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Home My WebLink AboutForm 460 - Firefighters' Association PAC (2015-12-31)Recipient Committee Campaign Statement Cover Page Statement covers period from July 12015 3. Committee Information I.D. NUMBER 891308 San Rafael Firefighters Political Awarness Committee STREET ADDRESS (NO P.O. BOX) Dec 312015 SEE INSTRUCTIONS ON REVERSE 999 5th Ave Suite 350 through 1. Type of Recipient Committee: All Committees—Complete Parts 1, 2, 3, and 4. ❑ Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure O State Candidate Election Committee Committee O Recall O Controlled (Also Complete Pert 5) O Sponsored 415-726-4394 (Also Compete Part B) ® General Purpose Committee ❑ Primarily Formed Candidate/ ® Sponsored * Small Contributor Committee Officeholder Committee * Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 891308 San Rafael Firefighters Political Awarness Committee STREET ADDRESS (NO P.O. BOX) 999 5th Ave Suite 350 CITY STATE ZIP CODE AREA CODE/PHONE San Rafael Ca 94901 415-726-4394 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX PO BOX 2519 CITY STATE ZIP CODE AREA CODE/PHONE San Rafael Ca 94901 415-725-4394 OPTIONAL: FAX I E-MAIL ADDRESS Date of election if applic�tjLI j I JAN 2 2 206 (Month, Day, Year) LJ CLERK'S OFFI 2. Type of Statement: ❑ Preelection Statement Ia Semi-annual Statement ❑ Termination Statement (Also fl Is a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) COVER PAGE e 1 of 4 For Official Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report NAME OF TREASURER Andrew Rogerson MAILING ADDRESS 1532 Mathias PI CITY STATE ZIP CODE AREACODE/PHONE Rohnert Park Ca 94928 415-726-4394 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE 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 California that the forego�g-ig true and correct.,` Executed on Jan, 17th 2016 By Dale igneture of T surer or Assistant Treasurer Executed on Date By Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officer of Sponsor Executed on Dais By Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on BY Date Signature of Controlling Officeholder, Candidate, Slate Measure Proponent FPPC Form 460 (tan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Amounts may be rounded Summary Page to whole dollars. Statement covers period from July 1 2015 SUMMARY PAGE Expenditures Made Dec 31 2015 2 4 SEE INSTRUCTIONS ON REVERSE $ 0 7. Loans Made....................................................................... Schedule H, Line 3 through 0 Page of 8. SUBTOTAL CASH PAYMENTS .......................................... Add Lines 6 + 7 NAME OF FILER 0 $ 0 9, Accrued Expenses (Unpaid Bills Schedule F, Line 3 1,0, NUMBER San Rafael Firefighters Political Awarness Committee 0 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 891308 Contributions Received Column A Column B Calendar Year Summary for Candidates $ 0 TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) CALENDAR YEAR TOTAL TO DATE Running in Both the State Primary and 12. Beginning Cash Balance"""""""""""""" Previous Summary Page, Line 16 $ General Elections I. Monetary Contributions................................................... Schedule A, Line 3 0 $ $ 0 2. Loans Received................................................................ Schedule e, Line 3 0 0 1/1 through 6130 7l1 to Date 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2 0 $ $ 0 20. Contributions Received $ $ 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 $ 0 $ 0 7. Loans Made....................................................................... Schedule H, Line 3 0 0 8. SUBTOTAL CASH PAYMENTS .......................................... Add Lines 6 + 7 $ 0 $ 0 9, Accrued Expenses (Unpaid Bills Schedule F, Line 3 0 0 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 0 0 11. TOTAL EXPENDITURES MADE ........................................ Add Lines 8 + g + 10 $ 0 $ 0 Current Cash Statement 12. Beginning Cash Balance"""""""""""""" Previous Summary Page, Line 16 $ 87,581 To calculate Column B, 13. Cash Receipts........................................................... Column A, Line 3 above 0 add amounts in Column 14. Miscellaneous Increases to Cash .................................. schedule ►, Line 4 4 Ato the correspondingamounts from Column B 15. Cash Payments .............................. Column A, Line 8 above 0 of your last report. Some 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 87 586 amounts In Column A may be negative figures that If this Is a termination statement, Line 16 must be zero. should be subtracted from previous period amounts. If this is the first report being 17. LOAN GUARANTEES RECEIVED ................................ Schedule e, Part 2 $ 0 filed for this calendar year, only cavy over the amounts from Lines 2, 7, and 9 (if Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 0 any)' 19. Outstanding Debts .............................. Add Line 2 + Line 9 In column a above $ 0 Expenditure Limit Summary for State Candidates 22, Cumulative Expenditures Made" (H Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mmldd/yy) $ —� $ `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 Amounts may be rounded SCHEDULE A Monetary Contributions Received LIJ VV11W""U110„' Statement covers period July 12015 CALIFORNIA from FORM460 3 4 Dec 31 2015 SEE INSTRUCTIONS ON REVERSE wh through Page of NAME OF FILER I.D. NUMBER San Rafael Firefighters Political Awamess Committee 891308 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE, ALSO ENTER IA. NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) ❑ 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 $ x I Q *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 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule I Amounts may be rounded SCHEDULE I Miscellaneous Increases to Cash to whole dollars. SEE INSTRUCTIONS ON REVERSE Statement covers period from July 1 2015 through Dec 31 2015 CALIFORNIA 4•1 FORM Page 4 of 4 NAME OF FILER San Rafael Firefighters Political Awarness Committee I.D. NUMBER 891308 DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF RECEIPT AMOUNT OF INCREASE TO CASH 12/31/2015 Bank Of America 1000 4th St San Rafael, Ca. 94901 Intrest Earned $4 Attach additional Information on appropriately labeled continuation sheets, Schedule I Summary 1. Itemized increases to cash this period............................................................................................................................$ 2. Unitemized increases to cash of under $100 this period.................................................................................................$ 3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).) .......................................$ 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the SummaryPage, Line 14.)............................................................................................................................. TOTAL $ SUBTOTAL $ 4 4 4 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca,gov (866/275-3772) www.fppc.ca.gov