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Polly Low Date Initial Filing Received CALIFORNIA FORM 700 STATEMENT OF ECONOMIC INTERESTS RECEELP"'y FAI R e .o PRACTICES COMMISSION CITY OF ROSEMEAD A PUBLIC DOCUMENT COVER PAGE MAR 2 2 .;2 Please type or print in ink. NAME OF FILER (LAST) FIRST) (MIDDLE) CITY CLERK'S OFFICE Low Polly BY: 1. Office, Agency, or Court Agency Name (Do not use acronyms) City of Rosemead Division, Board, Department, District, if applicable Your Position City Council Council Member ■ 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) D State D Judge or Court Commissioner(Statewide Jurisdiction) ❑Muli-County D County of O city of City of Rosemead D Other 3. Type of Statement (Check at least one box) ▪ Annual: The period covered is January 1, 2015,through D Leaving Office: Date Left I_J December 31, 2015. (Check ane) or- The period covered is J—J ,through 0 The period covered is January 1, 2015,through the date of December 31, 2015. leaving office. -or- ❑ Assuming Office: Date assumed J.i 0 The period covered is_1_1 through the date of leaving office. D Candidate: Election year and office sought, if different than Part 1. 4. Schedule Summary (must complete) ► Total number of pages including this cover page: 3 Schedules attached D Schedule A•1 • Investments-schedule attached 0 Schedule C•Income,Loans, &Business Positions-schedule attached D Schedule A-2-.Investments-schedule attached l)4 Schedule D-Income-Guts-schedule attached ❑ Schedule B-Real Properly-schedule attached Schedule E-Income-Gilts-Travel Payments-schedule attached -or- • None • No reportable interests on any schedule 5. Verification MAILING ADDRESS STREET CITY STATE ZIP CODE (Business or Agency Address Rewmmende -Public Document) 8836 East Valley Blvd Rosemead CA 91770 DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS ( 626 ) 569-2100 I have used all 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. Date Signed 3/.24 OAS Signature (maMh deg rear) -.the ion- roil statement Mb yaw filing official) FPPC Form 700(2015/2016) FPPC Advice Email:advice @fppc.ca.gov FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov CALIFORNIA FORM 700 SCHEDULE D FAIR POLITICAL PRACTICES COMMISSION Income — Gifts Name I. NAME OF SOURCE(Not an Acronym) I. NAME OF SOURCE(Nor an Acronym) Hong Kong Schools Alumni Federation Si Chuan no 1 ADDRESS(Business Address Acceptable) ADDRESS(Business Address Acceptable) 919 Fremont Ave, Suite#318 Alhambra, CA 91803 8772 E.Valley Blvd, Rosemead, CA 91770 BUSINESS ACTIVITY,IF AN OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE Non-Profit community organization Restaurant Grand Opening DATE(mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) DATE(mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) 03 / 06 / 15 s 200.00 Raffle Prize 05 / 26 115 s 100.00 Gift Certificate J J— s _1_1 s _1_1 s JJ— s • NAME OF SOURCE(Not an Acronym) la NAME OF SOURCE (Not an Acronym) Burke, Williams&Sorensen LLP Eastwest Player Union Center for the Arts ADDRESS(Business Address Acceptable) ADDRESS(Business Address Acceptable) 444 S Flower St#2400, Los Angeles, CA 90071 120 Judge John Aiso St. LA, California 90012 BUSINESS ACTIVITY,IF ANY,OF SOURCE BUSINESS ACTIVITY IF ANY.OF SOURCE Contract City and League of Cities Conference Asian American Theatre DATE(mm/dbtyy) VALUE DESCRIPTION OF GIFT(S) DATE(mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) 05 t 14 r 15 g 155.76 Dinner _ 09l 16 t 15 s 130.00 Ticket J J— s _1_1 s J J— s _1J s la NAME OF SOURCE(Not an Acronym) • NAME OF SOURCE(Nat an Acronym) Athens Services Paul Owen ADDRESS(Business Address Acceptable) ADDRESS(Business Address Acceptable) 15045 Salt Lake Ave. City of Industry, CA 91746 1135 Centre Drive, City of Industry, CA 91789 BUSINESS ACTIVITY.IF ANY,OF SOURCE BUSINESS ACTIVITY, IF ANY,OF SOURCE Contract City and League of Cities Conference Health Product DATE(mm/dd/yy) VALUE DESCRIPTION OF GIFT(S) DATE(mn dd/yy) VALUE DESCRIPTION OF GIFT(S) 05 / 15 t 15 $ 100.00 Dinner 11 t 21 t 15 s 160.00 Dinner JJ— $ _1_1 s _l_l s JJ— s Comments: FPPC Form 700(2015/2016)Srh.D FPPC Advice Email:advice@fppc.ca.gov 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, 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) US Army War College League of California Cities ADDRESS(Business Address Acceptable) ADDRESS(Business Address Acceptable) 632 Wright Avenue 1400 K Street CITY AND STATE CITY AND STATE Carlisle, PA 17013 Sacramento CA 95814 fl 501(c)(3)or DESCRIBE BUSINESS ACTIVITY IF ANY OF SOURCE p 501(c)(3)or DESCRIBE BUSINESS ACTIVITY.IF ANY OF SOURCE DATE(S) - AMY$540.90 DATE(S)_f—)—--)—/— AMT$ 762.52 Of gif) (If gift) MUST CHECK ONE: U Gift -Or- 2 Income • MUST CHECK ONE fl Gift -or- 2 Income Co Made a Speech/Participated in a Panel Q Made a Speech/Participated in a Panel Other- Provide Description Q Other- Provide Desuiption Travel Payments for National Security Seminar Travel Payments for League Leaders Board Meeting_ P. If Gin, Provide Travel Destination t If Gift.Provide Travel Destination le NAME OF SOURCE(Not an Acronym) to NAME OF SOURCE(Not an Acronym) Calif. Asian Pacific Islander Legislative Caucus Inst. ADDRESS(Business Address Acceptable) ADDRESS(Business Address Acceptable) P. 0. Box 189488 CITY AND STATE CITY AND STATE Sacramento CA 95818 © 501([)(3)or DESCRIBE BUSINESS ACTIVITY,IF ANY,OF SOURCE P 501 (c)(3)or DESCRIBE BUSINESS ACTIVITY,IF ANY OF SOURCE DATE(S):_/J --(—J— AMT$697.12 DATE(S): - AMT$ Of gift) (If gin) • MUST CHECK ONE. U Gift -or- [0 Income • MUST CHECK ONE. [1 Gift -or- ❑ Income Q Made a Speech/Participated in a Panel 0 Made a Speech/Participated in a Panel Q Other-Provide Description 0 Other- Provide Description Travel Pnymentc Mr Capitnl At- demy 120 • If Gift Provide Travel Destination _ • If Gin,Provide Travel Destination Comments: FPPC Form 700(2015/2016/Sch.E FPPC Advice Email:advice@fppc.ca.gov FPPC Toll-Free Helpline:866/275-3772 www.fppc.ca.gov