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Home My WebLink AboutForm 460 - Firefighters' Association PAC (2011-10-22)Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period from 9/25/2011 through 10/22/2011 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. E] Officeholder, Candidate Controlled Committee F-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) Fv] General Purpose Committee (g Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 3. Committee Information I.D.NUMBER 1 891308 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) San Rafael Firefighter's Political Awareness 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 PO Box 2519 CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94912 OPTIONAL: FAX / E-MAIL ADDRESS Dale Stamp t. Date of election if applicable: (Month, Day, Year) 11/8/2011 2. Type of Statement: � Preelection Statement E] Semi-annual Statement E] Termination Statement (Also file a Form 410 Termination) E] Amendment (Explain below) COVERPAGE Page of / -7 For Official Use Only 0 Quarterly Statement F-1 Special Odd -Year Report E] Supplemental Preelection Statement - Attach Form 495 Treasurer(s) NAME OF TREASURER Jason Hatfield MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94912 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY OPTIONAL: FAX / E-MAIL ADDRESS STATE ZIP CODE AREA CODE/PHONE 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. Y--- / -, Executed on 10/26/2011 By Date Executed on By Date Executed on Date Executed on Date By Signature of Controlmg Officetidder. Candidate, State Measure Proponent By Signature of Cora oglmg Cflkeholder, Cardidate, State Measure Proponent FPPC Form 460 (January[05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866,1275-3772) State of California Campaign Disclosure Statement Summary Page Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 9/25/2011 SUMMARY PAGE SEE INSTRUCTIONS ON REVERSE 6. Payments Made ....................................................... Schedule E, Line 4 $ through 10/22/2011 Page Z- of NAME OF FILER 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 I.D.NUMBER San Rafael Firefighters Political Awareness Committee 891308 CAolumn Column B Calendar Year Summary for Candidates Contributions Received TOT ALTHISFERIOD CALENDAR YEAR Running in Both the State Primary (FROM ATTACHED SCHEDULES) TOTALTODATE and General Elections 1. Monetary Contributions ........................................... Schedule A, Line 3 $ 1265 $ 14237.50 1/1 through 6/30 7/1 to Date 2. Loans Received ...................................................... Schedule B, Line 3 1 SUBTOTAL CASH CONTRIBUTIONS Add Lines 1 + 2 $ 1265 $ 14237.50 20. Contributions ......................... Received $ $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ................. ......... Add Lines 3 +4 $ 1265 $ 14237.50 Made $ $ Expenditures Made 6. Payments Made ....................................................... Schedule E, 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 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. 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse $ 19. Outstanding Debts......................... Add Line 2 +Line gin Cohirrm B above $ 9738.96 $ 9738.96 $ 9738.96 $ 84282.94 3.65 9738.96 74547.63 13738.96 13738.96 13738.96 To calculate Column 8, 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). Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (if Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy} IAmounts 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) Grhafii iIIP A Type or print in ink. SCHEDULE A Moneta Contributions Received Amounts may be rounded Monetary to whole dollars. Statement covers period CALIFORNIA� from 9/25/2011 ' ' . 