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HomeMy WebLinkAboutForm 460 - Firefighters' Association PAC (2011-12-31)acipient Committee ampaign Statement aver Page )vernment Code Sections 84200-84216.5) Type or print in ink. Date Stamp i C� Statement covers period Date of election if applicable: Page 7/1/7n11 (Month, Day, Year) from COVER PAGE Of -1 For Official Use Only Committee Information 1 I.D. NUMBER 891308 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) San Rafael Firefighter's Political Awareness Committee STREET ADDRESS (NO P.O. BOX) 999 5th Ave CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 707-975-4764 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX PO Box 2519 CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94912 707-975-4764 OPTIONAL: FAX / E-MAIL ADDRESS Treasurer(s) NAME OF TREASURER Jason Hatfield MAILING ADDRESS PO Box 2519 CITY STATE ZIP CODE AREA CODE/PHONE San Rafael Ca 94912 707-975-4764 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS jmhaffield43@gmaii.com 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 cogect. 1/25/2012 12/31/2011 Date Executed on E INSTRUCTIONS ON REVERSE through Executed on Date Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. 2. Type of Statement: E] Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure E] Preelection Statement F-1 Quarterly Statement • State Candidate Election Committee Committee W Semi-annual Statement E] Special Odd -Year Report • Recall 0 Controlled E] Termination Statement ❑(Also F-1 Supplemental Preelection (Also Complete Part 5) 0 Sponsored file a Form 410 Termination) Statement - Attach Form 495 General Purpose Committee (Also Complete Part 6) ❑ Amendment (Explain below) t Sponsored ❑ Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Pan 7) Committee Information 1 I.D. NUMBER 891308 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) San Rafael Firefighter's Political Awareness Committee STREET ADDRESS (NO P.O. BOX) 999 5th Ave CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 707-975-4764 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX PO Box 2519 CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94912 707-975-4764 OPTIONAL: FAX / E-MAIL ADDRESS Treasurer(s) NAME OF TREASURER Jason Hatfield MAILING ADDRESS PO Box 2519 CITY STATE ZIP CODE AREA CODE/PHONE San Rafael Ca 94912 707-975-4764 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS jmhaffield43@gmaii.com 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 cogect. BY SgnatLre of ControlIN OfficehoWer. Candidate, State Measure Proponent By SQnature of Controthrg Officeholder, Candxkft, State Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772) State of California 1/25/2012 Executed on Date Executed on Date Executed on Date Executed on Date BY SgnatLre of ControlIN OfficehoWer. Candidate, State Measure Proponent By SQnature of Controthrg Officeholder, Candxkft, State Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772) State of California impaign Disclosure Statement immary Page Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period frnm 7/1/2011 FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) through 12/31/2011 Page z of 1-7 INSTRUCTIONS ON REVERSE AE OF FILER I.D.NUMBER 3an Rafael Firefighter's Political Awareness Committee 891308 )ntributions Received Column A Column B Calendar Year Summary for Candidates TOTALTHISPERIOD (FROM ATTACHED SCHEDULES) CAUENDARYEAR TOTALTO DATE Running in Both the State Primary and General Elections Monetary Contributions ........................................... Schedule A, Line 3 $ 8818.08 $ 17420.56 0 0 1/1 through 6130 7/1 to Date Loans Received ..................................................... Schedule B, Line 3 SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines I + 2 $ 8818.08 $ 17420.56 20. Contributions Received $ $ Nonmonetary Contributions .................................... Schedule C, Line 3 0 0 21. Expenditures TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 + 4 $ 8818.08 $ 17420.56 Made $ $ ipenditures Made Expenditure Limit Summary for State Payments Made ....................................................... Schedule E Line 4 $ 13770.13 $ 14770.13 Candidates Loans Made ............................................................. Schedule H, Line 3 0 0 SUBTOTAL CASH PAYMENTS .. ........................... ...... Add Lines 6+7 $ 13770.13 $ 14770.13 22. Cumulative Expenditures Made* (If Subject to Voluntary Ey4mriditure Urnit) Accrued Expenses (Unpaid Bills) ............................... Schedule F, Line 3 0 0 Date of Election Total to Date Nonmonetary Adjustment .......................................... Schedule C, Line 3 0 0 (mm/dd/yy) TOTAL EXPENDITURES MADE ................................Add Lines 8 + 9 + 10 $ 13770.13 $ 14770.13 $ $ irrent Cash Statement Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 82902.07 To calculate Column B, add Cash Receipts ..... ...................... .......... Column A, Line 3 above 8818.08 amounts in Column A to the Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 0 corresponding amounts from Column B of your last *Amounts in this section may be different from amounts reported in Column B. Cash Payments ... ............... .................... Column A, Line 8 above 8818.08 report. Some amounts in Column A may be negative ENDING CASH BALANCE...... .... Add Lines 12 + 13 + 14, then subtract Line 15 $ 77950.02 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 LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ 0 for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if ash Equivalents and Outstanding Debts any). Cash Equivalents ........................................ See instructions on reverse $ 0 Outstanding Debts ......................... Add Line 2 + Line 9 in Column B above $ 0 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) hedule A Type or print in ink. SCHEDULE A meta Contributions Received Amounts may be rounded Statement covers period to whole dollars. • 7/112011 from • " 12/31/2011 3 4-7 INSTRUCTIONS ON REVERSE through Page of IE OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 STREETO DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR ACOMMITTEE,RALSAND ZIPD. CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE tECEIVED NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ® IND Daniel Barnes 14/2011 ❑coM Firefighter, City of San 166.38 304.38 ❑OTH Rafael f 1 ❑ PTY ❑ SCC MIND Paul Bowermaster 14/2011 ❑ Firefighter, City of San 166.38 304.38 OTH E] OTH Rafael 18 ❑ PTY ❑ SCC ®IND ❑coM Firefighter, City of San 166.38 304.38 Jeffery Conover 14/2011 F-1OTHRafael etaluma, CA 94954ElPTY ❑ SCC ®IND Justin Barrow '14/2011 ❑coM Firefighter, City of San 166.38 304.38 [_1 OTH Rafael Sonoma, CA 95476 F� pn ❑ SCC Paul Bernard ® IND '14/2011 ❑coM Firefighter, City of San 166.38 304.38 ElC k Grove, A 95624 ❑OTH Rafael ❑ PTY ❑ SCC SUBTOTAL $ '3 S t • C.3 hedule A Summary \mount received this period — itemized monetary contributions. 8818.08 Include all Schedule A subtotals.}........................................................................................................ $ amount received this period — unitemized monetary contributions of less than $100 ............................. $ 0 notal monetary contributions received this period. Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ....................... TOTAL $ 01U, *Contributor Codes IND — Individual COM— Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCG — Small Contributor Committee FPPC Form 464 (January/05) FPPC Toll -Free Helpline. 8661ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Firefiahter's Political Awareness Committee Type or print in ink. Amounts may be rounded to whole dollars. DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER RECEIVED flF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OCCUPATION AND EMPLOYER E]SCC (IF SELF-EMPLOYED, ENTER NAME Chris Cooper 7/14/2011 WIND F-1com Firefighter, City of San OF BUSINESS) nOTH IND San Rafael, CA 94903 7/14/2011" Richard Brown []COM Firefighter, City of San David Cornell 7/14/2011 EIOTH Rafael timmisim Oakley, CA 94561 D PTY Roseville, CA 95678 n PTY RSCC EISCC Paul Crimmins 7/14/2011 - 7/14/-2011 Nathan Clark 11MLj FICOM Firefighter, City of San nOTH Rafael Santa Rosa, CA 95404 El PTY E]SCC Chris Cooper 7/14/2011 WIND F-1com Firefighter, City of San nOTH Rafael San Rafael, CA 94903 F-1 PTY nSCC David Cornell 7/14/2011 OCOM IND [:] Firefighter, City of San timmisim F-JOTH Rafael Roseville, CA 95678 n PTY EISCC Paul Crimmins 7/14/2011 - OIND ®COM Firefighter, City of San FJOTH Rafael C 7otati, CA 94931 r-1 PTY EISCC SUBTOTAL$ *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 SCHEDULER (CONT) Statement covers period CALIFORNIA 7/1/2011 FORM 460 from through 12/31/2011 Page of tj I.D. NUMBER 891308 AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED THIS CALENDAR YEAR TO DATE PERIOD (JAN. I - DEC. 31) (IF REQUIRED) 166.38 304.38 166.38 304.38 166.38 1 304.38 166.38 1 304.38 166.38 1 304.38 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/276-3772) -.hedule A (Continuation Sheet) onetary Contributions Received AE OF FILER San Rafael Firefighter's Political Awareness Committee Type or print in ink. Amounts may be rounded to whole dollars. DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE Steven Davis JZ IND EICOM 14/2011 F-JOTH Penngrove, CA 94951 D PTY El SCC W]IND 714/2011 Robert deLambert EICOM ❑OTH Windsor, CA 95492 El PTY R SCC Chris Donohue ®IND [:]COM 14/2011 R OTH Ukiah, CA 95482 R PTY R SCC Gregory Geide OIND [:]Com 714/2011 EJOTHF1 Sebastopol, CA 95472 PTY IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Firefighter, City of San Rafael Statement covers period from 7/1/2011 through 12/31/2011 D. ge I.D. NUMBER 891308 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31) AMOUNT RECEIVED THIS PERIOD SCHEDULE A (CONT) 166.38 1 304.38 Firefighter, City of San Rafael 166.38 304.38 I Firefighter, City of San Rafael 166.38 304.38 Firefighter, City of San Rafael 166.38 304.38 I ❑ SCC Nick Giusti ®IND Firefighter, City of San /14/2011 EICOM 166.38 304.38 BOTH Rafael Novato, CA 94947 0 PTY E] SCC SUBTOTAL$ CI is, ®7 'ontributor Codes ID — Individual OM— Recipient Committee (other than PTY or SCC) TH — Other (e.g,, business entity) TY — Political Party CC — Small Contributor Committee of --A _1 PER ELECTION TO DATE (IF REQUIRED) FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULEA (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period a to whole dollars. 7/1/2011 a • • from through 12/31(2011 Page �' of NAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 STREETAN TERLD.N DEO DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR ACOMMITTEE.ADDRESS CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) M Firefighter, City of San RyGoodwinOco 7114!2011 ❑OTH Rafael 166.38 304.38 Petaluma, CA 94954 ❑PTY ❑ SCC RobertGround OcoM Firefighter, City of San 7114/2011 Iomega* ❑ OTH Rafael 166.38 304.38 Santa Rosa, CA 95404 ❑ PTY ❑ SCC Kyle Hamilton OIND Firefighter, City of San 7/14/2011 (� ❑ OTH Rafael 166.38 304.38 Folsom, CA 95634 ❑ PTY ❑SCC Richard Hamilton OIND Firefighter, City of San 7(14/2011 �rR!' ❑OTH Rafael 166.38 304.38 Ripon, CA 95366 0 PTY ❑ SCC Jason Hatfield MIND E]COM Firefighter, City of San 7/14/2011 �� ❑OTH Rafael 166.3$ 304.38 Santa Rosa, CA 95409 n PTY ❑ SCC SUBTOTAL$ S, 327. 6P; *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 464 (January/05) FPPC Toll -Free helpline: 866/ASK-FPPC (866/2754772) Schedule A (Continuation Sheet) Monetary Contributions Received ME OF FILER San Rafael Firefighter's Political Awareness Committee Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 7/1/2011 through 12/31/2011 DAA FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT RECEIVED (IF COMMITTEE, ALSO ENTER LD.NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS (IF SELF-EMPLOYED, ENTER NAME PERIOD OF BUSINESS) ® IND Gary Hax ❑Conn Firefighter, City of San 7/14/2011 ❑ OTH Rafael Novato, CA 94947 ❑ PTY ❑ SCC 7114/2011 Jaynes Hufford EICOM Firefighter, City of San ❑OTH Rafael Grass Valley, CA 95945 ❑ PTY ❑ SCC 7/14/2011 Eric Jennings OCOM IND Firefighter, City of San ❑OTH Rafael Oakland, CA 94611 ❑ PTY ❑ SCC 7/14/2011 Steve Kadzielawa om O oM Firefighter, City of San ❑OTH Rafael San Anselmo, CA 94960 ❑ PTY ❑ SCC Kevin Kelleher 7/1412011 ®IND FJCOM Firefighter, Ci of San ,�� ❑OTH Rafael Fairfield, CA 94534 ❑ PTY �j SCC "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 166.38 SCHEDULE A (CONT.) Page i of 11 891308 CUMULATIVE TO DATE PER ELECTION CALENDAR YEAR TO DATE (JAN. 1 - DEC. 31) (IF REQUIRED) 304.38 166.38 1 304.38 166.38 1 304.38 166.38 1 304.38 SUBTOTAL$ FPPC Form 460 (January/05) FPPC Toll -Free helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period to whole dollars. 7/1/2011 from thrminh 12/31/2011 ME OF FILER San Rafael Firefighter's Political Awareness Committee DATE 8 IF AN INDIVIDUAL, ENTER AMOUNT FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRI UTOR OCCUPATION AND EMPLOYER RECEIVED THIS RECEIVED tIF COMMITTEE, ALSO ENTER I.D, NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD OF BUSINESS) Conan Kelly IND E]COM Firefighter, City of San 7/14/2011 nOTH Rafael Mill Valley, CA 94941 R PTY RSCC Jim Kieffer 7/14/2011 VIINDM FICO Firefighter, City of San asumnow F-1 OTH Rafael Greenbrae, CA 94904 R PTY R SCC Ryan Kirkpatrick 7/14/2011 WJCOM IND FI Firefighter, City of San E:1 OTH Rafael San Francisco, CA 96123 El PTY R SCC 7/14/2011 Paul LeVeque OIND 1:1 COM Firefighter, City of San FJOTH Rafael Santa Rosa, CA 95409 F-1 PTY R SCC Matthew Locatelli OIND E]COM Firefighter, City of San 7/14/2011 ROTH Rafael Scotts Valley, CA 95066 [:] PTY EISCC I *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 W. - I.D. NUMBER 891308 CUMULATIVE TO DATE PER ELECTION CALENDAR YEAR TO DATE (JAN, 1 - DEC. 31) (IF REQUIRED) 166.38 1 304.38 166.38 1 304.38 166.38 1 304.38 166.38 1 304.38 166.38 1 304.38 SUBTOTAL$ 4/ ?911 1/0 FPPC Form 460 (January/05) FPPC Toil -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Firefiahter's Political Awareness Committee Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 7/1!2011 through 12/31/2011 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL; ENTER AMOUNT OCCUPATION AND EMPLOYER RECEIVED THIS RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD OFSUSINESS) IND Darren Lovecchio EICOM Firefighter, City of San 7/14/2011 ❑ oTH Rafael Monterey, CA 93940 n PTY ❑ SCC Eric MacAusland VICOM Firefighter, City of San 7/14/2011 QOTH Rafael San Anselmo, CA 94960 [:] PTY ❑ SCC 7/14/2011 Kenneth Martin ®IND ❑COM Firefighter, Cit of San g y ❑OTH Rafael Santa Rosa, CA 95409 n PTY ❑ ScC 7/14/2011 Marcus Mathis ZIND DCO❑OTH Firefighter, City of San Rafael Santa Rosa, CA 95405 ❑ PTY ❑ SCC 7114!2011 Michael McCarthy OIND Firefighter, City of San anew FJOTH Rafael Mill Valley, CA 94941 ❑ PTY SCC *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 SCHEDULE A (CONT.) Page ci of t-7 891308 CUMULATIVE TO DATE PER ELECTION CALENDAR YEAR TO DATE (JAN. 1 - DEC. 31) (IF REQUIRED) 166.38 1 304.38 166.38 1 304.38 