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Form 460- Yes on Measure D (2016-05-21)Recipient Committee Campaign Statement Cover Page Statement covers period Date of election If applicable: (Month, Day, Year) MAY 26 from ____ 4_-2_4_-2_0_1_6 __ CITY CLERK'S SEE INSTRUCTIONS ON REVERSE 5-21-2016 through ________ _ 1. Type of Recipient Committee: All Committees -Complete Parts 1, 2, 3, and 4. o Officeholder, Candidate Controlled Committee III Primarily Formed Ballot Measure Committee o State Candidate Election Committee o Recall (Also Complete P1W/5) o General Purpose Committee o Sponsored o Small Contributor Committee o Political Party/Central Committee 3. Committee Information NAME (OR o Controlled o Sponsored (Also Complete P1W/6) o Primarily Formed Candidate/ Officeholder Committee (Also Complete PIW/ 7) I.D. NUMBER 1383895 Committee to Support San Rafael Libraries -Yes on Measure D STREET ADDRESS (NO P.O. BOX) 1000 4th Street, Stet 600 CITY San Rafael STATE ZIP CODE CA 94901 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX P.O. Box 150488 CITY San Rafael OPTIONAL: FAX I E·MAlL ADDRESS 4. Verification STATE ZIP CODE CA 94915 AREA CO DElPH ONE ( AREA CODEIPHONE ( 6-7-2016 2. Type of Statement: o Preelection Statement o Semi·annual Statement o Termination Statement (Also file a Form 410 Termination) o Amendment (Explain below) Treasurer(s) NAME OF TREASURER Dirck W. Brinckerhoff MAILING AODRESS CITY San Rafael NAME OF ASSISTANT TREASURER. IF ANY Jeffrey Schoppert MAILING AODRESS CITY San Rafael DPTIONAL: FAX I E-MAILAODRESS ~ Quarterly Statement o Special Odd-Year Report STATE ZIP CODE AREA CODE/PHONE CA 94903 ( STATE ZIP CODE AREA CODE/PHONE CA 94901 ( 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. certify under penalty of perjury under the laws of the State of Califomia that the foregoing is true and correct !:llr-I,-_t_-______ -_ Executed on maL t 2~ "2,.,i::I (" BY _______ ~_......;,!JL="'~===::=====:_--------I Date / Signature of Treasurer or Assistant Treasurer Executed on -----...,O""a"'te------ Executed on -----...,O""a"'te------ Executed on -----'O'::a::::te------ By -";:"Si~gn~at::-::ur::-e ~of~Co==n:::tm:mlli==ng:-;:O;;:;ffi==ce.::ho:;:ld;:::e'...,. C;:"an:::d""'ida:::te=-. S""ta:::te:OM:;:e::::as::::ure=Pm=p~on==e:::nt-:::or:;;R;:::es=po==n=-sib:;:le:-;:O;;:;ffi;::ce=-r oJf"'Spo=n==s=or- By-----~Si~gn~aw::-::re::-o~f~Co==n:::~:mllin==g:-;:O;;:;ffi=ce.::ho:;:ld;:::e'...,.C;:"an:::d""'lda:::te=-.S""ta:::te:OM:;:e::::as::::ur=eD.pm=p=on==e:::nt----- By-----...,S~ig~na~W~re-o~fC~o~n~~lIin==g~O~ffi==ce~ho~ld"'e'~.C~a::-nd~ld"'at~e,~S~ta"'ta~M~ea==s==ure~P~m==p::-on==e:::nt------ FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page -Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) RESIDENTIAUBUSINESS ADDRESS (NO . AND STREET) CITY STATE ZIP Related Committees Not Included in this Statement: Ustanycommittees not included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behaff of your candidacy. COMMITTEE NAME 1.0. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? DYES COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME 1.0. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? DYES o NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COVER PAGE -PART 2 ~111!1!!!11~ 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE San Rafael Special Library Services Parcel Tax Measure D BALLOT NO. OR LETTER D JURISDICTION City of San Rafael III SUPPORT o 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 Ust names of officeholder(s) or candidate(s) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE Attach continuation sheets if necessary FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Support San Rafael Libraries -Yes on Measure D Contributions Received 1. Monetary Contributions ................................................... Schedule A. Une 3 2. Loans Received ................................................................ Schedule B. Une 3 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Unes 1 + 2 4. Nonmonetary Contributions............................................ Schedule C. Une 3 5. TOTAL CONTRIBUTIONS RECEIVED .................................... Add Unes 3 + 4 Expenditures Made $ $ $ 6. Payments Made................................................................ Schedule E. Une 4 $ 7. Loans Made....................................................................... Schedule H. Une 3 8. SUBTOTAL CASH PAyMENTS .......................................... Add Unes 6 + 7 $ 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F. Une 3 10. Nonmonetary Adjustment... ...................................................... Schedule C. Une 3 11. TOTAL EXPENDITURES MADE. ....................................... AddUnes8+9 + 10 $ Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page. Une 16 $ 13. Cash Receipts ................................. .......................... Column A. Une 3 above 14. Miscellaneous Increases to Cash .................................. Schedule I. Une 4 15. Cash Payments ......................................................... Column A. Une 8 above 16. ENDING CASH BALANCE .................. Add Unes 12 + 13 + 14. then subtract Une 15 $ If this is a tennination statement. Une 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 Une 2 + Une 9 in Column B above $ Amounts may be rounded to whole dollars. ColumnA TOTAL THIS PERIOD (FROM ATIACHEO SCHEDULES) 19,125.00 0 19,125.00 44.88 19,169.88 18,141.47 o 18,141.47 (7,849.28) 44.88 10.337.07 17,643.65 19,125.00 o 18,141.47 18,627.18 o o 4,980.76 SUMMARY PAGE Statement covers period CALIFORNIA 460 from ___ 4_-2_4_-_20_1_6 __ _ I FORM 5-21-2016 through _______ _ Page __ 3_ of L S" Column B CALENDAR YEAR TOTAL TO DATE $ 41,127.48 0 $ 41,127.48 381.88 $ 41,509.36 $ 22,500.30 o $ 22,500.30 4,980.76 381.88 $ 27,862.94 To calculate Column B. add amounts in Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative 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). 1.0. NUMBER 1383895 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 111 through 6/30 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made" (If Subject tD VDlunlary Expenditure Urnlt) Date of Election (mm/dd/yy) ~----1 __ Total to Date $----- $----- '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 A Monetary Contributions Received SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Support San Rafael Libraries -Yes on Measure D Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE. ALSO ENTER 1.0. NUMBER) CODE * IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYEO. ENTER NAME OF BUSINESS) See attached continuation sheets Schedule A Summary DIND DCOM DOTH DpTY Dscc DIND DCOM DOTH DpTY Dscc DIND DCOM DOTH DpTY Dscc DIND DCOM DOTH DpTY Dscc DIND DCOM DOTH DpTY Dscc SUBTOTAL $ SCHEDULE A Statement covers period from ___ 4_-2_4_-_2_0_16 __ _ CALIFORNIA 460 FORM through ___ 5_-2_1_-2_0_1_6 __ Page __ 4 __ of I~ AMOUNT RECEIVED THIS PERIOD ° I.D. NUMBER 1383895 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) ·Contributor Codes IND -Individual PER ELECTION TO DATE (IF REQUIRED) 1. Amount received this period -itemized monetary contributions. (Include all Schedule A subtotals.) .......................................................... _ .............................................. $ ___ 1_8:.....,8_75_._00_ COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g .• business entity) PTY -Political Party 2. Amount received this period -unitemized monetary contributions of less than $100 ........................... $ _____ 2_5_0._0_0 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ...................... TOTAL $ ___ 1_9:.....,1_2_5._0_0 SCC -Small Contributor Committee FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A (Continuation Sheet) Monetary Contributions Received Name of Filer Committee to Support San Rafael Libraries -Yes on Measure D Date Contrib Received Full Name, Street Address and Zip Code Code Albert J. Boro 4/27/2016 IND San Rafael CA 94901 Marin Professional Firefighters Political 4/28/2016 Action Committee COM 22 Hop Ranch ct. Santa Rosa CA 95403 San Rafael Firefighters PAC. 4/28/2016 1532 Mathias Place COM Rohnert Park CA 94928 McCullough for City Council 2015 4/30/2016 COM San Rafael CA 94901 Gary T. Ragghianti 5/1/2016 IND San Rafael CA 94901 San Rafael Public Library Foundatiuon 51212016 1000 4th St. Ste. 600 OTH San Rafael CA 94901 CPI (Cal-Pox Inc.) 51212016 103 Shoreline Pkwy. #100 OTH San Rafael CA 94901 Damon Connolly for Supervisor 2014 5/4/2016 COM San Rafael CA 94903 Barbara Heller 5/4/2016 IND San Rafael CA 94903 Occupation and Employeer Retired ID #930791 ID #891308 Attorney Self County Supervisor Marin County ID #1361168 Retired Statement covers period From: 4-24-2016 To: 5-21-2016 Amt Rcvd this Period $ 100.00 $ 500.00 $ 500.00 $ 2,500.00 $ 200.00 $ 5,000.00 $ 500.00 $ 250.00 $ 200.00 SUBTOTAL $ 9,750.00 Schedule A California 460 Form Page ~of '" 1.0. Number 1383895 Cumulatto Per Electn Date to Date $ 100.00 $ 500.00 $ 500.00 $ 2,500.00 $ 200.00 $ 5,000.00 $ 500.00 $ 250.00 $ 200.00 Schedule A (Continuation Sheet) Monetary Contributions Received Name of Filer Committee to Support San Rafael Libraries -Yes on Measure D Date Contrib Received Full Name. Street Address and Zip Code Code Pamela J. Nicolai 5/5/2016 IND San Rafael CA 94903 Deborah Breiner Grund 5/8/2016 IND San Rafael CA 94901 Resource Conservation PAC 5/9/2016 COM San Rafael CA 94901 Gary Giacomini 5/11/2016 IND Larkspur CA 94939 Virginia Mardesich 5/11/2016 IND San Rafael CA 94901 Paul G. Sloan 5/11/2016 IND San Rafael CA 94901 Diane angara 5/11/2016 . IND San Rafael CA 94901 Alastair F. Cumming 5/11/2016 IND San Rafael CA 94901 Service Employees International Union Local 5/12/2016 COM 555 Captol Mall . Ste . 1425 Schedule A California 460 Form Statement covers period From : 4-24-2016 To: 5-21-2016 Page ...i!.... of ( ~ 1.0. Number 1383895 Amt Rcvd this Cumulat to PerElectn Occupation and Employeer Period Date to Date Retired $ 200.00 $ 200.00 Attorney $ 100.00 $ 100.00 Self ID #1347886 $ 350.00 $ 350 .00 Attorney $ 100.00 $ 100.00 Hanson Bridgett LLP Retired $ 100.00 $ 100.00 Retired $ 100.00 $ 100.00 Retired $ 100.00 $ 100 .00 Vice President Bill Moore & Associates $ 100.00 $ 100.00 ID #1296947 $ 5,000.00 $ 5,000 .00 SUBTOTAL $ 6 ,150.00 Schedule A (Continuation Sheet) Monetary Contributions Received Name of Filer Committee to Support San Rafael Libraries -Yes on Measure D Date Contrib Received Full Name, Street Address and Zip Code Code Daniel C. Dufficy 5/1212016 IND San Rafael CA 94901 Jack Krystal 5/15/2016 IND San Rafael CA 94901 Patricia Kendall 5/15/2016 IND San Rafael CA 94903 Donald E. Leisey 5/16/2016 IND San Rafael CA 94901 Joseph M. O'Hehir 5/19/2016 IND San Rafael CA 94901 Gary O. Phillips 5/20/2016 IND San Rafael CA 94901 San Rafael Police Association Political 5/2112016 Action Fund COM San Rafael CA 94901 Occupation and Employeer Insurance Broker Marin Pacific Company, Inc. Businessman Diversified Realty & Services Medical Group Administrator Kaiser Permanente Retired CEO WhistleStop Mayor City of San Rafael ID #831553 Statement covers period From : 4-24-2016 To : 5-21-2016 Amt Rcvd this Period $ 100.00 $ 225.00 $ 250.00 $ 100.00 $ 100.00 $ 1,200.00 $ 1,000.00 SUBTOTAL $ 2,975.00 Schedule A California 460 Form Page lof I~ 1.0 . Number 1383895 Cumulat to Per Electn Date to Date $ 100.00 $ 225 .00 $ 250.00 $ 100.00 $ 100.00 $ 1,200.00 $ 1,000.00 Schedule C Nonmonetary Contributions Received SEE INSTRUCTIONS ON REVERSE NAME OF FILER Amounts may be rounded to whole dollars. Committee to Support San Rafael Libraries -Yes on Measure D DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITIEE, ALSO ENTER 1.0. NUMBER) IF AN INDIVIDUAL, ENTER CONTRIBUTOR OCCUPATION AND EMPLOYER CODE * DIND DCOM DOTH DPTY Dscc DIND DCOM DOTH DpTY DSCC DIND DCOM DOTH DpTY DSCC DIND DCOM DOTH DpTY DScc (IF SELF-EMPLOYEO, ENTER NAME OF BUSINESS) Attach additional information on appropriately labeled continuation sheets. Schedule C Summary SCHEDULEC Statement covers period CALIFORNIA 460 FORM from __ ....:4...,:-2=-4.:....-=2.::.0..:..;16=--__ through _----=-5--=2:...:1--=-2::..:0:....:1-=6~_ page __ i_ of~ DESCRIPTION OF GOODS OR SERVICES SUBTOTAL $ AMOUNTI FAIR MARKET VALUE 1.0. NUMBER 1383895 CUMULATIVE TO DATE CALENDAR YEAR (JAN 1 -DEC 31) 'Contributor Codes IND -Individual PER ELECTION TO DATE (IF REQUIRED) 1. Amount received this period -itemized nonmonetary contributions. (Include all Schedule C subtotals.) ...................................................................................................................... $ ____ --=0_ COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g., business entity) PTY -Political Party 2. Amount received this period -unitemized nonmonetary contributions of less than $100 .................................. $ ____ 4.:....4.:..: . .::.88=--_ 3. Total nonmonetary contributions received this period. SCC -Small Contributor Committee (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ..................... TOTAL $ ____ 4.:.,4:.:,.8=-:8=__ FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Amounts may be rounded to whole dollars. Committee to Support San Rafael Libraries -Yes on Measure D Statement covers period from __ 4_-_2_4_-2_0_1_6 __ 5-21-2016 through _______ _ SCHEDULEE CALIFORNIA 460 FORM page~of~ I.D. NUMBER 1383895 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP CNS CTB CVC FIL FND IND LEG LIT campaign paraphernalia/misc. campaign consultants contribution (explain nonmonetary)" civic donations candidate filing/ballot fees fund raising events independent expenditure supporting/opposing others (explain)" legal defense campaign literature and mailings NAME AND ADDRESS OF PAYEE (IF COMMITIEE. ALSO ENTER 1.0. NUMBER) PMCohen Public Affairs 23 Chestnut Ave. San Rafael, CA 94901 four waters media, inc. 3093 Lassen Street West Sacramento, CA 95691 PMCohen Public Affairs 23 Chestnut Ave. San Rafael, CA 94901 MBR MTG OFC PET PHO POL pas PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads CODE OR CNS CNS CNS * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Schedule E Summary RAD radio airtime and production costs RFD returned contributions SAL campaign workers' salaries TEL t.v. or cable airtime and production costs TRC candidate travel, lodging, and meals TRS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor VaT voter registration WEB information technology costs (intemet, e-mail) DESCRIPTION OF PAYMENT AMOUNT PAID 2,500.00 1,000.00 1,800.00 SUBTOTAL $ 5,300.00 1. Itemized payments made this period. (Include all Schedule E subtotals.) ............................................................................................................. $ ___ 1_8_,1_3_7_.2_7_ 2. Unitemized payments made this period of under $100 .......................................................................................................................................... $ _____ 4_.2_0_ o 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.) ........................... TOTAL $ ___ 1_8_,1_4_1_.4_7_ FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E (Continuation Sheet) Payments Made SEE INSTRucnONS ON REVERSE NAME OF FILER Amounts may be rounded to whole dollars. Committee to Support San Rafael Libraries -Yes on Measure 0 Statement covers period 4-24-2016 from ________ _ through __ 5_-_2_1-_2_0_16 __ SCHEDULE E (CONT.) CALIFORNIA 460 FORM Page~ of~ I.D. NUMBER 1383895 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. campaign paraphernalia/misc. campaign consultants contribution (explain nonmonetary)· civic donations candidate filing/ballot fees fund raising events CMP CNS CTB CVC FIL FND IND LEG LIT independent expenditure supporting/opposing others (explain)· legal defense campaign literature and mailings NAME AND ADDRESS OF PAYEE (IF COMMITTEE. ALSO ENTER I.D. NUMBER) four waters media , inc. 3093 Lassen Street West Sacramento, CA 95691 four waters media, inc. Subvendor: BreakPoint Sales 3093 Lassen Street 741 Via Casitas MBR MTG OFC PET PHO POL P~S PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads CODE OR LIT $267.67 LIT West Sacramento, CA 95691 Greenbrae, CA 94904 four waters media, inc. Subvendor: BreakPoint Sales $1,185.37 3093 Lassen Street 741 Via Casitas LIT West Sacramento, CA 95691 Greenbrae, CA 94904 four waters media, inc. Subvendor: BreakPoint Sales $741 .63 3093 Lassen Street 741 Via Casitas LIT West Sacramento, CA 95691 Greenbrae, CA 94904 four waters media, inc. Subvendor: BreakPoint Sales $745.63 3093 Lassen Street 741 Via Casitas LIT West Sacramento, CA 95691 Greenbrae, CA 94904 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. RAD RFD SAL TEL TRC TRS TSF VOT WEB radio airtime and production costs returned contributions campaign workers' salaries t.v. or cable airtime and production costs candidate travel, lodging, and meals staff/spouse travel, lodging , and meals transfer between committees of the same candidate/sponsor voter registration information technology costs (internet, e-mail) DESCRIPTION OF PAYMENT AMOUNT PAID 437.00 342.67 2,215.37 741 .63 1,000.63 SUBTOTAL $ 4,737.30 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E (Continuation Sheet) Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Amounts may be rounded to whole dollars. Committee to Support San Rafael Libraries -Yes on Measure D Statement covers period from __ 4_-_2_4_-2_0_1_6 __ _ through __ 5_-_21_-_2_0_16 __ SCHEDULE E (CONT.) CALIFORNIA 460 FORM Page_JJ _ of~ 1.0. NUMBER 1383895 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP CNS CTB CVC FIL FND IND LEG LIT campaign paraphemalia/misc. campaign consultants contribution (explain nonmonetary)" civic donations candidate filinglbaiiot fees fund raising events independent expenditure supporting/opposing others (explain)" legal defense campaign literature and mailings NAME AND ADDRESS OF PAYEE (IF COMMITTEE. ALSO ENTER I.D. NUMBER) MBR MTG OFC PET PHO POL POS PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads CODE OR RAD radio airtime and production costs RFD retumed contributions SAL campaign workers' salaries TEL t.v. or cable airtime and production costs TRC candidate travel, lodging, and meals TRS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor VOT voter registration WEB information technology costs (intemet, e-mail) DESCRIPTION OF PAYMENT AMOUNT PAID four waters media, inc. Subvendor: Doteasy Technology, Inc. $300.00 https:/Iwww.facebook.com/SupportSanRafaeILibrarie 3093 Lassen Street 3602 Gilmore Wy. #210 WEB West Sacramento, CA 95691 Burnaby, BC , Canada V5G 4W9 MarkSYS 3725 Cincinnati Ave., #200 POS Rocklin, CA 95765 U.S. Postal Service 16757th Street POS Oakland, CA 94615-0001 U.S. Postal Service 1675 7th Street POS Oakland, CA 94615-0001 four waters media, inc. Subvendor: Cornerstone Printing, Inc. $962.49 3093 Lassen Street 50 Francisco St. #245 CMP West Sacramento, CA 95691 San Francisco, CA 94133 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. s Signs 300.00 2,190.63 1,622.19 1,880.65 1 ,212.50 SUBTOTAL $ 7 ,205.97 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E (Continuation Sheet) Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Amounts may be rounded to whole dollars. Committee to Support San Rafael Libraries -Yes on Measure D Statement covers period from __ 4_-_24_-_2_0_16 __ _ through __ 5_-_2_1_-2_0_1_6 __ SCHEDULE E (CONT.) CALIFORNIA 460 FORM Page~ of~ I.D. NUMBER 1383895 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP CNS CTB CVC FIL FND IND LEG LIT campaign paraphemalia/misc. campaign consultants contribution (explain nonmonetary)" civic donations candidate filing/ballot fees fund raising events independent expenditure supporting/opposing others (explain)" legal defense campaign literature and mailings NAME AND ADDRESS OF PAYEE (IF COMMITTEE. ALSO ENTER 1.0. NUMBER) MBR MTG OFC PET PHO POL pas PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal , accounting) print ads CODE OR four waters media, inc. Subvendor: Shervin Shah nazi $125.00 3093 Lassen Street 74 Glen Dr. CNS West Sacramento , CA 95691 Sausalito, CA 94965 four waters media, inc. Subvendor: Shervin Shahnazi $105.94 3093 Lassen Street 74 Glen Dr. OFC West Sacramento, CA 95691 Sausalito, CA 94965 four waters media, inc. Subvendor: Nate Ostiller $375 3093 Lassen Street 425 the Alameda CNS West Sacramento, CA 95691 San Anselmo, CA 94960 four waters med ia, inc. Subvendor: Nate Ostiller $288.06 3093 Lassen Street 425 the Alameda OFC West Sacramento, CA 95691 San Anselmo, CA 94960 • Payments that are contributions or independent expenditures must also be summarized on Schedule D. RAD radio airtime and production costs RFD retumed contributions SAL campaign workers' salaries TEL t.v. or cable airtime and production costs TRC candidate travel, lodging, and meals TRS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor VaT voter registration WEB information technology costs (intemet, e-mail) DESCRIPTION OF PAYMENT AMOUNT PAID 125.00 105.94 375.00 288.06 SUBTOTAL $ 894.00 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEOULEF Schedule F Accrued Expenses (Unpaid Bills) Amounts may be rounded to whole dollars. Statement covers period from ___ 4,--2=.4_-_2_0_1...;..6 __ CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE through __ 5-_2_1_-2_0_1_6 __ Page~ of~ NAME OF FILER I.D. NUMBER Committee to Support San Rafael Libraries -Yes on Measure D 1383895 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 FNO fund raising events POL polling and survey research TRS staff/spouse travel, lodging, and meals INO 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 CREDITOR CODE OR (a) (b) (e) (d) OUTSTANDING AMOUNT INCURRED AMOUNT PAID OUTSTANDING (IF COMMITIEE. ALSO ENTER 1.0 . NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE four waters media, inc. 3093 Lassen Street West Sacramento, CA 95691 Subvendor: BreakPoint Sales $267.67 + $1,185 .37 741 Via Casitas Greenbrae, CA 94904 PMCohen Public Affairs Subvendor: Political Data, Inc. 23 Chestnut Ave. 12501 Imperial Hwy., Ste . 200 San Rafael, CA 94901 Norwalk, CA 90650 " Payments that are contributions or Independent expenditures must also be summarized on Schedule D. Schedule F Summary OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD LIT $2,558.04 0 $2,558.04 0 printing voter database $1,800.00 0 $1,800 .00 0 SUBTOTALS $ 4,358.04 $ o $ 4,358.04 $ 0.00 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $1 00.) ............................................. .lNCURRED TOTALS $ ____ 4_4_5_.7_6_ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) ................................... PAID TOTALS $ ___ 8-,-,2_9_5_.04_ 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.) ................................................................................................................................................................................... NET $ (7,849.28) May