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Home My WebLink AboutForm 460 - Greg Brockbank for City Council 2013 (2015-06-30)Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period from 1/1/15 through 6/30/15 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. ® Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure Q State Candidate Election Committee Committee Q Recall 0 Controlled (Also Complete Pan 5) 0 Sponsored (Also Complete Pan 6) ❑ General Purpose Committee Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee Q Political Party/Central Committee (Also Complete Pan 7) 3. Committee Information I.D. NUMBER 135049 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) BROCKBANK FOR CITY COUNCIL 2013 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE Date of election if applicable: (Month, Day, Year) COVER PAGE J;,lte Stamp. .- JUL 3 0 20S Page of For Official Use Only Time: 11/5/13 City Clerk's Of e G4111 of qnn Ra el 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement ❑ Supplemental Preelection (Also file a Form 410 Termination) Statement -Attach Form 495 ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Greg Brockbank MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE 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. Executed on . ' � c � By �' "' " �''� ,Date Signature afTreasurer orAssistant Treasurer �3d lj7 Executed on — - By '- s' -- Date Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officer of Sponsor Executed on By Date Signature atControlling Officeholder, Candidate, State Measure Proponent Executed on By Dale Signature ofCantmiling Officeholder, Candidate, StateMeasure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772) State of California Type or print in ink. COVERPAGE-PART2 Recipient Committee CALIFORNIA Campaign Statement FORM 460 Cover Page — Part 2 5. 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 RES IDENTIAUBUS[NESS ADDRESS (NO. AND STREET) CITY STATE ZIP San Rafael, CA 94901 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? YES NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMM ITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 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 ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ 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 if 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. Statement covers period from 1/1/15 SUMMARY PAGE Expenditures Made 6. Payments Made ....................................................... Schedule E, Line 4 $ _ 7. Loans Made............................................................. Schedule H. Line 3 _ S. SUBTOTALCASH PAYMENTS .................................... Add Lines 6+7 $ _ 9. Accrued Expenses (Unpaid Bills)...............................Schedule F. Linea _ 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 a 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. 62.00 $ 0 62.00 $ 0 0 62.00 $ 2251.45 0 0 62.00 2189.45 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ l Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse $ 19. Outstanding Debts ......................... Add Line 2 +Line 9 in Column B above $ UL.VV 0 0 62.00 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). Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (M Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) -J $ 'Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) through 6/30/15 Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 135049 ColumnA Column B Calendar Year Summary for Candidates Contributions Received T D Primary Running in Both the State Prima and (FROMATTACHEO SCHEDULES) TOTALTO DATE g General Elections 1. Monetary Contributions ........................................... Schedule A, Line 3 $ 0 $ 0 O 0 1/1 through 6/30 711 to Date 2. Loans Received...................................................... Schedule B, Line 3 0 0 20. ContributionsReceived 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 +z $ $ $ $ 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 _ S. SUBTOTALCASH PAYMENTS .................................... Add Lines 6+7 $ _ 9. Accrued Expenses (Unpaid Bills)...............................Schedule F. Linea _ 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 a 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. 62.00 $ 0 62.00 $ 0 0 62.00 $ 2251.45 0 0 62.00 2189.45 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ l Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse $ 19. Outstanding Debts ......................... Add Line 2 +Line 9 in Column B above $ UL.VV 0 0 62.00 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). Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (M Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) -J $ 'Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A Type or print in ink. SCHEDULE A Amounts may be rounded Monetary Contributions Received to whole dollars. Statement covers period CALIFORNIA 1/1/15 from • - 4 • through 6/30/15 Page L(.of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 135049 DATE AND ZIP 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 I.D. NUMBER) CODE * (IF SELF-EMPLOYED. ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ❑IND ❑COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL$ 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.) ....................... TOTAL $ '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 0 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule D SCHEDULED Summary or txpencutures Type or print in ink. Statement covers period Supporting/OpposingOther Amounts may be rounded ' A • , to whole dollars. 1/1/15 Candidates, Measures and Committees from rP.!,g 6/30/15 SEE INSTRUCTIONS ON REVERSE through of NAME OF FILER I . NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 135049 DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR TYPE OF PAYMENT DESCRIPTION AMOUNTTHIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE MEASURE NUMBER OR LETTER AND JURISDICTION, (IF REQUIRED) PERIOD (JAN. t -DEC. 31) (IF REQUIRED) OR COMMITTEE Katie Rice for Supervisor 2016 ll Monetary 4/1/15 Contribution 150.00 ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure Kate Sears for Supervisor 2016 0 Monetary 6/20/15 Contribution 100.00 ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure SUBTOTAL $ 250.00 Schedule D Summary 1. Itemized contributions and independent expenditures made this period. Include all Schedule D subtotals. 250.00 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 $ 339.00 589.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Type or print in ink. Amounts may be rounded to whole dollars. GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 Statement covers period from 1/1/15 through 6/30/15 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. Page 0 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 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) ' 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.).............................................................................................................. $ 0 2. Unitemized payments made this period of under $100.......................................................................................................................................... $ 62.00 3. Total interest paid this period on loans. Enter amount from Schedule B, Part 1, Column (e).) 0 4. Total payments made this period. Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6. TOTAL $ 62.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)