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Home My WebLink AboutForm 460 - Gary Phillips for Mayor 2011 (2011-10-22) AmendmentRecipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE fro Type or print in ink. Statement covers period 9-25-11 m through 10-22-11 1. Type of Recipient Committee: All Committees —Complete Parts 1, 2, 3, and 4. ® Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure O State Candidate Election Committee Committee O Recall O Controlled (Also Complete Part 5) 0 Sponsored (Also Complete Part 6) ❑ General Purpose Committee a Sponsored ❑ Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1339680 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Gary Phillips for Mayor 2011 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 CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS COVERPAGE Date Stamp _ Date of election if applicable: Page 1 of 5 (Month, Day, Year) For Official Use Only 11-8-11 2, Type of Statement: ❑ Preelection Statement ❑ Quarterly 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) Form 460 filed Oct. 27, 2011, Sched A omitted 1 check and Sched C omitted an in-kind donation reported to us on Oct. 27 Treasurer(s) NAME OF TREASURER Richard Kalish MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the,"f my knowledge the info rmatio ontained 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 e an ouec� Executed an October 28, 2011 Date Signa ®ofTreasureror Assstant Treasurer October 28, 2011 r - Executed on By Date ,,j,iaturecfControilinjfCfferrCandidate, State MeasurePrcponertorRespor,,sible'•-Mrerc€Sponsor f Executed on By Gate Signature of Contrcking 0ffi:,ehelder, Wand€gate, State Measure Proponent Executed on By Date Sgriatu=e cfControPng Otpceho€der, Candidate. State Measure Proponent FPPC Farm 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) State of California Recipient Committee Type or print in ink. COVERPAGE-PART2 Campaign Statement CALIFORNIA FORM � • i Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Gary Phillips OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Mayor, City of San Rafael RESI DENTIALIBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP San Rafael, CA 94903 Related Committees Not Included in this Statement: Listany committees not included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEENAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ 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 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Page 2 of 5 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION [:]SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee is primarily formed. 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 Attach continuation sheets if necessary FPPC Form 450 (January105j FPPC Toll -Free Helpline: 8551ASK-FPPC (8857275-3772) State of California Campaign Disclosure Statement Summary Page Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 9-25-11 SUMMARY PAGE through 10-22-11 Page 3 of 5 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Gary Phillips for Mayor 2011 1339680 Contributions Received ColumnA Column B Calendar Year Summary for Candidates TOTALTHIS PERIOD (FROMATTACHED SCHEDULES) CALENDAR YEAR TOTALTODATE Running in Both the State Primary and General Elections 1. Monetary Contributions ................. .......... ., Schedule A, Line 3 $ 16336 $ 50555 0 15000 1/1 through 6/30 7/1 to Date 2. Loans Received ...................................................... Schedule B, Line 3 1 SUBTOTAL CASH CONTRIBUTIONS ................. Add Lines 1 +2 $ 16336 $ 65555 20. Contributions Received $ $ 4, Nonmonetary Contributions .................................... Schedule C, Line 3 6495 9147 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED . ............ Add Lines 3 + 4 $ 22831 $ 74702 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made.. ...................................... .............. Schedule E, Line 4 $ 15945 $ 49216 Candidates 7. Loans Made ............ ............. .......... ...... ............. ... Schedule H, Line 3 0 0 & SUBTOTALCASH PAYMENTS .................................... Add Lines 6 + 7 $ 15945 $ 49216 22. Cumulative Expenditures Made* (it Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3 0 0 Date of Election Total to Date 10. Nonmonetary Adjustment .......................................... Schedule C, Linea 6495 9147 (mm/ddlyy) 11. TOTAL EXPENDITURES MADE... ............................. Add Lines 8 + 9 + 10 $ 22440 $ 58363 $ $ Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 15948 To calculate Column B, add 13. Cash Receipts..... ...... .............................. Column A, Line 3 above 16336 amounts in Column A to the 14. Miscellaneous Increases to Cash... .... ...... Schedule 1, Line 4 0 corresponding amounts from Column B of your last *Amounts in this section may be different from amounts reported in Column B. 15. Cash Payments .............. ............ ....... Column A, Line 8 above 15945 report. Some amounts in Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 16336 figures that should be subtracted from previous if this is a termination statement, Line 16 must be zero. period amounts. If this is the first report being filed — 17. LOAN GUARANTEES RECEIVED... .... Schedule B. Part 2 $ 0 for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if Cash Equivalents and Outstanding Debts any). 18. Cash Equivalents _ ..... ........ See instructions on reverse $ 0 19. Outstanding Debts......... ................ Add Line 2 + Line 9 in Column B above $ 15000 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A Type or print in ink. SCHEDULE A Monetary Contributions Received Amounts may oe rounaea Statement covers period CALIFORNIA460 to whole dollars. from 9-25-11 . 10-22-11 4 5 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER Gary Phillips for Mayor 2011 1339680 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 (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) TTandy®IND Tracy y.� ❑COM Writer, self-employed 100 100 DOTH San Rafael CA 94901 ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND [:]COM ❑ OTH ❑ PTY D SGC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCG ❑ IND ❑ COM DOTH ❑ PTY ❑SCC SUBTOTAL$ 100 I 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. Taal monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line I)_ ............ ..... $ 0 TOTAL $ 14799 1537 16336 *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 (8661275-3772) �t I1P_fiIIIP_ C Type or print in ink. ftCHFnHI_F C Amounts may oe rounaea Nonmonetary Contributions Received to whole dollars. period Statement covers p CALIFORNIA ' 9-25-11 • - • from 5 5 10-22-11 through Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Gary Phillips for Mayor 2011 1339680 FULL NAME, STREET ADDRESS AND CONTRIBUTOR IF AN INDIVIDUAL, ENTER DESCRIPTION OF AM CUMULATIVE TO DATE PER ELECTION DATE RECEIVED ZIP CODE OF CONTRIBUTOR CODE * OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED. ENTER GOODS OR SERVICES FAIR MARKET MARK VALUE CALENDAR YEAR I TO DATE (IF REQUIRED) (IF COMMITTEE, ALSO ENTER I.D. NUMBER) NAME OF BUSINESS) (JAN 1 - DEC 31) ❑IND San Rafael Firefighters P.A.C. oCOM Mailer 10-22-11 FPPC No. 891308 E10TH 2246 3246 P.O. Box 2519 n PTY San Rafael, CA 94912 ❑SCC []IND ❑COM GOTH O PTY O SCC ❑IND O COM GOTH O PTY OSCC OIND OCOM ❑OT O PTY O SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 2246 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 tye Summary Page, Column A, Lines 4 and 10.) ...................... TOTAL $ 6466 E. O *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 (8661275-3772)