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Home My WebLink AboutForm 460 - Firefighters' Association PAC (2011-09-24)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 July 1, 2011 through Sept 24 2011 Type of Recipient Committee: All Committees —Complete Parts 1, 2, 3, and 4. ❑ Officeholder, Candidate Controlled Committee [j Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall Q Controlled (Aso Complete Part 5) Q Sponsored (Also Complete Part 6) ® General Purpose Committee ❑ Primarily Formed Candidate! (R) Sponsored Officeholder Committee Q Small Contributor Committee (Also Complete Part 7) Q Political Party/Central Committee I.D. NUMBER 3. Committee Information 891308 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) San Rafael Firefighter's Political Awareness Committee STREET ADDRESS (NO P.O. BOX) 999 5th Ave 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 San Rafael CA 94912 OPTIONAL: FAX t E-MAIL ADDRESS Date of election if applicable: (Month, Day, Year) Nov 8 2011 Date Stamp Page J COVER PAGE of _5_ For Official Use Only 2. Type of Statement: V Preelection Statement ❑ Quarterly Statement ❑ Semi-annual Statement ❑ Special Odd -Year Report F❑ Termination Statement ❑ Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Jason Hatfield MAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE San Rafael CA 94912 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL: FAX / 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 un7;;- laws%of the State of California that the foregoing is true and correc Executed on _ �` --- By Date Signature of Treasurer or Assistant Treasurer Executed on Cate Executed 01. ;ate By By ia.: aftxe of --ontrok-a f':ce �3ider Ca3pdda:e.. State Measure ?rO;c^c::.t Executed. on :"ate By S,grat=r.eofCurar inece,. ei laer:'ardGate.SateDeas+re^rro :er.Y FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) State of California Campaign Disclosure Statement Summary Page Type or print In Ink. Amounts may be rounded to whole dollars. Statement covers period from July 1 2011 SUMMARY PAGE 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. 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 9 in Column B above $ RUM 0- 3000 $ 0 0 4000 0 4000 0 0 4000 82902.07 To calculate Column B, add through Sept 24 2011 Page of - SEE INSTRUCTIONS ON REVERSE from Column B of your last report. Some amounts In Column A may be negative 3000 84282.94 figures that should be subtracted from previous NAME OFFILERI.D.NUMBER 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 San Rafael Firefighter's Political Awareness Committee 891308 ColumnA Column B Calendar Year Summary for Candidates Contributions Received TOTALTHISPERIOD CALENDAR YEAR DATE Running in Both the State Primary and (FROM ATTACHED SCHEDULES) TOTALTO General Elections A, Line 3 4370 $ $ 12972.50 1, Monetary Contributions ........................................... Schedule 1/1 through 6/30 7/1 to Date 0 2. Loans Received ...................................................... Schedule B, Line 3 4370 $ 1297250 . 20Contributions . 3. SUBTOTALCASH CONTRIBUTIONS ......................... Add Lines I +2 $ Received $ $ 0 0 4. Nonmonetary Contributions .................................... Schedule C, Line 3 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 + 4 $ 4370 $ 12972.50 Made $ $ 1 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. 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 9 in Column B above $ RUM 0- 3000 $ 0 0 4000 0 4000 0 0 4000 82902.07 To calculate Column B, add 4370 amounts in Column A to the corresponding amounts 10.87 from Column B of your last report. Some amounts In Column A may be negative 3000 84282.94 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 0 anv). Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* IN Subject to Voluntary Expenditure Urnit) Date of Election Total to Date (mm/dd/yy) $ *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. Amounts may be rounded Monetary Contributions Received to whole dollars. Statement covers period from July 1, 2011 SCHEDULE A Sept 24 2011 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 N INDIVIDUAL, EN ER AMOUNT CUMULATIVE TO DATE PER EI E FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR I CONTRIBUTOR CCPATION AND EMPLCALENDAR YEAR(ICOME,ALSOENTERI.D. NUMBER) OYER � RECEIVED THIS TORECEVED CODE FELF-EMPLOYEDENEPERIODNDEC)(IF REQUIRD) OF BUSINESS) Davis, Steven ®IND F-1com Firefighter - City of San ❑OTH "? - / I F-1 PTY Rafael /7 Penngrove, CA 94951 F-ISCC deLambert, Robert ®IND FICOM Firefighter - City of San OOTH Rafael le-- - mom F-1 PTY • EISCC Donohue. Chris )2 ®IND ❑Com Firefighter - City of San -7^ 9/�� []OTH Rafael 27-17, PTY _tAaah__CA_ _95482 F_1SCC Geide, Gregory ®INDL, E -]COM Firefighter - City of San DOTH Rafael 7� . /7')- -71-7 el' ❑ PTY Sebastopol, CA 95473 ❑ ScC Giusti. Nick ZIND 000M Firefighter - City of San �:]OTH PTY Rafael -7 e,13'_ [:] Nov_ato,_CA._9_4941,_.__ 0SCC SUBTOTAL$ J97. Schedule A Summary 1. Amount received this period — itemized monetary contributions. (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 I and 2. Enter here and on the Summary Page, Column A, Line .............. $ 0 .......I TOTAL $ 7/, :r 7,:::2 *Contributor Codes IND - Individual COM - Recipient Committee (other than PTY or SCC) OT H - 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) Monetary Contributions Received Type or print In ink. Amounts may be rounded to whole dollars. Statement covers period fromJuly1, 2011 SCHEDULE A (CONT) Brown, Richard 9/1/11 *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 ®CND E]COM Firefighter - City of San OCITH Rafael 71 PTY SCC SUBTOTALS 7?,K, 79.45 1 217.45 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Sept 24 2011 through 5 — — Page - of NAMEOF FILER I.D. NUMBER San Rafael Firefighters Political Awareness Committee 891308 DATE FULL NAME. STREET ADDRESS AND ZIP CCCE OF CONTRIBUTOR CONTRIBUTOR CON IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE NF COMMITTEE, ALSO ENTER I.D. NUMBER) RECEIVED CODE JIF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) %rnts� Danit+ OF BUSINESS) WIND F� Com Firefighter -City of San 9/1/11 70TH Rafael 79.45 217.45 7 PTY Nfill Valley, CA 94941 7SCC Barrow, Justin WIND Firefighter -City of San 9/1/11 ICOM Rafael 79.45 217.45 70TH 7 PTY San Rafael, CA 94903 []SCC WIND Firefighter - City of San Bernard, Paul 9/1/11 – mom— ':]COM 7 OTH Rafael 79.45 217.45 0 PTY illl!k . :rovc, CA 95624 0SCC Bowermaster. Paul WIND 000M Firefighter - City of San 9/1/11 F] OTH Rafael 79.45 217.45 r7 PTY L] SCC Brown, Richard 9/1/11 *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 ®CND E]COM Firefighter - City of San OCITH Rafael 71 PTY SCC SUBTOTALS 7?,K, 79.45 1 217.45 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 Firefiqhter's Political Awareness Committee Type or print in Ink. Amounts may be rounded to whole dollars. DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR RECEIVED (IF COMMITTEE. ALSO ENTER LD NUMBER) CODE Clark, Nathan ®IND 9/1/11 51"10diffivoka.❑ ocom OTH ❑ PTY Santa Rp_sa CA 9540A-- SCC Conover, Jeffery IND 9/1/11 ocom F-1 OTH 0 PTY ❑SCC Petal t;ma_CA_-9-4-954-- - Cooper, Chris IND D COM 9/1/11 ❑ OTH ❑ PTY ❑ SCC � an R CA 9490-- --- Corn;il, David IND 9/1/11 E]COM FIOTH [] PTY f -I SCC Crimmins, Paul ®IND 9/1/11 L] COM Cj OTH PTY SCC .Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) GTH — Other (e.g., business entity) P—i Y — Political Party SCC — Small Contributor Committee IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Firefighter - City of San Rafael SCHEDULE A (CONT.) Statement covers period CALIFORNIA July 1, 2011 fromm— JFORM 4� Sept 24 2011 Gf JS through Page of I.D. NUMBER 891308 AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED THIS CALENDAR YEAR TO DATE PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 79.45 1 217.45 Firefighter - City of San Rafael 79.45 217.45 I I Firefighter - City of SanI Rafael 1 79.45 1 217.45 Firefighter - City of San Rafael 79.45 217.45 I Firefighter - City of SanI 1 Rafael 79.45 217.45 i SUBTOTAIL$ 1191.715 - FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Firefighter's Political Awareness Committee DATE RECEIVED 9/1111 9/11/11 9/1/11 9/1/11 9/1/11 Type or print in ink. Amounts may be rounded to whole dollars. FULL NAME, STREET �-,CDRESS 4,ND ZIP CODE OF CCNTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OF COMMITTEE ALSO ENTER 10 'UVSER) CODE OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Good,win, Ryan WIND EICOM Firefighter -City of San ❑OTH Rafael ❑ PTY Petahi ' na, CA 94954 ❑SCC 6ZIND Firefighter - City of San Groilrld, Robert E]COM [:] OTH Rafael E] PTY Santa Rusa—C-A-95404-- E] SCC Hamilton, Kyle ICOM Firefighter - City of San OTH Rafael ❑ PTY ❑ SCC Folsom, CA 95630 - Hamilton. Richard IND Firefighter -City of San ❑ DOM —OTH Rafael ❑ PTY Ripo_ nC 9 SGC WIND com Firefighter - City of San Hatfieid, Jason OTH Rafael PTY %] SCC _,Swta_Rkys&_C,k� 9_5-404-___-__ SUBTOTAL$ *Contributor Codes IND — Individual CCM — Recipient Committee (other than PTY or SCC) O T H — Other (e.g_ business entity) PTY — Political Party SCC — Small Contributor Committee Statement covers period from —July 1, 2011 throughSept 24 2011 pagg AMOUNT RECEIVED THIS PERIOD 79.45 79.45 79.45 79.45 79.45 SCHEDULE (CONT) I.D. NUMBER 891308 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31) 217.45 217.45 217.45 217,45 217.45 of / PER ELECTION TO DATE (IF REQUIRED) 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) Statement covers period CALIFOIII RNIA Monetary Contributions Received Amounts may be rounded to whole dollars. July 1, 2011 FORM 460 from— Sept 24 2011 through — Page Of NAME OF FILER I.D. NUMBER San Rafael Firefighters Political Awareness Committee 891308 DATE FULL NAME, STREET AGGRESS 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 0F COWA11TEE. ALSO ENTER LD. NUMBER) RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. I - DEC. 31) (IF REQUIRED) OF BUSINESS) WIND EICOM Firefighter - City of San Flax, Gary 9/1/11 [] OTH Rafael 79.45 217.45 F-1 PTY Novato, CA 94949 [-1 SCC ®IND Firefighter - City of San Hufford, James 9/1/11 F1 com Rafael 79.45 217.45 E] OTH 11 PERM F-1 PTY ❑IF-] SCC - Grass Valley--CA--95-945-,--------------.---- WJIND EICOM Firefighter -City of San Jennin,,s, Eric 9/1/11 1 F1 OTH Rafael 79.45 217.45 ❑ PTY ❑ SCC -- Oakland, CA 94611 Kadzielawa, Steve ®IND Firefighter - City of San 9/1/11 ocom E] OTH Rafael 79A5 217.45 El PTY _S=An5gtm_oCA_94960__ n SCC I IND ICOM El Firefighter - City of San 'Kelleher, Kevin 9/1/11n OTH Rafael 79.45 217.45 rj 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 FPIPC 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. CALIFORNIA from -July 1, 2011 FORM 460 through — Sept 24 2011 Page of 15" NAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR DATE i CONTRIBUTOR RECEIVED IF COMMI-TEE ALSO EN7ER LO. NUVEIER) CODE OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JW 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) Kelly. Conan WIND 9/1/11 F-1com Firefighter - City of San 79.45 217.45 ❑OTH Rafael ❑ PTY -Mill Valley, CA 94941 7SCC Kieffer, Jim WIND Firefighter - City of San 9/1/11 000M 79.45 217.45 ,70TH Rafael F-1 PTY Green.brae, ❑ CA 94904 L]SCc - Kirkpatrick, Ryan WIND Firefighter - City of San 9/1/11 E]COM 79.45 217.45 I �OTH Rafael E]PTY San Francisco, CA 96123 E] SCC LeVeqUe, Paul WIND �]Com Rafael Firefighter - City of San 911111 79.45 217.45 OTH ❑ PTY Santa Rosa, CA 95409 ❑SCC Locatelli, Matthew WIND Firefighter - City of San C 9/1/11 ❑ OM 79.45 217.45 BOTH Rafael ❑ PTY 0SCC `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 $ 2 IS 5- 5-rs 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 period0%0 CALIFRNIA O to whole dollars. 1, 2011 FORM from —July Sept 24 2011 through — Page of NAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 1 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE F -,:)f,A 6i SO ENTER I.C. NUNISER) RECEIVED DE CODE OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME RECEIVED THIS PERIOD CALENDAR YEAR (JAN. I - DEC. 31) TO DATE (IF REQUIRED) Of BUSINESS) WIND E]COM Firefighter - City of San Lovecchio. Darren 9/1/11 E]OTH Rafael 79.45 217.45 F❑I PTY Monterey, CA 93940 [:]SCC WIND Firefighter - City of San MacAusland, Fric 9/1/11 EICOM F�GTH Rafael 79.45 1 217.45 7 PTY Can Ansdrao_f11_2496D__________ ❑SCC Mark, Bradley WIND [:]Com Firefighter -City of San 9 ,7 OTH Rafael 79.45 217.45 El PTY F� SCC -Santa, Rosa. CA-95409. - — — ----- Martin, Kenneth ND COI 0,C�" Firefighter - City of San 9/1/11 OOTH Rafael 79.45 217.45 MR PTY Santa Rosa. CA 95409 ❑SCC WIND Firefighter - City of San — Mathis, Marcus 91/1/11 i BOTH Rafael 79.45 217.45 r-1 PTY Santa Rosa- CA 95405 --_______LSCC SUBTOTAL$ Contributor Codes IND – Individual COM – Recipient Committee i 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) 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. DATE FULL NAVE, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR RECEIVED 1 (1F COMMITTEE, ALSO ENTER I.D. NUMBER) CODE McCarthy, Michael ®IND F-1COM 9/11,11 F-1 OTH F� OTH E] PTY MillVallev. CA 94941 F -jSCC Minard, Evan ®IND 9/1/11 [JCOM [:] OTH M SCC __ F-1 PTY IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Firefighter - City of San Rafael Statement covers part from — July 1, 2011 through Sept 24 201 SCHEDULE A (CONT) 17 Page of I 891308 AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED THIS CALENDAR YEAR TO DATE PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 79.45 1 217.45 Firefighter - City of San Rafael 79.45 217.45 I I '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) EISCC ®IND EICOM Firefighter - City of San Morgenlaender, Mike 9/1/11 F� OTH Rafael 79.45 217.45 [] PTY ------ --.------Petaluma. CA 94954 M SCC __ Mrsnv, Cameron Z IND DCOM Firefighter -City of San 9/1/11 F-1 OTH Rafael 79.45 217.45 F-1 PTY East Palo Alto, CA 94303 F� sCC " ettelman, Rich ;Z IND Firefighter -City of San 9/1/11 'Com ❑ OTH Rafael 79.45 217.45 Now❑PTY El SCC _N.ovafty,.CA 94947: 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) Monetary Contributions Received Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from July 1, 2011 _ SCHEDULE A (CONT.) through Sept 24 2011 Page /49 of / <' NAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 I IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IIF CCMMrTFE ALSO ENTER LD NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED :1 CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAW I - DEC. 31) (IF REQUIRED) OF BUSINESS) Northern, Garrett IND Firefighter -City of San 9/1/11 [:]Com Firefighter OTH Rafael 79.45 217.45 El PTY [:] SCC Olson, Brian ®IND Firefighter - City of San 9/1/11 000M Rafael 79.45 217.45 F -10TH rj PTY nSCC WJIND Phillips., Artie F -ICOM Firefighter - City of San 79.45 217.45 9/1/11 Rafael F-1 PTY F-ISCC -_,_;onon4aXA 95476 Reuter, Kyle VIIND C]COM Firefighter - City of San 9/1/11 DOTH(Rafael 79.45 217.45 PTY Et5Dbxante_C_A_94S03 44$0______ ❑SCC ZD Rogerson, Andrew OCINOM+Firefighter - City of San 9/1i11❑OTH Rafael 79.45 1 217.45 1 FLI PTY C'SCC .Contributor Codes IND — Individual COM — Recipient Committee 'other than PTY or SCC) OTH — Other (e.g., business entity, PTY — Political Party SCC — Small Contributor Committee SUBTOTAL$ j S X 2 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.) unts may be rounded Monetary Contributions Received Amoto Statement covers period CALIFORNIA whole dollars. July 1, 2011 FORM 460 from— Page of Sept 24 2011 through — — NAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 FULL NAME, STREET DATE ADDRESS AND ZIP CODE OF CONTRIBUTOR -ER CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF CnMMITTEE �,LSO FN 10 IJUAIBER� CODE OF SELF-EMPLOYED, ENTER NAME PERIOD (JAN, 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) Schmitt, Jason IND [--jC0M Firefighter - City of San 9/1/11 OOTH Rafael 79.45 217.45 PTY SCC Sedlack, Mark ®IND Firefighter - City of San 9/1/11 FICOM OTH Rafael 7945 217.45 PTY ❑ SCC ShUbin, David VIIND [:]Com Firefighter - City of San 9/1/11 F -10TH Rafael 79.45 217.45 L] PTY 0SCC Napa,-C-A -94559--- Sutherlin, Daniel OIND Firefighter - City of San 9/1/11 1 COM E] CITH Rafael79.45 217.45 PTY ❑ SCC --BIND Vasco, Joe F -]COM Firefighter -City of San 9/1/11 �_] OTH Rafael 79.45 217.45 r �:] PTY F1 SCC _Pt:Wut= CA- 9495,4-- SIUBTOTAL$ `Contributor Codes IND – Individual COM – Recipent Committee i other than PTY or SCC) OTH – Other (e.g., business entity) PTY – Political Party SCC – Small Contributor Ccmrnittee FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from — July 1, 2011 _ through Sept 24 2011 SCHEDULE A (CONT.) Page of San Rafael Firefighter's Political Awareness Committee 891308 IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE ALSO ZIP NUMBER) CODE (IFSELF-EMPLOYED ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) Wasdvke, Bill ®IND Firefighter -City of San 9/1/11 EICOM OTH Rafael 79.45 217.45 E] ❑PTY El Dorado Hills, CA 95762 El SCC Wasdyke, Michael ZIND Firefighter - City of San 9/1/11 ❑Com Rafael 79.45 217.45 Fj OTH FIFTY F-1 SCC Windrern, Matt ®IND Firefighter - City of San 9/1/11 [:]Com Rafael 79.45 217.45 Fj OTH EIPTY F-ISCC CA 45492- Winkelman, Graham ®IND DDcom Rafael Firefighter - City of San 9/1/11 79.45 217.45 1 L�j CITH PTY SCC VINDm Winner, Rob Firefighter - City of San 'E] Co 9/1/11 Rafael 79.45 217.45 []OTH [_1 PTY vali-jo,CA, A44-590, - - SCC SUBTOTAL$ 7d f *Contributor Codes IND — Individual 110M — Recipient Committee other than PTY or SCC) 0TH — Other te.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 D Summary of Expenditures Type or print in ink. Statement covers period . !! Supporting/OpposingOther Amounts may be rounded to whole dollars. July 1, 2011 • . Candidates, Measures and Committees from Sept 24 2011 page �> through of SEE INSTRUCTIONS ON REVERSE _ NAME OF FILER I.D. NUMBER San Rafael Firefighter's Political Awareness Committee 891308 DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR TYPE OF PAYMENT DESCRIPTION AMOUNT THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE MEASURE NUMBER OR LETTER AND JURISDICTION. OR COMMITTEE (IF REQUIRED) PERIOD (JAN. i -DEC. 31) IIF REQUIRED) Damon Connolly for City Council Monetary 9/23/11 Contribution 1000 1500 1500 ❑ Nonmonetary Contribution ❑ Independent ® Support ❑ Oppose Expenditure McCullough for Cit Council g y ® Monetary Contribution 9/19/11 1000 1000 1000 ❑ Nonmonetary Contribution —�_ ❑ Independent ® Support ❑ Oppose Expenditure Gary Phillips for Mayor 2011 ® Monetary I 9/15/11 Contribution 1000 1000 1000 ❑ Nonmonetary Contribution _._—_— ❑ Independent __ ® Support ❑ Oppose Expenditure SUBTOTAL $ 3000 Schedule D Summary 1. Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals. 3000 2. Unitemized contributions and independent expenditures made this period of under $100 ........ ..... ___ ...... ..................... .......... ........... $ 0 3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enter on the Summa Page,) TOTAL $ 3000 P P Pe Summary g t ............ FPPC Form 460 (January/05) FPPC Tall -Free Helpline: 8661ASK-FPPC (8661275-3772) Schedule E Type or print in ink. Amounts may be rounded Payments blade to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER San Rafael Firefighter's Political Awareness Committee Statement covers period from July 1, 2011 through Sept 24 2011 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. Page I _ of 7 I.D. NUMBER 891308 CNP 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 PEr 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 FIND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals ND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candid atelsponsor 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 (IF COMMITTEE, ALSO ENTER I. D. NUMBER) CODE OR DESCRIPTION OF PAYMENT Damon Connolly for City Council San a CTB ae , FPPC#1299779 AMOUNT PAID X10 McCullough for City Council CTB 1000 San Ratael, MIMIC# 1-33y79 Gary Phillips for Mayor 2011 I CTB a ae FPPC#1339680 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.)... ...................... _ ........... ................. .......... 2. Unitemized payments made this period of under $100....................................................................................................................... 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ............................................................ 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ....................... 1000 SUBTOTAL$ $ 3000 $ 0 $ 0 TOTAL $ 3000 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) _qt-harino&= 8 .qcupnnr-/ ,_---'--' Miscellaneous Increases to Cash nt a berounded to whole dollars. SEE INSTRUCTIONS ON REVERSE Statement covers period from July 1, 2011 through — Sept 24 2011 CALIFORNIA FORM 4601 Page of /S '4AME OF FILER San Rafael Firefighter's Political Awareness Committee I.D. NUMBER 891308 DATE RECEIVED FULL NAMEAND ADDRESS OF SOURCE (IF COMMITTEE ALSO ENTER I.D. NUMBER) DESCRIPTION OF RECEIPT AMOUNTOF INCREASE TO CASH 9/16/2011 Bank of America lRaInTafMael, CA 94901 Interest 10.87 Attach additional information or, appropriately labeled continuation sheets. Schedule I Summary 1.Itemized increases to cash this period ....... —..... ... ......... ......... —.......... .................. ................ —' 2.Unhemizedincreases to cash of under $1OUthis period .............. --................. ........ —......... ' 3. Total of all interest received this period on loons made to others. (Schedule H. Column (e),) --- 4. Tbbs| miscellaneous increases hocash this period, (Add Lines 1. 2. and 3. Enter here and on the -------�� -------�� -------.8 TOTAL $ SVBTOTAL$ 10.87 � � FppcForm *un(Jmnuarymo)