be a negative number FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule F (Continuation Sheet) Accrued Expenses (Unpaid Bills) NAME OF FILER Committee to Support San Rafael Libraries -Yes on Measure D Amounts may be rounded to whole dollars. Statement covers period from __ 4_-2_4_-_2_0_16 __ _ through __ 5-_2_1_-2_0_1_6 __ SCHEDULE F (CO NT.) CALIFORNIA 460 FORM Page ~ of'':- I.D. NUMBER 1383895 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP CNS CTB CVC FIL FND IND LEG LIT campaign paraphernalia/misc. campaign consuHants contribution (explain nonmonetary)" civic donations candidate filing/ballot fees fundraising events independent expenditure supporting/opposing others (explain)" legal defense campaign literature and mailings MBR MTG OFC PET PHO POL POS PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads * Payments that are contributions or independent expenditures must also be summarized on Schedule D. (a) NAME AND ADDRESS OF CREDITOR CODE OR OUTSTANDING (IF COMMITTEE. ALSO ENTER 1.0 . NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING OF THIS PERIOD four waters media, inc. LIT 3093 lassen Street 437.00 West Sacramento, CA 95691 Subvendor: BreakPoint Sales $437.00 printing 741 Via Casitas Greenbrae, CA 94904 four waters media, inc. CNS 3093 lassen Street 2,500.00 West Sacramento, CA 95691 PMCohen Public Affairs 23 Chestnut Ave. CNS 5,500.00 San Rafael, CA 94901 SUBTOTALS $ 8,437.00 $ RAD radio airtime and production costs RFD returned contributions SAL campaign workers' salaries TEL t.v. or cable airtime and production costs TRC candidate travel, lodging, and meals TRS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor VOT voter registration WEB information technology costs (internet, e-mail) (b) (e) (d) AMOUNT INCURRED AMOUNT PAID OUTSTANDING THIS PERIOD THIS PERIOD BALANCE AT CLOSE (ALSO REPORT ON E) OF THIS PERIOD 0 437.00 0 0.00 1,000.00 1,500.00 0.00 2,500.00 3,000.00 0.00 $ 3,937.00 $ 4,500.00 FPPC Form 460 (Jan/20i6) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule F (Continuation Sheet) Accrued Expenses (Unpaid Bills) NAME OF FILER Committee to Support San Rafael Libraries -Yes on Measure D Amounts may be rounded to whole dollars. Statement covers period from __ 4_-_24_-_2_0_16 __ _ through __ 5_-_2_1_-2_0_1_6 __ SCHEDULE F (CO NT.) CALIFORNIA 460 FORM page~ of~ 1.0. NUMBER 1383895 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP CNS CTB CVC FIL FND IND LEG LIT campaign paraphernalia/misc. campaign consultants contribution (explain nonmonetary)" civic donations candidate filing/ballot fees fund raising events independent expenditure supporting/opposing others (explain)" legal defense campaign literature and mailings MBR MTG OFC PET PHO POL POS PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads * Payments that are contributions or independent expenditures must also be summarized on Schedule D. NAME AND ADDRESS OF CREDITOR CODE OR (a) OUTSTANDING (IF COMMITIEE. ALSO ENTER 1.0. NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING OF THIS PERIOD PMCohen Public Affairs WEB 23 Chestnut Ave. 0 San Rafael, CA 94901 Subvendor: Facebook $384.40 1601 Willow Road Menlo Park, CA 94025 Subvendor: Gateway Media, Inc. $ 61.36 2150 River Plaza Dr., Ste. 150 Sacramento, CA 95833 SUBTOTALS $ $ RAD radio airtime and production costs RFD returned contributions SAL campaign workers' salaries TEL t.v. or cable airtime and production costs TRC candidate travel, lodging, and meals TRS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor VOT voter registration WEB information technology costs (internet, e-mail) (b) (e) (d) AMOUNT INCURRED AMOUNT PAID OUTSTANDING THIS PERIOD THIS PERIOD BALANCE AT CLOSE (ALSO REPORT ON E) OF THIS PERIOD 445.76 0 445.76 445.76 $ $ 445.76 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov