISPOSED ACQUIRED DISPOSED
Comm e n ~: ______
FPPC Form 700 (2015/2016) 5ch. A-I FPPC Advice Email: [email protected] FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov SCHEDULE C CALIFORNIA FORM 700 Income, Loans, & Business FAIR POLITICAL PRACTICES COMMISSION Positions Name (Other than Gifts and Travel Payments) Richard Bloom
~ 1. INCOME RECEIVED ~ 1. INCOME RECEIVED NAME OF SOURCE OF INCOME NAME OF SOURCE OF INCOME Cedars-Sinai Medical Center ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 8700 Beverly Blvd, Los Angeles, CA 90048 BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE Health Care YOUR BUSINESS POSITION YOUR BUSINESS POSITION
GROSS INCOME RECEIVED GROSS INCOME RECEIVED o $500 - $1 .000 0 $1 ,001 - $10,000 0$500 - $1 .000 0 $1 ,001 - $10 ,000 o $10,001 - $100,000 [lI OVER $100,000 0$10,001 - $100,000 0 OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED CONSIDERATION FOR WHICH INCOME WAS RECEIVED o Salary [lI Spouse's or registered domestic partner's income o Salary 0 Spouse's or registered domestic partner's income (For self-employed use Schedule A-2.) (For self-employed use Schedule A-2.) o Partnership (Less than 10% ownership For 10% or greater use o Partnership (Less than 10% ownership For 10% or greater use Schedule A-2 ) Schedule A-2 ) o Sale of ______o Sale of ------ (Real property. car, boat. etc) (Real property. car. boat. etc) o Loan repayment o Loan repayment o Commission or 0 Rental Income, list each source of $1 0.000 or more o Commission or 0 Rental Income, list each source of SI0.000 or more
(Descnbe) (Descnbe)
Other ------ Other ------o (Descnbe) o (Descnbe)
~ 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 (MonthslYears)
____% o None ADDRESS (Business Address Acceptable) SECURITY FOR LOAN
BUSINESS ACTIVITY, IF ANY, OF LENDER o None o Personal residence
Real Property ------ o Street address HIGHEST BALANCE DURING REPORTING PERIOD
$500 - $1.000 o C,ty o $1,001 - $10,000 o Guarantor ------o $10,001 - $100,000 DOVER $100,000 Other ------o (Describe)
Comments: FPPC Form 700 (2015/2016) 5ch. C FPPC Advice Email: [email protected] FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov ',I.· 'I'
CALIFORNIA FORM 700 SCHEDULE D FAIR POLITICAL PRACTICES COMMISSION Name Income - Gifts Richard Bloom
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) Toni Atkins for State Assembly 2014 Toni Atkins for State Assembly 2014 ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 330 Encinitas Blvd., Ste. 101, Encinitas, CA 92024 330 Encinitas Blvd., Ste. 101, Encinitas, CA 92024 BUSINESS ACTIVITY, IF ANY. OF SOURCE BUSINESS ACTIVITY. IF ANY. OF SOURCE Campaign Campaign DATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(S) DATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(S)
38.88 Business Card Holder 80.19 Food & Beverage ~~~ $ ~~~ $
52.27 Food & Beverage 31.66 Food & Beverage ~5~ $ ~5~ $
67.76 Oem. Caucus Jacket 7.00 Food & Beverage ~~~ $ ~~~ $
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) Toni Atkins for State Assembly 2014 Toni Atkins for State Assembly 2014 ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 330 Encinitas Blvd., Ste. 101, Encinitas, CA 92024 330 Encinitas Blvd., Ste. 101, Encinitas, CA 92024 BUSINESS ACTIVITY, IF ANY. OF SOURCE BUSINESS ACTIVITY. IF ANY, OF SOURCE Campaign Campaign DATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(S) DATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(S)
~~~ $ 71.42 Food & Beverage 5~~ $ 116.00 Tour Ticket for Louvre
~~~ $ 149.06 Food & Beverage ~~~ $ 11.27 Food & Beverage
~~~ $ __5_8_ .5_0 Food & Beverage
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) California Charter Schools Association Big Heart Pet Brands ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 1107 9th Street, Ste. 200, Sacramento, CA 95814 One Maritime Plaza, San Francisco, CA 94111 BUSINESS ACTIVITY. IF ANY. OF SOURCE BUSINESS ACTIVITY, IF ANY. OF SOURCE State Charter School Advocacy Producer & Distributor of Pet Products DATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(S) DATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(S)
~5~ $ __3_6_ .8_7 Food & Beverage ~!.L~~ $, __1_. 1_5 Pet Brands Cookie
---1---1___ $ ______---1---1_ $ ____
---1---1___ $ ______
Commen~ : ______
FPPC Form 700 (2015/2016) 5ch. 0 FPPC Advice Email: [email protected] FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov ': I ' I
CALIFORNIA FORM 700 SCHEDULE D FAIR POLITICAL PRACTICES COMMISSION Name Income - Gifts Richard Bloom
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) California Business Industry Association Phillips 66 ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 1215 K Street, Ste. 1200, Sacramento, CA 95814 1201 K Street, Ste, 1930, Sacramento, CA 95814 BUSINESS ACTIVITY. IF ANY. OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE Home Building & Land Development Advocacy Energy Manufacturing Company DATE (mmldd/yy) VALUE DESCRIPTION OF GIFT{S) DATE (mm /dd /yy) VALUE DESCRIPTION OF GIFT{S)
~~~ $, __5_.5_9 Back-to-Session Bash ~~~ $ __2_,8_0 Back-to-Session Bash
--.1--.1_ $ ____
--.1--.1___ $ ______--.1--.1___ $ ______
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) Pomo of Upper Lake Habematolel California Tribal Business Alliance ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 375 E. Hwy. 20, Ste. I, Upper Lake, CA 95485 1530 J Street, Suite 410, Sacramento, CA 95814 BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE Small Land Indian Reservation in Upper Lake County California Tribal Advocacy DATE (mmldd/yy) VALUE DESCRIPTION OF GIFT{S) DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT{S)
~5~ $. __5_,2_4 Back-to-Session Bash ~5~ $ __2_7_.7_8 Back-to-Session Bash
--.1--.1_ $, ____ --.1--.1_ $ ____
--.1--.1___ $ ______
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) LiUNA California State Council of Laborers Native American Financial Services Association ADDRESS (BuSiness Address Acceptable) ADDRESS (Business Address Acceptable) 1121 L Street, Ste, 502, Sacramento, CA 95814 325 7th Street, NW, Suite 400, Washington, DC 2000 BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE State Labor Council Native American Financial Advocacy Services DATE (mmldd/yy) VALUE DESCRIPTION OF GIFT{S) DATE (mm /dd/yy) VALUE DESCRIPTION OF GIFT{S)
~~~ $. __3_,_50_ Back-to-Session Bash ~5~ $ __5_,2_5 Back-to-Session Bash
~~.L~.~~ $. __55_,_35_ Food & Beverage
--.1--.1___ $, ______--.1--.1_ $ ____
Commen~: ______
FPPC Form 700 (2015/2016) Sch, D FPPC Advice Email: [email protected] FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov ft' I ••
CALIFORNIA FORM 700 SCHEDULE D FAIR POLITICAL PRACTICES COMMISSION Name Income - Gifts Richard Bloom
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) California Healthcare Institute California Federation of Teachers ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 1201 K Street, Ste. 1840, Sacramento, CA 95814 1107 Ninth Street, Ste. 460, Sacramento, CA 95814 BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE Healthcare Advocacy California Labor Federation Council DATE (mmldd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mm /dd /yy) VALUE DESCRIPTION OF GIFT{S)
~~~ $ __4_8_.5_6 Food & Beverage ~ 26 I~ $, __36_._85_ Food & Beverage
---.l--.l_ $, ____ ---.l---.l_ $, ____
---.l--.l_ $, ____ ---.l---.l___ $ ______
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) The Humane Society of the United States California Democratic Party
ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 2100 L Street, NW, Washington DC 20037 1830 Ninth Street, Sacramento, CA 95811
BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY. OF SOURCE Animal Welfare Advocacy Campaign DATE (mmldd/yy) VALUE DESCRIPTION OF GIFT{S) DATE (mm/dd /yy) VALUE DESCRIPTION OF GIFT{S)
$, __1_6_.6_9 Food & Beverage 35.21 Food & Beverage ~~~ ~E.J~ $ 44.99 Food & Beverage ---.l--.l___ $ ______~~~ $ 144.38 Food & Beverage ---.l--.l___ $, ______~~~ $
~ NAME OF SOURCE (Not an Acronym) .. NAME OF SOURCE (Not an Acronym) The Walt Disney Company Heal the Bay ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 500 South Buena Vista Street, Burbank, CA 91521 1444 9th Street, Santa Monica, CA 90401 BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY. OF SOURCE Media and Entertainment Environmental Nonprofit Greater Los Angeles DATE (mmldd/yy) VALUE DESCRIPTION OF GIFT{S) DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT{S)
~~~ $ __1_0_'0_0 Movie Ticket ~~~ $, __3o_._00_ Event Ticket
---.l---.l___ $, ______
---.l--.l_ $ ____ ---.l--.l___ $ ______
Commen~ : ______
FPPC Form 700 (2015/2016) Sch. D FPPC Advice Email: [email protected] FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov CALIFORNIA FORM 700 SCHEDULE D FAIR POLITICAL PRACTICES COMMISSION Name Income - Gifts Richard Bloom
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) Monterey Bay Aquarium Foundation Energy Foundation ADDRESS (Busmess Address Acceptable) ADDRESS (Business Address Acceptable) 886 Cannery Row, Monterey, CA 93940 301 Battery St, San Francisco, CA 94111 BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE Public Aquarium Major Foundations Interested in Sustainable Energy DATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(S) DATE (mmldd /yy) VALUE DESCRIPTION OF GIFT(S)
~~~ $, __79_ ,_60_ Admission Tickets (2) ~~~ $ 125.00 Food & Beverage
~~~ $ 107,96 Food & Beverage
---1---1__ $, ____ ---1----.1_ $ ____
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) Sempra Energy Utilities Los Angeles County Museum of Art ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 925 L Street, Ste, 650, Sacramento, CA 95814 5905 Wilshire Blvd, Los Angeles, CA 90036 BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE Public Utilities County Museum of Art DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
Food & Beverage Event Ticket _~~_L2~. .J~ $ 107.56 ~~~ $ 5,000.00
---1---1_ $ ____
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) California Medical Association Toy Industry Association Inc. ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 1201 J Street, Ste. 200, Sacramento, CA 95814 1115 Broadway #400, New York, NY 10010 BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE Healthcare Advocacy Nonprofit Trade Association DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mm /dd /yy) VALUE DESCRIPTION OF GlFT(S)
~~~ $ __3_1_.7_9 Food & Beverage ~~~ $ __2_.0_0 Toy Day Gift Bag
---1---1__ $ ____
---1---1_ $, ____
Commen~ : ______
FPPC Form 700 (2015/2016) 5ch, 0 FPPC Advice Email: [email protected] FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov , .~ . .. .
CALIFORNIA FORM 700 SCHEDULE D FAIR POLITICAL PRACTICES COMMISSION Name Income - Gifts Richard Bloom
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) California Chamber of Commerce (Hyatt Regency) California Automatic Vendors Council ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 1209 L Street, Sacramento, CA 95814 80 S. Lake Ave., Ste. 539, Pasadena, CA 91101 BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE CA Jobs & Economic Development Advocacy Vending & Coffee Service Industry DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
~~~ $ __5_6_ .7_2 Food & Beverage ~~~ $ __2_0_ .0_0 Food & Gift Bag
---1---.1_ $, ____ ---1---.1_ $ ____
---1----1_ $, ____
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) California Planned Parenthood Education Fund Jewish Public Affairs Committee of California
ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 555 Capitol Mall, Ste. 510, Sacramento, CA 95814 1127 Eleventh St., Ste. 400, Sacramento, CA 95814 BUSINESS ACTIVITY. IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE Healthcare, Education, Patient Services Jewish Organization Coaltion DATE (mmldd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
Food & Beverage ~~~ $ __4_5_.0_0 Event Ticket ~~.L2~~ $ __2_7_ .1_4
---1---.1_ $, ____ ---.1---.1_ $, ____
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) California Refuse Recycling Council Northern District California Refuse Recycling Council Southern District ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 1121 L Street, Ste. 505, Sacramento, CA 95814 1851 E First Street, Ste. 1220, Santa Ana, CA 92705 BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE Recycling & Waste Advocacy Recycling & Waste Advocacy DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/dd /yy) VALUE DESCRIPTION OF GIFT(S)
Trash Bash Reception ~~.L!~~ $ __3_4_.1_4 Trash Bash Reception ~5~ $ __3_4_.1_4
---1---1_ $ ____ ---.1---.1___ $ ______
---.1----1___ $,______
Commen~ : ______
FPPC Form 700 (2015/2016) 5ch. 0 FPPC Advice Email: [email protected] FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov " .
CALIFORNIA FORM 700 SCHEDULE D FAIR POLITICAL PRACTICES COMMISSION Name Income - Gifts Richard Bloom
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) California Beer and Beverage Distributors UCLA Institute of Transportation Studies ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 1415 L St #890, Sacramento, CA 95814 3320 Public Affairs Building, Los Angeles, CA 90095 BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE Beer & Beverage Distribution and Advocacy Transportation Studies DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
~L:~.~~ $, __1_2_.0_6 Food & Beverage ~~~ $ __7_5_,0_0 Event Ticket
Conference Admission ---1~___ $, ______~~~ $ 799.00
---1~___ $ ______---1~_ $ ____
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) Lorena Gonzalez for State Assembly 2016 Los Angeles Waterkeeper ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 330 Encinitas Blvd., Ste. 101, Encinitas, CA 92024 120 Broadway, Santa Monica, CA 90401 BUSINESS ACTIVITY. IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY. OF SOURCE Campaign Water Quality Protection in Los Angeles County DATE (mm/ddlyy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
~~~ $, __19_._63_ Food Event Ticket
--1~_ $ ____
---1~___ $, ______---1~_ $ ____
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) Civil Justice Association of California Comcast Corporation - NBC Universal ADDRESS (Business Address Acceptable) ADDRESS (Business Address Accep.table) 1201 K Street, Ste. 1850, Sacramento, CA 95814 1 Comcast Center, 1701 JKF Blvd., Philadelphia, PA BUSINESS ACTIVITY. IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE Civil Justice Advocacy Media & Entertainment DATE (mmldd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
15.96 Food & Beverage ~~~ $ __1_4_,0_0 Movie Ticket ~~~ $
9.86 Food & Beverage ~~~ $ __1_0_.0_0 Food & Beverage ~5~ $
15.00 Parking --1~___ $ ______~5~ $
ommens: ______Address Continued: Comcast Corporation 19103-2838 ______C t
FPPC Form 700 (2015/2016) 5ch. D FPPC Advice Email: [email protected] FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov '. '
CALIFORNIA FORM 700 SCHEDULE D FAIR POLITICAL PRACTICES COMMISSION Name Income - Gifts Richard Bloom
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) Calpine Corporation The Nature Conservancy ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 4160 Dublin Blvd" Ste, 100, Dublin, CA 94568 555 Capitol Mall, Ste, 1290, Sacramento, CA 95814 BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE Electricity, Natural Gas, and Geothermal Resources Nature Protection DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
~~~ $ __8_9_ ,9_6 Food & Transportation ~~~ $ 858,00 Food,Transportation,
~~--- $------~~--- $------
~~- $,----
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) California Energy Efficiency Industry Council California Fresh Fruit Association ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 1535 Farmers Lane,Ste, 312, Santa Rosa, CA 95405 978 West Alluvial, Ste, 107, Fresno, CA 93711-5700 BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE Energy Efficiency Council Nonprofit Trade Association for Agriculture Growers DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
~~~ $, __20_ ,_62_ Food & Beverage ~ 20 I~ $ __1_4_,0_0 Food & Lunch Pail
~~--- $------
~~- $---- ~~- $,----
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) California Cable & Telecommunications Association West Hollywood Beverly Hills Democratic Club ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 1001 K Street, 2nd Floor, Sacramento, CA 95814 8149 Santa Monica Blvd" Ste, 190, West Hollywood, BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE Cable & Telecommunication Services Campaign & Democratic Club DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
Event Ticket ~~~ $,__ 4_,_54_ Baseball Viewing Party ~~~ $ __5_0_,0_0
~~- $----
Comments: The Nature Conservancy Continued Description: SCI Day Use Fee; West Hollywood Beverly Hills DemocratIc Club (Address Continued) CA, 90046
FPPC Form 700 (2015/2016) 5ch. 0 FPPC Advice Email: [email protected] FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov ' ..
CALIFORNIA FORM 700 SCHEDULE D FAIR POLITICAL PRACTICES COMMISSION Name Income - Gifts Richard Bloom
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) The Jewish Federation of Greater Los Angeles Found Animals Foundation ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 6505 Wilshire Blvd., Los Angeles, CA 90048 4235 Sepulveda Blvd., Culver City, CA, 90230 BUSINESS ACTIVITY, IF ANY, OF SO URCE BUSINESS ACTIVITY. IF ANY, OF SOURCE Los Angeles Jewish Community Advocacy Nonprofit Pet Adoption & Clinical Services DATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/ddlyy) VALUE DESCRIPTION OF GIFT(S)
~~~ $ 250.00 Event Ticket ~~~ $ 500.00 Event Tickets (2)
---1---1___ $ ______---1---1__ $~ _____
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) American Friends of Magen David Adorn Friends of Ballona Wetlands ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 6505 Wilshire Blvd., Ste 450, Los Angeles, CA 90048 211 Culver Blvd, Playa Del Rey, CA 90293 BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY. IF ANY. OF SOURCE Emergency First Responders & Disaster Relief Protection of the Ballona Wetlands DATE (mm/ddlyy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/dd/yy) VALUE DESCRIPnoN OF GIFT(S)
Event Ticket ~ 24 I~ $ 100.00 Event Ticket
---1---1__ $ _____ ---1---1__ $ ______
---1---1__ $ ______---1---1_ $ ____
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) Armenian National Committee of America Meals on Wheels West ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 104 N Belmont Ste 200, Glendale, CA 91206 1823 Michigan Ave, Santa Monica, CA 90404 BUSINESS ACTIVITY, IF ANY. OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE Armenian Grassroots Political Organization Food Provider to Homebound or Disabled Individuals DATE (mm /ddlyy) VALUE DESCRIPTION OF GIFT(S) DATE (mmldd/yy ) VALUE DESCRIPTION OF GIFT(S)
~~~ $ 250.00 Event Ticket ~~~ $ 200.00 Event Tickets (2)
---1---1_ $,___ _ ---1---1_ $ ____
---1---1_ $ ____
ommens: ____American______Friends______of Magen______David Adorn______Continued:______Organization______C t
FPPC Form 700 (2015/2016) 5ch. 0 FPPC Advice Email: [email protected] FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov " . , .
CALIFORNIA FORM 700 SCHEDULE D FAIR POLITICAL PRACTICES COMMISSION Name Income - Gifts Richard Bloom
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) California Chamber of Commerce - The Ritz Carlton West Hollywood Chamber of Commerce ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 4375 Admiralty Way, Marina del Rey,CA 90292 8272 Santa Monica Blvd, West Hollywood, CA 90046 BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE CA Jobs & Economic Development Advocacy WEHO Jobs & Economic Development Advocacy DATE (mm/ddlyy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/ddlyy) VALUE DESCRIPTION OF GIFT(S)
Food & Beverage ..22...t 04 I~ $ 200.00 Event Ticket
~~--- $------~~--- $------
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) CLARE Foundation California League of Conservation Voters ADDRESS (Busmess Address Acceptable) ADDRESS (Business Address Acceptable) 909 Pico Blvd, Santa Monica, CA 90404 350 Frank H Ogawa Plaza #1100, Oakland, CA 9461 BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY. IF ANY, OF SOURCE Recovery Drug Rehab Treatment Nonpartisan California Environmental Advocacy DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/ddlyy) VALUE DESCRIPTION OF GIFT(S)
Event Ticket ~5~ $ 300.00 Event Ticket
~~--- $------
~~- $,----
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) Los Angeles County Economic Development ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 444 S. Flower St.,Ste. 3700, Los Angeles, CA 90071 BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE LA County Economic & Business Development DATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/ddlyy) VALUE DESCRIPTION OF GIFT(S)
Event Ticket __~_~_L~.~~ $ 500.00 ~~--- $------
~~- $----
~---1___ $, ______
California Chamber of Commerce - The Ritz Carlton (Continued), Marina del Rey; Los Angeles County Commen~:~~~~~~~==~~~~~~~~~~~=-______-- ______Economic Development (Continued) - CorporatIon
FPPC Form 700 (2015/2016) 5ch. D FPPC Advice Email: [email protected] FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov ' ..
CALIFORNIA FORM 700 SCHEDULE E FAIR POLITICAL PRACTICES COMMISSION Income - Gifts Name Travel Payments, Advances, Richard Bloom and Reimbursements
• Mark either the gift or income box. • Mark the "501(c)(3)" box for a travel payment received from a nonprofit 501(c)(3) organization or the "Speech" box if you made a speech or participated in a panel. These payments are not subject to the $460 gift limit, but may result in a disqualifying conflict of interest. • For gifts of travel that occurred on or after January 1, 2016, provide the travel destination.
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) California Foundation on the Environment and The The Energy Coalition ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) Pier 35, Suite 202 523 West 6th, Ste.1110 CITY AND STATE CITY AND STATE San Francisco, CA 94133 Los Angeles, CA 90014 o 501 (c)(3) or DESCRIBE BUSINESSA CTIVITY. IF ANY. OF SOURCE III 501 (c)(3) or DESCRIBE BUSINESS ACTIVITY. IF ANY, OF SOURCE Environmental & Economic Infrastructure Issues in CA Energy Architects for a Sustainable Living
DATE(S) 04 / 30 /~ _~ ~~ AMT $_6_5_1._8_4 ___ DATE(S) 05/ 23 /~ _ 05 / 30 /~ AMT: $ 4,111 .99 (If gift) (If gift)
~ MUST CHECK ONE [l] Gift -or- 0 Income ~ MU ST CHECK ONE: [l] Gift -or- 0 Income
@ Made a Speech/Participated in a Panel @ Made a Speech/Participated in a Panel o Other - Provide Description ______o Other - Provide Description ______
~ If Gift, Provide Travel Destination ______~ If Gift, Provide Travel Destination ______The Silverado Spa & Resort Napa California-1600 Atlas Peak Road, Napa, CA 94558 Tokyo, .Japan
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) Kenes Exhibitions Climate Action Reserve ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 6, Ha-Yotsrim Str., 3rd Floor 601 West 5th, Ste. 650 CITY AND STATE CITY AND STATE Yehuda, 6021820, Israel Los Angeles, CA 90071 o 501 (c)(3) or DESCRIBE BUSINESS ACTIVITY, IF ANY, OF SOURCE o 501 (c)(3) or DESCRIBE BUSINESS ACTIVITY, IF ANY, OF SOURCE World Wide Business Conferences and Exhibitions Market-Based Climate Change Solutions that Benefit DATE(S) . ~~~ _~~~ AMT·$3,190.36 DATE(S) : ~ 03/~_~~~ AMl: $ 4,156.56 (If gift) (If gift)
~ MUST CHECK ONE: 0 Gift -or- [l] Income ~ MUST CHECK ONE: 0 Gift -or- [l] Income
@ Made a Speech/Participated in a Panel @ Made a Speech/Participated in a Panel o Other - Provide Description ______o Other - Provide Description ______
~ If Gift, Provide Travel Destination ______~ If Gift, Provide Travel Destin ation ______
California Foundation on the Environment and The (Continued) Economy; Climate Action Reserve - Comments: ECOl lOli lieS, ECOSysteli IS alld SOciety.
FPPC Form 700 (2015/2016) 5ch. E FPPC Advice Email: [email protected] FPPC Toll-Free Helpline: 866/275-3172 www.fppc.ca.gov CALIFORNIA FORM 700 SCHEDULE D FAIR POLITICAL PRACTICES COMMISSION Income - Gifts N . ~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) Toni Atkins for State Senate 2016 ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 330 Encinitas Blvd., Ste. 101, Encinitas, CA 92024 BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE Campaign DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
~~~ $ __4_7_ .2_8 Food & Beverage
---.-1---.-1- $ ____ ---.-1---.-1- $ ____
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable) ADDRESS (BuSiness Address Acceptable)
BUSINESS ACTIVITY. IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE
DATE (mmldd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mmldd/yy) VALUE DESCRIPTION OF GIFT(S)
---.-1---.-1-- $ ____
---.-1---.-1-- $ ____ ---.-1---.-1-- $ ______
---.-1---.-1- $ ____ ---.-1---.-1- $ ____
~ NAME OF SOURCE (Not an Acronym) Filer's Verification
Print Name Richard H. Bloom ADDRESS (Business Address Acceptable) Office, Aaencv . . .., or Court - • California state Assembly BUSINESS ACTIVITY, IF ANY, OF SOURCE Statement Type \ll2015/2016 Annual D Assuming D Leaving D __ Annual DCandidate DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) (yr) I have used all reasonable diligence in preparing this statement. I have ---.-1---.-1-- $ ____ reviewed this statement and to the best of my knowledge the information contained herein and in any attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
---.-1---.-1-- $, _____ Date Signed _____---:-"0:..:;3:;-::/0=-:-1:.:.:/2:.;0=-17-=6=-- _____ (month, day. year) (d)(5) Filer's Signature __ ⁌⁌‽ ⁾† ____ _
Comments: ______
FPPC Form 700 (2015/2016) 5ch. D FPPC Advice Email: [email protected] FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov h~ ;,;c .V l:J :> ? POI IT,f"' , j' L I\.... . CALIFORNIA FORM 700 i r', ,CT ICES CO ,1 ' :S' SCHEDULE D FAIR POLITICAL PRACTICES COMr.1ISSION Income - Gifts IG JUL 29 PH /: 24
• NAME OF SOURCE (Not an Acronym) • NAME OF SOURCE (Not an Acronym) UCLA Institute of Transportation Studies American Friends of Magen David Adom ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) Box 165606, 3320 Public Affairs Building, LA, 6505 Wilshire Boulevard, Suite 450, Los Angeles, CA BUSINESS ACTIVITY, IF ANY. OF SOURCE BUSINESS ACTIVITY, IF ANY. OF SOURCE Transportation Studies Emergency First Responders & Disaster Relief DATE (mm/ddlyy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S)
~~~ $, ____70_,_00_ Event Ticket Meal Cost
~ 29 I~ $ __9_0_.0_0 Conference Admission -----1-----1_ $, ______
-----1-----1_ $, ______
• NAME OF SOURCE (Not an Acronym) • NAME OF SOURCE (Not an Acronym) LA Waterkeeper Found Animals Foundation ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 120 Broadway, Santa Monica, CA 90401 P.O. Box 66370, Los Angeles, CA 90066 BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE Water Quality Protection in LA County Nonprofit Pet Adoption & Clinical Services DATE (mmlddlyy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/ddlyy) VALUE DESCRIPTION OF GIFT(S)
~J..!.J~ $ 100.00 food/bev/entertainment ~~~ $ 100.00 Attend.lparticipation
-----1-----1_ $ ______-----1-----1_ ....$ ______
• NAME OF SOURCE (Not an Acronym) Filer's Verification The Nature Conservancy Print Name Richard Bloom ADDRESS (Business Address Acceptable) Office, Agency 555 Capitol Mall, Suite 1290, Sacramento, CA 95814 or Court CA State Assembly BUSINESS ACTIVITY, IF ANY. OF SOURCE Nature Protection Statement Type ill 2015/2016 Annual o Assuming D Leaving D_--Annual DCandldate DATE (mm/ddlyy) VALUE DESCRIPTION OF GIFT(S) (ytJ I have used all reasonable diligence in preparing this statement. I have ~~~ $ 429.00 Trans.lDay use !food reviewed this statement and to the best of my knowledge the Information contained herein and In any attached schedules Is true and complete, ~~~ $ 429.00 Trans.lDay use !food I certify under penalty of perjury under the laws of the State of California that the foregoing Is true and correct.
-----1-----1__ $, ______Date Signed ---⁔›‧⁾‽›⁔‧⁆‧ ‧-(d)(5)
Filer's Signature ⁾›››››⁾-
Comments: ______⁾⁾†
FPPC Form 700 (2015/2016) Sch. D FPPC Advice Email: [email protected] FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov • •
CALIFORNIA FORM 700 SCHEDULE D FAIR POLITICAL PRACTICES COMMISSION Income - Gifts AMENDMENT \ t, J\jl 29 PM \! 24
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) LA County Economic Development ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) 444 S. Flower Street, 37th Floor, Los Angeles CA 90 BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE LA County Economic & Business Development DATE (mmtdd/yy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/ddlyy) VALUE DESCRIPTION OF GIFT(S)
~~~ $ __50_ ._00_ Food & Beverage
~~- $,---- ~~- $,----
~~- $,---- ~~- $,----
~ NAME OF SOURCE (Not an Acronym) ~ NAME OF SOURCE (Not an Acronym) Los Angeles County Museum of Art ADDRESS (Business Address Acceptable) ADDRESS (Businass Address Accaptable) 5905 Wilshire Blvd., Los Angeles, CA 90036 BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE County Museum of Art DATE (mm /dd /yy) VALUE DESCRIPTION OF GIFT(S) DATE (mm/ddlyy) VALUE DESCRIPTION OF GIFT(S)
Event Ticket ~~~ $ 211 .00 ~~- $,----
~~- $,----
~~- $,---- ~~- $,----
~ NAME OF SOURCE (Not an Acronym) Filer's Verification
Print Name Richard Bloom ADDRESS (Business Address Acceptable) Office, Agency or Court CA State Assembly BUSINESS ACTIVITY, IF ANY, OF SOURCE Statement Type III 2015/2016 Annual D Assuming D Leaving D __ Annual DCandidate DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) lyrJ I have used all reasonable diligence In preparing this statement. I have reviewed this statement and to the best of my knowledge the infonnation contained herein and In any attached schedules Is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing Is true and correct.
~~- $,---- (d)(5) Date Signed --⁴‷‼››››⁉‷‧⁾›※›››.------
Flier's Signatu ------
Comments: ______
FPPC Form 700 (2015/2016) Sth. 0 FPPC Advice Email: [email protected] FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov