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Home My WebLink AboutForm 460 - Firefighters' Association PAC (2017-06-30)Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from ____ 1_1_1_/2_0_1_7 __ 06/30/2017 through ________ _ 1. Type of Recipient Committee: All Committees -Complete Parts 1.2.3. and 4. 3. D Officeholder, Candidate Controlled Committee o State Candidate Election Committee o Recall (Also Comploto PIIrl5) D General Purpose Committee ® Sponsored o Small Contributor Committee o Political Party/Central Committee COMMITIEE D Primarily Formed Ballot Measure Committee o Controlled o Sponsored (Also Complete PIIrl6) D Primarily Formed Candidatel Officeholder Committee (Also Comptete Petl 7) SAN RAFAEL FIREFIGHTERS POLITICAL AWARNESS COMMITTEE STREET ADDRESS (NO P.O . BOX) CITY SAN RAFAEL STATE CA ZIP CODE 94901 MAILING ADDRESS (IF DIFFEREND NO. AND STREET OR P.O. BOX CITY SAN RAFAEL OPTIONAL: FAX I E-MAIL ADDRESS andyr3755@comcast.net STATE CA ZIP CODE 94912 AREA CODE/PHONE AREA CODE/PHONE 4. Verification Date of election if apl)lIc;at~rt. (Month, Day, Year) 2. Type of Statement: D Preelection Statement Ik1 Semi-annual Statement D Termination Statement JUl (Also file a Form 410 Termination) D Amendment (Explain below) Treasurer(s) NAME OF TREASURER ANDREW ROGERSON MAILING ADDRESS CITY ROHNERT PARK NAME OF ASSISTANT TREASURER. IF ANY MAILING ADDRESS CITY OPTIONAL: FAX I E-MAIL ADDRESS 2 7 2017 D Quarterly Statement D Special Odd-Year Report STATE ZIP CODE CA 94928 STATE ZIP CODE AREA CODE/PHONE AREA CODE/PHONE I have used all reasonable diligence in preparing and reviewing this statement and to the of my knowledge the information contained herein and in the attached schedules is true and complete . certify under penalty of p rjury und the laws of the State of California that the fore g is t Executed on an~ ______ ~~~~ By __ ~~~~~~~~~~~~~~~~~~~~~~~~~~~ ___ sure Proponent or Responsible Officer of Sponsor Executed on Date Executed on Date Executed on Date By ______ ~~~~~~~~~~~~~~~~~~~------Signature of Controlling Officeholder. Candidate. State Measure Proponent By _________ ~~~~~~~~~~~~~~~~~~~---------Signature of Controlling Officaholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@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 RAFEAL FIREFIGHTERS POLITICAL AWARNESS COMMITTEE Contributions Received ColumnA TOTAL THIS PERIOD (FROM 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 $ 50 7. Loans Made....................................................................... Schedule H. Line 3 a 8. SUBTOTAL CASH PAyMENTS .......................................... Add Lines 6 + 7 $ 50 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F. Line 3 a 10. Nonmonetary Adjustment... ...................................................... Schedule C. Line 3 a 11 . TOTAL EXPENDITURES MADE. ....................................... Add Lines 8 + 9 + 10 $ 50 Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page. Line 16 $ 87,103 13 . Cash Receipts ........................................................... ColumnA. Line 3 above a 14 . Miscellaneous Increases to Cash .................................. Schedule I. Line 4 9 15. Cash Payments ................................... ...................... Column A. Line 8 above 50 16. ENDING CASH BALANCE .................. Add Lines 12 + 13 + 14. then subtract Line 15 $ 87,062 If this is a termination statement. Line 16 must be zero. 17 . LOAN GUARANTEES RECEiVED ................................ ScheduleB. Part 2 $ a Cash Equivalents and Outstanding Debts 18. Cash Equivalents ............................ .................... See instructions on reverse $ a 19. Outstanding Debts .... .......................... Add Line 2 + Line 9 in Column B above $ a SUMMARY PAGE Statement covers period 111/2017 from ________ _ CALIFORNIA 460 FORM 2 5 06/30/2017 through _______ _ Page ___ of __ _ $ $ $ Column B CALENDAR YEAR TOTAL TO DATE o o o o o $ 50 a $ 50 a a $ 50 To calculate Column S, add amounts in Column A to the corresponding amounts from Column S of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is Ihe first report being filed for this calendar year, only carry over Ihe amounts from Lines 2 . 7, and 9 (if any). I.D .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. Contributions Received $ ____ _ $----- 21 . Expenditures Made $ ____ _ $----- Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Limit) Dale of Election (mm/dd/yy) -----.J-----.J __ Total 10 Date $----- $----- *Amounts in this section may be different from amounts reported in Column S. 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 RAFEAL FIREFIGHTERS POLITICAL AWARNESS COMMITTEE DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITIEE. ALSO ENTER 1.0. NUMBER) CODE * DIND DCOM DOTH DpTY Dscc DIND o COM DOTH DPTY Dscc DIND DCOM DOTH DpTY Dscc DIND DCOM DOTH DpTY Dscc DIND DCOM DOTH DpTY Dscc Schedule A Summary IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF·EMPLOYED. ENTER NAME OF BUSINESS) SUBTOTAL $ SCHEDULE A Statement covers period from ___ 1_'_1 '_2_0_1_7 __ _ CALIFORNIA 460 FORM through __ 0_6_1_30_'_2_0_1_7 __ 3 5 Page ___ of __ _ AMOUNT RECEIVED THIS PERIOD I.D. NUMBER 891308 CUMULATIVE TO DATE CALENDAR YEAR (JAN . 1 -DEC . 31) ·Contributor Codes IND -Individual PER ELECTION TO DATE (IF REQUIRED) 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, Column A , Line 1.) ...................... TOTAL $ ______ 0_ SCC -Small Contributor Committee FPPC Form 460 (Jan/2016) FPPC Advice: advlce@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule D 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 RAFEAL FIREFIGHTERS POLITICAL AWARNESS COMMITTEE DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR MEASURE NUMBER OR LETTER AND JURISDICTION, OR COMMITTEE o Support o Oppose o Support o Oppose o Support o Oppose Schedule D Summary TYPE OF PAYMENT 0 Monetary Contribution 0 Nonmonetary Contribution 0 Independent Expenditure 0 Monetary Contribution 0 Nonmonetary Contribution 0 Independent Expenditure 0 Monetary Contribution 0 Nonmonetary Contribution 0 Independent Expenditure DESCRIPTION (IF REQUIRED) SUBTOTAL $ Statement covers period from ___ 1.:..;./...;.;1/c.::2:..::c0-'-17'--__ through __ 0-,-6.:..;.'..:...30-,-1_2-,-0_17,--_ SCHEDULED CALIFORNIA 460 FORM Page __ 4_ of __ 5 _ 1.0. NUMBER 891308 AMOUNT THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN . 1 -DEC . 31) PER ELECTION TO DATE (IF REQUIRED) 1. Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.) ....................................................... $ ____ ---=0,- 2. Unitemized contributions and independent expenditures made this period of under $100 .................................................................................... $ ____ =50=_ 3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2 . Do not enter on the Summary Page.) .......... TOTAL .. $ ____ ----'5:<,>0<-. FPPC Form 460 (Jan/2016) FPPC Advice: advlce@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule I Miscellaneous Increases to Cash SEE INSTRUCTIONS ON REVERSE NAME OF FILER SAN RAFEAL FIREFIGHTERS POLITICAL AWARNESS COMMITTEE DATE RECEIVED 6/30/2017 BANK OF AMERICA FULL NAME AND ADDRESS OF SOURCE (IF COMMITTEE ALSO ENTER LD. NUMBER) 1000 4TH ST SAN RAFAEL CA. 94901 Attach additional information on appropriately labeled continuation sheets. Schedule I Summary Amounts may be rounded to whole dollars. Statement covers period from ___ 1_/1_1_2_0_17 __ _ through __ 0_6_/3_0_/2_0_1_7 __ DESCRIPTION OF RECEIPT INTEREST EARNED SUBTOTAL $ 1. Itemized increases to cash this period ............................................................................................................................ $ ______ 9 2. Unitemized 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).) ....................................... $ ______ 0 4 . Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Line 14.) ............................................................................................................................. TOTAL $ _____ 9_ SCHEDULE I CALIFORNIA 460 FORM Page _5_ of_5 __ I.D. NUMBER 891308 AMOUNT OF INCREASE TO CASH 9 FPPC Form 460 (Jan/ZOI6) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov