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Home My WebLink AboutForm 460 - Greg Brockbank for Mayor 2011 (2011-09-24) AmendmentRecipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period from through _ 1, Type of Recipient Committee: All Committees – Complete Parts 1, 2, 3, and 4. Measure Officeholder, Candidate Controlled Committee Formed Ballot ❑Primaricommittee 0 State Candidate Election Committee 0 Controlled 0 Recall 0 Sponsored (Also complete Part 5) (Also complete Part e) ❑ General Purpose Committee ❑ Primarily Formed Candidate! 0 Sponsored Officeholder Committee 0 Small Contributor Committee (Also Complete Part 7) 0 political party/Central Committee I.D. � B 3, Committee Information (OR CANDIDgATEg'S NAME IF NO COMMITTEE} COMMITTEE ggNAMgqE M�.F3' �'. STREET ADDRESS (NO P.O. BOX) STATE zipCODE (( AREA CODE/PHONE CITY r • ill `t ��ca (,4 ii) e2I"- STATE ZIP CODE AREA CODE/PHONE CITY Date Stamp Date of election if applicable: (Month, Day, Year) COVER PAGE i Page _ 1_ — of For Official Use Only 2. Type of Statement: ❑ Preelection Statement c arterly Statement ❑ Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement ❑ Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 Amendment (Explain below) p !! p tPW g Ls cam"' ) QA *3 F1€, �-Tf" F ` tgCrit Treasurer(S) NAME OF TREASUREttR�� pp ZIP CODE . MAILING G ADDRESS STATE ZIP CODE AREA CODEIPHONE CITY ' fy 4, Verification I have used all reasonable diligence in preparing and reviewing this stat foregoing n d sto the true andtcofrm ctnowledge the information contained herein and in the attached schedules is true and complete. 1 cerci under penalty of perjury under the laws of the State of California that the g 9 ori i � BY Signature of Traasurx or Assist t Treasoror Executed on !!! oats (. c €11, (1 BY Signalise of Contro0ng Oficelmkbr, Candidate, State Measure Proponent or Responsible Olfs:er ot5ponwr Executed on t� By Signature of Controlling Otliceholc�r, Cand date, State Measure Proponent Executed on Date By ggnaturcofControNmg0(A�I laal,Candidate'StateMeaZi 'Proponent FPPC Form 460 (January/061 Executed on Daffi FPPC Toll -Free Helpline: 8661ASK-FPPC (8661276-3772) State of Callfomia 3 Type or print In Ink. Campaign Disclosure Statement Amounts may be rounded Summary Page to whole dollars. - MHTlnk]Q r)M Pr-VFR.RP NAME of FILER f _0 Statement covers period from through 4/it Expenditures Made 6. payments Made ....................................................... Column A Column B Contributions Received 8. SUBTOTAL CASH PAYMENTS .................................... TOTALTHISPERIOD (FROM ATTACHED SCHEDULES) CALENDARYEAR TOTALTO DATE Schedule F Line 3 10. Nonmonetary Adjustment ...... _._ ... ..... ................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ...... .... _ ....... .......... Add Lines 8 + 9 + 10 1. Monetary Contributions ........................................... Schedule A, Line 3 $ It COO 0(i 2. Loans Received ...................................................... Schedule 8, Line 3 62*So 3 3. sUBTOTALCASH CONTRIBUTIONS ......................... Add Lines 1 +2 $ qC10.00 $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Line, 3 + 4 $ $ 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. $ ffsf $ $ 0 $ 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 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 from Lines 2, 7, and 9 (if any). Page �t' of t V.) I.D. NUMBER ( 1, 3 Cl a -3, Calendar Year Summary for Candidates Running in Both the State Primary and General Elections ill through 6130 711 to Date 20. Contributions Received $ $ 21, Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* IN Subject to Voluntary Expenditure Umtt) Date of Election Total to Date (mm/dd/yy) $ I*Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/276-3772) A YC Pe FryContributions Received SEE INSTRUCTIONS ON REVERSE Type or print in Ink. Amounts may be rounded to whole dollars. DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR RECEIVED (W COMMnTEE, ALSO ENTER I.D. W*AwM CONTRIBUTOR I I CODE* IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OF SELF-EMPLOYED, ENTER M&AW OF Susimss) Statement covers periodSCHEDULE 17 A 0 nIND [ACOM 460i FORM nOTH I . I through P a g U3 -•11 0 PTY of I.D. NUMBER EISCC 1-33 Clio 065-N- ..,j, IND EICOM PERIOD (JAN. 1 - DEC, 31) (IF cfic{Cic EIOT fir+ Qos c } El PTY El SCC KIND EICOM MR E30TH El PT -Y EISCC: ®IND EICOM EIOTHIND TM 00 H E❑PTY l ISCC E❑SCC $7 IND HCOM EIOTH 0 P PT TY SCCC EIE]SC IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OF SELF-EMPLOYED, ENTER M&AW OF Susimss) Statement covers periodSCHEDULE 17 A 0 i CALIFORNIA from V A I 460i FORM I . I through P a g U3 -•11 _0 of I.D. NUMBER 1-33 2 AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED THIS CALENDAR YEAR PERIOD (JAN. 1 - DEC, 31) (IF TO DATE REQUIRED) seg, W.Ses_e" I N' EM Schedule A Summary 1 Amount received this period — itemized monetary contributions. A (include all Schedule A subtotals.) .............................................. ............... . ........ ... ...... $ 2. Amount received this period — uniternized monetary contributions of less than $1 $ 3. Total monetary contributions received this period (Add Lines I and 2.. Enter here and on the Summary Page, Column A, Line 1.) ' TOTAL $ It 5�y��j ?— `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) 4— 0 FPPC Toll -Free Helpline: 866/ASK-FPPC (86612754772) -.tedule A (Continuation Sheet) Type or print In Ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement coven; period I CALIFORNIA to whole dollars. 460C, from FORM through Page - of NAME OF FILER I.D. NUMBER q23c DATE ZIP CODE OF CONTRIBUTOR FULL NAME, STREET ADDRESS AENTM I.D. �KMWM OF COMMMEE ALSO CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED CODE* (IF SMF -EMPLOYED. ENTM NWE OF NAWSM PERIOD (JAN. I - DEC. 31) (IF REQUIRED) [glND EICOM Ck r -10TH 1165 r-1 PTY r-1SCC "90o r%2IND i5com EJOTH 0 [3 PTY EISCC ff]IND EICOM E]OTH'A [:]PTY EISCC ('Qvay EIIND FICOM wtql'or OW F-JOTH El PTY lg�-1 Ahv 5 FIIND C]COM Ww4t4l�r- oc� �,k C]OTH PW EISCC SUBTOTALS 5 *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/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661276-3772) chedule 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. from Vv 11 1 FORM 460, through V2-4 A 1 -1- 4 Page NAME OF FILER wo� I.D. NUMBER 133 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR W COMM[rrrEE. ALSO ENTER I.D. NUMBER) CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED CODE (W SELF-EMPLOYED. ENTER NAME OFOLONESS) PERIOD (JAN. I - DEC. 31) (IF REQUIRED) [3,11ND MCOM []OTH --5o00 F-1 PTY , EISCC ZIND nCOM MOD FJOTH C] PTY SCC F]IND E]COM [:]OTH <"' M"to' r A— EIPTY E]SCC EIIND (I ®COM nOTH '5r, EIPTY EISCC ,t4 X55 M ND om�7 41 12-k� []OTH T;!� `7v EIPTY V 0 []SCC SURTO XL$,3 f *Contributor Codes I 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/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (86612754772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER Type or print In Ink. Amounta may be rounded DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) i r�vza' CONTRIBUTOR CODE WIND E]COM [] OTH 77 77�' 7� El PTY ri SCC IND EICOM E] OTH F1 PTY EISCC nIND E]COM C. ot r" []OTH El PTY EISCC [-] IND EICOM []OTH El PTY ❑ SCC E]IND EICOM FJOTH El PTY E]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 IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) SCHEDULE A Statement covers period CALIFORNIA from FORM 4011 through Page of to I.D. NUMBER AMOUNTCUMULATIVE TO DATE PER ELECTION RECEIVED THIS CALENDAR YEAR TO DATE PERIOD (JAN. I - DEC. 31) (IF REQUIRED) $1 / ot? . �!_ E", �f � 5-0, �V SUBTOTAL$ �5_0, '�' FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) SCHEDULEB-PART1 Jule B —Part 1 'unt yPW "' may b " e Amounts may be rounded Statement covers period CALIFORNIA 460 Loans Received to whole dollars. from f i� 11FORM through � f 1 Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER FULL NAME, STREET ADDRESS AND ZIP CODE OF LENDER IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER a OUTSTANDING BALANCE Ib) AMOUNT RECEIVED THIS W AMOUNT PAID OR FORGIVEN Id1 OUTSTAND BALA AT N INTEREST PAID THIS ORIGINAL AMOUNT OF 4 CUMULATIVE CONTRIBUTIONS I� COMMITTEE,ALso ENTER I.D. NUMaEa) (F SELF-EMPLDYED. ENTER NAME OFKAINES l BEGINNING THI5 PERIOD • THIS PERIOD PERIOD LOAN TO DATE j 1 rt ❑ PAID qq I I gg � } CALENDAR YEAR i Laf.��wp•— RATE % $ f J.jf.J � z ,p (/�A�, E] FORGIVEN PER EtFCT10N•` t[A IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR s s x s s ❑ FORGIVEN PER ELECTION'* _ RATE t❑ IND ❑ COM ❑ OTH [I PTY ❑ SCC s s $ $ $ DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR ❑ FORGIVEN PERELECTION" RATE t❑ IND E]COM ElOTH ElPTY ❑ SCC S DATE DUE I DATE INCURRED SUBTOTALS S�?J4ti.dsJ 3 S S "� Schedule B Summary 1. Loans received this period............................................................ ......................... $ �r 000, Oct (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. NET $ 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. «„—,a,— SdvdLe Ic L W 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 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (866/275-3772) Pch eWdule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF Type or print in ink. Amounts may be rounded to whole dollars. ;V Statement covers period from ?I(k/( CA i r+. through tf Page 3r— of I.D. NUMBER CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP campaign paraphemalialmisc. 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 TEL campaign workers' salaries Im. or cable airtime and production costs CVC Fid civic donations candidate fifinglbadot fees PET PHO petition circulating phone banks TRC candidate travel, lodging, and meals FND Iltindralsing events POL polling and survey research TRS 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 WM voter registration information technology costs (internet, e -mad) LIT campaign literature and mailings PRT print ads NAME AND ADDRESS OF PAYEECODE OF cOMMn�. ALSO ENTER I.D. MANNER) OR DESCRIPTION OF PAYMENT AMOUNT PAID T -- 1J< I erre) �-"- INV ck 1-hf1td nct 4 l 0q, LOC t v*(° C i F7 r " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ ( 1 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.).............................................................................................................. $ f t 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.) ............................. TOTAL $ FPPC Forth 460 (January/06) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) tile E ontinuation Sheet) Payments Made Type or print in ink. Amounts may be rounded to whole dollars. CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. Clue campaign paraphernaltalmisc. NW 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 FL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FAD fundraising events POL polling and survey research TRS staf /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, a -mail) NAME AND ADDRESS OF PAYEE IF COMM MME. ALSO ENTER I.D. NIAWR) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID �} �„ �,, C t <q�nr f s`�• h,�, `SES �.�rc��`�3"' 1 i.� , �- ih� t 1A'�.i`��.a.i�,�, i� � lj, Ase„r,'�ti� r� �dJ`.t i.}��.. f t � , �.'�'✓ s�y 1 F1 L- 4 j " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ C If FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule GSCHEDULE G Type or print in ink. Payments Made by an Agent or Independent Amounts may be rounded Statement covers period CALIFORNIA Contractor (on Behalf of This Committee) to whole dollars. from �,/►) 1 through Ll Page (0 of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER r�a� ftcc# tt� t,33x236 NAME OF AGENT OR INDEPENDENT CONTRACTOR DW t,�(AUl _t� C4tg4_Cf- P0LLi 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 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 VVEB information technology costs (intemet, 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 IA. NUMBER) CODE OR DESCRIPTION OF PAYMENT - AMOUNT PAID �° @@ ( SOA Vk1-0- F 41 l °cl x r 1+ ,Q emp ' x i Attach additional information on appropriately labeled continuation sheets. TOTAL* $ I * 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 66/275 3772) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)