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Home My WebLink AboutForm 806 - City of San Rafael 2017Agency Report of: Public Official Appointments A Public Document 1. Agency Name CITY OF SAN RAFAELDivision, For OfficiagOnly 100.00 District Department, or Region (IfApplicable) SAN RAFAEL CITY COUNCIL ► 01 / 03 / 17 ►Per Meeting: $ Designated Agency Contact (Name,Title) JIM SCHUTZ, CITY MANAGER ►Name Page 1 of 1 Date Posted: 01/09/2017 Area Code/Phone Number 415-485-3070 E-mail city.manager@cityofsanrafael.org (Month, Day, Year) 2. Appointments Agency Boards and Appt Date and Commissions Name of Appointed Person Length of Tenn Per Meeting/Annual Salary/Stipend San Rafael Sanitation 100.00 District Phillips, Gary ► 01 / 03 / 17 ►Per Meeting: $ ►Name (Last, First) Appt Date ► Estimated Annual. McCullough, Andrew 1 year [1$0-$1,000 [:1$2.001-$3,01)0 Alternate, if any ► (Lest, First) Length of Term 91$1,001-$2,000 ❑ Other San Rafael Sanitation 100.00 District Bushey, Maribeth ► 01 / 03 / 17 ►Per Meeting: $ ►Name (Last, First) Appt Data ► Estimated Annual. McCullough, Andrew 1 year y [:]$0-$1,000 ❑ $2,001-$3,000 Altemate, if any ► (Last, First) Length of Term ®$1,001-$2,000 ❑ Other ►Name ► l l 1 Per Meeting. $ (Lest, First) Appt Date ► Estimated Annual: Alternate, if any ► E-1$0-$1,000 [1$2,001-$3,000 Length of Term (Last, First) ❑$1,001-$2,000 ❑ Other ► / / ► Per Meeting: $ ►Name (Last, First) Appt Date ► Estimated Annual: Alternate, if any ► [1$041,000 F-1$2,001-$3,000 Length of Term (Last, First) ❑$1,001-$2,000 ❑ Other 3. Verification 1 h e read an nderstan PP egulafion 18702.5. 1 have verified that the appointment and information identified above is true to the best of my information and belief. JIM SCHUTZ CITY MANAGER 01/09/2017 gnature ofAgencyHea rD ignee Print Name Title (Month, Day, Year) Comment: FPPC Form 806 (4/16) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Agency Report of: Public Official Appointments Background This form is used to report additional compensation that officials receive when appointing themselves to positions on committees, boards, or commissions of another public agency or to a committee or position of the agency of which the public official is a member. This form is required pursuant to FPPC Regulation 18702.5. Each agency must post on its website a single Form 806 which lists all the paid appointed positions to which an official will vote to appoint themselves. When there is a change in compensation or a new appointment, the Form 806 is updated to reflect the change. The form must be updated promptly as changes occur. Instructions This form must be posted prior to a vote (or consent item) to appoint a governing board member if the appointee will participate in the decision and the appointment results in additional compensation to the appointee. FPPC Regulation 18702.5 provides that as long as the public is informed prior to a vote, an official may vote to hold another position even when the vote results in additional compensation. Part 1. Agency Identification Identify the agency name and information on who should be contacted for information. Part 2. Appointments Identify the name of the other agency, board or commission. List the name of the official, and an alternate, if any. List the appointment date and the length of term the agency official will serve. Disclose the stipend provided per meeting and the estimated annual payment. The annual salary is an estimate as it will likely vary depending upon the number of meetings. It is not necessary to revise the estimate at the end of the calendar year. Part 3. Verification The agency head or his/her designee must sign the verification Frequently Asked Questions (FAQs) 1. When does an agency need to complete the Form 806? A Form 806 is required when an agency's board members vote to appoint a board member to serve on another governmental agency or position of the agency of which the official is a member and will receive additional compensation. 2. The city council votes to serve as the city's housing authority, a separate entity. Will the Form 806 be required? If the council members receive additional compensation for serving on the housing authority, the Form 806 is required. A Public Document 3. Are appointments made by a governing board to appoint one of its members to serve as an officer of that board for additional pay (e.g., mayor) required to be disclosed on Form 806? No. FPPC Regulation 18702.5(b)(6) exempts from this requirement decisions to fill a position on the body of which the official is a member (such as a councilmember being appointed as mayor) despite an increase in compensation. 4. In determining the income, must the agency include mileage reimbursements, travel payments, health benefits, and other compensation? No. FPPC Regulation 18702.5 requires only the amount of the stipend or salary to be reported. 5. Which agency must post the Form 806? The agency that is voting to appoint a public official must post the Form 806 on its website. The agency that the official will serve as a member is not required to post the Form 806. The form is not sent to the FPPC. 6. When must the Form 806 be updated? The Form 806 should be amended promptly upon any of the following circumstances: (1) the number of scheduled meetings is changed, (2) there is a change in the compensation paid to the members, (3) there is a change in membership on the board or commission, or (4) there is a new appointment to a new agency. 7. If officials choose to recuse themselves from the decision and leave the room when a vote is taken to make an appointment, must the Form 806 be completed? No. The Form 806 is only required to identify those officials that will vote on an appointment in which the official will also receive additional compensation. Privacy Information Notice Information requested by the FPPC is used to administer and enforce the Political Reform Act. Failure to provide information may be a violation subject to penalties. All reports are public records available for inspection and reproduction. Direct questions to FPPC's General Counsel, Fair Political Practices Commission, 428 J Street, Ste. 620, Sacramento, CA 95814. FPPC Form 806 (4/16) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Agency Report of: California 806 Public Official Appointments Continuation Sheet A Public Document Page of 1 1. Agency Name 01/ CITY OF SAN RAFAEL Date Posted: ay, Y (Month,, Day, Year) ear) 2. Appointments Agency Boards and Commissions Name of Appointed Person t Date and Length of TermPer Meeting/Annual Salary/Stipend 10 / ► Per Meeting: $ Warne (Lest, First) Appt Date 1 Estimated Annual [:]$0-$1,000 ❑$2,001-$3,000 Attemate, if any / (Lest, First) Length of Term ❑$1,001'$2,000 ❑ Other / / Per Meeting: $ /Name (Last, First) Appt Data ► Estimated Annual: [--]$0-$1,000 ❑ $2,001-$3,000 Alternate, if any 1 (Lest, First) Length of Term ❑$1,001-$2,000 ❑ Other 10 1 Per Meeting: $ Warne (Last, First) Appt Data / Estimated Annual: ❑ $0-$1,000 ❑ $2,001-$3,000 Aftemate, if any ► Length of Term (Lest, First) ❑$1,001-$2,000 ❑ Other /Name ► 1 Per Meeting: $ (Last, First) Appt Date ► Estimated Annual: ❑ $041,000 [--1$2,001-$3,000 Alternate, if any ► Length of Term (Last, First) ❑ $1,001-$2,000 ❑ Other 10► Per Meeting: $ Warne (Last, First) Appt Date ► Estimated Annual: [:]$0-$1,000 ❑ $2,00143,000 Aftemate, if any ► Length of Term (Last, First) ❑$1,001-$2,000 ❑ Other /Name / 0,Per Meeting: $ (Lest, First) Appt Date / Estimated Annual.- nnual:Altemate, [:]$0-$1,000 ❑ $2,001-$3,000 Alternate,if any / Length of Term (Last, Fiat) ❑$1,001-$2,000 ❑ Other FPPC Form 806 (4/16) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275.3772)