166.38 1 304.38 166.38 1 304.38 166.38 1 304.38 SUBTOTAL$ �7,,kZ45, 51 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (86612753772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Firefighter's Political Awareness Committee Type or print in ink. Amounts may be rounded to whole dollars. SCHEDULE A (CONT) Statement covers period from 7/1/2011 through 12/31/2011 1 Page lit) of IF AN INDIVIDUAL, ENTER AMOUNT DATE FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD OF BUSINESS) IND 7/14/2011 Evan MinardEICOM Firefighter, City of San F-1 OTH Rafael Dublin, CA 94568 n PTY EISCC 7/14/2011 Mike Morgenlaender ®IND [3Com Firefighter, City of San [:] OTH Rafael Petaluma, CA 94954 El PTY FISCC Cameron Mrsny ®IND ocom Firefighter, City of San 7/14/2011 E] OTH Rafaeln East Palo Alto, CA 94303 PTY nSCC Rich Nettelman 7/14/2011 OIND 000M Firefighter, City of San FIOTH Rafael Novato, CA 94947 n PTY EISCC Garrett Northem 7/14/2011 OIND EICOM Firefighter, City of San FJOTH Rafael Forestville, CA 95436 n PTY El SCC *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 1891308 CUMULATIVE TO DATE PER ELECTION CALENDAR YEAR TO DATE (JAN. 1 - DEC. 31) (IF REQUIRED) 166.38 1 304.38 166.38 1 304.38 166.38 1 304.38 166.38 1 304.38 166.38 1 304.38 FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule A (Continuation Sheet) Type or print in ink SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period to whole dollars. CALIFORNIA , 7/1/2011 from • through 12/31/2011 Page It of 1-1 NAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR IFCOMMITTEE,ALSOENTERLD.NUMHER) CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED CODE* {IF SELF-EMPLOYED. ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ®IND MCOM Firefighter, City of San Artie Phillips 7114/2011 ,� ❑ OTH Rafael 166.38 304.38 Sonoma, CA 95476 M PTY —Kyle M SCC 7!1412011 Reuter WIND Firefighter, City of San 166.38 304.38 _ - —111111111M.MOTH Rafael EI Sobrante, CA 94803 M PTY M SCC Andrew Rogerson 7!14/2011 ZINDFICO Firefighter, City of San 166.38 304.38 MOTH Rafael Rohnert Park, CA 94928 ❑ PTY M SCC Jason Schmitt OCNM Firefighter, City of San 7(1412011 mob MOTH Rafael 166.38 304.38 Livermore, CA 94550 M PTY M SCC 7(1412011 Mark Sedlack IND OCOM Firefighter, City of San MOTH Rafael 166.38 304.38 Morgan Hill, CA 95037 M PTY ❑SCG SUBTOTAL$ 71 Al,?17 to *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 Fors 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (86612754772) Schedule A (Continuation Sheet) Monetary Contributions Received Type or print in ink. Amounts may be rounded to whole dollars. Statement covers perio from 7/1/2011 through 12/31/2011 SCHEDULE (CONT) Page - ) I- of __L7 NAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 IF N 4DIVIDUAL, ENTER AMOUNT ( CUMULATIVE TO DATE PER ELECTION DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR ( CONTRIBUTOR I OCCAPATION AND EMPLOYER � RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER L0. NUMBER CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OFBUSINESS) I JZ IND 7/14/201, David Shubin EICOM Firefighter, City of San 166.38 304.38 FJOTH Rafael Napa, CA 94558 El PTY[:] SCC Daniel Sutherlin 7/14/2011 WIND EICOM Firefighter, City of San 1 66.38 304.38 F-1 OTH Rafael El Dorado Hills, CA 95762 El PTY El SCC Joe Vasco 7/14/2011 WIND FICOM Firefighter, City of San 166.38 304.38 nOTH Rafael Petaluma, CA 94954 n PTY n SCC Bill Wasdyke OIND ocom Firefighter, City of San 7/14/2011 F] OTH Rafael 166.38 304.38 El Dorado Hills, CA 95762 ❑ PTY ❑ SCC 7/14/2011 Michael Wasdyke OIND E]COM Firefighter, City of San 166.38 304.38 DOTH Rafael Rancho Cordova, CA 95670 17 PTY SUBTOTAL$ *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 (8661275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received ME OF FILER San Rafael Firefiahter's Political Awareness Committee Type or print in ink. Amounts may be rounded to whole dollars. SCHEDULE A (CONT) Statement covers period from 7/1/2011 through 12/31/2011 Page 1-5 of I'l DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD OF BUSINESS) IND Graham Wiftkelman 7/14/2011 q1INSIMM. Santa Rosa, CA 95403 Rob Winner EICOM DOTH r-] PTY []SCC Firefighter, City of San Rafael ®IND MOTH Firefighter, City of San 7/14/2011 DOTH F-1 Rafael Vallejo, CA 94590 F-1 PTY n SCC Matt Windrem 7/14/2011 ®IND EICOM Firefighter, City of San nOTH Rafael Windsor, CA 95492 n PTY n SCC OIND ncom nOTH [:] PTY EISCC OIND OCOM nOTH n PTY nSCC *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 I.D. NUMBER 891308 CUMULATIVE TO DATE PER ELECTION CALENDAR YEAR TO DATE (JAN. 1 - DEC 31) (IF REQUIRED) 166.38 1 304.38 166.38 1 304.38 166.38 1 304.38 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661276-3772) K A FA :hedule D . HFDI 11 F D r print in ink. immary or Cxpenanures TypeAmounts Statement covers period may be rounded ipporting/Opposing Other CALIFORNIA , • " to whole dollars. 7/1/2011 • 3ndidates, Measures and Committees from INSTRUCTIONS ON REVERSE through 12/31/2011 Page` of AE OF FILER LD. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 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. 1 -DEC. 31) (IF REQUIRED) OR COMMITTEE Gary Phillips for Mayor 2011 Monetary /16/2011 Contribution 4000 6246.32 ❑ Nonmonetary Contribution ❑ Independent ® Support ❑ Oppose Expenditure 1/22/2011 Gary Phillips for Mayor 2011 ❑ Monetary Contribution Mailer. 6738.95 in support of three candidates. 2246.32 6246.32 m Nonmonetary Contribution ❑ Independent ® Support ❑ Oppose Expenditure 1/22/2011 Damon Connolly for City Council ❑ Monetary Mailer. 6738.95 in support Contribution of three candidates 2246.32 3246.32 Nonmonetary Contribution ❑ Independent 10 Support ❑ Oppose Expenditure SUBTOTAL $ 8492.64 -hedule D Summary Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.) ......................................................... $ Unitemized contributions and independent expenditures made this period of under $100..................................................................................... $ Total contributions and independent expenditures made this period. (Add Lines 1 and 2. 'Do not enter on the Summary Page.) ............ TOTAL $ 0 FPPC Form 464 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) RN r.hedule D 'ontinuation Sheet) Type or print in ink. Limmary of Expenditures Amounts may be rounded Statement covers period to whole dollars. M1423 Lipporting/Opposing Other 7/1/2011 andidates, Measures and Committees from through 12/31/2011 Page I;— of 1--7 AE OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 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. I - DEC. 31) (IF REQUIRED) OR COMMITTEE McCullough for City Council ❑Monetary Mailer. 6738.95 spent in /19/2011 Contribution support of three 2246.32 3246.32 Nonmonetary candidates. Contribution ❑ Independent Support ❑ oppose Expenditure McCullough for City Council Monetary 119/2011 Contribution 1000 3246.32 ❑ Nonmonetary Contribution ❑ Independent 0 Support El oppose Expenditure Damon Connolly for City Council Monetary /23/2011 Contribution 1000 3246.32 ❑ Nonmonetary Contribution rl Independent Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent F1 Support ❑ Oppose Expenditure SUBTOTAL $ 12738.96 FPPC Form 460 (January/05) FPIPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule E Payments Made SEE INSTRUCTIONS omREVERSE Type or print mink. Amounts may u*rounded mwhole dollars. Statement covers period from 7/1/2011 through 12/31/2011 SCHEoUIE Page \ of k.'7 NAME OF FILER San Rafael Firefighter's Political Awareness Committee | 891308 | CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNIP campaign MR member communications mm radio airtime and production costs GNS campaign consultants MTG meetings and appearances ma returned contributions CTB contribution (explain mmmonotan)~ Opo office expenses SAL campaign workers' salaries cvc :*iu donations PEr petition circulating TEL tx vrcable airtime and production costs nL candidate filing/ballot fees PHO phone banks TRIC candidate travel, lodging, and meals FwID fundraising mmmv pOL polling and survey mm,onm TRS otaff/opouseoa*w. lodging, and meals No independent oxnonoxupe wuppvmnompouxino umem (explain)* pcm puntaoe, un|wory and messenger vonxp,a TSF transfer between committees of the same canumotemnvnvv, LEG legal defense FR) professional services (woo|, accounting) voT voter registration ur campaign literature and mailings pnr print ads vwEo information technology costs (imemv.v,^ax) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Gary Phillips for Mayor 2011 999 5th St #369 CTB 4000 San Rafael, CA 94901 Inner Workings Lawn signs in support of Measure F 1415 Third St LIT 898.26 San Rafael, CA 94901 Fedex Office Campaign flyers in support of Measure F 439 Rohnert Park Ecpressway I LIT 132.92 Rohnert Park, CA 94928 ° Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBT7TAL$ 4000 Schedule E Summary 1.Itemized payments made this period. (include all Schedule Eoubbotols.).............................................................................................................. $ 2.Undennizedpayments made this period ufunder *1OU..... ............................... .......................... .................... —................................................ $ 3.Total interest paid this period onloans. (Enter amount from Schedule 8.Part i.Column (e)i---------............................... ................... $ 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ............................. TOTAL $ 1377O]4 O � � 1377U]4 FPPC Form 460(Januarym6) FPpCToll-Free Helpline: uomAom-FPpcHowazr5-3rru Schedule EType or print in ink. Statement covers period SCHEDULE E (CONT) (Continuation Sheet) Amounts may be rounded CALIFORNIA AA rs. --WW0 7/1/2011 FORM Payments Made to whole collars. from SEE INSTRUCTIONS ON REVERSE through 12/31/2011 Page 1-7 ofL7 NAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 CODES: If one of the following CW CNS CTB CVC FL FIND IND LEG LIT campaign paraphernalia/mise. campaign consultants contribution (explain nonmonetary)* civic donations candidate filing/ballot fees fundraising events independent expenditure supportin legal defense campaign literature and mailings codes accurately describes the payment, you may enter the code. MBR member communications MTG meetings and appearances OFC office expenses PET petition circulating PHO phone banks POL polling and survey research g/opposing others (explain)* POS postage, delivery and messenger services PRO professional services (legal, accounting) PRT print ads Otherwise, describe the payment. 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) NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Damon Connolly for City Council I Mailer supporting Connolly/McCullough and 1888 Las Gallinas Ave LIT Phillips. Total cost for mailer was 6738.96 2246.32 San Rafael, CA 94903 FPPC#1299799 McCullough for City Council see above 369 Third St #493 LIT 2246.32 San Rafael, CA 94901 Gary Phillips for Mayor 2011 see above 999 5th St #396 LIT 2246.32 San Rafael, CA 94901 Damon Connolly for City Council 1888 Las Gallinas Ave CTB 1000 San Rafael, CA 94903 McCullough for City Council 369 Third St #493 CTB 1000 San Rafael, CA 94901 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 8,738.96 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/276-3772)