10/22/2011 3 17 through Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 FULL NAMESTREET ADDRESS AND ZIP CODE OF CONTRIBUTOR DATE , 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-EMPLovED,ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) Wasdyke, Bill F,�IND C 10/22 El COM Firefighter -City of San 23.87 241.32 E] OTH Rafael IEl Dorado Hills, CA 95762 ❑ PTY ❑SCC Wasc yke, Michael BIND ❑COM Firefighter - City of San 10/22 ❑ OTH Rafael 23.87 241.32 ❑ PTY Rancho Cordova. CA 95670 ❑scc Windrem, Matt BIND 10/22 El COM Firefighter - City of San 23.87 241.32 ❑ OTH Rafael ❑ PTY Windsor, CA 95492 ❑SCC Winkelman, Graham []IND ❑coM Firefighter -City of San 10!22 ❑ OTH Rafael 23.87 241.32 ❑ PTY Santa Ro��, CA 95403 _ F-1 SCC ZIND Firefighter -City of San Winner, Rob 10122 ❑ COM ❑ OTH Rafael 23.87 241.32 ❑ PTY Vallain C A 4d54(l El SCC SUBTOTAL$, Schedule A Summary 1 . Amount received this period — itemized monetary contributions. 1265 (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 $ L,J 1265 *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: 866/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. 9125/2011 FORM • from , ? 10/22/2011 through Page !?� of NAME OF FILER I. D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 DATE E O FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR STREETADDRESSZIP CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED ALSAND O ENTER LD.Nur CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) arnes, Dame BIND Firefighter -San Rafael 10/22 F] COM Fire Dept 23.87 241.32 F] OTH ❑ PTY Mill Valley, CA 94941 ❑ scC Barrow, Justin IND Firefighter - San Rafael 10/22 El CO Fire Dept 23.87 241.32 �Saj,n,'JR!3ff.a,11._CC,AAn-949-03—,—seC ❑ PTY Bernard, Paul QIND Firefighter - San Rafael 10/22 El COM Fire Dept 23.87 241.32 ❑ OTH ❑ Pte' k -Grave, CA- 9 ❑SCC _ Bowermaster, Paul BIND Firefighter - San Rafael 10/22 I' ` El COM ❑ OTH Fire Dept 23.87 241.32 ❑ PTY ❑SCC -Concord,-CA- _-945-19- Brown, Richard CD IND Firefighter - San Rafael 10/22 ❑ COM Fire Dept 23.87 241.32 ❑ OTH ❑ PTY [Antioch__C_A_9d ift9 ❑SCG -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 _ — SUBTOTAL. $ `r 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 may be rounded Statement covers period • 1 to whole dollars. 9/25/2011• • ' RM from 10/22/2011 through Page of VAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE STREETADDRESSZIP OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE ALSAND O ENTER LD, NUMBER) * RECEIVED CODE (JF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) Clark, Nathan QIND Firefighter - San Rafael 10/22 ❑COM ❑ OTH Fire Dept 23.87 241.32 ❑ PTY n a RoA4Q4 El SCC FjIND Firefighter - San Rafael Conover, Jeffery 10/22 El COM Fire Dept 23.87 241.32 ❑ OTH ❑ PTY LPjexatunla,-CA__94954—_.____ __.____ _______ F-1 SCC Cooper, Chris BIND Firefighter - San Rafael 10/22 El COM Fire Dept 23.87 241.32 ( ❑ OTH ❑ PTY l CA_�9Qt El SCC ;Cornell, David FIND Firefighter - San Rafael 10122 El COM Fire Dept 23.87 241.32 ❑ OTH ❑ PTY )Roseville, CA 95678 ❑SCC BIND Firefighter - San Rafael Crimmins, Paul 10/22ElCOM Fire Dept 23.87 241.32 I, ,7OTH ❑ PTY Cntati C_A 9 49`i 1_ E] SCC � ' ---- SUBTOTALS 4,(;77 `Contributor Codes IND -Individual COIN - Recipient Committee (other than PTY or SCC) CTH - Other (e.g., business entity) PTY - Political Party SCC Small Contributor Committee FPPC Form 460 (January105) FPPC Toil -Free Helpline: 666/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. 9/2512011 FORM 460 from f 10/22/2011 through Page of NAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 FULL NAMESTREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION , DATE OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLovED,ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) Davis, Steven RIND Firefighter - San Rafael 10/22 ❑COm E] OTH Fire Dept 23.87 241.32 ❑ PTY Pen wove , CA 94951 ❑ SCC deLambert, Robert FIND Firefighter -San Rafael g 10/22 ❑COM Fire Dept 23.87 241.32 ❑ OTH ❑ PTY ❑ SCC --Windsor-.-CA; 9-5432_ [BIND Firefighter - San Rafael Donohue, Chris 10/22 COM OFire Dept 23.87 241.32 OTH ❑ PTY Ukiah, _ ❑SCC BIND Firefighter - San Rafael Geide, Gregory 10/22 ❑ Com Fire Dept 23.87 241.32 ❑ OTH Sebastopol, CA 95472 ❑ PTY ❑ SCC Giusti, Nick IND Firefighter - San Rafael 10/22 1 El COM i Fire Dept 23.87 241.32 ❑ OTH ❑ PTY invatn f' A Ad9d7 SCC SUBTOTAL $ *Contributor Codes IND— Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTV — 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. 9/25/2011 • RM 460 from -7 r 10/22/2011 through Page of NAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 FULL NAMESTREET ADDRESS AND ZIP CODE OF CONTRIBUTOR DATE , 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) OF BUSINESS) Goodwin, Ryan IND Firefighter - San Rafael 10/22 ❑ COM ❑ OTH Fire Dept 23.87 241.32 ❑ PTY Pette _C A._9�54 ❑SCC Ground, Robert Cj IND Firefighter - San Rafael 10/22 ❑ conn ❑ OTH Fire Dept 23.87 241.32 ❑ PTY ❑SCC .Hamilton, Kyle BIND Firefighter - San Rafael 10/22Elconn Fire Dept 23.87 241.32 ❑ CITH PTY olsom,. CA__95630_ _ ❑ SCC Hamilton, Richard ❑r IND Firefighter - San Rafael 10/22 ❑ COM Fire Dept 23.87 241.32 ❑ OTH ❑ PTY �__9536f�_ __ _ ___ .__ Ripon—CA ❑ SCC Hatfield, Jason BIND Firefighter- San Rafael 10/22ElCOM Fire Dept 23.87 241.32 ❑ OTH ❑ PTY �antaFnca r n ocnno ❑ SCG - SUBTOTAL $ _/f �, • 4/6 '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: 6661ASK-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 /7 10/22/2011 through Page of NAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR ZIPD.N DEO DATE CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE pFOOMMIDRE.AISAND RECEIVEDER CODE * IIF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) Hax, Gary IND 2 Firefighter - San Rafael 10/22 COM El CO OTH Fire Dept 23.87 241.32 ❑ PTY Nnyato , CA _ 9494_9 _ ❑ SCC Hufford, James �INo Firefighter - San Rafael 10/22 ❑ COM Fire Dept 23.87 241.32 ❑ OTH ❑ PTY ❑SCC _IC7�n"al_ley� CA- 95945--- — _ �co Firefighter - San Rafael Jennings, Enc 10/22 M Fire Dept 23.87 241.32 ❑ OTH ❑ PTY Oakland, A 946tt ❑scc BIND Firefighter - San Rafael _ -- __ __ Kadzielawa, Steve 10/22 j El COM Fire Dept 23.87 241.32 OTH ❑ PTY 1 San Anselmo GA 94960 _ _ ❑scc Kelleher, Kevin BIND Firefighter - San Rafael 10/22 COM El Fire Dept 23.87 241.32 ilmommmm OTH qmmmwmmmm ❑ PTY CA 44901 _ _---__._-- � ❑ SCC SUBTOTAL $ '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 (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period to whole dollars. 9/25/2011 CALIFORNIA • from FORM Page / through 10/22/2011 of NAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 FULL NAMESTREET ADDRESS AND ZIP CODE OF CONTRIBUTOR DATE , (IF COMMITTEE, ALSO ENTER LD. NUMBER) CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED CODE (IF SELF -EMPLOYEE, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) Kelly, Conan QIND Firefighter - San Rafael 10/22 ElCOM ❑ OTH Fire Dept 23.87 241.32 ❑ PTY 'Mill Valley CA 94941 ❑ SCC Kieffer, Jim RIND Firefighter - San Rafael 10/22 0 COM Fire Dept 23.87 241.32 OTH ❑ PTY free CA_ -94904 _ F-1 SCC OIND Firefighter -San Rafael Kirkpatrick, Ryan 10/22 El COM Fire Dept 23.87 241.32 OTH I ❑ PTY 8_.FraciS,CA 96123 [:]scC LeVeque, Paul EIND Firefighter - San Rafael 10/22 El COCIT Fire Dept 23.87 241.32 ` ❑ PTY j Santa Rosa ,CA 95409 _ ❑ SCC Locatelli, Matthew IND Firefighter - San Rafael 10/22 0 CO Fire Dept 23.87 241.32 „ ' ❑ PTY ❑SCG *Contributor Codes IND- Individual COM - Recipient Committee (other than PTY or SCC) OTH - Other ie.g., business entity; PTY- Political Party SCC - Small Contributor Committee SUBTOTAL $ t FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Firefighter's Political Awareness Committee Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 9/25/2011 through 10/22/2011 SCHEDULE A (CONT) Page /0 of 1 -7 891308 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR COMMITTEE, CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATIONIF AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED CODE k (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) Lovecchio, Darren OIND Firefighter - San Rafael 10/22 [:] Com F] OTH Fire Dept 23.87 241.32 n PTY El SCC MacAusland, Eric IND Firefighter - San Rafael 10/22 ❑Com E] OTH Fire Dept 23.87 241.32 [:] PTY San -Anselmo,-CA-94960 El SCC Martin, Kenneth E IND Firefighter - San Rafael 10/22 EICOM Fire Dept 23.87 241.32 [:] OTH f -I PTY -Santa-Rosa, E -A---9540,9-,,-,,,- -- ----- -- -- -- ------ ❑ SCC Mathis, Marcus RIND Firefighter - San Rafael 10/22 El CO Fire Dept 23.87 241.32 n OTH n PTY Santa Rosa, SGC McCarthy, Michael OIND Firefighter - San Rafael 10/22 El COM Fire Dept 23.87 241.32 ❑ OTH ❑ PTY ❑ SCC SUBTOTAL$ *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 A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period I , to whole dollars. 9/25/2011 460 from FORM %! 17 10/22/2011 through Page of NAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 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,ALSOENTERID.NUMBER) CODE (IF SELF-EMPLOVEo,ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS Minard, Evan RIND Firefighter - San Rafael 10/22 0 CO Fire Dept 23.87 241.32 ❑ PTY Dublin, CA 94568 ❑ SCC Morgenlaender, Mike BIND Firefighter - San Rafael 10/22 ❑ COM Fire Dept 23.87 241.32 ❑ OTH ❑ PTY ❑ SCC Mrsny, Cameron Firefighter -San Rafael 10/22 El conn Fire Dept 23.87 241.32 El OTH ❑ PTY ❑ SCC 3 a Nettelman, Rich IND Firefighter - San Rafael 10/22 COM Fire Dept 23.87 241.32 OTH ❑ PTY xi,,.0A onan '7 F-1 SCC i Northern, Garrett [ICOM Firefighter - San Rafael 10/22 � COTH Fire Dept 23.87 241.32 ❑ PTY ❑ SCC SUBTOTAL $ *Contributor Codes INC - Individual COM - Recipient Committee (Other than PTY Or SCG) 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. 9!25/2011 ' 4 from FORM page It?- < through 10/22/2011 of NAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR IF AN INDIVIDUAL, ENTER IF OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED FCOMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) Shubin, David FjIND Firefighter - San Rafael 10/22 O COM ❑ OTH Fire Dept 23.87 241.32 ❑ PTY - Napa CA __9455&_ _. _ ❑ sCC Sutherlin, Daniel FIND Firefighter - San Rafael 10/22 ❑ CoM Fire Dept 23.87 241.32 j ❑ OTH ❑ PTY Ef Dorado, -Hi1 -CA --9,5762 - El Vasco, Joe IND BIND Firefighter - San Rafael 10/22 ❑ COM Fire Dept 23.87 241.32 !14 ❑ OTH ❑ PTY Petaluma, CA 44° ❑SCC4 RIND Firefighter - San Rafael 10/22 El COM Fire Dept 23.87 241.32 ❑ PTY ❑ SCC [:, IND Firefighter - San Rafael 10/22 ❑ COM Fire Dept 23.87 241.32 ❑ OTH ❑ PTY ❑ SCC SUBTOTAL $ �s $ `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 D eruenI u c n vul1111 Ical y {d1 LJltdi'l 1uff G.7 Amo Amounts I,r PW V( FAlfll 1(1 If7R. may be rounded Statement covers period ► I Supporting/Opposing Other to dollars. * ' whole 9/25/2011 FORM Candidates, Measures and Committees from SEE INSTRUCTIONS ON REVERSE through 10/22/2011 Page l3 of 7 NAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 DATE NAME OF CANDIDATE, OFFICE. AND DISTRICT, OR MEASURE NUMBER OR LETTER AND JURISDICTION, TYPE OF PAYMENT DESCRIPTIONCUMULATIVE (IF REQUIRED) TO DATE PER ELECTION AMOUNT THIS CALENDAR YEAR TO DATE OR COMMITTEE PERIOD (JAN.1-DEC. 31) (IF REQUIRED) Damon Connolly for City Council ❑ Monetary Mailers - 6738.95 total 10/22/11 Contribution spent. Mailer supported 3 3746.32 ❑r Nonmonetary candidates 2246.32 3746.32 Contribution ❑ Independent Q Support ❑ Oppose Expenditure McCullough for City Council ❑ Monetary Mailers - 6738.95 total 10/22/11 Contribution spent. Mailer supported 3 3246.32 rv-1 Nonmonetary candidates. 2246.32 3246.32 Contribution ❑ Independent Support ❑ Oppose Expenditure Gary Phillips for Mayor 2011 E] Monetary see above 10/22/11 Contribution 6246.32 Q Nonmonetary 2246.32 6246.32 Contribution ❑ Independent 0 Support ❑ Oppose Expenditure SUBTOTAL $ 6738.96 Schedule D Summary 1. Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.)......................................................... $ 2. Unitemized contributions and independent expenditures made this period of under $100..................................................................................... $ 3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enter on the Summary Page.) ............ TOTAL $ FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772) Schedule D (Continuation Sheet) Type or print in Ink. SCHEDULED (CONT.) Summary of Expenditures Amounts may be rounded Supporting/Opposing Other to whole dollars. Candidates, Measures and Committees statement covers period 9/25/2011 from 10/22/2011 through . • CALIFORNIA ' / Page �� of r NAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR MEASURE NUMBER OR LETTER AND JURISDICTION, OR COMMITTEE TYPE OF PAYMENT DESCRIPTION (IF REQUIRED) AMOUNTTHIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. t -DEC. 31) PER ELECTION TO DATE IF REQUIRED) 10/22 Gary Phillips for Mayor 2011 0 Monetary Contribution 3000 6246.32 6246.32 ❑ Nonmonetary Contribution ❑ Independent 0 Support ❑ Oppose Expenditure E] Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure E] Monetary Contribution ❑ Nonmonetary i Contribution I E] Independent ❑ Support ❑ Oppose Expenditure SUBTOTAL $ 3000 FPPC Form 460 (January/05) FPPC Toil -Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule E Payments Made SEE INSTRUCTIONS owREVERSE NAME OF FILER San Rafael Firefighter's Political Awareness Committee Type or print mink. Amounts may be munuwu to whole dollars. Statement covers period from 0/25/2O11 through 10/22/2011 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. 614C141111IMMA �- y7 Page / =_^__- or_-�_� I.D. NUMBER 891308 CW campaigpparaphemalia/misc. MBR member communications RAD radio airtime and production costs owa campaign consultants Mrn meetings and appearances RFD mmmeu contributions CTB contribution (explain nomnmnetary)* OFC mnoo expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.vmcable airtime and production costs RL candidate filing/ballot fees pm) phone banks TRC candidate travel, lodging, and meals pxm mnxruiui"u events poL polling and survey research TRS otaff/upmuaaoawm|. |cmning, and meals W independent expenditure supporting/opposing umum (explain)* poa pootaov, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG |ooa| gomnxo pno professional services (|oga|, accounting) voT voter registration ur campaign literature and mailings pnT print ads vvEe inmnnunv" mcmnumov costs <mtemet. o+nai0 NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Damon Connoll X for City Council 1 Mailer supporting Connolly/McCullough and I LIT Phillips. Total cost for mailer was 6738.96. 2246.32 SW aMe1WCMA094900W1�PPC#1299779 Mccullo h for ity Council see above i LIT 2246.32 Gary Phillips for Mayor 2011 see above LIT 2246.32 97MONeMM901 ° Payments that are contributions vrindependent expenditures must also be summarized on Schedule D. SVBTOTAL$ 6738.96 Schedule E Summary 9738.96�Q6 1.|tem�edpayme�amade this per�d.(|ndudeoUSchedule Esubto�lal------------------------------------.s 2.Unbemizmdpayments made this period ofunder $lOO.......................................................... _................................ .................. ............... ....... S 3.Total interest paid this period onloans. (Enter amount from Schedule B.Part 1.Column (e)l--------..................................... .............. $ 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ....... ..................... TOTAL $ 9738.96 FPPC Form 460(January/05) prpoToll-Free Helpline: moswSn-Fppc(000/2rs3r7u) Schedule CODE OR DESCRIPTION OF PAYMENT �c*�ouus�xzowT) Statement covers period �n p�tmin� (Continuation Sheet) Amounts may be rounded 3000 Payments Made to whole dollars. from 9/25/2011 10/22/2011 7 through Page t16 of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 CODES: If one of the following codes accurately doenhbos the poymemd, you may enter the node. Othenwise, describe the payment. c*VIP oompaiQnnorapmemanumisc Man member communications RAD radio airtime and production costs owa campaign consultants wno meetings and appearances RFD mtumou contributions CTB contribution (explain nonmvnmary)^ cFcoffice expenses SAL campaign workers' salaries CVC civic donations PET pponovn mmu|uuno TEL tx or cable airtime and production costs nL vandivatennnnmenot fees p*0 phone banks TRC candidate travel, lodging, and meals pwo fundraising events PoL polling and survey research TRS stamspov000avo|. |wuoino, and meals IND muaponoem expenditure supporting/opposing mhcm (explain)* POs postaou, delivery and mooeoneo, oemirov TSF transfer between committees of the same candidate/sponsor uEs |noa| defense PRO nmmooivna| norwoao (|ogo|, accounting) v0T voter registration LIT campaign literature and mailings PRT print ads vwEo information technology costs (intema«.e-moiV NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID Gary Phillips for Mayor 2011 4WHOW San Rafael, Ca 94901 FPPC#1 339680 CTB 3000 °Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 3000 FPPC Form wm(January/05) pppcToll-Free Helpline: usa#\onfppC(naa/275-o77u) ~__---r—' ed Miscellaneous Increases to Cash Am 0� ay to whole dollars. Statement covers period from 9/25/2011 CALIFORNIA FORM 460 Page_,/� of 7 SEE INSTRUCTIONS ON REVERSE through 10/22/2011 NAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF RECEIPT AMOUNTOF INCREASE TO CASH Bank of America Interest 10/22 1000 4th St 3.65 San Rafael CA 94901 Attach additional information onappropriately labeled continuation sheets. SUgTOTAL$ 3.65 Schedule USummary 3�G5 1.Itemized increases tocash this pohod.---------------------------------------'$ 2.Unihamizedincreases to cash of under $1OOthis pohod.—.......... ............ ................................................................ $ 3. Total of all interest received this period on loans made to others. (Schedule H. Column (e)j -----------8 4. Total miscellaneous increases to cash this period. (Add Lines 1. 2. and 3. Enter here and on the 3.65 FPPC Form wm(Januarym5) pppcToll-Free Helpline: ussovaK-Fppo(usn127s-37ru)