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Home My WebLink AboutForm 460 - Firefighters' Association PAC (2016-06-30)Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period Jan 1,2016 from _____ -'-___ _ June 30,2016 through ________ _ 1. Type of Recipient Committee: All Committees -Complete Perts 1, 2, 3, and 4. 3. o Officeholder, Candidate Controlled Committee o Primarily Formed Ballot Measure Committee o State Candidate Election Committee o Recall (Also CompIeI. PIIII 6) fi2l General Purpose Committee ® Sponsored o Small Contributor Committee o Political Party/Central Committee o Controlled o Sponsored (Also Complate Parl 5) o Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 1.0. NUMBER 891308 San Rafael Firefighters Political Awarness Committee STREET ADDRESS (NO P.O. BOX) 999 5th Ave #350 San Rafael STATE Ca ZIP CODE 94901 M"ILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX PO BOX 2519 STATE ZIP CODE San Rafael Ca 94901 OPTIONAL: FAX I E-MAIL ADDRESS AREA CODE/PHONE AREA CODE/PHONE 4. Verification Date of election /f apl,lIcabl,el (Month, Day, Year) CITY CLERK'S 0 2. Type of Statement: o Preelection Statement Ii2I Semi-annual Statement o Termination Statement (Also file a Form 410 Termination) o Amendment (Explain below) Treasurer(s) NAME OF TREASURER ANDREW ROGERSON MAILING ADDRESS 1532 MATHIAS PLACE ROHNERT PARK NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CllY OPTIONAL : FAX I E-MAIL ADDRESS o Quarterly Statement o Special Odd-Year Report STATE ZIP CODE CA 94928 STATE ZIP CODE AREA CODE/PHONE 415=7264394 AREA CODE/PHONE I have used all reasonabla 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 p ury under the laws of the State of California that the foregoing Is e and correct. ~-7 -Z 7--6 i (. Executed on --4~--+'=------ Executed on ------.O ... a.,..te------ Executed on ----~O-:::a~te------ Executed on ----~O-:::a~le------ BY------~s~lgn~a~tur=e~ol~~==~~Hj~ng~O'"ffi~~~OO~ld~er~.C~a~nd~ld~at~e,~S~~t~e~Me=a=su=m~~==~=ne=nrt---------- BY __________ ~~~~~~~~~~~~~~~~~~----------SIgnature of Con~lIIng Officeholder, Candldata. Stata Measure Proponenl FPPC Form 460 (Jan/2016) FPPC Advice: advlce@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Amounts may be rounded to whole dollars. SAN RAFAEL FIREFIGHTERS POLITICAL AWARNESS COMMITTEE Contributions Received ColumnA TOTAL THIS PERIDD (FRDM ATTACHED SCHEDULES) 1. Monetary Contributions ................................................... Schedule A. Line 3 $ 0 2. Loans Received................................................................ Schedule B, Line 3 0 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2 $ 0 4, Nonmonetary Contributions ............................................ Schedule C, Line 3 0 5. TOTAL CONTRIBUTIONS RECEIVED .................................... Add Lines 3 + 4 $ 0 Expenditures Made 6, Payments Made................................................................ Schedule E. Line 4 $ 500 7. Loans Made....................................................................... Schedule H. Line 3 o 8. SUBTOTAL CASH PAyMENTS .......................................... Add Lines 6 + 7 $ 500 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F. Line 3 o 10. Nonmonetary Adjustment.. ....................................................... Schedule C. Line 3 o 11. TOTAL EXPENDITURES MADE. ....................................... Add Lines 8 + 9 + 10 $ 500 Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 87,586 13. Cash Receipts ........................................................... Column A, Line 3 above o 14. Miscellaneous Increases to Cash .................................. Schedule I, Line 4 8 15. Cash Payments ......................................................... Column A, Line 8 above 500 16. ENDING CASH BALANCE .................. Add Lines 12 + 13 + 14, then subtract Line 15 $ 87,094 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule B. Part 2 $ o Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ o 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ o SUMMARY PAGE Statement covers period CALIFORNIA 460 FORM from ___ J_a_n_1 ,_2_0_1_6 __ 2 6 June 30, 2016 through _______ _ Page ___ of __ _ $ $ $ $ $ $ Column B CALENDAR YEAR TDTAL TD DATE o o o o o 500 o 500 o o 500 To calculate Column B, add amounts in Column A to the cDrresponding amounts frDm CDlumn 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). 1.0. NUMBER 891308 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6/30 7/1 to Date 20. CDntributiDns Received $ ____ _ $----- 21. Expenditures Made $ ____ _ $----- Expenditure Limit Summary for State Candidates 22 . Cumulative Expenditures Made- (If Subject to Voluntary Expenditure Limit) Date Df Election (mm/dd/yy) -----1-----1 __ Total to Date $----- $----- "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 Monetary Contributions Received Amounts may be rounded to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER SAN RAFAEL FIREFIGHTERS POLITICAL AWARNESS COMMIITEE DATE RECi:IVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE. ALSO ENTER 1.0. NUMBER) CODE * olND oCOM DOTH oPTY oscc DIND DCOM DOTH oPTY OSCC DIND DCOM DOTH DpTY oscc DIND DCOM DOTH DPTY OSCC DIND DCOM DOTH DpTY OSCC Schedule A Summary IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF.eMP~aYEC . ENTER NAME OF BUSINESS) SUBTOTAL $ SCHEDULE A Statement covers period from ___ Ja_n_1,_2_0_1_6 __ CALIFORNIA 460 FORM through __ J_u_n_e_3_0_,_2_0_16 __ Page _3 __ Of __ 6 _ AMOUNT RECEIVED THIS PERIOD 1.0. NUMBER 891308 CUMULATIVE TO DATE CALENDAR YEAR (JAN . 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) ·Contrlbutor Codes INO -Individual 1. Amount received this period -itemized monetary contributions. (Include all Schedule A subtotals.) ......................................................................................................... $ ______ 0 COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g., business entity) PTY -Political Party 2. Amount received this period -unitemized monetary contributions of less than $100 ........................... $ ______ 0 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, ColumnA, Line 1.) ...................... TOTAL $ ______ 0 SCC -Small Contributor Committee FPPC Form 460 (Jan/1016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule 0 Summary of Expenditures Supporting/Opposing Other Candidates, Measures and Committees SEE INSTRUCTIONS ON REVERSE NAME OF FILER Amounts may be rounded to whole dollars. SAN RAFAEL FIREFIGHTERS POLITICAL AWARNESS COMMITIEE DATE 4/27/2016 NAME OF CANDIDATE, OFFICE, AND DISTRICT. OR MEASURE NUMBER OR LETTER AND JURISDICTION. ORCOMMIITEE COMMITIEE TO SUPPORT SAN RAFAEL LIBRARIES MEASURE 0 (Z) Support o Oppose o Support o Oppose o Support o Oppose Schedule 0 Summary TYPE OF PAYMENT i2I Monetary Contribution o Nonmonetary Contrlbutlon o Independent Expenditure o Monetary Contribution o Nonmonetary Contrlbutlon o Independent Expenditure o Monetary Contribution o Nonmonetary Contribution o Independent Expenditure DESCRIPTION (IF REQUIRED) Statement covers period from _---:J:..:a:;,.n:.-1;..!.,-=2:..::0....:..1.::..6 __ through June 30, 2016 SCHEDULED CALIFORNIA 460 FORM Page __ 4_ of __ 6_ 1.0. NUMBER 891308 AMOUNT THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN . 1 • DEC . 31) PER ELECTION TO DATE (IF REQUIRED) $500.00 $500.00 SUBTOTAL $ 1. Itemized contributions and independent expenditures made this period. (Include all Schedule 0 subtotals.) ....................................................... $ ____ ... 5:::,:O""'O=__ 2. Unitemized contributions and independent expenditures made this period of under $100 .................................................................................... $ _____ -'0'- 3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enter on the Summary Page.) .......... TOTAL .. $ ____ .:::.:50~O:.. FPPC Form 460 (Jan/2016) FPPC Advice: advlce@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULEE Schedule E Payments Made Amounts may be rounded to whole dollars. Statement covers period from __ J_a_n_1..;..' _20_1_6 __ CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE through June 30, 2016 Page _5 __ of_6 __ NAME OF FILER SAN RAFAEL FIREFIGHTERS POLITICAL AWARNESS COMMITTEE CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. 1.0. NUMBER 891308 CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign conSUltants MTG meetings and appearancas RFD returned contrtbutlons CTe contrtbutlon (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 fundralslng 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 trensfer 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 (Internet, a-mali) NAME AND ADDRESS OF PAYEE (IF COMMITTEE , ALSO ENTER 1.0. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID COMMITTEE TO SUPPORT SAN RAFAEL LlBRARIES-YES ON MEASURE D, PO BOX 150488, SAN RAFAEL CA. 94915 FPPC# 1383895 CTB $500.00 * Payments that are contributions or Independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 500 Schedule E Summary 500 1. Itemized payments made this period. (Include all Schedule E subtotals.) ............................................................................................................. $ _____ _ a 2. Unitemlzed payments made this period of under $100 .......................................................................................................................................... $ _____ _ a 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ............................................................................. $ _____ _ 500 4. Total payments made this period. (Add lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ........................... TOTAL $ _____ _ FPPC Form 460 (Jan/201S) FPPC Advice: advlce@fppc.ca.gov (866/27S-377~) www.fppc.ca.gov Schedule I Miscellaneous Increases to Cash SEE INSTRUCTIONS ON REVERSE NAME OF FILER SAN RAFAEL FIREFIGHTERS POLITICAL AWARNESS COMMITIEE DATE RECEIVED 6/30/2016 FULL NAME AND ADDRESS OF SOURCE (IF COMMITTEE. ALSO ENTER 1.0. NUMBER) BANK OF AMERICA 1000 4TH ST, SAN RAFAEL CA. 94901 Amounts may be rounded to whole dollars. Statement covers period Jan 1,2016 ~om ______ ~ ______ _ through June 30, 2016 DESCRIPTION OF RECEIPT INTREST EARNED SCHEDULE I CALIFORNIA 460 FORM paga_6_ of_6 _ I.D. NUMBER 891308 AMOUNT OF INCREASE TO CASH $8 Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 8 Schedule I Summary 1. Itemized increases to cash this period ............................................................................................................................ $ ___________ 8 2. Un itemized increases to cash of under $100 this period ................................................................................................. $ ___________ 0 3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).) ....................................... $ ______ ~O 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Line 14.) ............................................................................................................................. TOTAL $ ______ ~8 FPPC Form 460 (Jan/2016) FPPC Advice: advlce@fppc.ca.gov (866/275-3772) www.fppc.ca.gov