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Home My WebLink AboutForm 460- Greg Brockbank for City Council 2013 (2013-10-19)Recipient'Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) Type or print in ink. Statement covers period from 9/22/13 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) BROCKBANK FOR CITY COUNCIL 2013 STREET ADDRESS (NO P.O. BOX) 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the 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. A, Pk `4 Executed on 10/24/13 By Date --,Sifature of Treasurer or Assistant Treasurer Executed on 10/24/13 By Date &,gnature- of Contolfing Officeholder, C"andidate, State Measure Proponent or Responsible off,,cer of Sporsor Executed on Date By Signature of Controlling Officeholder, Canddate, State Measure Proponent Executed on [Date By Signattuine of ControHing Officeholder, Candidate, State Beare Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) State of California Type or print in ink. S. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE GREG BROCKBANK OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Councilmember, City of San Rafael RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP r San Rafael Ct 1 " i r, Related Committees Not Included in this Statement: List any committees not included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D.NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? Q YES ❑ NO COMM ITTEF ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D.NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? [] YES NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COVER PAGE - PART 2 Page of 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION SUPPORT OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER., CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee is primarily formed NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD El SUPPORT [:] OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD [:] SUPPORT F] OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD SUPPORT ❑ OPPOSE Attach continuation sheets it necessary FPPc Form 460 (January!05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) State of California Campaign Disclosure Statement Type or print in ink. Amounts may be rounded Summary Page to whole dollars. SEE INSTRUCTIONS ON REVERSE Statement covers period from 9/22/1 3 10/19/13 through Page of NAME OF FILER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 - 6. Payments Made ....................................................... Schedule E, Line 4 $ 9380.62 $ 32,753.99 Column A Column B Contra buttons Received 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 TOTALTHIS PERIOD CALENDAR YEAR 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F, Line 3 (FROM ATTACHED SCHEDULES) TOTALTO DATE 1. Moneta I ry Contributions ........................................... Schedule A, Line 3 $ 8127.18 $ 30,038.18 2. Loans Received ...................................................... Schedule B, Line 3 0.00 41000.00 3. SUBTOTAL CASH CONTRIBUTIONS .................... Add Lines I + 2 $ 8127.18 $ 34,038.18 4. Nonmonetary Contributions .................................... Schedule C, Line 3 0.00 547.80 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 + 4 $ 8127.18 $ 34,585.98 Expenditures Made - 6. Payments Made ....................................................... Schedule E, Line 4 $ 9380.62 $ 32,753.99 7. Loans Made ............................................................. Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ 9380.62 $ 32,753.99 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F, Line 3 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ................................Add Lines 8 + 9 + 10 $ 9380.62 $ 322753.99 Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 2537.63 To calculate Column B, add 13. Cash Receipts ........... ........................................ Column A, Line 3 above 8127.18 amounts in Column A to the I corresponding amounts 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 from Column B of your last 9380.62 report. Some amounts in 15. Cash Payments .................................................. Column A, Line 8 above Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 1284.19 figures that should be subtracted from previous If this is a termination statement, Line 16 must be zero. period amounts. If this is the first report being filed 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if Cash Equivalents and Outstanding Debts any). 18. Cash Equivalents .............. ........... see instructions on reverse $ 19. Outstanding Debts ......................... Add Line 2 + Line 9 In Column B above $ I.D.NUMBER 135049 3lendar Year Summary for Candidates Linning in Both the State Primary and Bneral Elections 1/1 through 6/30 7/1 to Date I. Contributions Received $ $ I. Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (if Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) $ *Amounts in this section may be different from amounts reported in Column B. FPLC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A Type or print in ink. SCHEDULE A Moneta Contributions Received Amounts may be rounded Monetary to whole dollars. Statement covers period , from 9/22/13 - , 10/19/13 page ` SEE INSTRUCTIONS ON REVERSE through of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 135049 DATE ZIP FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR E(IF CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ®IND 9/22 Denise Luc ❑COM Professor 350.00 350.00 [_]0TH Dominican Univ. of Calif. Dominican San Rafael, CA 94901 ❑ PTY ❑ SCC ®IND 9/22 & Jonathan Frieman ❑COM football coach 250.00 500.00 500.00 E] OTH A 94901 ❑ PTY ❑ SCC ❑IND 9/23 Democratic Central Committee of Marin ®COM 100.00 100.00 100.00 ❑ OTH San Rafael, CA 94903 ❑ PTY ❑ SCC ®IND 9/23 Wade Holland — El COM retired 100.00 200.00 200.00 ❑ OTH Inverness, CA 94937 ❑ PTY ❑ SCC ®IND 9/24 Eileen Prendiville ❑COM nurse 100.00 100.00 100.00 E] OTH Calif. Pacific Med. Ctr. San Rafael, CA 94903 ❑ PTY ❑ SCC SUBTOTAL $ 800.00 Schedule A Summary Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.) .................................................. 2. Amount received this period — unitemized monetary contributions of less than $100 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ...... 7073.00 i"WERE 1 'Contributor Codes IND— Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee TOTAL $ 8127.18 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period • , to whole dollars. 9/22/13 FORM ' from through 10/19/13 Page ' of `P NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 135049 DATE FULL NAMESTREET ADDRESS AND ZIP CODE OF CONTRIBUTOR , CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D.NUMBER) CODE (IF SELF-EMPLOYED. ENTER NAME PERIOD (JAN. 1 -DEC. 37) (IF REQUIRED) OF BUSINESS) IND WJCOM 9/24 ngelo Douvos retired 100.00 200.00 200.00 E] OTH San Rafael, CA 94901 ❑ PTY ❑ SCC V]IND 9/25 MoniuAnderson ❑COM mgr. 150.00 150.00 150.00 ❑ OTH S.R. Downtown Farmers San Rafael, CA 94901 ❑ PTY Market ❑ SCC 9/26 Amy Likover ®IND ❑COM retired 200.00 300.0 300.0 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC BIND 9/27 Josh Walstrom ❑COM n , 500.00 500.00 500.00 ❑ OTH San Mateo, CA 94330 ❑ PTY ❑ SCC ❑ IND 9/28 ®COM 250.00 400.00 400.00 ❑ OTH San Rafael, CA 94903 ❑ PTY ❑ SCC SUBTOTAL$ 1200.00 *Contributor Codes IND—Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY—Political Party SCC — Small Contributor Committee FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period ' towhole dollars. 9/22/13 O • 460 from Pageof through 10/19/13 NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 135049 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) ®IND El COM video director (self) 9/28 E] OTH 100.00 200.00 200.00 San Rafael, CA 94901 ❑ PTY ❑ scC 9/28 Jeff Kroot ®IND ❑COM architect (self) 100.00 200.00 200.00 --- —•---- ❑OTH San Anselmo, CA 94960 ❑ PTY ❑ scC 9/29ON la dba West End Cafe ®IND ❑COM owner 100.00 250.00 250.00 E]OTH West End Cafe & San Rafael, CA 94901 ❑ PTY Catering ❑ SCC 9/29 Belle Cole ®IND ❑COM retired 100.00 700.00 700.00 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC 9/30 Gail Altschuler IND IOM physician (self) 100.00 100.00 100.00 ❑ OTH Novato, CA 94947 ❑ PTY ❑ scC SUBTOTAL$ 500.00 *Contributor Codes IND—Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 9/22/13FORM , from Page— I of through 10/19/13 NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 135049 DATE FULL NAMESTREET ADDRESS AND ZIP CODE OF CONTRIBUTOR , CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) IND 9130 Ed Boyce OCOM retired 200.00 450.00 450.00 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC 10/1 Lorenzo Ersland ®IND EICOM retired 100.00 100.00 100.00 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC 10/1 Katherine Cuneo ®IND ❑ COM retired 100.00 100.00 100.00 ❑ OTH an a ae , 94903 ❑ PTY ❑ SCC 10/1 Stuart Brown ® IND ❑COM retired 100.00 100.00 100.00 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC 10/1 Nona Dennis OIND COM retired 50.00 150.00 150.00 ❑ OTH i a ey, 941 ❑ PTY ❑ SCC SUBTOTAL$ 550.00 *Contributor Codes IND– Individual COM – Recipient Committee (other than PTY or SCC) OTH – Other (e.g., business entity) PTY – Political Party SCC – Small Contributor Committee FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period • to whole dollars. 9/22/13 • • , from 10/19/13 through Page ' of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 135049 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (E COMMITTEE,ALSO ENTER I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) IND 10/1 Stan Gold NOW❑OTH ICOM retired 50.00 200.00 200.00 Petaluma, CA 94952 ❑ PTY ❑ SCC Bill Carney & Tamra Peters ®IND [j com consultants (self) 250.00 500.00 500.00 10/2 E] OTH an a ae , ❑ PTY ❑ sCC 10/2 Don Miller® IND ❑ coM retired 100.00 250.00 250.00 ❑ OTH Tiburon Dr. ❑ PTY ❑ SCC 10/2 Robert Gibson MIND ❑ COM retired 1,000.00 1,000.00 1,000.00 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC 10/3 Jack Be s® IND ❑ COM retired 30.00 140.00 140.00 ❑ OTH San Rafael, CA 94903 ❑ PTY ❑ SCC SUBTOTAL$ 1430.00 "Contributor Codes IND—Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity; PTY — Political Party SCC — Small Contributor Committee rPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Tyne or print in ink. SCHEDULEA (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period • . to whole dollars. 9/22/13 FORM , from through 10/19/13 Page of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 135049 DATE FULL NAMESTREET ADDRESS AND 21P CODE OF CONTRIBUTOR , CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) WIND 10/3 Jo Dahlgren retired 50.00 100.00 100.00 E] OTH an a ae , 3 ❑ PTY ❑ SCC 10/3 Jer Belletto ®IND EICOM retired 50.00 100.00 100.00 L] OTH San Rafael, CA 94901 ❑ PTY ❑ SCC 10/3 Salamah Locks ®❑IoM IND nurse (self) 100.00 100.00 100.00 E] OTH San Rafael, CA 94903 ❑ PTY ❑ SCC 10/3 Bill Sims OCOM retired 100.00 200.00 200.00 ❑OTH Sausalito, CA 94965 ❑ PTY ❑ SCC 10/4 Ray Katz ICOM IND dentist (self) 100.00 200.00 200.00 ❑OTH Larkspur, CA 94939 ❑ PTY ❑ SCC *Contributor Codes IND— Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee SUBTOTAL$ 400.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Tvoe or print in ink. SCHEDULEA (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 9/22/13 FORM 460 - from Page of through 10/19/13 NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 135049 DATE FULL NAMESTREET ADDRESS AND ZIP CODE OF CONTRIBUTOR , CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF•EMPLOYED,ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) ® IND 10/4 p ❑COM retired 50.00 100.00 100.00 E] OTH San Rafael, CA 94901 ❑ PTY ❑ SCC No. Calif. Carpenters Regional Council Small ❑IND VICOM 250.00 250.00 250.00 10/5 E] OTH 265 Hegenberger Rd., Oakland, CA 94621 ❑ PTY ❑ SCC Ken SmithIND ®❑IoM video producer (self) 100.00 100.00 100.00 10/5 ❑ OTH San Rafael, CA 94903 ❑ PTY ❑ SCC Eleanor Kellogg-SmithIOM El retired 100.00 100.00 100.00 10/5 ❑ OTH San Anselmo, CA 94960 ❑ PTY ❑ SCC 10/5 Vicki Sievers lZCOM IND retired 50.00 150.00 150.00 F-1 OTH San Rafael, CA 94901 ❑ PTY ❑ SCC SUBTOTAL$ 550.00 *Contributor Codes IND—Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC —Small Contributor Committee FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULEA (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 9/22/13 FORM 60 from through 10/19/13 Page t ( of ( C NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 135049 DATE ADDRESSZIP FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR STREET CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED I.D.NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) Richard Benson ®IND [:]COM Assessor/Recorder/Clerk 100.00 200.00 200.00 10/6 F-1 OTH County of Marin Novato, CA 94947 ❑ PTY ❑ ScC 10/6 Ken Hobbs® IND ❑ COM retired 50.00 150.00 150.00 ❑ OTH San Rafael, CA 94903 ❑ PTY ❑ ScC 10/6 Lindsay Vurek W]coM retired 50.00 $125.00 $125.00 ❑ OTH Oakland, CA 94609 ❑ PTY ❑ ScC 10/6 ara S. Geor e MIND ❑coM J Pes7 Cc=,�P 125.00 125.00 125.00 Oan E] OTH a ae , ❑ PTY ❑ SCC 10/7 ®IND ❑ COM retired 18.00 126.00 126.00 "evy, ❑ OTH I 94941 ❑ PTY ❑ ScC SUBTOTAL$ 343.00 'Contributor Codes IND—Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 9/22/13 FORM ' from through 10/19/13 Page t of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 135049 DATE FULL NAMESTREET ADDRESS AND ZIP CODE OF CONTRIBUTOR , CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 0IND 10/7 Keith Meloney retired 100.00 100.00 200.00 ❑ OTH San Rafael, CA 94903 ❑ PTY ❑ SCC 10/8 Bob & Sue Spofford ®IND ❑COM retired 150.00 400.0 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC Gail Theller IND ®❑COM Ex. Dir.'> 10/10 E] OTH Community Action Marin 100.00 200.00 20t Novato, CA 94949 ❑ PTY ❑ SCC E] IND 10/10 San Rafael Police Assn. PAC t fp" jFw 331' T5 3) com DoH 250.00 250.00 2 • San Rafael, CA 94915 ❑ PTY ❑ SCC 10/11 Unn ®IND ❑COM Writer/editor (self) 100.00 100.00 100.00 E] OTH A 94915 ❑ PTY ❑ SCC 'Contributor Codes IND— Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee SUBTOTAL$ 700.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Tvoe ororint in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 9/22/13 FORM , from 10/19/13 I through Page of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 135049 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER D R AMOUNT RECEIVED HIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITEE,ALSO ENTER I.D.NUMBER) CODE * (IF SELPFEMP OENTER SELF-EMPLOYED, NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) IND 10/14 Mar a Macris®❑IoM retired 50.00 135.00 135.00 E] OTH Mill Valley, CA 94941 ❑ PTY ❑ SCC Broadway & Grand Retail Piaza LLC ❑IND EICOM 150.00 150.00 150.00 10/15 EI OTH San Rafael, CA 94901 ❑ PTY ❑ SCC ®IND ❑COM school administrator 50.00 100.00 100.00 10/15 E] OTH Ross Valle School y San Rafael, CA 94901 ❑ PTY District ❑ sCC Jody & Dee Stevens ®IND consultant/contractor 100.00 100.00 100.0 10/15 EI off (selves} Oakland, CA 94618 ❑ PTY ❑ SCC 10/18 Ellen Obstler DIOM IND retired 250.00 750.00 750.00 ❑ OTH an a ae , 4901 ❑ PTY ❑SCC SUBTOTAL$ 600.00 *Contributor Codes IND—individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee rPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Summary of Expenditures Type or print in ink. Statement covers period Supporting/Opposing Other Amounts may be rounded to dollars. 9/22/13 CALIFORNIA 460 FORM whole from Candidates, Measures and Committees 10/19/13 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D.NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 135049 DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR TYPE OF PAYMENT DESCRIPTION AMOUNT THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE MEASURE NUMBER OR LETTER AND JURISDICTION, (IF REQUIRED) PERIOD (JAN. I DEC. 31) (IF REQUIRED) OR COMMITTEE Monetary Contribution ] Nonmonetary Contribution ] Independent Support ❑ Oppose Expenditure Cj Monetary Contribution Nonmonetary Contribution Independent Support ❑ Oppose Expenditure Monetary Contribution Nonmonetary Contribution Independent Support ❑ Oppose Expenditure Schedule D Summary 1. Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.) ......................................................... $ 3. Total contributions and independent expenditures made this period. (Add Lines I and 2. Do not enter on the Summary Page.) ............ TOTAL $ Elm F1PPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/276-3772) Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE Type or print in ink. Amounts may be rounded to whole dollars. NAME OF FILER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 Statement covers period from 9/22/13 through 10/19/13 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. Page I of I.D. NUMBER 135049 CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals M independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID reimbursement for fundraiser food, printer ink for flyers, snck for phone bank 353.22 San Anselmo, CA 94960 ervice Deposit for fundraiser venue, food for camp. mtgs. 470.44 St.114141,3179 Indie Politics fundraiser invitation design, printing, & mailing; monthly retainer; reimbursement for 1st mailer 8500.11 ovato, * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ Schedule E Summary 1. Itemized payments made this period. Include all Schedule E subtotals. $ 9323.77 2. Unitemized payments made this period of under $100 ................................ ......................_..... $ 55.85 3. Total interest paid this period on loans. Enter amount from Schedule B, Part 1, Column (e).) $ 0.00 4. Total payments made this period. Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6. TOTAL $ 9380.62 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule G Type or print in ink. SCHEDULE G period Payments Made by an Agent or Independent Amounts may be rounded Statement covers pCALIFORNIA , Contractor (on Behalf of This Committee) to whole dollars. from 9/22/13 FORM • through 10/19/13 Page i ( of (� SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 135049 NAME OF AGENT OR INDEPENDENT CONTRACTOR CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/mist. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. NAME AND ADDRESS OF PAYEE OR CREDITOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID olitics *ov FND 1093.20 , Indie Politics 1 LIT 5906.91 Novato, CA 94949 I Attach additional information on appropriately labeled continuation sheets. TOTAL* $ 7000.11 * Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or independent contractor as reported on Schedule E. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)