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Form 460- Yes on Measure D (2016-04-23) Amendment #2Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from ____ 1_-_1_-2_0_1_6 __ 4-23-2016 through ________ _ 1. Type of Recipient Committee: All Committees -Complete Parts 1, 2, 3, and 4. 3. o Officeholder, Candidate Controlled Committee !;z] Primarily Formed Ballot Measure Committee o State Candidate Election Committee o Recall (Als. Complet. Petl 51 o General Purpose Committee o Sponsored o Small Contributor Committee o Political Party/Central Committee o Controlled o Sponsored (AJs. Complet. Petl 51 o Primarily Formed Candidate/ Officeholder Committee (Als. Complet. Petl 7) 1.0. NUMBER 1383895 Committee to Support San Rafael Libraries -Yes on Measure D STREET ADDRESS (NO P.O. BOX) 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 AREACODEIPHONE ( AREA CODEIPHONE ( 4. Verification Date of election If applicable: (Month, Day, Year) MAY CITY CLERK'S 0 FICE 6-7-2016 2. Type of Statement: o Preelection Statement o Semi-annual Statement o Termination Statement (Also file a Form 410 Termination) III Amendment (Explain below) o Quarterly Statement o Special Odd-Year Report Amended to place consultant contract amounts in correct columns on Sched F continuatn pg. and resulting changes in Summary page Treasurer(s) NAME OF TREASURER Dirck W. Brinckerhoff MAILING ADDRESS CITY San Rafael NAME OF ASSISTANT TREASURER, IF ANY Jeffrey Schoppert MAILING ADDRESS 1000 4th Street, Ste. 600 CITY San Rafael OPTIONAL: FAX I E-MAIL ADDRESS 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. Executed on M.d€.( lSI :uJ{b I Date • Executed on Date Executed on Date Executed on Date By By By By .." <' lit ture of Treasurer or Assistant Treasurer Signature of Controlling Officeholder. Candidate . State Measure Proponent or Responsible Officer of Sponsor Signature of Controlling Officeholder. Candidate, Stata Measure Proponent 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 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 MAD E. ....................................... Add Unes 8 + 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 $ "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 ATTACHED SCHEDULES) 22,002.48 0 22,002.48 337.00 22,339.48 4,358.83 o 12,830.04 337.00 17,525.87 o 22,002.48 o 4,358 .83 17,643.65 o o 12,830.04 SUMMARY PAGE Statement covers period CALIFORNIA 460 FORM 1-1-2016 from ________ _ 2 4 4-23-2016 through _______ _ Page ___ of __ _ Column B CALENDAR YEAR TOTAL TO DATE $ 22,002.48 0 $ 22,002.48 337.00 $ 22,339.48 $ 4,358.83 o $ 4,358 .83 12,830.04 337.00 $ 17,525.87 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 1/1 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 Voluntary expenditure Umlt) Date of Election (mmldd/yy) -.1----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 F Accrued Expenses (Unpaid Bills) SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee to Support San Rafael Libraries -Yes on Measure D Amounts may be rounded to whole dollars. Statement covers period from ___ 1-_1_-2_0_1_6 __ _ through _--..,;.4--=2:.;::3--=-2::..:0:....:1-=6 __ SCHEDULE F CALIFORNIA 460 FORM Page __ 3_ of __ 4_ 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 campaign paraphemalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD retumed 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 (intemet, e-mail) NAME AND ADDRESS OF CREDITOR (IF COMMITIEE. ALSO ENTER 1.0. NUMBER) 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 CODE OR DESCRIPTION OF PAYMENT LIT printing voter database SUBTOTALS $ (a) (b) (e) (d) OUTSTANDING AMOUNT INCURRED AMOUNT PAID OUTSTANDING BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD 0 $2,558.04 0 $2,558.04 0 $1,800 .00 0 $1,800 .00 o $ 4,358.04 $ o $ 4,358.04 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 $100.) ............................................. .INCURRED TOTALS $ ___ 1_6..:..,3_3_0_.0_4_ 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 $ ___ 3...:...,5_0_0_.0_0_ 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 $ 12,830.04 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 0 Amounts may be rounded to whole dollars. Statement covers period from ___ 1-_1_-2_0_1_6 __ _ through __ 4_-_2_3_-2_0_1_6 __ SCHEDULE F (CO NT.) CALIFORNIA 460 FORM Page __ 4_ of __ 4_ 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/rnisc. campaign consultants 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. CODE OR (a) NAME AND ADDRESS OF CREDITOR OUTSTANDING (IF COMMITIEE. ALSO ENTER 1.0. NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING OF THIS PERIOD four waters media, inc. LIT 3093 Lassen Street 0 West Sacramento, CA 95691 Subvendor: BreakPoint Sales $437.00 printing 741 Via Casitas Greenbrae, CA 94904 four waters media, inc. CNS 3093 Lassen Street 0 West Sacramento, CA 95691 PMCohen Public Affairs 23 Chestnut Ave. CNS 0 San Rafael, CA 94901 SUBTOTALS $ o $ 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 437.00 0 437.00 4,000.00 1,500 2,500 7,500.00 2,000 5,500 11,937.00 $ 3 ,500 $ 8,437.00 FPPC Form 460 (Jan/20i6) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov