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Home My WebLink AboutForm 460 - Firefighters' Association PAC (2017-12-31)Recipient Committee Campaign Statement Cover Page Statement covers period from July 1 2017 Date of election if app licable, I (Month, Day, v __ f, '-11-----------' SEE INSTRUCTIONS ON REVERSE through Dec 31 2017 1. Type of Recipient Committee: All Committees -Complete Parts 1, 2, 3, and 4. 2. Type of Statement: o Preelection Statement Iii1! Semi·annual Statement 3. o Officeholder, Candidate Controlled Committee o Primarily Formed Ballot Measure Committee o State Candidate Election Committee o Recall (Also Complete Pert 5) ~ General Purpose Committee ~ Sponsored o Small Contributor Committee o Political Party!Central Committee o Controlled o Sponsored (Also Complete Part 6) o Primarily Formed Candidate! Officeholder Committee (Also Comptet. Part 7) 1.0. NUMBER 891308 San Rafael Firefighters Political Awamess Committee STREET ADDRESS (NO P.O. BOX) CITY San Rafael STATE ZIP CODE Ca 94901 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY San Rafael OPTIONAL: FAX I E-MAIL ADDRESS STATE Ca ZIP CODE 94912 AREA CODE/PHONE AREA CODE/PHONE o Termination Statement (Also file a Form 410 Termination) o Amendment (Explain below) Treasurer(s) NAMt=OF-ffiEASURER ANDREW ROGERSON MAILING ADDRESS CITY ROHNERT PARK NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY 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 AREA CODE/PHONE 4. Verification I have used all reasonable diligence in preparing and rev iewing this statement and to the best of my knowledge the jnform~contained herein and in the attached schedules is true and complete. certify under penalty of pe~ury u lJ der the laws of the State of California that the f oreg olAtrTS'true and correct. Executed on !.,,...' .-- , y Executed on Date Executed on Oale Executed on Date B --\ ~ ~\..~ y <:=» SlgnalUre of Trea5urej<\li"',8£i;lsAUt:U!!StJ!er ~ ~ ( (t'inn""t ......... ,,' f"'. ...... .,f' ... It~.." I"\Ff'k-ohnfAar ,..""n..ri.r4""t .... C:f,.,.t"" l..Jft""~ •• ~~Doe-'""' ... e ;,.,la nm,...",r ... r c:."","C'nr By Signature of ContrOlling Officeholder, Candidale, State Measure Proponent By Signature of ContrOlling Officeholder, 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 San Rafael Firefighters Political Awarness Committee Contributions Received 1. Monetary Contributions Schedule A, Line 3 2 . Loans Received ................................................................ Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2 4. Nonmonetary Contributions ............................................ Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED .................................... Add Lines 3 + 4 Expenditures Made $ $ $ 6. Payments Made.... ............................................................ Schedule =, Line 4 $ 7. Loans Made....................................................................... Schedule H, Line 3 8 . SUBTOTAL CASH PAyMENTS .......................................... Add Lines 6 + 7 $ 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F, Line 3 10. Nonmonetary Adjustment... ...................................................... Schedule C, Line 3 11 . TOTAL EXPENDITURES MADE ........................................ Add Lines B + 9 + 10 $ Current Cash Statement 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 13. Cash Receipts ........................................................... Column A, Line 3 above 14. Miscellaneous Increases to Cash .................................. Schedule I, Line 4 15. Cash Payments ......................................................... Column A, Line 8 above 16. ENDING CASH BALANCE .................. Add Lines 12 + 13 + 14, then subtract Line 15 $ If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts Amounts may be rounded to whole dollars. ColumnA TOTAL THIS PERIOD (FROM ATIACHED SCHEDULES) o o o o o 650 o 650 o o 650 87,062 o 9 650 86,421 o 18. Cash Equivalents See instructions on reverse 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ $ o o SUMMARY PAGE Statement covers period CALIFORNIA 460 FORM from July 1 2017 through Dec312017 2 5 Page of __ _ $ $ $ $ $ $ Column B CALENDAR YEAR TOTAL TO DATE o o o o o 700 o 700 o o 700 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). 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. Contributions Received $ _____ _ $---- 21. Expenditures Made $ __________ _ $---- Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subjoct to Voluntary Expondlture Umit) Date of Election (mm/dd/yy) ---1--1 __ --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 SEE INSTRUCTIONS ON REVERSE NAME OF FILER San Rafael Firefighters Political Awarness Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR I CONTRIBUTOR (IF COMMITIEE.ALSO ENTER 1.0. NUMBER) CODE * IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED. ENTER NAME OF BUSINESS) Schedule A Summary DIND DCOM DOTH DPTY Dscc DIND DCOM DOTH DPTY Dscc OIND OCOM DOTH OPTY OSCC DIND DCOM DOTH DpTY OSCC OIND DCOM DOTH DpTY Dscc SUBTOTAL $ SCHEDULE A Statement covers period from July12017 CALIFORNIA 460 FORM through Dec 31 2017 Page 3 of 5 AMOUNT RECEIVED THIS PERIOD I.D. NUMBER 891308 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) r ----------I 'Contributor Codes IND -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, Column A, Line 1.) ...................... TOTAL $ 0 SCC -Small Contributor Committee FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULE E Schedule E Payments Made Amounts may be rounded to whole dollars. Statement covers period from July 1 2017 CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE through Dec 31 2017 Page _4 __ of __ 5_ NAME OF FILER I.D. NUMBER San Rafael Firefighters Political Awarness Committee 891308 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/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 FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FNO fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals INO 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 serv ices (legal , accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITIEE, ALSO ENTER 1.0 . N UM B ER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID SAN RAFAEL FIRE FOUNDATION SAN RAFAEL FIRE FOUNDATION CRAB FEED CVC PAC TABLE 650.00 - * Payments that are contributions or independent expenditures must also be summarized on Schedule D . SUBTOTAL $ 650.00 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) ............................................................................................................. $ 650 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 $ 650 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca .gov (866/275-3772) www.fppc.ca.gov Schedule I Miscellaneous Increases to Cash SEE INSTRUCTIONS O N REVERSE NAME OF F ILER San Rafael Firefighters Political Awarness Committee DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF COMMmEE, ALSO ENTER 1.0. NUMBER) Amounts may be rounded to whole dollars. Statement covers period from July 1 2017 through Dec 31 2017 DESCRIPTION OF RECEIPT BANK OF AMERICA 1000 4TH ST SAN RAFAEL CA 94901 INTEREST EARNED 12/31/17 SCHEDULE I CALIFORNIA 460 FORM Page _5__ of_5 __ I.D. NUMBER 891308 AMOUNT OF INCREASE TO CASH 9 Attach additional information on appropriately labeled continuation sheets, SUBTOTAL $ 9 Schedule I Summary 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 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov