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Home My WebLink AboutForm 460 - Andrew McCullough for City Council 2011 (2011-10-22)Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) fro Type or print In Ink. Date Stamp Statement covers period Date of election it applicable: 9/25/2011 1 (Month, Day, Year) n SEE INSTRUCTIONS ON REVERSE I through 10/22/2011 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. Officeholder, Candidate Controlled Committee r-1 Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also Complete Part 5) 0 Sponsored (Also Complete Part 6) M General Purpose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee 3. Committee Information 'OMMITTEE NAME (OR CANDIDATE'S NAME I McCullough for City Council 2011 M Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) I.D.NUMBER 1339798 COMMITTEE) STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE San Rafael ca 94901 MAILING ADDRESS (IF DIFFERENT) NO, AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL: FAX / E-MAIL ADDRESS 11/8/2011 2. Type of Statement: Preelection Statement ❑ Semi-annual Statement ❑ Termination Statement (Also file a Form 410 Termination) M Amendment (Explain below) COVER PAGE Page ___L_ of -1 � For Official Use Only M Quarterly Statement M Special Odd -Year Report M Supplemental Preelection Statement - Attach Form 495 Treasureqs) NAME OF TREASURER Randy Coleman MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE San Rafael ca 94901 NAME OF ASSISTANT TREASURER, IF ANY Andrew McCullough MAILING ADDRESS ca 94901 CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX i E-MAIL ADDRESS 4. 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 correct. t� Executed on ... BY Signature of ireasurar or Assistant Treasurer Executed on 0 Dals I If P Date Tgnatirre drontroorg OfficeiioldTr7Canddatm, State measure Proponent or Responsible Of of Sponsor Executed or Date By Signature of Controging Officoh"r, C andidale, State Measure Proponent Executed or, Date By Sgrature of Contro' Ring OftehoWar, Canddate, State Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) State of California Type or print in ink. Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Andrew McCullough OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City of San Rafael Council RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP San Rafael ca 94901 Related Committees Not Included In this Statement: List any committees not included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE LD.NUMBER NAME OF TREASURERI CONTROLLED COMMITTEE? ❑ YES p NO ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEfPHONE 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE COVER PAGE - PART 2 Page J, of _ �- i BALLOT NO. OR LETTERI JURISDICTION I ❑ SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE Attach continuation sheets if necessary FPPC Form 460 (January/05) FPPC Toil -Free Helpline: 866/ASK-FPPC (866/275-3772) State of California Campaign Disclosure Statement Type or print In ink. Amounts may be rounded • Summary Page to whole dollars. Statement covers period from 9/25/2011 VTW 4 Expenditures Made 6. Payments Made ....................................................... Schedule E, Line 4 $ through 10/22/2011 Page —7 of SEE INSTRUCTIONS ON REVERSE 9. Accrued Expenses (Unpaid Bills) . .............................. Schedule F Line 3 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 + 9 + 10 $ NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHIS PERIOD CALENDAR YEAR Running Both the State Primary and (FROMATTACHED SCHEDULES) TOTALTODATE In General Elections 1. Monetary Contributions .......................................... Schedule A, Line 3 22 581 $ ,.00 $ 39,792.99 1/1 through 6/30 7/1 to Date 0 15,000.00 2. Loans Received ..................................................... Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 +2 $ 22,581.00 $ 54,792,99 20. Contributions—Received $ $ 104.00 104.00 4. Nonmonetary Contributions .................................... Schedule C, Line 3 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ............ .............. Add Lines 3 + 4 $ 22,685.00 $ 54,896.99 Made $ $ Expenditures Made 6. Payments Made ....................................................... Schedule E, Line 4 $ 7. Loans Made ............................................................. Schedule H, Line 3 8. SUBTOTALCASH 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 8 + 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 1, 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. 11,762.42_ $ _20,475.25 0 0 11,762.42 $ 20,475.25 0 0 I 11,762.42 $ $ 23,499,43 22,581.00 0 11,762,42 $ 34,318.01 17, LOAN GUARANTEES RECEIVED ........................... Schedule a, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents..... ... __ ............ __ ........... see instructions on reverse 19. Outstanding Debts........ ... ...... ...... Add Line 2 + Line 9,,r, Column B above I 0 15,000,00 0 20,475.25 To calculate Column B, add amounts in Column A to the corresponding amount 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). Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (if Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/ddtyy) *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A Type or print in ink. SCHEDULE A Amounts may be rounded Monetary Contributions Received to whole dollars. Statement covers period CALIFORNIA / , 9!25/2011 from e page_ of . through 10/22/2011 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 DATE ZIP FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR ADDRESS CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED ALSAND (IF COMMITTEE, I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) []IND Law Offices of Geoffrey Speliberg ICOM $250 $250 09/26/11 ®OTH an rancisco, CA 94 7 PTY 7 SCC ®IND Matt White PCOM Lawyer $10p $100 09/26/11 70TH Monty White LLP San Rafael, CA 94901 7 PTS' 7 SCC []IND Al BoroI, ®COM Mayor. $250 $250 09/27/11 70TH San Rafael San Rafael, CA 94901 psco PTY FPPC# 910701 ®IND Dou, Van Gessel COM ICOM Attorney $250 $250 09/27/11 Shepard, Mullin, et al San Rafael, CA 94901 7 PTY 7scC ®IND Jack Nixon ICOM Ins Sales $500 $500 09/27/11 MOTH Self Tan Rafael, CA 94901 7 PTY 7 SGC SUBTOTAL $ 1,350 Schedule A Summary 1. Amount received this period - itemized monetary contributions. 21,220 (Include all Schedule A subtotals.)........................................................................................................ $ 2, Amount received this period - unitemized monetary contributions of less than $100 ............................. $ 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and On the Summary Page, Column A, Line 1.) ....................... TOTAL $ 1,361 *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 (866/275-3772) Schedule A (Continuation Sheet) Tvoe or print In ink. SCHEDULE A (CONT.) • Amounts may be rounded Monetary Contributions Received dollars. Statement covers period CALIFORNIA (05 0 to whole 9/25/2011 FORM from Page;,_ of through 10/22/2011 NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 DATE FULL NAMESTREET ADDRESS AND ZIP CODE OF CONTRIBUTOR , CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER LD. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) Lou &Marge Bartolini IND ®ICOM Retired $100 $100 09/27/11 [❑OTH a o, ❑ PTY p SCC Haden Ongaro IND ®coM Real Estate $100 $100 09/27/11 pOTH Cornish Carrey an nseimo, 94960 p PTY ❑ SCC Michael Winter & Maureen Boro OINDProfssor/UCSF $100 $100 09/29/11 ❑OTH Pharmasist/SFVAMC San a ael, LA ❑ PTY []SCC Stan Urban MIND Real Estate Dev $100 $100 09/29/11❑COM OTH Self a ael, CA 94901 ❑ PTY [:]SCC Tim Freudenber er VICOM Attorney $500 $500 09/29/11 [BOTH Cox, DiSante & an Juan Capistrano, CA 92675 ❑ PTY Freudenberger LLP []SCC SUBTOTAL$ 900 *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 Tolt-Free Helpline: 866/ASK-FPPC (86661275-3772) Schedule A (Continuation Sheet) TYDe or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 9/25/2011 FORM -r60 ii from through 10/22/2011 Page 4 of NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR DRE, CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (EETAIF ALSOENTERLp.NDEO CODE* (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ®IND Keven Holl M COM Attorney $250 $250 09/29/11 MOTH Gordon, Creed, Kelley, an Francisco, CA 94127 M PTY Holt & Sugerman M SGC Scott Rogermaim s ® IND 17-1 COM Attorney $250 $250 09/29/11 MOTH Holme, Robert & Owen ansa ito, CA 94965 M PTY LLP []SCC ❑ IND 09/29/11 Taylor &Wiley 0 M COM $250 $250 ®OTH Sacramento CA 95833 M PTY M SCG Brian Huben °' ZINDAttorney mcom $500 $500 09/29/11 MOTH Katten, Muchin, Palos Verdes Estates, CA 90274 M PTY Roseenman LLP []SCC Marin Builders Assoc MIND ®COM PAC#760140 $1,500 $1,500 09/29/11 MOTH San Rafael, CA 94 M PTY ❑ SCC SUBTOTAL$ 2,750 `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/45) FPPC Tall -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Tvpe or print In ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period r to whole dollars. 9/25/2011 s • 5 0 from Page of through 10/22/2011 NAME OF FILER I.D, NUMBER Andrew McCullough 1339798 DATE CODE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (EETAIF COMMITTEE, ALSO ENTERL CODE * (IF SELF•EMPLOYED,ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) MIND IND North Bay Leadership Council PAC# 1246290 $1,000 $1,000 09/29/11 MOTH a ae > M PTY M SCC Sandy Greenblatt ®IND Real Estate $100 $100 09/29/11 MQOH HL Commercial Real Es. San Rafael, CA 94901 M PTY M sCC IND MCOD MacPjj ro erties, Inc $250 $250 09/29/11 MOTH San Rafael, CA 94901 M PTY M SCC Viktoriya Wise mIND pIND Senior Transportation $100 $100 09/30111 MOTH Planner aae , 4901 M PTY City of San Francisco M SCG Michael Craford ZIND r-ICOMOTH President $1.000 $1,000 09/30/11 Craford Benefit San Rafael, CA 94901 M PTY Consulting ❑ sCC SUBTOTAL$ 2,450 `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 (866/275-3772) Schedule A (Continuation Sheet) Tvoe or print in Ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period to whole dollars. 9/25/201 1 from - Page of P L of through 10/22/2011 NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IFCOMMITTEE, ALSO ENTER A. NUMBER) CODE (IF SELF•EMPLOYEO, ENTER NAME PERIOD (JAN, 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) MIND Law Offices of Greg Shaughhnesy [:] COM 9/30/2011 OOTH $500 $500 4920 M PTY E]SCC Christina Camors W] IND PCOM Homemaker $250 $250 9/30/2011 'GatosCa nOTH Cos 95030 FIPTY FISCC Jeremy Sugerman OIND ®COM Attorney $150 $150 9/30/2011 MOTH GKHS San Francisco Ca 94110 E]PTY [:] SCC Daryl Audileft W]IND PCOM Attorney $250 $250 10/3/2011 16W E]OTH Kimble Nelson NRRW" 8-5749 EJPTY R SCC Barbara Heller n IND OCOM Re election Campaign 10/3/2011 1 []OTH Fppc#930680 $100 $100 San Rafael cCa 94901 E]PTY El SCC SUBTOTAIL$ 1,2507 *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 (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. 9/25/2011 from Of 10/22/2011 through NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN, I -DEG. 31) (IF REQUIRED) OF BUSINESS) IND Amy Silverstein COM Attorney $200 $200 10/03/11 E] OTH Silverstein & Pomerantz San 7706TEF, CA 94114 [] PTY MSCC 10/03/11 10/03/11 Scott Mroz ®IND Attorney SDMPA $100 $100 "7a'f —ae nOTH San I-, 7A_ 94901 F-1 PTY E] SCC Operating Engineers Local Union 3 MIND ®COM$100 PAC#891394 $100 10/03/11 I-] OTH Alameda, CA 946 2 n PTY n SCC Carrie Costama na W31NDm nco Software $250 $250 10/05/11 79'an'Pa'fael, n OTH Autodesk CA 94901 1771 PTY R SCC Kris Kelson ZIND MCOM Ins Agent $100 $100 10/05/11 [] OTH State Farm TFIRTa'fael, CA 94901 r-1 PTY ❑ SCC SUBTOTAL$ 750 *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) FPIPC 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 CALIFORNIA to whole dollars. 9/25/2011 / ' FORM from Page of -z — through 10/22/2011 NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED FcoMMITrEE,ALSANDZILD.NDE CODE* {IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) Gregory Moss DOOM Real Estate 10/05/11 MOTH Cassidy Turley $250 $250 an a ae , A 94903 M PTY M sCC Michael Di Geronimo ®CND ❑COM Attorney 10!05/11 . , ❑ OTH Miller, Starr, Regalia g $120 $120 M PTY M SCC Dr. James Clever ®IND MCOM Retired 10/06/11 $150 $150 MOTH i alley, CA 94941 M PTY M sCC Gary Cohen ®COM IND FI Real Estate 10/06/11 Self $100 $100 a Bel, CA 94 1 M PTY M sCC Andrew Do IND PCOM Lawyer 10/06111 MOTH Self $100 $100 nta Ana, CA 92705 M PTY M SCC SUBTOTAL$ 720 *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) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts maybe rounded Statement covers period to whole dollars. 9/25/2011 from Page / 1 of through 10/22/2011 NAME OF FILER I.D. NUMBER Andrew McCullough 1 1339798 DATE O FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR ET(IFCO CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED ITE, ALSO ENTERLD.NE CODE* (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS} ®IND Arthur Friedman ❑COM Lawyer $100 $100 10/06/11 ❑OTH Sheppard Mullin Mill Valley, CA 94941 ❑ PTY p SCC Edward Gschwind ®IND ❑COM Retired $1,000 $1,000 10/06/11�,� M OTH Jackson, WY 83002 M PTY M SCC Kenneth Conner V] IND MCOM Investor $250 $250 10/07/11" �, MOTH Sound Check Mgmt 'an Rafael, CA 94901 M PTY M sCC John Robertson pcoM IND Real Estate $150 $150 10/07/11 [BOTH Lennar Urban San afael, CA 94901 ❑ PTY M sCC MIND Wareham Properties Group, Inc ❑COM $250 $250 10/07!11 ®OTH San Hafael, UA 949U1 PTY ❑ SGC SUBTOTAL $ 1,750 '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 (666/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers perl;j-111111111111111111CALIFORNIA to whole dollars. 9/25/2011 FORM from Page of _ 2' through 10/22/2011 NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 DATE A FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR O RE,ALSAND ZIPp. CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED IT (IF COMMITTEE, NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS} IND ®OCOM Dana Tsubota Lawyer 10/8/2011 ODTH Miller Starr Regalia $200 $200 San Ramon CTM2 0 PTY ❑SCC 10/8/2011 Ghibtti Bras s ❑IND OCOM $200 $200 WIDTH san afael ca 94901 0 PTY ❑SCC California Real Estate PAC ❑IND ®CDM PAC # 890106 10/8/2011 $1,000 $1,000 GOTH Las angeles Ca 90020 0 PTY ❑ SCC David Sickle WINDAttorney 10/11/2011 0CTH DLA Piper LLP $500 $500 C i go 1160614 0 PTY 0 SCC Dr Stephen Mizroch VIIND Retired 10/11/2011 $100 $100 00TH San a aeI Ca 94901 [] PTY [] SCC SUBTOTAL$ 2,000 `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 (866/275-3772) Schedule A (Continuation Sheet) Tvpe or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA • � to whole dollars. 09/25/11 eRM � 6 from Page —- of through 10/22/11 NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 DATE ZIP FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (E COMMITTEE, ALSAND O ENTER I.D. NUMBER) CODE * (IFSELF•EMPLOYED,ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) Don & Pat Leisey IND r1coM Retired $100 $100 10/11(11 ❑OTH -9—an—PI af 7e"1", C 01 F1 PTS' ❑ sCC Anthony Derose �GoM Manager $100 $100 10/11/11 4 [3CTH Pixar San Rafael, CA 94901 ❑ PTY ❑ sCC 10/12/11 Basil Shiber lJoNglillillift JZ] Lawyer Miller, Starr, Regalia $1,000 $1,000 poTH Alameda,CA 94501 ❑ PTY []SCC Eduardo Angeles OIND DAttorney FICOM $15D $150 10/12/11 ❑OTH City of Los Angeles asadena; A ❑ PTY ❑ sCC Geoffre, Gordon -Creed '�� OIND ❑COM FICO Attorney $540 '� $500 10/14/11 �9 _... ❑OTH Self San Francisco, CA 94118 ❑ PTY ❑ sCC SUBTOTAL $ 1i850 'Contributor Codes IND - Individual COM - Recipient Committee (other than PTY or SGC) OTH - Other (e.g., business entity) PTY - Political Party SCC - Small Contributor Committee FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK+PPC (8661275-3772) Schedule A (Continuation Sheet) Tvps or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 9/25/2011 • RM 460! from Page _ I q of XV through 10/22/2011 NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 DATE DEO FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR ZIP CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED pFCOMMIDRE,ALSAND LD.N CODE * QFSELF•EMPLOYED,ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) Maynard Willms MIND Retired $100 $100 10/14/2011 DOTH an Rafael Ca 94903 ❑ PTY D SCC Mark Carbone DCOM Attorney $100 $100 10/16/2011 DOTH AAA San Rafael Ca 94901 D PTY D SCC Larry Paul ®GOM DU Architect $100 $100 10/16/2011 DOTH LA Paul & Assoc San Rafael Ca 94903 D PTY D SCC 10/16/2011 Reide &Mason ""^ DOOFICO M $250 $250 ®OTH San Rafael Ca 94901 D PTY D SCC 10120/2011 Gari' t,: f+!rt: ag,P,.;,:,.,, N� MIND DCOM Attorney Hanson Bridgett LLp $1,500 $1,500 DOTH LdT0Fq7w to D PTY []SCC SUBTOTAL.$ 2,050 *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: 666/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 9/25!2011 FORM from Page ! of through 10/22/2011 NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 DATE FULL NAMESTREET ADDRESS AND ZIP CODE OF CONTRIBUTOR , CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF•EMPLOYED,ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OFBUSINESS) IND John Thomason ICOM Not employed 10!2012011 BOTH $100 $100 San Raf ae a 4901 ❑ PTY p scC Michele Miller ®IND Attorney 10/20/2011 pOTH Miller Law Group $500 $500 San Rafael Ca 94903 p PTY ❑ SCC Michael May ®CO 10/19/2011 Executive pM OTH M P May Inc $250 $250 San Rafael ca 94901 ❑ PTY ❑ SCC Lawrence Andow MIND ❑COM Banker 10/19/2011 i ` ❑OTH Union Bank $250 $250 San Rafael Ca 94901 ❑ PTY ❑ SCC Kerry Mazzoni OIND DConsultant 10/21/2011 pOTH Mazzoni & Assoc $100 $100 an Rafael Ca 94901 ❑ PTY [:]SCC SUBTOTAL $ 1,200 `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 (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 CALIFORNIA to whole dollars. 09/25(11 - / i , from Page_ of through 10/22/11 NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 DATE FULL NAMESTREET ADDRESS AND ZIP CODE OF CONTRIBUTOR , CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IFSEIF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OFBUSINESS) Fred Divine ��OM Architect 10/21/11 ❑OTH Self $100 $100 Fairfax, CATMO 0 PTY ❑ SCC ach ®IND COM Enrolled agent 10/21/11 �.,, pOTH Self $100 $100 o San Rafael, A 94901 p PTY ❑ SGC William Cranford ®IND COM Real Estate 10/21/11Q ❑ OTH Cornish & Garrey y $100 $100 No va o, 47 ❑ PTY ❑ SCC Isidoor Bornstein ®IND ❑COMn Attorney 10/21/11 ❑ OTH Bornstein Law Offices $100 $100 rae, GreeCA 94904 ❑ PTY ❑ SCC Dr. Gordon Manashill ®IND com Retired 10/21/11 pOTH $100 $100 94901 ❑ PTY ❑ SCG SUBTOTAL$ $500 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 Tall -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 CALIFORNIA to whole dollars. 09/25/11a4601 RM from Page of through 10/22/11 NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR ADDRESSZIPER CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED ALSAND (IF COMMITTEE, O. NUMBER) CODE * (IF SELF•EMPLOYED,ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) Tom Allen OCOM Financial Manager 10/21/11 [JpTH Wells Fargo $100 $100 n Rafael, CA 94901 ❑ PTY ❑ SCC 10/22/11 edric Yiung "„ FIIND Manager Madison Marquette $100 $100 ❑OTH Mill Valley, CA 94942 ❑ PTY ❑ sCC Gregory Schreader ®CND ❑COM Retired $500 $500 09/27/11 ❑ OTH a ae ; 4901 ❑ PTY ❑ SGC Owen Clem$ "`"r` ' coM ❑CO Attorney $100 $100 10/02/11 �f `941 ❑oTH City of San Francisco Mi alley, A 9 ❑ PTY ❑ SCC Steve Datnow MIND ❑COM Engineer $100 $100 10/02/11 ❑ OTH Human Concepts P Mn Kataei, .UA 994901 ❑ PTY ❑ SCC SUBTOTAL$ 900 *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 (860275-3772) Schedule A (Continuation Sheet) Tvpe or print in ink. SCHEDULE A (CONT.} Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. 9/25/2011 FORM 4607 from Page of through 10/22/2011 NAME OF FILER I.D. NUMBER Andrew McCullough 133979$ DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER O EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * C SELF -EMP OYED, ENTER NAME HIS (JAN. 1 - DEC. 31) (IF REQUIRED) OFBUSINESS) IND Naomi Lee OCOM Homemaker $100 $100 10/04/11 ❑OTH Davis, CA 95618 p PTY ❑ SCC David Marks OIND Elco❑OTH Attorney $100 $100 10/07/11 CCA Law Mountain View, CA 94040 ❑PTY ❑ SCC Andre Shashaty OCOM President $150 $150 10/10/11 []0TH Alexander Edwards an Rafael, CA 94901 ❑ PTY []SCC Robert Corbolotti OcoM Financial Advisor $250 $250 10/10/11loolko�x y [loTH Capital Strategies Group San Rafael, CA 94901 ❑ PTY LLP ❑ SCC Benjamin Reyes OCOM IND Attorney $100 $100 10/11/11 E]OTH Meyers Nave ameda, CA 94501 f-1PTY ❑ SCC SUBTOTAL$ 700 '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 Toil -Free Helpline: 8661ASK-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 CALIFORNIA to whole dollars. 9/25/2011 sRM 460 from Page—- Of r through 10/22/2011 NAME OF FILER I.D. NUMBER Andrew McCullough 133979$ DATE DE O FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED pFcoMMittEE,ALSND .D.N CODE * QF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) James Sowers E]CpM Attorney $100 $100 10/21/2011 ilm []OTH Total Phase an a '9 . 9 ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCG [:]IND COM ❑ OTH ❑ PTY []SCC ❑IND ❑ COM ❑ OTH n PTY ❑ SCC ❑IND ❑ COM ❑ OTH PTY SCC SUBTOTAL$ 100 'Contributor Codes IND - Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other (e.g., business entity) PTY - Political Party SGC - Small Contributor Committee FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 860ASK-FPPC (860275-3772) SCHEDULE B - PART 1 Schedule B - Part 1 'ypa unt "' may b "' ,�� Amounts may be rounded Statement covers period CALIFORNIA , Loans Received to whole dollars. 9/25/2011 e . from Page of through 10/22/2011 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OUTSTANDING BALANCE AMOUNT (el AMOUNT PAID OUTSTA DING BALANCE AT INTEREST ORIGINAL CUMULATIVE OF LENDER (IFSELF-EMPLOYED, ENTER BEGINNING THIS RECEIVED THIS OR FORGIVEN CLOSE OF THIS PAID THIS AMOUNT OF CONTRIBUTIONS (IF COMMITTEE, ALSO ENTER I.D.NUMBER) NAMEOFBUSINESS) PERIOD THIS PERIOD" R PERIOD LOAN TO DATE Andrew McCullough Attorney [3 PAID CALENDAR YEAR 21 Biscayne Ct SYUFY s 0 s 15,000. o $ 15,000. $ 15,000 ❑ FORGIVEN PER ELECTION" San Rafael Ca 94-901 RATE 15,000,0 $ 0 $ 0 3 s $ DATE DUE DATE INCURRED t® IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ PAID CALENDAR YEAR S S t S S ❑ FORGIVEN PER ELECTION RATE S S $ $ $ DATE DUE to IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE INCURRED ❑ PAID CALENDAR YEAR ❑ FORGIVEN PER ELECTION"" RATE $ S $ $ S DATE DUE DATE INCURRED t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTALS $ 0 $ 0 $ 15,000 $ 0 Schedule B Summary 1. Loans received this period................................................................... (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period ................ ....... ............................ --................ (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 3. Net change this period. (Subtract Line 2 from Cine 1.) ................................... Enter the net here and on the Summary Page, Column A, Line 2. Amounts forgiven or paid by another party also must be reported on Schedule A. * If required. I ... I ........ I ..... $ 0 NET $ 0 (May Ge a regat-,e numt>ar, (tncer lel on Schedule E, Line 3) tContributor Codes IND— Individual COM — Recipient Committee (other than PTY or SGC) 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 (860275-3772) �r_hprlt tlr� [`. Type or print in ink. crruGni u G r. Amounts may oe rounaea Nonmonetary Contributions Received to whole dollars. Statement coverserlod from 9/25/2011 • ' Page l of through 1012212011 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 DATE FULL NAME, STREET ADDRESS AND CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF AMOUNT/ FAIR MARKET CUMULATIVE TO DATE PER ELECTION TO DATE RECEIVED ZIP CODE OF CONTRIBUTOR F COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * F NAMEOF BUS NESS)TER GOODS OR SERVICES VALUE CALENDAR YEAR (JAN 1 - DEC 31) (IF REQUIRED) MIND ❑COM MOTH M PTY []SCC MIND MCOM MOTH M PTY [-]SCC MIND MCOM MOTH M PTY MSCC MIND MCOM MOTH M PTY M SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ Schedule C Summary 1. Amount received this period — itemized nonmonetary contributions. (Include all Schedule C subtotals.)................................................................................. 2. Amount received this period — unitemized nonmonetary contributions of less than $100 3. Total nonmonetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10) 0 104.00 104.00 *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: 8661ASK-FPPC (866/275-3772) Schedule E ^Payments Made SEE INSTRUCTIONS owREVERSE Type mprint mInk. Amounts may urrounded »vwhole dollars. Statement covers perm from Q/2582011 through 1UX22/2O11 Page )A of W. NUMbLH NAME OF FILER Andrew McCullough 1339798 CODES: Mone of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaignparaphernalia/misc. MBR member communications FAD radio airtime and production costs CNS campaign consultants wDG meetings and appearances opo mmmad rvnmuummo CTB contribution (explain nv"mpnmary)~ OFC office expenses SAL campaign workers' salaries CVC m,io donations eT petition circulating TEL tx v,cable airtime and production costs FIL candidate filing/ballot fees pFIJ phone banks TRIC candidate travel, lodging, and meals pNIo mnuna|omg events p0L polling and survey research TRIS stp#/spouoetrovo/. lodging, and meals wo independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees ofthe same candidate/sponsor LEG legal defense pm] professional neminon Vega|, accounting) vOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs <|nmmm.o-nuiV NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Unicorn Group LIT $4,574.16 San Rafael Ca 94901 InnerWorkings CMP $211.58 InnerWorki CMP $861.24 San Rafael Ca 94901 °Payments that are contributions or Independent expenditures must also be summarized on Schedule D. SUBTOTAL$ $5.64&98 SChedUUe E Summary 11028�47 1.|hem�edpayme�omade this pehod.({ndudeall Schedule Eeubtotao.)------------------------..----------_'$ ' 1O5'S5 2.Undomizedpayme�omade this por�dofunder 31OO----------------------------------------------$ 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) .................... ... TOTAL $ - 11 76242 FPPC Form wm(Januaryn pppcToll-Free Helpline: oomxmm-Fppo(mmm275-orr2) Schedule E CODE OR DESCRIPTION OF PAYMENT Type in ink. AD va�e Marketing Inc SCHEDULE E (CONT) Statement covers period $513.21 or print Amounts may be rounded Amo (Continuation Sheet) Muelrath Public Affairs Inc 3 Payments Made to whole dollars. from 9/25/2011 American Express / US Post Office "San"aae 10/22/2011 through page )k- of SEE INSTRUCTIONS ON REVERSE Ca 94901 NAME OF FILER I.D. NUMBER Andrew McCullough 1339798 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. MBA member communications RAID 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 TRIC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRIS staff/spouse travel, lodging, and meals IND 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 services (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 (Ir COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID AD va�e Marketing Inc CMP $513.21 '?arta -Rosa _Ca15401 Muelrath Public Affairs Inc 3 CNS $5,000.00 Sania mosa ua 95401+ American Express / US Post Office "San"aae Stamps $466.28 Ca 94901 Payments that are contributions or Independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 5,979,49 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule GType or print in Ink. SCHEDULE Payments Made by an Agent or Independent Amounts may be rounded Statement covers period ------I C A LIFORNIA Contractor (on Behalf of This Committee) to whole dollars. from 9/25/2011 FORt)lM 4^6 NAME AND ADDRESS OF PAYEE OR CREDITOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID through 10/22/2011 Pages of SEE INSTRUCTIONS ON REVERSE 2,246.32 NAME OF FILER - — I.D. NUMBER Andrew McCullough 1339798 NAME OF AGENT OR INDEPENDENT CONTRACTOR San Rafael Firefighters Assoc PAC 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 TRIC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRIS staff/spouse travel, lodging, and meals M 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 services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (Internet, e-mail) * Payments that are contributions or Independent expenditures must also be summarized on Schedule D. NAME AND ADDRESS OF PAYEE OR CREDITOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID San Rafael Firefighters Assoc PAC 891308 jAQQW9MWWNffiW* ="Rafdea 94901 LIT 2,246.32 - — I Attach additional information on appropriately labeled continuation sheets. TOTAL* $ 2,24632 ' Do not transfer to any other schedule or to the Summary Page, This total may not equal the amount paid to the agent or independent contractor as reported on Schedule E FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)