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HomeMy WebLinkAboutForm 460 - Greg Brockbank for Mayor 2011 (2011-12-31)Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print In Ink. Statement covers period Date of election If applicable: from (Month, Day, Year) through _A uL 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also Complete Part 5) 0 Sponsored (Also Complete Pad 6) El General Purpose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee 3. Committee Information COMMITTEE Ej Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) a 2. Type of Statement: E] Preelection Statement Semi-annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) II . NUMBER 3 Treasurer(s) AMITTEE) NAME OF TREASURER CITY STATE ZIP CODE ct q 0, MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE COVER PAGE Page k of For Official Use Only M Quarterly Statement F-1 Special Odd -Year Report M Supplemental Preelection Statement - Attach Form 495 CITY 51AIL ZIP Uut 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 best of my knowledge the information contained 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 true and corre Executed on 1'13 1,/ ( - ByP-/-- Date Signature ofTreasurer orAssistant Treasurer Executed on By Date S,gnature ofControffing Olfflcetx-Ader. CarKkiate, State Measure Proponent or Responsible Officerof Sponsor Executed on Date By Signature of Contro" OffsmIG6Y, Candidate, State Measure ProqcTwnt Executed on Date By Signature cfCor?to#ing011imhold-r, Canckdate, State Measure Poponant FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK-FPPC (866/275-3772) State of California Type or print in ink. COVERPAGE-PART2 Recipient Committee CALIFORNIA Campaign Statement ,RM 460 Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE i _ (1't t4 r'"" OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) 4 RESIDENT AND STREET) CITY STATE ZIP 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 contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY COMMITTEE NAME STATE ZIP CODE AREA CODEIPHONE I.D. NUMBER NAME OF TREASURERI CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) Page , of 6. Primarilv Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER I 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 UI1 T .7 Aft LIY tIuum AMtA UUUtVrNUNt Attach continuation sheets it necessary FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) State of California Campaign Disclosure Statement Type or print in ink. SUMMARY PAGE Statement covers period I CALIFORNIA 4 6) 01 Amounts may be rounded Summary Page to whole dollars. 7. Loans Made ............................................................. Schedule H, Line 3 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6 + 7 $ FORM Schedule F Line 3 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 from 11. TOTAL EXPENDITURES MADE .............. ............ .... Add Lines a+ 9 + 10 $ # Page of SEE INSTRUCTIONS ON REVERSE through iNAME OF FILER I.D.NUMBER Contributions Received A ColTHISumPERIOD ColumAR YnEAR B CAn Calendar Year Summary for Candidates TOTALLEND (FROMATTACHED SCHEDULES) TOTALTO DATE Running in Both the State Primary and r General Elections 1. Monetary Contributions ........................................... Schedule A, Line 3 $ $ 1/1 through 6/30 7/1 to Date 2. Loans Received ...................................................... Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 12 $ $ -1, C 1 20. Contributions Received $ $ 4. Nonmonetary Contributions ............... - ....... -- ........ Schedule C, Line 3 0, 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ................. ... ..AddLines3+4 $ $ 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 a+ 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 i Column B above $ i-,, 3-10-37 $ $ 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). Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (K Subject to Voluntary Expenditure Limit) 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) 0 -k -Ai migm A Type or print In Ink. SC.HFr)tJl F A Amounts may be rounded Monetary Contributions Received to whole dollars.CALIFORNIA Statement covers period A!) N•460 FORM from ^ Page It SEE INSTRUCTIONS ON REVERSE through of ME OF FILER C, ��,xz 13 C<z C N �Zl t,o N, I.D.NUMBER 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. I - DEC, 31) (IF REQUIRED) OF BUSINESS) 1 VNIN &)IND [:]COM te,4 1 1v -J [:]OTH q�.l 014 lie [-I PTY EISCC rtt CRIND C]CO - eA acirtk rabs I IV E]OMTH F-1 PTY [:]SCC IND EICOM 4_4 []OTH 5'-wn Q -06o. -I th "1" 44 0, El PTY nSCC E31ND COM q E]OTH PTY �A C1 4v El FiSCC G yr, RIND EICOM nOTH 5,0 q, ,TI ko, 4 3 r-1 PTY EISCC SUBTOTALS 11010 � — Schedule A Summary 1. Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.) ........................................................ ...... ........................................ $ 2. Amount received this period — unitqmized 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 ....................... TOTAL $ *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: 8661ASK-FPPC (8661276-3772) Schedule A (Continuation Sheet) Type or print In Ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period, I CALIFO RNIA to whole dollars. i I / FORM 4 0 from 5— through Page of '4AME OF FILER I.D. NUMBER 1 -3 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF COMMITTEE, ALSO ENTER LD. NUMBER) RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. I - DEC. 31) (IF REQUIRED) OF BUSINESS) EJIND EICOM rf y 5 , Nitro nOTH PTY x too. El El SCC L <m [RIND EICOM E]OTH 0 PTY O 3-17-71 Ck aqt El SCC KIND EICOM r-JOTHb CO El PTY EISCC f'I FJIND WCOM FJOTH El PTY nscc ism c [ND EICOM CI OTH \:'jA1 El PTY [:]SCC Lvis4�' c SUBTOTAL$ CC, *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 (8661276-3772) Schedule A (Continuation Sheet) TvDe or DrInt In Ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period CALIFORNIA to whole dollars. FORM from through—( / /it Page of NAME OF FILER I.D. NUMBER 3' cl 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 COMMITTEEALSO ENTER IDNUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) IND FICOM *444'.1 - \ _0 E] CITH El PTY El SCC Fil IND Com - 9 E] CITH F1 PTY El SCC fRIND EICOM ilia a. -Y-1 nOTH 100 El PTY EISCC Lo G rte' [OIND EICOM if 1-7 CITH PTY (00 'T El EISCC t 'C',� 1 6 [IND FICOM )e C�6 joar La cA Cv� n\o E]OTH ❑ PTY J f�k EISCC SUBTOTAL$ 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/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) schedule A (Continuation Sheet) Woe or orint In Ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded to whole dollars. Statement covers period Lt from through J, S_ /3 t41 I Page , Of NAME OF FILER I.D. NUMBER 73 1 cZ'�1_1C 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. I -DEC. 31) (IF REQUIRED) OF BUSINESS) IND EICOM E]OTH El PTY EISCC VjL"W t'31 E]IND �COM- v E]OTH T cK71 F-1 PTY EISCC e''4 Ott F IND FICOM E]OTH El PTY El SCC E]IND EICOM E]OTH ❑ PTY EISCC FJIND EICOM FJOTH El PTY EISCC 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: 8661ASK-FPPC (8661275-3772) Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE Type or print in Ink. Amounts may be rounded to whole dollars. Statement covers period from '0:i�L_3A through lttPage CALIFORNIA FORM 46 —.-2— Of ME OF FILER 1A I.D. NUMBER CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CW campaign paraphemalia/misc. WOR 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 TRIC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals W 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 (intemet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. WIVISER) 7F 0 CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID 7 13 9 > S> 4f 3n, ? o9,93 P fi, -S f A Ck 1 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 1 :� , � 5 9 , Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) .................................................................................................... ...... $ 2. Uniternized payments made this period of under $100 ........................................................... .............................................................................. $ 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) . ... ...... ........ ........ $ 21 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) _ ................. ...... ... TOTAL $1 -','7 C FPPC Form 460 (January/06) FPPC Toll -Free Helpfine: 866/ASK-FPPC (866/275-3772) Schedule E Type or print in Ink. (Continuation Sheet) Amounts may be rounded Payments Made to whole dollars. Statement covers period from t Q ;L 3/11 SCHEDULE E (CONT.) 9 SEE INSTRUCTIONS ON REVERSE I through Page of NAME OF FILER CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID I.D. NUMBER 31 n_ Ofs k)J i, 13 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CW campaign paraphemalia/misc. WOR 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 Lv. 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 W 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 31 n_ Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 1 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/276-3772)