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)