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Home My WebLink AboutForm 460 - Rachel Kertz for Board of Education 2018 1st Preelection Statement AmendmentRecipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE COVER PAGE 11 Statement covers period Date of election if applic 'Ial OCT 2 5 2018 (Month, Day, Year) ge 1 of . from 01/01/2018 R 4t/ or Official Use Only through 09/22/2018 11/06/2018 GITY 1w� CLERK'S 0FFI II 1. Type of Recipient Committee: All Committees — Complete Parts 1, z, 3, and 4. Q Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure Q State Candidate Election Committee Committee Q Recall Q Controlled (Also Complete Part 5) Q Sponsored (Also Complete Part 6) ❑ General Purpose Committee Q Sponsored Q Small Contributor Committee Q Political Party/Central Committee ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 3. Committee InformationI I.D. NUMBER 1410420 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Rachel Kertz for Board of Education 2018 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE Roseville CA 95661 AREA CODE/PHONE ( MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS ( 2. Type of Statement: ❑x 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) Treasurer(s) NAME OF TREASURER Chelsea Johnson MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE Roseville CA 95661 ( NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY OPTIONAL: FAX / E-MAIL ADDRESS STATE ZIP CODE AREA CODE/PHONE 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. t certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on A2 � 19- By 14 �Da�le SignalureofTreasurerorAss� tanlTreasurer Executed on _ �� vBy Dath SianalureofControl6naOfTceber.Candidate.Sta easurePr000nentorResoonsibleOfficerofSoonsor Executed on Date Executed on Date www.netfile.com By Signature of Controlling Officeholder, Candidate, Slate Measure Proponent By Signature of Controlling Officeholder, Candidate. Stale 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 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Rachel Kertz OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Board of Education: City of San Rafael RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP San Rafael CA 94903 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? COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME LD NUMBER NAME OF TREASURER CONTROLLED COMMITTEE) ;] YES ] NO COVER PAGE - PART 2 Page 2 of --L3- 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. COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary 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 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov www.netfile.com Campaign Disclosure Statement Amounts may be rounded SUMMARYPAGE Summary Page to whole dollars. Statement covers periodCALIFORNIA 460. . ' from 01/01/2018 FORM SEE INSTRUCTIONS ON REVERSE _ NAME OF FILER Rachel Kertz for Board of Education 2018 Expenditures Made Column Contributions Received Schedule E, Line 4 $ TOTALTHIS PERIOD 7. Loans Made............................................................. Schedule H, Line 3 (FROMATTACHED SCHEDULES) 1. Monetary Contributions ........................................... Schedule A, Line 3 $ 1,929.00 9. Accrued Expenses (Unpaid Bills) ............................... 2. Loans Received...................................................... Schedule e, Line 3 3,706.16 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 +2 $ 5,635.16 4. Nonmonetary Contributions .................................... Schedule C, Line 3 0.00 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3+4 $ 5,635.16 Expenditures Made 6. Payments Made ....................................................... Schedule E, Line 4 $ 66.26 7. Loans Made............................................................. Schedule H, Line 3 0.00 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6 + 7 $ 66.26 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3 10, 257.48 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 0.00 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8+g+10 $ 10,323.74 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 in Column B above $ www.nettile.com 0.00 5,635.16 0.00 66.26 5,568.90 0.00 0.00 13,963.64 through Column B CALENDARYEAR TOTALTO DATE $ 1,929.00 3,706.16 $ 5,635.16 0.00 $ 5,635.16 $ 66.26 0.00 $ 66.26 10,257.48 0.00 $ 10,323.74 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). 09/22/2016 I Page 3 of 13 I.D. NUMBER 1410420 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6/30 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If 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 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule F Accrued Expenses (Unpaid Bills) SEE INSTRUCTI NAME OF FILER Rachel Kertz for Board of Education 2018 Amounts may be rounded to whole dollars. Statement covers period from 01/01/2018 through 09/22/2018 SCHEDULEF Page 8 of 13 I.D. NUMBER 1410420 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 WEB information technology costs (intemet, e-mail) * Payments that are contributions or independent expenditures must also be SUBTOTALS $ summarized on Schedule D. $ 2,824.05$ 0.00$ 2,824.05 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.) ............................................ INCURRED TOTALS $ 10,257.48 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.) ................................. PAID TOTALS $ 0.00 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and onthe Summary Page, Column A, Line 9.)................................................................................................................................................ NET $ 10, 257.48 May be a negative number www.netfile.com FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov (a) (b) (c) (d) NAME AND ADDRESS OF CREDITOR CODE OR OUTSTANDING AMOUNT INCURRED AMOUNTPAID 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 C. SX 206.16 0.00 206.16 Roseville, CA 95661 Four Waters Media, Inc. LIT i]. UO 305.68 0.00 305.68 West Sacramento, CA 95691 Four Waters Media, Inc. CMP 0.00 2,312.2? 2,312.21 West Sacramento, CA 95691 * Payments that are contributions or independent expenditures must also be SUBTOTALS $ summarized on Schedule D. $ 2,824.05$ 0.00$ 2,824.05 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.) ............................................ INCURRED TOTALS $ 10,257.48 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.) ................................. PAID TOTALS $ 0.00 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and onthe Summary Page, Column A, Line 9.)................................................................................................................................................ NET $ 10, 257.48 May be a negative number www.netfile.com FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov Schedule F (Continuation Sheet) Amounts may be rounded Statement covers period to whole dollars. Accrued Expenses (Unpaid Bills) from 011 01, 2018 through 09/22/2018 NAME OF FILER Rachel Kertz for Board of Education 2018 SCHEDULE F (CONT.) Page 9 of 13 I.D. NUMBER 1410420 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 WEB information technology costs (internet, e-mail) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. www.neffile.com SUBTOTALS $ 0.00$ 3,666.01$ 0.00 $ 3,666.01 FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov ( ( (c) ( NAME AND ADDRESS OF CREDITOR CODE OR OUTSTAA NDING AMOUNTIN CURRED AMOUNTPAID 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 Four Waters Media, Inc. LIT 0.00 1,666.01 0.00 1,666.01 West Sacramento, CA 95691 Four Waters Media, Inc. CNS 0.00 150.00 0.00 150.00 West Sacramento, CA 95691 Four Waters Media, Inc. LIT 0.00 950.00 0.00 950.00 West Sacramento, CA 95691 Four Waters Media, Inc. WEB 0.00 900.00 0.00 900.00 West Sacramento, CA 95691 www.neffile.com SUBTOTALS $ 0.00$ 3,666.01$ 0.00 $ 3,666.01 FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov Schedule F (Continuation Sheet) Amounts may be rounded Statement covers period to whole dollars. Accrued Expenses (Unpaid Bills) from 01/01/2018 through 09/22/2018 NAME OF FILER Rachel Kertz for Board of Education 2018 SCHEDULE F (CONT.) Page 10 of 13 I.D. NUMBER 1410420 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 PEf 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 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) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. www.netfile.com SUBTOTALS $ 0.00$ 2,217.42$ 0.00 $ 2,217.42 FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov (a) (b) (c) (d) NAME AND ADDRESS OF CREDITOR CODE OR OUTSTANDING AMOUNT INCURRED AMOUNTPAID OUTSTANDING (IF COMMITTEE, ALSO ENTER LD NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD PMCohen Public Affairs CNS 0.00 500.00 0.00 500.00 San Rafael, CA 94901 PMCohen Public Affairs CNS :.00 1,000.00 i!: 1,000.00 San Rafael, CA 94901 PMCohen Public Affairs WEB 0.00 617.42 0.00 617.42 San Rafael, CA 94901 Four Waters Media, Inc. CNS 0.00 100.00 0.00 100.00 West Sacramento, CA 95691 www.netfile.com SUBTOTALS $ 0.00$ 2,217.42$ 0.00 $ 2,217.42 FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov Schedule F SCHEDULE F (CONT) (Continuation Sheet) Amounts may be rounded Statement covers period • ' to whole dollars. • Accrued Expenses (Unpaid Bills) from 01/01/201P through 09/22/2018 Page11 of 13 NAME OF FILER I.D. NUMBER Rachel Kertz for Board of Education 2018 1410420 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CWIP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants WG 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) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. NAME AND ADDRESS OF CREDITOR CODE OR ( ( (c) OUTS NDING AMOUNT IN INCURRED AMOUNT PAID (IF COMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD OF THIS PERIOD (ALSO REPORT ON E) Four Waters Media, Inc. WEB 0.00 750.00 0.00 West Sacramento, CA 95691 Four Waters Media, Inc. LIT 800.00 0.00 West Sacramento, CA 95691 www.netfiie.com (d) OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD 750.00 800.00 SUBTOTALS $ 0.00$ 1,550.00$ 0.00 $ 1, 550.00 FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/276-3772) www.fppc.ca.gov