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Form 460- Firefighters' Association PAC (2016-05-23)Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from April 24, 2016 through May 23, 2016 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. ❑ Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure O State Candidate Election Committee Committee O Recall O Controlled (Also Complete Part 5) O Sponsored (Also Complete Pert 6) 0 General Purpose Committee ® Sponsored ❑ Primarily Formed Candidate/ O Small Contributor Committee Officeholder Committee O Political Party/Central Committee (Also Complete Part l) 3. Committee Information I.D. NUMBER 891308 San Rafael Firefighters Political Awarness Committee STREET ADDRESS (NO P.O. BOX) Preelection Statement ❑ Semi-annual Statement 999 5th Ave Suite 350 Termination Statement (Also file a Form 410 Termination) CITY STATE ZIP CODE AREA CODE/PHONE San Rafael Ca 94901 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX PO BOX 2519 CITY STATE ZIP CODE AREA CODE/PHONE SAN RAFAEL CA 94901 OPTIONAL: FAX/ E-MAIL ADDRESS MAY 2 3 2016 Date of election if applicable (Month, Day, Year) June 7, 2016 11 CITY CLERK'S OFA{CE 2. Type of Statement: W Preelection Statement ❑ Semi-annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) COVER PAGE 1 of 5 Official Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report NAME OF TREASURER ANDREW ROGERSON MAILING ADDRESS 1532 MATHIAS PL CITY STATE ZIP CODE AREACODE/PHONE ROHNERT PARK CA 94928 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/ E-MAIL ADDRESS 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 fore ' g is tr a and correct. Executed on v 7, z G / ,6 Date Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officer of Sponsor Executed on By Dale Signature of Controlling Officeholder, Candidate, Stale Measure Proponent Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Amounts may be rounded Summary Page to whole dollars. - Statement covers period from April 24, 2016 SUMMARY PAGE Expenditures Made 6. Payments Made................................................................ Schedule E, Line 4 $ 7. Loans Made....................................................................... Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS .......................................... Add Lines 6+7 $ 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 $ Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 13. Cash Receipts........................................................... Column A, Line 3 above 14. Miscellaneous Increases to Cash .................................. Schedule 1, Line 4 15. Cash Payments......................................................... Column A, Line 8 above 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ if this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ 500.00 $ 0 0 $ 500.00 0 500.00 500.00 0 0 500.00 0 $ 500.00 87,586 To calculate Column B, 0 May 23, 2016 2 5 SEE INSTRUCTIONS ON REVERSE 500 of your last report. Some amounts in Column A may through Page of NAME OF FILER previous period amounts. If this is the first report being I.D. NUMBER San Rafael Firefighters Political Awarness Committee „ 891308 Contributions Received Column A Column B Calendar Year Summary for Candidates TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) CALENDAR YEAR TOTAL TO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions................................................... Schedule A, Line 3 $ 0 $ 0 2. Loans Received 0 0 1/1 through 6/30 7/1 to Date ................................................................ schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2 $ $ 0 20. Contributions Received $ 4. Nonmonetary Contributions ............................................ Schedule c, Line 3 0 0 $ 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ................................... Add Lines 3+4 $ 0 $ 0 Made $ $ Expenditures Made 6. Payments Made................................................................ Schedule E, Line 4 $ 7. Loans Made....................................................................... Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS .......................................... Add Lines 6+7 $ 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 $ Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 13. Cash Receipts........................................................... Column A, Line 3 above 14. Miscellaneous Increases to Cash .................................. Schedule 1, Line 4 15. Cash Payments......................................................... Column A, Line 8 above 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ if this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ 500.00 $ 0 0 $ 500.00 0 500.00 500.00 0 0 500.00 0 $ 500.00 87,586 To calculate Column B, 0 add amounts in Column A to the corresponding amounts from Column B 0 500 of your last report. Some amounts in Column A may 87,086 be negative figures that should be subtracted from previous period amounts. If this is the first report being 0 filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if „ any). J xpenditure Limit Summary for State ,andidates 22. Cumulative Expenditures Made* (if Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) -Jl $ *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule D SCHFr]III F In .+ c.. y v1 L-nNe11U1Lu1 Wa MJIIUUIILb May ue rounoea Statement covers period Supporting/Opposing Other to whole dollars. CALIFORNIA 460 ' Candidates, Measures and Committees from April 24, 2016 FORM SEE INSTRUCTIONS ON REVERSE through May 23, 2016 Page 3 of 5 NAME OF FILER I.D. NUMBER San Rafael Firefighters Political Awarness Committee 891308 DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, ORTYPE OF PAYMENT DESCRIPTION AMOUNT THIS CUMULATIVE TO DATE PER ELECTION MEASURE NUMBER OR LETTER AND JURISDICTION, (IF REQUIRED. CALENDAR YEAR TO DATE OR COMMITTEE PERIOD (JAN.1- DEC. 31) (IF REQUIRED) Committee to support San Rafael Libraries Moneta 4/27/2016 Measure D Contribut on $500.00 $500.00 ❑ Nonmonetary Contribution ❑ Independent 0 Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure SUBTOTAL $ Schedule D Summary 1. Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.)....................................................... $ 5w- 2. Unitemized contributions and independent expenditures made this period of under $100.................................................................................... $ 3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enter on the Summary Page.) .......... TOTAL.. $ 6 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Payments Made INSTRUCTIONS ON REVERSE Amounts may be rounded to whole dollars. SCHEDULE E Statement covers period from April 24, 2016 through May 23, 2016 I Page 4 of 5 NAML UI- HLLK I.D. NUMBER San Rafael Firefighters Political Awarness Committee 1891308 7 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. 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 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) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Committee to support San Rafael Libraries -Yes on Measure D PO BOX 150488, San Rafael Ca. 94915 FPIY_1 3& 3cbqCTB 500.00 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.).............................................................................................. 2. Unitemized payments made this period of under $100........................................................................................................................... 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column(e).).............................................................. 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ......................... SUBTOTAL $ 500 $ 0 ............ $ 0 TOTAL $ 500 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule I Amounts may be rounded SCHEDULE I Miscellaneous Increases to Cash to whole dollars. SEE INSTRUCTIONS ON REVERSE Statement covers period from April 24, 2016 through May 23, 2016 • _ , �•1 • ' Page 5 of 5 NAME OF FILER San Rafael Firefighters Political Awarness Committee I.D. NUMBER 891308 DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF COMMITTEE, ALSO ENTER I.D. NUMBER 1 DESCRIPTION OF RECEIPT AMOUNT OF INCREASE TO CASH Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ Schedule I Summary 1. Itemized increases to cash this period. 0 2. Unitemized increases to cash of under $100 this period. $ 0 3. Total of all interest received this period on loans made to others. Schedule H, Column (e).) $ 0 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Line 14.) . TOTAL $ 0 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov