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Home My WebLink AboutForm 460 - Firefighters' Association PAC (2013-10-19)W a *&A RecipuftlentComminee Campaign Statement CoverPage (Government Code Sections 84200-84216.5) Statement covers period 9-P-2013 u0m 10- -2013 through I . Type of Re6plient Commiftee: All Committees - Complete Parts 1, 2,3, and 4. Ej Officeholder, Candidate Controlled Committee E3 Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also Complete Part 5) 0 Sponsored (Also Complete Part 6) General Purpose Committee Primarily Formed Candidate/ 0 Sponsored Officeholder Committee 0 Small Contributor Committee (Also Complete Pait 7) 0 Political Party/Central Committee 3. CommIftee Informatibn &MM'"IF-5 1TV :13" STREET ADDRESS (NO P.O. BOX) 999 5th Street Suite 350 I IT TY STATE ZIP CODE AREA COD6644AbNE San Rafael CA 94901 707.975.4764 MAILING ADDRESS (IF DIFFERE T) NO. AND STREET OR P.O. BOX PO Box 2519 CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94912 707.975.4764 O# _f ADDRESS Date of election if applicable: (Month, Day, Year) qggr A "_J LAI ;,I Page Of For Official Use Only Preelection Statement Ej Quarterly Statement E:] Semi-annual Statement Special Odd -Year Report Termination Statement Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 Amendment (Explain below) Treasurer(s) NAME OF TREASURER Jason Hatfield MAILING ADDRESS PO Box 2519 CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94912 707.975.4764 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE 0 Ti16"N_L: _FXX / E-MAIL ADDRESS TRAIR10, _Ar X;' 1v eel ti Executed on Date Executed on Date Executed on Date M mi By Signakre of Contro&V Ofteholder, Candidate, State Measwe Proponent By Signattire of Controlling Ofteholder, Candidate, State Measwe Proponem FPPC Form 460 (January/05) FC Toll -Free Helpline: 866/ASK-FPPC (866/276-3772) Atata cif r.alifnmla 'Aft, a Type or print in ink. t;ampaqg-an Disclosure Statement Amounts may be rounded Summary Page to whole dollars. NAME OF FILER San Rafael Firefighters Political Awareness Committee. Current Cash Statement 99,459-31 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 1,357 13. Cash Receipts ................................................... Column A. Line 3 above 0 14. Miscellaneous Increases to Cash ........................... Schedule /, Line 4 5000 15. Cash Payments .................................................. Column A, Line 8 above 953816.31 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ If this is a termination statement, Line 16 must be zero. Statement covers period 9-22r2013 from 10- il-2013 through Column B CALENDAR YEAR TOTALTOCATE 14007 0 14007 0 14007 13362.69 13362.69 17 Page 4� Of I.D. NUMBER 891308 Calendar Year Summary for Candidates Running gin Both the State Primary and General Elections 1/1 through 6/30 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates Date of Election 0 1 (mm/dd/yy) 13362.69 To calculate Column 13, add amounts in Column A to tht corresponding amounts from Column B of your last report. Some amounts in figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). $ *Arnounts in this section may be different from amounts reported in Column B. FPPC Form d': (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) ColumnA Contributions Received TOTALTHIS PERIOD (FROM ATTACHED SCHEDULES) 11357 1. Monetary Contributions ........................................... Schedule A, Line 3 $ 0 2. Loans Received ...................................................... Schedule 8, Line 3 1357 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines I+ 2 $ 0 4. Nonmonetary Contributions .................................... Schedule Q, Line 3 1357 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 + 4 $ Expenditures Made 5000 6. Payments Made ...................... ................................ Schedule E, Line 4 $ 0 7. Loans Made ............................................................. Schedule H, Line 3 5000 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6 + 7 $ 0 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3 0 10. Noto mori etary Adjustment .......................................... Schedule C, Line 3 5000 11. TOTAL EXPENDITURES MADE ................................ Acid Lines 8 + 9 + 10 $ Current Cash Statement 99,459-31 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 1,357 13. Cash Receipts ................................................... Column A. Line 3 above 0 14. Miscellaneous Increases to Cash ........................... Schedule /, Line 4 5000 15. Cash Payments .................................................. Column A, Line 8 above 953816.31 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ If this is a termination statement, Line 16 must be zero. Statement covers period 9-22r2013 from 10- il-2013 through Column B CALENDAR YEAR TOTALTOCATE 14007 0 14007 0 14007 13362.69 13362.69 17 Page 4� Of I.D. NUMBER 891308 Calendar Year Summary for Candidates Running gin Both the State Primary and General Elections 1/1 through 6/30 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates Date of Election 0 1 (mm/dd/yy) 13362.69 To calculate Column 13, add amounts in Column A to tht corresponding amounts from Column B of your last report. Some amounts in figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). $ *Arnounts in this section may be different from amounts reported in Column B. FPPC Form d': (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule D Summary of Expenditures a Supporting/Opposing Other Candidates, Measures and Commloftees SEE INSTRUCTIONS ON REVERSE NAME OF FILER San Rafael Firefighters Political Awareness Committee NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR MEASURE NUMBER OR LETTER AND JURISDICTION, OR COMMITTEE Friends of Kate Colin for San Rafael City Council 16 Support 0 Oppose Committee for a safer San Rafael -Yes on 9/27/2013 measure E Support Oppose Friends of Kate Colin for San Rafael City Council NJ Support 0 oppose Type or print in ink. Amounts may be rounded to whole dollars. 21 Monetary Contribution 0 Nonmonetary Contribution 0 Independent Expenditure 0 Monetary Contribution 0 Nonmonetary Contribution 0 Independent Expenditure Monetary Contribution 0 Nonmonetary Contribution 0 Independent Expenditure DESCRIPTION (IF REQUIRED) Campaign Breakfast Statement covers period 9-2 112013 17 10- 2013 through �1 Page of I.D. NUMBER 891308 CUMULATIVE TO DATE PER ELECTION AMOUNTTHIS CALENDAR YEAR TO DATE PERIOD (JAK I - DEC. 31) (IF REQUIRED) 40ft Schedule D (Continuation Sheet) Summary of Expenditures Supporting/Opposing Other 041d Candidates, Measures and Committees NAME OF FILER San Rafael Firefighters Political Awareness Committee Type or print in ink. Amounts may be roundeit, to whole dollars. DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT OR TYPE OF PAYMENT MEASURE NUMBER OR LETTER AND JURISDICTION, ORCOM MITTEE Maribeth Bushey Lang for an Rafael City Monetary 9/16/2013 Council Contribution 0 Nonmonetary Contribution 0 Independent M Support 0 oppose Expenditure 0 Monetary Contribution 0 Nonmonetary Contribution 0 Independent 0 Support 0 Oppose Expenditure 0 Monetary Contribution 0 Nonmonetary Contribution 0 Independent 0 Support 0 Oppose Expenditure 0 Monetary Contribution 0 or mon Contribution 0 Independent 0 Support 0 Oppose Expenditure Statement vers period 9 -ZZ -2013 from 10. 0�-2013 through DESCRIPTION AMOUNTTHIS (IF REQUIRED) PERIOD 7 10 I.D. NUMBER 891308 U� � ! ill � � i�� CUMULATIVE TO D�� ATE . � . i�ii�ii M i� PER ELECiri�i TION CALENDAR YL -AR TO DATE (JAN. I - DEC. 31) (IF REQUIRED) SUBTOTAL $ FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) AMAL bchedule E Type or print in Ink. (Continuation Sheet) Amounts may be rounde Payments Made to whole dollars. I SEE INSTRUCTIONS ON REVERSE NAME OF IL• . - # el Firefighters Political Awareness Committee -Statement covers period 9-,41-2013 r CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. Nam Committee for a Safer San Rafael -Yes on measure E 1000 Fourth St San Rafael, CA 94901 FPIIA C#1359556 -------------- HIS Nam Committee for a Safer San Rafael -Yes on measure E 1000 Fourth St San Rafael, CA 94901 FPIIA C#1359556 -------------- Schedule A Monetary Contributions Received SEE INSTRL;CTIONS O REVERSE NAM t U San Rafael Firefighters Political Awareness Tyape or print in -ink. Amounts - mbe rounded to whole dollars. OATEBULL INANME,-STREETDESASP C� I OR -7 Er, ALSO ENTER LD, NVh,4,BE;R,) CONTRIBUII-OR IF AN INDIVIDUAL, E T OCCUPATION EMPLOYER SELF -19 YMENTER, NAM OF SUS I N ESS;, Firefighter San Rafael " Department Firefighter San Rafael Fire Department ff 3 3r .# €e er San Rafael Fire Department � x Firefighter San Rafael it Department Firefighter titer San Rafael Fire Department g F E]CO M SCC 3-/7dc4t:� OIND a 1710TH Pry SCCi � s i a e 3 LRIIND � * 5d5� 5 c• m x � $ t t a c a, g&e ,7,. s IND coma COME I Preo s 3 C IF AN INDIVIDUAL, E T OCCUPATION EMPLOYER SELF -19 YMENTER, NAM OF SUS I N ESS;, Firefighter San Rafael " Department Firefighter San Rafael Fire Department ff 3 3r .# €e er San Rafael Fire Department � x Firefighter San Rafael it Department Firefighter titer San Rafael Fire Department g F Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Firefighters r l Awareness Committee, Type or print in ink. roundedAmounts may be to whhole dollars. O SCHEDULE A (C - %/ I rtove m. period from °_, 15 throughOf I.D, NUMBER 891308 RECEIVED s DII DU ENTER FULL STREE FINDIVIDUAL, FT ADDRESS AND ZIP CODE OF C-rj-NR'1BUTCRa CONTRIBUTOROCCUPATION�E , o mF 3S E EI,D, UM RY i ou l REQ` THIS UM ULA LYEAR TO DATE D g. e ,, �E Sfi ."EM6Y.>r+�'a `a+s'ms. ENTER NAME }'a � i F BUSINESS) PERIOD � sg 1 <` D 3� � (IF REQUIRED'.�� `cd , FB a IND I Firefighterq .. :$ IEJOTH Fire ::nt r 2 55 11 ley $ [. ' Z m DS j x 3 3 le- ti r $gIND ocom E x E ` er Isan of r ¢ a rc 1� g z "b n g s I gg r 3 a g sm � ec 4 a a Firefighter gg g# Ile j mo!:� Wotla 6�� § £ com 1 ]OTH San Rafael Fire Departments ¢3¢3 x <10' et e P st 2 scc ".: :++ z r 5 z:�Ie, 24v4*, 4,wle r-/511 I Fighter _ a 3 ocom c sTN San Rafael Fireiref i � " z s a: g g SCC X ?:�o 01,0 C'-� e g gIN g - p OTH D Department x ' PTY s � Nom.. . .. .... 1, IDSCC � ik # �.. .... *Contributor t Indhiidual Recipient Commirdree (other than PTY Y I Other(e.g., business entity PoliticalSCC — Small Contributor y Committee FPPC Form 460 y FPPC Toll -Free% l ContributorCode fndMdual ORecipient (other than P7Y or SCC) O Other _+ business tis# 711-Y'- Political Party CContributor nt b t omm htee FPPC Foffn 460 (January/05) II r l Schedule A (Continuatlion Sheet) Monetary Contributions eiv+ NAME OF F ILER San Rafael Firefighters Political reps o print in ink, Amounts may u wholeto SCC , (CON ) DATIEE NAME,FULL I �STREETADDRESS I `0 M M IT T CONTaIBUTOR �� EAMOUNTION PIEt CUMULA IVE TO DAT REECEIVED E E, A L SZ 0 CODE *i OCCUPATION rh A MIE PERIOD CALENDAR YEAR TO EDATE .1 v v OF F IN (JAN- 'z - 0 4 � g � REQUIRED) ry p m s 1. 4L t.,J AD 4- s L71 IND d S _.117 ' 0 8 t r' I $ geg RafaelFirefighter San # Fire ire Department g g .,. il"-. p 3 Pry 4 77 # OSCC giND com r ss '9 San y re. t z' Ty E ISCC v _ - s.cwn =ma.-.rrs.ms ua+•m ..,.v..re«..,.w... .wnx..evr....n . � � � P } e a a {� v = S .:. 33 * 3 CO& 3 e Fire 4. e z F a 3 a a C. (fat � fi Department 2 2,3 t .t 4. .a 5 z 4 }, 3 # f e gFirefighter .. T qn y _ San Rafaelr f E Con— 9::� 5 ?Z, 7 } i 9 pry Department7 z " fi e e ` s+ u' S � P§ 7 r I ND L ter t s tt w RafaelSan Firms i De ent $. ,El z a. z Ye A t i x ¢ 4 € SUBTOTAL $ -700 a 7S *Contributor Codes IND Individual Recipient Committlee tithe`.. an P .1 S g C sOfther a dies ante Political Party E Small Contributor Committee FPPC Form 460 (January/06) FPPC Toll -Free Schedule A (Continuation Sheet) Monetary Contributions Received NAIME OF FILER San Rafael,Firefighters Po i g Type or print in ink. roundedAmounts may be to T-&Mlole dollars. Stetement covers period from through Page of I.D. 891308 *Contributor Codes Individual 1 -Recipient o m (other than PTr' or SCCA t TH (e.g.,busfness Political SCC — Small Contributor Committee FPPC Form 460 (January.105) FPPC Toll -Free l l :(8661276-3772) NAME F FILER San Rafael Firefighters Political Awareness Committee 189,11308 � FUATE RPADDRESS a' a S A ZIP COD O Ta U . S3 u�P. su+am. . CON %I � W INDIVIDUAL, ENTER OCCUPATION s EILS k Amouur RECEI -./ED THIS U A 11V O `E�r eELECTION CALENDAR Y�T.� RECEIVED CODE asp- SELF—EMPLOYED, — M$ LOPED, N �IN M PERIOD s N. 1 - DEC. 3REQUIRED) 'OF UN I II ND{ EICOM Firefighter I San Rafael Fire i tzz Lk g I Department � P a k r AA j 15'5 f f 6 PTY s i N.. 1 hter gs RafaelFire t � g 04 OPTY C t c � Firefighter 4 3 tdeie t l Z, G I ck gag§ ]com E OTH C San g Firec # Department $ E { r s SC s s a a r s � r u -5 LI; t *kAg% e> CAAJt- E10TH q ree Department f y 2-3 £' 0SCC z g�g gg a m. Firefighter r 6 } d e ! E30TH Rafael Fir Department e fi PTYi F C C $ E z a d *Contributor Individual (otherCOM - Recipient Commir-tee than 11y, r 0T business entity) y>Political Party SCC - Small Contributor Commiftee FPPC Foryn 460 (January/05) FPPC Toll -Free MAfWt-- Vf- 1-tLt--K San Rafael Firefighters Political Awareness Committee Statement covers period from - - - - - - - - - - - through if DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COKWTEE, ALSO ENTER 1. D. NUM SER) CONTRIBUTOR CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE PER ELECTION CALENDAR YEAR TO DATE (IF SELF-EMPLOYED, ENTER NAME OF WSINESS) PERIOD (JAK I - DEC. 31) (IF REQUIRED) VNt o'Le-CA gIND Firefighter EICOM [30TH San Rafael Fire Department 4mA,"tv e --o r do 44. 70 0 PTY EISCC C �r P'e +0 @11ND []com C]OTH San Rafael it Department t 74) 7 1--4,r w-1 'e'di 7 -D6o rc. 14 1 115 q S-7 Z C]PTY EISCC RJIND Firefighter k-�5 2-0 �.yG- C+ [3Com C]OTH San Rafael Fire Department W 4 C1 C]PTY []SCC W L %00% ZIND FIrefighter San E]COM Rafael Fire O 50,j%A+eo,. [:]OTH [3PTY Department 0SCC LA) k tA "t r gIND irefighter t C" [3Com [30TH San Rafael it Department 1k �ql 0 [3PTY []SCC SUBTOTAL$ FPPC Fonn 460 (January/06) FPPC Toll -Free Helpfine: 866/ASK-FPPC (866/27S-3772) rH Al 1111 11E 1111 11 Type or pn'nt in ink. Amounts may be rounded to whole dollars. NAME Cf FILER San Rafael Firefighters Political Awareness Committee DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF �s p CONTRIBUTOR CODE IF AN r OCC OCCUPATION AND . EMPLOYER) { L CF BUSINESS) OIND Firefighter L� 0\1i k �Z'\N 0 V' -A 0.- [3Com C]OTH San Rafael Fire Department CA ( &4C, (4- RJIND tre ig ter C]COM San Rafael FireRJIND C] PTY ffi t Firefighter H.it "Pr. [3com San Rafael 0 z 0 S'e- []OTH Department PTY ZIND Firefighter [3Com s San Rafael i V% �t DepartmentPTY104ocao--cto 441L k( 7, E]SCCc [3Com San Rafael Fire[30TH DepartmentE] PTY SUBTOTAL $ FPPC Forin 460 (January/05) g NAME OF FILER San Rafael Firefighters Political Awareness Committee CATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR B .i.OCCUPATION CONTRIIBUTOR CODE IF AN I , ENTER AMOUNT CUMULATNETODATE PER ELECTION RECEIVED THIS SELF-EMPLOYED, OF BUSINESS) PERkQD (JAN. 1 -DEC. 31) (IF REQUIRED) I CA-tv.- Ave, [3Com C]OTH San Rafael Fire Departmentk 6& -r r e- 45 r4A& L--l-I I OIND -1- �--F�tre C]COM i�g5Fr�� San Rafael Fire Zot [] OTH DepartmentCIPTY osecC f F:,R,IIND 7 Firefighter v c4 [3Com [3 C]OTH San Rafael Fire Department [3 PTY CISCC i ND FD— i fig F rre hter Firefighter San Rafael Fire c3com []OTH Department q 5-6 PTY []SCc OIND Firefighter B 8 ocom C]OTH San Rafael re Department 13 PTY EISCCi SUBTOTAL $ FPPC Form 460 (January/06) I.D. NUMBER. 891308 AMOUNT CUMULATNETODATE PER ELECTION RECEIVED THIS CALENDAR YEAR TQ DATE PERkQD (JAN. 1 -DEC. 31) (IF REQUIRED) SUBTOTAL $ FPPC Form 460 (January/06) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Firefighters Political Awareness Committee Type or print In ink. Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER 1. D. NUMBER) CONTRIBUTOR CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS C UMU LATIVE TO DATE PER ELECTION CALENDAR YEAR TO DATE (IF SELF-EMPLOYED ENTER NAME OF BUSINESS) PERIOD (JAK I - DEC. 31) (IF REQUIRED) ter el Fire OTH [3 PTY Department 03 z 3; C]Scc F, r RJIND ire ig r ry 7;> r [3Com [30TH San Rafael Fire Department Z"; [3PTY []SCC M-�Lt I%kc-6--A40-f 16IND C]COM Firefighter San Rafael Fire C]OTH Department ':k4 cVkk [:]PTY EISCC IZIND Firefighter lk(004k C-'rC-(r_ Wy E]COM [10TH San Rafael Fire Department C]SCC OIND Fire, ghter DCOM San Rafael it [10TH PTY Departmentb. CISCC, SUBTOTAL $ FPPC Form 460 (January/06) FPPC Toll -Free Helpline.- 866/ASK-FPPC (8661276-3772) it is hters Political Awareness Committee t9 Type or pnint in ink. wnts-raa)-b-3*m4ed to whole dollars. NAMt Ul- [-[LtK San Rafael Statement covers oerlod 7 / � -A from 0 through SCHEDULE A (CONT.� Page 01 /,*1 DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTCER I.D. NUMMR) CONTRI13UTOR N RSffR CODE T 0 IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATWE TO DATE PER ELECTION PER EL' CALENDAR YEAR TO DATE To D, OF SEL- WPLOWED, ENTER NAME OF BUSINESS) PERIOD (IF Qj (JAN. I DM 31) (IF REQUIRED) t W44a Artv- k ��& R1 I�ND Firefig "6 " Owe. [3Com [30TH San Rafael Fire Department [3PTY []SCC ND COM [3Com '7 ef S� San Rafael Fire 6afftiA.6..., 64. TH C]OTH Di Department z 4 PTY 0 �Ty EISCC i> 4-4 gIND Firefighter [3Com San Rafael Fire [10TH E]PTY Department L( el []SCC VIC& 0 - tot 6k 0 L� OIND Firefighter [JGOM C]OTH PTY San Rafael Fire Department �:7r0k..%t.A Sep Ot &t []SCC OIND Firefighter [3Com San Rafael Fire [:]OTH Department PTY SCC SUBTOTAL $ FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772)