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Home My WebLink AboutForm 460- Rachel Kertz for City Council 2020 (2023-06-30); terminationRecipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) Statement covers period from � 1 4_g�s SEE INSTRUCTIONS ON REVERSE ( through 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. 0 Officeholder, Candidate Controlled Committee 0 State Candidate Election Committee Q Recall (Also Complete Part 5) ❑ General Purpose Committee Q Sponsored Q Small Contributor Committee Q Political Party/Central Committee 3. Committee Information ❑ Primarily Formed Ballot Measure Committee Q Controlled Q Sponsored (Also Complete Part 6) ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) I.D. NUMBER 1427074 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Rachel Kertz for City Council 2020 STREET ADDRESS (NO P.O. BOX) CITY Antelope STATE ZIP CODE AREA CODE/PHONE CA 95843 ( MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX COVER PAGE ■ Date of election if app (Month, Day, Year i [�)jage 1 Ci of For Official Use Only 11/03/2020 5 OFFICE 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement [ Semi-annual Statement ❑ Special Odd -Year Report D;P Termination Statement ❑ Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Chelsea Johnson MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE Antelope CA 95843 ( NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE C STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS 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 Measure Proponent or Responsible Officer of Sponsor Executed on Date Executed on Date By Signature of Controlling Officeholder, Candidate, State Measure Proponent By Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page — Part 2 COVER PAGE - PART 2 CALIFORNIA FORM -r60 [Page 2 of 9 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE Rachel Kertz OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT City Council Member City of San Rafael District 4 ❑ OPPOSE RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP Identify the controlling officeholder, candidate, or state measure proponent, if any. San Rafael CA 94903 NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT 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 OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER 7. Primarily Formed Candidate/Officeholder Committee List names of NAME OF TREASURER CONTROLLED COMMITTEE? officeholder(s) or candidate(s) for which this committee is primarily formed. ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) 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 CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary www.netfile.com FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppe.ca.gov Campaign Disclosure Statement SUMMARYPAGE Amounts may be rounded Statement covers period • - Summary Page to Whole dollars. NIA ' from 01/01/2023 •_ through 06/30/2023 Page 3 of 9 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Rachel Kertz for City Council 2020 1427074 AoD Column B Calendar Year Summary for Candidates Contributions Received ToColumn Running in Both the State Prima and (FROM ATTACHED SCHEDULES) TOTALTO DATE General Elections 1. Monetary Contributions Schedule A, Line $ 16,000.00 $ 16,000.00 1/1 through 6/30 7/1 to Date 2. Loans Received...................................................... Schedule B, Line 3 -16,000.00 0.00 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 +2 $ 0.00 $ 16, 000.00 20. Contributions Received $ $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 186.75 186.75 21 Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3+4 $ 186.75 $ 16,186.75 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. 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ 521.83 $ 0.00 521.83 $ -221.75 186.75 486.83 $ 521.83 0.00 521.83 0.00 186.75 708.58 521.83 To calculate Column B, add amounts in Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts 0.00 0.00 521.83 0.00 0.001 Equivalents and Outstanding Debts from Lines 2, 7, and 9 (if Cash E �i 9 any). 18. Cash Equivalents ........................................ See instructions on reverse $ 0.00 19. Outstanding Debts ......................... Add Line 2 +Line 9 in Column B above $ 0.00 www.netfile.com :xpenditure Limit Summary for State 'andidates 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) f Amounts in this section may be different from amounts eported in Column B. FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Cr-horli do A SCHEDULE A — - - - Amounts may be rounded Monetary Contributions Received to whole dollars. Statement covers period CALIFORNIA ' from 01/01/2023 FORM through 06/30/2023 Page 4 of 9 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Rachel Kertz for City Council 2020 1427074 DATE DE O FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR ZIP E(IF CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVETO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED COADDRE,ALSAND I.D.N CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OFBUSINESS) 06/30/2023 Rachel Kertz ®IND Candidate 6,000.00 16,000.00 ❑ COM Candidate San Rafael, CA 94903 ❑ OTH Loan Forgiven ❑ PTY ❑ SCC 06/30/2023 Rachel Kertz ®IND Candidate 10,000.00 16,000.00 ❑ COM Candidate San Rafael, CA 94903 ❑ OTH Loan Forgiven ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL$ 16, 000.00 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 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ....................... TOTAL $ 16,000.00 0.00 16,000.00 "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 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) www.fppc.ca.gov www.netfile.com Schedule B — Part 1 Amounts may be rounded Statement covers period 0. , • ' Loans Received to whole dollars. 01/01/2023 • . from SEE INSTRUCTIONS ON REVERSE through 06/30/2023 Page 5 of 9 NAME OF FILER I.D. NUMBER Rachel Kertz for City Council 2020 1427074 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUALENTER , a OUTSTANDING (b) AMOUNT (c) AMOUNT PAID (d) OUTSTANDING (e) INTEREST M ORIGINAL W CUMULATIVE OF LENDER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER BALANCE BEGINNING THIS RECEIVED THIS OR FORGIVEN BALANCEAT CLOSE OF THIS PAID THIS AMOUNT OF CONTRIBUTIONS (IF COMMITTEE, ALSO ENTERI.D.NUMBER) NAME OF BUSINESS) PERIOD PERIOD THIS PERIOD* PERIOD PERIOD LOAN TO DATE Rachel Kertz Candidate ❑ PAID CALENDARYEAR 11 San Rafael, CA 94903 $ n no $ n on n nn/ $ e.000.00 $ 16.000.00 [Z FORGIVEN PERELECTION- RATE $ 6, 000.00 $ 0.00 $ r 000.00 06/18/2021 $ n nn 12/18/2020 $ DATE DUE DATE INCURRED tZ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC Rachel Kertz Candidate ❑ PAID CALENDAR YEAR 11 San Rafael, CA 94903 $ n- nn $ n nn n_nn/ $ 10,000.00 $ 16.000_nn FORGIVEN PER ELECTION** RATE $ 10,000.00 $ 0.00 $ in, 00o no 07/22/2021 $ n nn 01/22/2021 $ DATE DUE DATE INCURRED tFC1 IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ PAID CALENDARYEAR ❑ FORGIVEN PERELECTION— RATE DATE DUE DATE INCURRED t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTALS $ 0.00$ 16,000.00$ 0.00$ 0.00 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 Line 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. iM L ' R M 1L 0.00 16,000.00 NET $ -16, 000.00 (May be a negative number) (Enter (e) on Schedule E, Line 3) tContributor 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 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Sr_har•li lip C WT110.1057111110701 Amounts may oe rounaea Nonmonetary Contributions Received to whole dollars. Statement covers period • ' ' , from 01/01/2023 • - through 06/30/2023 Page 6 of 9 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Rachel Kertz for City Council 2020 1427074 FULL NAME, STREET ADDRESS AND CONTRIBUTOR IF AN INDIVIDUAL, ENTER DESCRIPTION OF AMOUNT/ CUMULATIVE TO DATE PER ELECTION DATE RECEIVED ZIP CODE OF CONTRIBUTOR CODE r OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER GOODS OR SERVICES FAIR MARKET VALUE CALENDAR YEAR TO DATE IF REQUIRED ( ) (IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAME OF BUSINESS) (JAN 1 - DEC 31) 6/30/2023 Loren Kertz ]IND Bill Forgiven 43.00 186.75 ❑COM San Rafael, CA 94903 ❑ OTH ❑ PTY ❑SCC 6/30/2023 Loren Kertz ]IND Bill Forgiven 143.75 186.75 ❑COM San Rafael, CA 94903 ❑ OTH ❑ PTY ❑ SCC RIND ❑COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑COM ❑ OTH ❑ PTY ❑ SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 186.75 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.) $ 186.75 ....... $ ..... TOTAL $ 0.00 186.75 `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 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov www.netfile.com 6Yi7:1��1�1!� Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Rachel Kertz for City Council 2020 Amounts may be rounded to whole dollars. Statement covers period from 01/01/2023 through 06/30/2023 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. Page 7 of 9 I.D. NUMBER 1427074 CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)' OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FIND fundraising events POL polling and survey research TRS 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 (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID CJ & Associates, Inc. PRO 35.00 Antelope, CA 95843 CJ & Associates, Inc. PRO 142.71 Antelope, CA 95843 CJ & Associates, Inc. I PRO I 1 105.18 Antelope, CA 95843 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 282.89 Schedule E Summary 1. Itemized payments made this period. Include all Schedule E subtotals. 471.83 2. Unitemized payments made this period of under $100.......................................................................................................................................... $ 50.00 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).)............................................................................... $ 0.00 4. Total payments made this period. Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6. TOTAL $ 521.83 www.netfile.com FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov Schedule E SCHEDULE E (CONT.) (Continuation Sheet) Amounts may be rounded Statement covers period • _ , to whole dollars. • ' Payments Made from 01/01/2023 SEE INSTRUCTIONS ON REVERSE through 06/30/2023 page 8 of 9 NAME OF FILER I.D. NUMBER Rachel Kertz for City Council 2020 1427074 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 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 TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS 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 (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID CJ & Associates, Inc. Antelope, CA 95843 PRO 188.94 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 188. 94 www.netfile.com FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) www.fppe.ca.gov SCHEDULEF Schedule F Statement covers period • - Amounts may be rounded / � ' Accrued Expenses (Unpaid Bills) to whole dollars. from 01/01/2023 • through 06/30/2023 Page 9 of 9 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Rachel Kertz for City Council 2020 1427074 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 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 TRC candidate travel, lodging, and meals FIND fundraising events POL polling and survey research TRS 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) (a) ( (c) ( NAME AND ADDRESS OF CREDITOR CODE OR OUTSTANDING AMOUNTIN INCURRED AMOUNT PAID OUTSTANDING (IF COMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD CJ & Associates, Inc. PRO 35.00 0.00 35.00 0.00 Antelope, CA 95843 Loren Kertz OFC 43.00 -43.00 0.00 0.00 San Rafael, CA 94903 Loren Kertz WEB 143.75 -143.75 0.00 0.00 San Rafael, CA 94903 * Payments that are contributions or independent expenditures must also be SUBTOTALS $ 221.75$-186.75$ 35. 00$ 0.00 summarized on Schedule D. Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under$100.)....................................... 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) ................. 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.)................................................................................................................ INCURRED TOTALS $ PAID TOTALS $ -186.75 35.00 ..................... NET $ -221.75 May be a negative number FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.netfile.com www.fppc.ca.gov