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Home My WebLink AboutForm 460 - Andrew McCullough for City Council 2015 (2015-09-19)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 7/1/2015 through 9/19/2015 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. ® Officeholder, Candidate Controlled Committee ❑ Ballot Measure Committee Q State Candidate Election Committee Q Primarily Formed Q Recall Q Controlled (A/soComplete Part 5) O Sponsored Dale (Al- Complete Part 6) ❑ General Purpose Committee Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee Q Political Party/Central Committee (Also Comp/efePart7) 3. Committee Information I.D. NUMBER 1339798 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) McCullough for City Council 2015 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 Date of election if applicable: (Month, Day, Year) November 3, 2015 SEP 2 2 2015 Time. Page C ty Clerk's Off c City of San Rafa 2. Type of Statement: Preelection Statement ❑ Semi-annual Statement ❑ Termination Statement ❑ Amendment (Explain below) COVER PAGE of 5 For Official Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report ❑ Supplemental Preelection Statement -Attach Form 495 Treasurer(s) NAME OF TREASURER Jeffrey S. Schoppert MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 NAME OF ASSISTANT TREASURER, IF ANY Andrew McCullough MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODEIPHONE San Rafael CA 94901 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 besof 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 California that the foregoinqoAq true anj correct. September�.2015 vV Executed on By Dale Signalize ofTreasurprorAssisUirtTmasurer September�2015 Executed on By Dale SignatureolControllingOfficeholder, Candidate,StateMeasvreProponertorRespomiWeOfficerofSponsor Executed on By Date Sig aline of Controlling Officeholder, Candidate, State Measure Proponent Executed on Date By Sbroh eolControlling Officeholder, Cenddate, State Measure Proponent FPPC Fort 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC State of Califomia Recipient Committee Type or print in ink. COVER PAGE -PART2 CALIFORNIA Campaign Statement F RM • 1 Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Andrew McCullough OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) San Rafael City Councilmember RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP San Rafael, CA 94901 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. COMMITTEENAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEEADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMI TEENAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEEADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE Page 2 of 5 6. Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTERI JURISDICTION I ❑ 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 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 Fortn 460 (June/01) FPPC Toll -Free Helpline: 8661ASK-FPPC State of Califomia Campaign Disclosure Statement Type or print in ink. SUMMARYPAGE Summary Page schedule E, Line 4 $ Amounts may be rounded to whole dollars. 4,793.28 Statement covers period11! 0 0 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ 1,885.68 S 4,793.28 7/1/2015from Schedule F Linea (750.00) 10. Nonmonetary Adjustment .......................................... Schedule C, Linea 0 0 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 + 9 + 10 $ 1,135.68 $ 4,793.28 9/19/2015 5 SEE INSTRUCTIONS ON REVERSEthrough NAME OF FILER McCullough for City Council 2015 ColumnA Column B Calendar Year Summary for Candidates Contributions Received TOTALTHSPERIOD CALENDARYEAR Primary Runningin Both the State Prima and (FROM ATTACHEDSCHEDUUS) TOTALTODATE General Elections 0 0 1. Monetary Contributions ........................................... Schedule A, Line 3 $ $ 0 0 1/1 through 6130 7/1 to Date 2. Loans Received...................................................... Schedule B, line 3 0 0 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 + 2 $ $ Received $ $ 4. Nonmonetary Contributions .................................... Schedule C, tine 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 $ 1,885.68 $ 4,793.28 7. Loans Made............................................................. Schedule H, Line 3 0 0 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6+7 $ 1,885.68 S 4,793.28 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Linea (750.00) 10. Nonmonetary Adjustment .......................................... Schedule C, Linea 0 0 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 + 9 + 10 $ 1,135.68 $ 4,793.28 Current Cash Statement 12. Beginning Cash Balance ....................... Previous summary Page, Line 16 $ 7,438.52 13. Cash Receipts ................................................... Column A, Line 3 above 0 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 0 15. Cash Payments .................................................. Column A. Line 8 above 1,885.68 16. ENDING CASH BALANCE .......... Add Lines 12 + 13+ 14, then subtract Line 15 $ 5,552.84 If this is a termination statemen4 Line 16 must be zero. 17- LOAN GUARANTEES RECEIVED ........................... Schedule B, Part $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse $ 19. Outstanding Debts ......................... Add Line 2 +Line s in Column B above $ 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" (IrSubjecttovoluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) -I $ -J� $ Since January 1, 2001. Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER McCullough for City Council 2015 Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 7/1/2015 through 9/19/2015 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment Page 4 of 5 I.D. NUMBER 1339798 CNP campaign paraphemalia/misa NBR 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 tv. 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 W 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 PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID PMCohen Public Affairs P.O. Box 150268 CNS $1,000.00 San Rafael, CSA 94915-0268 PMCohen Public Affairs P.O. Box 150268 WEB $60.68 San Rafael, CSA 94915-0268 four waters media, inc. 3093 Lassen St. CNS $825.00 West Sacramento, CA 95691 " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 1,885.68 Schedule E Summary 1. Payments made this period of $100 or more. Include all Schedule E subtotals. 1,885.68 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 $ 1,885.68 FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC Schedule F Accrued Expenses (Unpaid Bills) Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 7/1/2015 SCHEDULEF SEE INSTRUCTIONS ON REVERSE through 9/19/2015 Page 5 of 5 NAME OF FILER I.D. NUMBER McCullough for City Council 2015 1339798 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 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 RL 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 VVEB information technologv costs (Internet. e-mail) NAME AND ADDRESS OF CREDITOR (IF COMMITTEE. ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT (a) OUTSTANDING (b) AMOUNTINCURRED (c) AMOUNT PAID (d) OUTSTANDING BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCEAT CLOSE OF THIS PERIOD (ALSO REPORT ONE) OF THIS PERIOD PMCohen Public Affairs P.O. Box 150268 CNS $500.00 $500.00 $1,000.00 0 San Rafael, CSA 94915-0268 four waters media, inc. 3093 Lassen SL CNS $250.00 $575.00 $825.00 0 West Sacramento, CA 95691 PMCohen Public Affairs P.O. Box 150268 web 0 $60.68 $60.68 0 San Rafael, CSA 94915-0268 * Payments that are contributions or independent expenditures must also be SUBTOTALS $ 1,135.68 $ 1,885.68 $ 0 summarized on Schedule D. $ 750.00 Schedule F Summary 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 $ 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. Net change this period. (Subtract Line 2 from Line 1. Enter the difference he and 1,135.68 1,885.68 0 on the Summary Page, Column A, Line 9.)................................................................................................................................................ NET $ 750.0 May be a negative number FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC