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Home My WebLink AboutForm 460 - Paramedic Services PAC (2014-06-30)Recipient Committee Campaign Statement Cover Page Type or print in ink. (Govemment Code Sedions 84200-84216 5) Statemenl7i7 period from I if i see INSTRUCTIONS ON REVERSE through {, at) Ii tl-I , 1. Type of Recipient Committee: All Commltteetl -Complete Parts 1, 2, 3, end 4. o OffICeholder. Candidate Controlled CommiHee o State Candidate Eledion Committee o RecaM (N_ Corr.-.e PM .5) ~ General Purpose Committee ~ Sponsored o Small Contributor Cammill •• o Political PartyICentral Committee 3. Committee Information III Primarily Formed Ballot Measure Committee Ii' ConlrOned o Sponsored IAIJo~pr.1a} o Primarily Fanned Candidatel Offlceho\der ColTUTlittee (AI$OC~P8Ifn I,D. NUMBER Committee for San Rafael Paramedic Services STREET ADDRESS INO P.O. BOX) 3950 Civic Center Drive #310 CITY San Rafael STATE CA ZIP CODe 94903 UAILING ADDRESS (IF DIFFERENn NO. AND STREET OR P.O . BOX CITY OPTIONAL FAX / E·MAIL ADDRESS 4. Verification STATE ZIP CODE Executed on _____ =:::-_____ _ Execuled on _____ "'_=------ Exe<ulad on ____ -,"""= _____ _ AREA CODE/PHONE AREA CODE/PHONE Dale of election if applicable : (Month . Day. Year) OCT - 2 2014 lime: City Clerk's 2. Type of Statement: o Preelection Statement ~Semt.aMuatStatement III Termination statement (Also file a Form 410 Termination) o Amendment (Explain below) Treasurer(s) N.-ME OF TREASURER Greg Knell MAILING ACDRESS Same as committee CITY NAME OF ASSISTANT TREASURER, IF ANY MAILING ADORESS CITY OPTIONAL. FAX I E·MAIL ADDRESS STATE STATE o Quarterly Statement o Special Odd-Year Report o Supplemental Preeledion Statement· AIIach Form 495 ZIP coce AREA CODE/PHONE ZIP CODE AREA CODE/PHONE herein and in the attached schedules is true and complete. I certify ) FPPC Form 480 (January/OS) FPPC TolI·Free Helpline: 8661ASK-FPPC (1661275.3n2) Slate of California Type or print In Ink. Campaign Disclosure Statement Summary Page Amounts may be rounded to whole dollars . SEE INSTRUCTIONS ON REVERSE Contributions Received 1. Monetary Contributions .................... _,' ,_, ..... ,_ ...... ' Schcdu/f) A. Unit 3 S 2. Loans Received .................................................. _'" ScheOO~ B. Line 3 ColumnA TOTAL nflSPEflIOO l"AOUAnACHEDSCHEIlULES) 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines " 2 S --fI,l,-.L..J"'-~ 4 . Nonmonetary Contributions •......... _ ....•.•.............. _.. Schedule C. Lin e 1 5 . TOTAL CONTRIBUTIONS RECEIVED ......•................... Add Lines 3.. $ -4'<~=0-~ Expenditures Made 6. Paymenls Made ...................... ................................ Schedule E. Lin. • S 7. loans Made ................................................. _, ......... _ Schedule H, Line 3 8 . SUBTOTAL CASH PAYMENTS ................................... AddLines6.7 S 9. Accrued Expenses (Unpaid Bills) ............................. ScheduleF. Lin. 3 10. Nonmoneta ry Adjustment .......................................... ScheduieC. Line 3 11 . TOTAL EXPENDITURES MADE .............................. Add Lin es 8 + •• 10 $ Current Cash Statement 12. Begi nning Cash Balance ................. _ ... , PleviousSummstyP8Qe,Une16 $ 13. Cash Receipts ........... ,' ...... ....................... .... Column A, Line 3 above 14, Miscellaneous Increases to C ash ...... _ ...... _ .. , .. ... Schedule I. Line'- 15. Cash Payments _._ ............. ., ,_. _ ... " ..•....•.. , •... , ..... Column A. Line B above 16 . ENDING CASH BALANCE .......... Add Llne5 12 .. 13" 14. then subtract tine '5 S If Ihis ;s a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ........................... Schedule B. Pan 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See inSfruction$ on revet'Se S 19. Outstanding Oebts ................... ".... Add Line 2 .. Une9in ColumnS above $ o 6'V.(}O 0 o o ,g}.()o a S']yS/oy (;;, ; fc, () o o o SUMMARY PAGE Statement covers period from I /I/;t.f CALIFORNIA 460 FORM through ColumnS CALENDAR YEAR TOTM..TO~ -b. 3b 0 a p.3b 0 0 b.. 7b 0 $ _..:::Sl~lJ.:..:.' -=::O~('J_ S g).o1J To calculate Column 8, add amounts WI Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figu~ thatshou~ be subtracted from previous period amounts . If this is the first report be ing filed for this calendar year. only carry over the amounts hom Lines 2, 7 . and 9 f' any). (:j'JtJ/;Lj , Page 2--of 1.0 NUMBER t)E; /'1-1 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6130 7/1 Ie Dale 20. Contributions 0 Received $ $ 21 . Expenditures 0 Made $ S Expenditure Limit Summary for State Candidates 22 . Cumulative expenditures Made* lit' Subject lit Voluntary EJlpendltu •• Umltl Oate of Election (mmlddlyy) Total '0 Dale 0 0 $----- ----1----1__ $ ____ _ -Amounts in this sedion may be different from amounts reported ",Column 8 . FPPC Form 460 (Janual}'/05) FPPC TOIl-Fre. Holpllne: 866/ASK.FPPC (866/275-3772) Schedule A Monetary Contributions Received Type or print In Ink. Amount. me)' b. rOllndld 10 whol. doll.,., SCHEDULE A ftorn --J'-I-'-':'~L;i'-- CALIFORNIA 460 FORM SEE INSTRUCTIONS Ofi FlE\lERSE DATE RECEIVED FULL NMlE, STREET ADORf55 AND ZIP CODE OF COHfRIBurOR CONTRIBUTOR C.COIoNTTII! . ..uolHTERIO NUt.IBDII coDE. Schedule A Summary 1. Amount received th is period -contributions ofS100 or more. 0"'0 DeOM DOnt DPTY osee OIND oeOM D°nt DPTY osee OIND DeoM DOnt DPTY osee DINO DCOM DOnt DPTY osee DINO DeOM Dont DPTY osee IF AN INDIVIDUAl., ENTER OCCUPATION AND !MPlOYER (I' 5I:11'.( ...... 01"lO. (HI'(ANAM! " ....... , SUBTOTALS through "'00"' RECEIVED THIS PERIOD (Include aN Schedule A subtotal •. ) ........................................................................................................ $ _~_~~_ 2. Amount received thlsperiod-unitemlzed oontribuUonsollesslhan Sloo ............................................. $ &z. :Jb 3. Total monetary contributions received this period. JC, :1/- (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Llnel .) ....................... TOTAL $ _-,fP"-!,--,,,,,,,(£7:::..._ CUMULATlVETODATE CALfNOAR YEAR (JAN. 1 • DEC. 31) PER ELECTION TODATE (If REQUIRED) ·Contributor Code, INO -Individual COM ~ Rodpienl CommIttee (other than pry 01' SCC) OTH-Olher PTY -Political Par1y sec -Small Contributor CommittH FPPC Fonn 460 (JunelO1) FPPC Toll.ffH Helpline: IISSIASK-FPPC ScheduleE Payments Made ~ptI or pt'lnt in Ink. AmlMlnta may ba roundad to who" dolla,... rrom --I.'f-~L!-;-- through CODES: II one of the following codes accurately describes the payment. you may enter the code. Otherwise. desc.ribe the payment. CM' ~ paraphemalaInQc MBR membet c:ommunlCllUaNI RAD ,,010 a/ttime and procIuttIon COIls CNS ~ COMUlants MfG meeUngt and .ppe .... ncet RFD ,eturned conlrlbuUon. CTB conttibuIIon (a.paln nOhlloIlMII,,)· OFC offlea aspan,as SAL elmpalgn WOttIe,.· MIaMS eve cMc donations FEr petition drcuIating m I.V. Of cable airtime and production costs FL candidate fllrnglballol faas PH:) phona banks 1RC ce ndldata travel, lodging , and me.'s FNJ fundralslng avents PO.. polling and survey resa.n:h TRS ,tatuspotJse travel. lodging, and meels N) Independent 8spendllure supporting/opposing others (e .. plaln)· FOS postage, delivery and mOIl.nger urvlces TSF transfer between committees or tot same candidate/sponsor lEG 'egal defense FIRO professional serv~s (leg.l, accounUng) VOT voter reglstraUon LIT campalgn literature and mailings PRJ' print ads 'he Information technology costs (Intemal. .mall) NAME AND ADDRESS OF PAYEE fll'aIINTTlI.loI.SOlHTEJItto.~1I.1 COOE OIl DESCRIPTION OF PAYMENT AMOUHTPAID • Plyman\a that .... contrlbullona or Independenl expenditure. mu.t alao btl summarlz:ad on Schedule D. SUBTOTALS Schedule E Summary 1. Payments made this period of $100 or more. (Include all Schedule E subtotals.) .................................................................................................. S ___ =-__ 2. Unltemlzed payments made this period 0lunderS100 ............................................................................................. M ...... H ................................... $ :;-C. C C; 3. Totallnterest paid this period on loans. (Enter amount from Schedule B. Part 1. Colomn (8).) ............................................................................... $ ___ --::-_-", 4. Total paymenls madelhls period . (Add Uoe,1. 2. end 3. Enter here and on the Summary Page. Column A. Una 6 .) .......................... _. TOTAL S £&'7 . e:?Z> FPPC Form 4'0 (JuneJ01) FPPC TolI.f'ree Helplln.: UISIASK·FPPC