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Home My WebLink AboutForm 460 - Greg Brockbank for City Council 2013 (2015-12-31) TerminationRecipient 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 12/31/15 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 Q Controlled (Also Complete Part 5) O Sponsored (Also Complete Part 6) ❑ General Purpose Committee Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee O Political Party/Central Committee (Also Complete Part 7) FEB -1 Date of election if applicable: (Month, Day, Year) COVER PAGE of b Use Only 3. Committee Information I.D. NUMBERTreasurer(s) l3J CITY CLERK'S FACE COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) 11/5/13 NAME OF TREASURER BROCKBANK FOR CITY COUNCIL 2013 Greg Brockbank 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) 3. Committee Information I.D. NUMBERTreasurer(s) l3J COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER BROCKBANK FOR CITY COUNCIL 2013 Greg Brockbank MAILING ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 CITY STATE ZIP CODE AREA CODEIPHONE NAME OF ASSISTANT TREASURER, IF ANY San Rafael CA 94901 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS 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 Califomia that the foregoing is true and correct. )_0 t (a � Executed on i By Date ^ Signature of Treasurer or Assistant Treasurer Executed on I / ld `� By I}cjTj�I� Wale Signature of controlling Officeholder, Candidate, State Measure Proponent or Responsible OfficerofSponsor Executed on By Date Signature ofConhalling Officeholder, Candidate, State Measure Proponent Executed on By Date Signature ofConlrollingOfficeholder Candidate. State Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) State of California Type or print in ink. COVER PAGE-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 RESIDENTIAL/BUSINESS 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. COMMITTEENAME 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 COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) Page I of C 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 UI IT JIMIC Llr UUUM HKMA UUUC/rr9UNt 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 Summary Page Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 7/1/15 SUMMARY PAGE Expenditures Made through 12/31/15 Page 7 of SEE INSTRUCTIONS ON REVERSE 7. Loans Made............................................................. Schedule H Line 3 2189.45 2189.45 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6+7 $ NAME OF FILER $ 62.00 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F, Linea 0 I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 0 0 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 + 9 + 10 135049 0 $ 2167.45 oollum Column B Calendar Year Summary for Candidates Contributions Received 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 TColumn EAD 2189.45 Running to Both the State Primary and r 13. Cash Receipts ................................................... Column A, Line 3 above (FROM ATTACHED SCHEDULES) TOTALTO DATE g 0 corresponding amounts 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 General Elections 1. Monetary Contributions ........................................... Schedule A, Line 3 $ 0 $ 0 2189.45 report. Some amounts in 0 0 1/1 through 6/30 7/1 to Date 2. Loans Received...................................................... Schedule B, Line 3 0 figures that should be 3. SUBTOTALCASH CONTRIBUTIONS Add Lines 1 +2 $ 0 $ 0 20. Contributions ......................... period amounts. If this is the first report being filed 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 Received $ $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 0 0 21. Expenditures carry over the amounts from Lines 2, 7, and 9 (if 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3+4 $ 0 $ 0 Made $ $ 18. Cash Equivalents ........................................ See instructions on reverse Expenditures Made 6. Payments Made ....................................................... Schedule E, Line 4 $ 0 $ 62.00 7. Loans Made............................................................. Schedule H Line 3 2189.45 2189.45 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6+7 $ 0 $ 62.00 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F, Linea 0 0 10. Nonmonetary Adjustment .......................................... Schedule Linea 0 0 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 + 9 + 10 $ 0 $ 2167.45 Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 2189.45 To calculate Column 8, add 13. Cash Receipts ................................................... Column A, Line 3 above 0 amounts in Column A to the 0 corresponding amounts 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 from Column B of your last 15. Cash Payments .................................................. Column A, Line a above 2189.45 report. Some amounts in Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 0 figures that should be subtracted from previous If this is a termination statement, Line 16 must be zero. period amounts. If this is the first report being filed 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if Cash Equivalents and Outstanding Debts v). 18. Cash Equivalents ........................................ See instructions on reverse $ 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column B above $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made' (If Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) 'Amounts in this section may be different from amounts reported in Column B. FPPC Foran 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A Type or print in ink. SCHEDULE A Moneta Contributions Received Amounts may rounded Monetary to dollars.CALIFORNIA statement covers period whole o J ' from 7/1/15 • FORM through 12/31/15 Page of E SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 135049 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVETO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IFCOMMITfEE,ALSOENTERI.D-NUMBER) CODE (IF SELF-EMPLOVED.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 1. 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 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) f:fedl 0 51111 a .a ail ii Schedule B — Part 1 '''" _' r""- "' 'u' n" Amounts may be rounded Statement covers eriod P . Loans Received to whole dollars. 7/1/15 � . from e 12/31/15 a SEE INSTRUCTIONS ON REVERSE th Page a 9e of NAME OF FILER I.D. NUMBER GREG BROCKBANK / BROCKBANK FOR CITY COUNCIL 2013 135049 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUALENTER , a OUTSTANDING (b) AMOUNTOUTSTANDING (c) AMOUNT PAID (d) (e) INTEREST (f) ORIGINAL (g) CUMULATIVE OF LENDER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED. ENTER BALANCE BEGINNING THIS RECEIVED THIS OR FORGIVEN BALANCEAT CLOSE OF THIS PAID THIS AMOUNT OF CONTRIBUTIONS (IFCOMMITTEE, ALSO ENTER I.D. NUMBER) NAMEOFBUSINESS) PERIOD PERIOD THIS PERIOD' PERIOD PERIOD LOAN TO DATE Greg Brockbank Attorney -self PAID CALENDAR YEAR (Marin Law Center) s 2189.45 s 0 % s 10,000 s Q FORGIVEN PER ELECTION" San Rafael, CA 94901 RATE S 10,000.0 s s 7810.55 s 0 2013 s tv IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR S s % S s ❑ FORGIVEN PER ELECTION *` RATE 5 5 S S s DATE DUE DATE INCURRED t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ PAID CALENDARYEAR S S % 5 5 ❑ FORGIVEN PER ELECTION" RATE s S s s S DATE DUE DATE INCURRED t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTALS $ $ $ $ Schedule B Summary 1. Loans received this period.................................................................................................................... $ (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period......................................................................................................... $ (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 10,000.00 3. Net change this period. ( Subtract Line 2 from Line 1.) ................................................. NET $ 10,000.00 Enter the net here and on the Summary Page, Column A, Line 2. (May be a negative number) 'Amounts forgiven or paid by another party also must be reported on Schedule A. " If required. (rruer(e)on Schedule E. tine 3) tContributor Codes IND— Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC—Small Contributor Committee 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 7/1/15 through 12/31/15 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. Page 6 of I.D. NUMBER 135049 L 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 M 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.......................................................................................................................................... $ 0 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 $ 0 FPPC Form 460 (January/05) FPPCToll-Free Helpline: 866/ASK-FPPC (866/275-3772)