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Form 460- Yes on Measure D (2016-08-15)Recipient Committee Campaign Statement Cover Page COVER PAGE !!IIIIII!!II!II!!IIIIIIIJII Statement covers period from ____ 7_-_1_-2_0_1_6 __ Date of election if aplpli(:ab't~ (Month, Day, Year) AUG 25 2016 For Official Use Only SEE INSTRUCTIONS ON REVERSE 8-15-2016 through ________ _ 6-7-2016 1. Type of Recipient Committee: All Committees -Complete Parts 1,2,3, and 4. 2. Type of Statement: 3. o Officeholder, Candidate Controlled Committee 121 Primarily Formed Ballot Measure Committee o State Candidate Election Committee o Recall (Also Complele Part 5) o General Purpose Committee o Sponsored o Small Contributor Committee o Political Party!Central Committee o Controlled o Sponsored (Also Complele Part 6) o Primarily Formed Candidate! Officeholder Committee (Also Complele Part 7) I.D. NUMBER 1383895 Committee to Support San Rafael Libraries -Yes on Measure D STREET ADDRESS (NO P.O. BOX) 1000 4th Street, Ste. 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-MAIL ADDRESS STATE ZIP CODE CA 94915 AREA CODE/PHONE ( AREA CODE/PHONE ( o Preelection Statement o Semi-annual Statement [;lJ Termination Statement (Also file a Form 410 Termination) o Amendment (Explain below) Treasurer(s) NAME OF TREASURER Dirck W. Brinckerhoff MAILING ADDRESS CITY San Rafael NAME OF ASSISTANT TREASURER, IF ANY Jeffrey Schappert MAILING ADDRESS CITY San Rafael OPTIONAL: FAX I E-MAIL ADDRESS o Quarterly Statement o Special Odd-Year Report STATE ZIP CODE AREA CODE/PHONE CA 94903 ( STATE ZIP CODE AREA CODE/PHONE CA 94901 (415) 755-2178 4. Verification I have used all reasona ble 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 o. f pe~ury under the ~ws of th~ State of California that the foregoing is true and:2flrect. ." Executed on A-uA<d ,.1-: Z..') 2e)L" By ----{~;(Lt~rJt.=::::;;;;;::;:~;:;:;;_;=:::::::__--------~ ;rate I b Signature of Treasurer or Assistant Treasurer Executed on ------::D:-a,-"te------ Executed on ------::D:-a:-te------ Executed on ------;:D:-a:-te------ By_~~ __ ~~~~~~~~~~~~~~~~~~~~~~~~~­Signature of Controlling Officeholder. Candidate. State Measure Proponent or Responsible Officer of Sponsor By _____ ~~ __ ~~~~~~~~~~~~~~~=_-----Signature of Controlling Officeholder. Candidate, State Measure Proponent By-----~~~~~~~~~~~~~~~n====_----­Signature of Controlling Officeholder. Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) 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: Ust 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. COMMITIEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITIEE? DYES o NO COMMITIEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITIEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITIEE? DYES o NO COMMITIEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COVER PAGE -PART 2 "'IIJIJ!II~ 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE San Rafael Special Library Services Parcel Tax Measure D BALLOT NO. OR LEDER D JURISDICTION City of San Rafael ~ 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 Ustnames 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 D 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, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Unes 1 + 2 4 . Nonmonetary Contributions............................................ Schedule C, Une 3 5. TOTAL CONTRIBUTIONS RECEIVED .................................... Add Lines 3 + 4 Expenditures Made 6 . Payments Made................................................................ Schedule E, Une 4 7. Loans Made....................................................................... Schedule H, Une 3 B. SUBTOTAL CASH PAyMENTS .......................................... Add Lines 6 + 7 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F. Line 3 10. Nonmonetary Adjustment... ...................................................... Schedule C, Une 3 $ $ $ $ $ 11 . TOTAL EXPENDITURES MADE ........................................ Add Lines B + 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 B above 16. ENDING CASH BALANCE .................. Add Lines 12 + 13 + 14, then subtract Une 15 $ If this is a termination statement, Une 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts 1 B. 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 ATIACHED SCHEDULES) o o o o o 331 o 331 o o 331 266 65 .00 331 o o o o SUMMARY PAGE Statement covers period , CALIFORNIA 460 FORM 7-1-2016 from _________ _ 3 5 8-15-2016 through ________ _ Page ___ of __ _ $ $ $ $ $ $ Column B CALENDAR YEAR TOTAL TO OATE 41,307 o 41,307 382 41,689 41,372 o 41,372 o 382 41,754 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 to Volunlary EApendlt ure Urnlt) Date of Election (mm/dd/yy) 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 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 ___ 7_-1_-_2_01_6 __ _ through __ 8_-_1_5_-2_0_1_6 __ SCHEDULE E CALIFORNIA 460 FORM Page _4 __ of_5 __ 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 filinglballot fees fundraising 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) four waters media, inc. 3093 Lassen Street West Sacramento, CA 95691 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 CNS * Payments that are contributions or independent expenditures must also be summarized on Schedule D . Schedule E Summary 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 331 SUBTOTAL $ 331 331 1. Itemized payments made this period. (Include all Schedule E subtotals.) ............................................................................................................. $ _____ _ o 2. Unitemized payments made this period of under $100 .......................................................................................................................................... $ _____ _ o 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ............................................................................. $ _____ _ 331 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ........................... TOTAL $ _____ _ FPPC Form 460 (Jan/20I6) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule I Miscellaneous Increases to Cash SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Support San Rafael Libraries -Yes on Measure D DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF COMMITTEE. ALSO ENTER 1.0. NUMBER) Attach additional information on appropriately labeled continuation sheets. Schedule I Summary Amounts may be rounded to whole dollars. Statement covers period from ___ 7_-_1-_2_0_1_6 __ _ through __ 8_-_1_5-_2_0_1_6 __ DESCRIPTION OF RECEIPT SUBTOTAL $ 1. Itemized increases to cash this period ............................................................................................................................ $ _______ 0 2. Unitemized increases to cash of under $100 this period ................................................................................................. $ ______ 6_5 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 $ _____ 65_ SCHEDULE I CALIFORNIA 460 FORM Page _5 __ of_5 __ I.D. NUMBER 1383895 AMOUNT OF INCREASE TO CASH FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov