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Home My WebLink AboutForm 460 - Maribeth Bushey-Lang for City Council 2013 (2013-12-31)4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of under penalty of perjury under the laws of the State of California that the foregoing is true and CO) Executed on I— ?--I— I By Date Executed on 40-- o2 ci By Date Sig:l Executed on By Date Executed on By Date ct. 4 Signatt e of Tre �gna ire of Controlling Officeholder, Candidate, State Measure Proponent or EMS111111194M Signature of Controt Officeholder, Candidate, State Measure Proponent ------ . -r---.-- FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) State of California J _J, COVERPAGE Recipient Committee Type or print in ink. 04 4� Campaign Statement Cover Page (Government Code Sections 84200-84216.5) I N Page of Statement covers period Date of election if applicable: 10/20/13 (Month, Day, Year) For Official Use Only from 12/31/13 11/5/13 SEE INSTRUCTIONS ON REVERSE through 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. 2. Type of Statement: Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ Preelection Statement ❑ Quarterly Statement 0 State Candidate Election Committee Committee V Semi-annual Statement F-1 Special Odd -Year Report 0 Recall 0 ControlledF_� Termination Statement F_� Supplemental Preelection (Also Complete Part 5) 0 Sponsored (Also file a Form 410 Termination) Statement - Attach Form 495 F-1 General Purpose Committee (Also Complete Part 6) Q Amendment (Explain below) 0 Sponsored F-1 Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D.NUMBER 1 Treasurer(s) 358370 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER Maribeth Bushey Lang for San Rafael City Council 2013 Mark Kyle, Esq. MAILING ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 ( CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY San Rafael CA 94901 ( James Waite, CPA MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX MAILING ADDRESS ZIP CODE AREA CODE/PHONE San Rafael CA 94901 ( OPTIONAL: FAX / E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of under penalty of perjury under the laws of the State of California that the foregoing is true and CO) Executed on I— ?--I— I By Date Executed on 40-- o2 ci By Date Sig:l Executed on By Date Executed on By Date ct. 4 Signatt e of Tre �gna ire of Controlling Officeholder, Candidate, State Measure Proponent or EMS111111194M Signature of Controt Officeholder, Candidate, State Measure Proponent ------ . -r---.-- FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) State of California Ah dk CALIFORNIA Im 0 FORM 46 RM&111 EW41 0 LO [a Vis] A W4 W i I# F 1 0AR61 111 to] I [_1� 11391*1 11111 I It NAME OF OFFICEHOLDER OR CANDIDATE Maribeth Bushey Lang OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City Council, City of San Rafael RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP San Rafael, CA 94901 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? F] YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? YES F� NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Page 2 of � 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION SUPPORT Q 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 464 Januar /0 FPPC Tell -Free Helpline: 8 6iASK-FPPC ( ffi1275-3772) State of California Campaign Disclosure StatemenI Summary Page Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 10/20/13 SEE INSTRUCTIONS ON REVERSE 447197.92 6. Payments Made ....................................................... Schedule E, Line 4 $ through 12/31/13 Page 3 of NAME OF FILER 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F, Line 3 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 895.08 figures that should be 35580370 Contributions Received period amounts. If this is Column A Column B Calendar Year Summary for Candidates for this calendar year, only TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) CALENDAR YEAR TOTALTO DATE Running in Both the State Primary and any). General Elections 1. Monetary Contributions ........................................... Schedule A, Line 3 $ 7 1725 $ 44,544 0 0 1/1 through 6/30 7/1 to Date 2. Loans Received ...................................................... Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS Add Lines I + 2 $ 7,725 $ 44,544 20. Contributions ......................... Received $ $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 1,550 71271 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 + 4 $ 9,375 $ 51,815 Made $ $ Expenditures Made 447197.92 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. 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ....................................... See instruc6ons on reverse $ 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column B above $ 18,959.92 $ 447197.92 0 0 187959.92 $ 44,197.92 0 0 11650.00 71271.00 20,609.92 $ 517468.92 127130.00 To calculate Column B, add 71725.00 amounts in Column A to the 0 correspondinci amounts from Column B of your last 18,959.92 report. Some amounts in Column A may be negative 895.08 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 any). I 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 diftrent from amounts reported in Column B. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule A Type or print in ink. SCHEDULE A Moneta Contributions Received Amounts may be rounded to whole dollars. Statement covers period CALIFORNIA A60 from 10/20/13 FORM 12/31/13 4 `�` SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE ZIP 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 (E COMMITTEE, ALSOAENTERND I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ®IND 10/23/13 Rich Nave ❑COM Retired 100 100 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC ®IND 10/23/13 Michael Cronin ❑COM Retired 100 100 �...�.. .. []OTH San Rafael, CA 94901 ❑ PTY ❑ SCC ®IND 10/23/13 Thomas Tucker ❑COM Retired 125 125 E] OTH San Rafael, CA 94901 ❑ PTY ❑ SCC ❑IND San Rafael Chamber Candidates PAC ICOM 10/23/13 FPPC #1281286 E] OTH 2500 2500 817 Mission Ave., San Rafael, CA 94901 ❑ PTY E] SCC Marin Professional Firefighters, #930791 ❑ IND COM 10/23/13 555 Capitol Mall, Suite 1425 ❑OTH 1000 1000 Sacramento, CA 95814 ❑ PTY ❑ ScC SUBTOTAL$ 3,825 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. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ...... TOTAL $ 7,700.00 25.00 7,725.00 '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 (866/275-3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period I. CALIFO to whole dollars. 10/20/13 NIA , from FORM through 12/31/13 Page 5 of NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 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 (EFTA COMMITTEE, ALSO ENTER I.D.N CODE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) ®IND Timothy Sullivan ❑COM Retired 10/23/13 1 ❑ OTH 125 125 Berkeley, CA 94708 ❑ PTY ❑ SCC Perry Lichfield ®IND ❑ COM Businessman, 10/28/13 --- — — — -- E] OTH self-employed 1750 2500 San Rafael, CA 94901 ❑ PTY ❑ SCC Cal -Pox Inc. ❑IND ❑ COM 10/30/13 500 1000 ® OTH Novato, CA 94948 ❑ PTY ❑ SCC GSB Partners ❑IND ❑ COM 10/30/13 500 1000 ® OTH San Rafael, CA 94912-2126 ❑ PTY ❑ SCC SF Laborer's Local 261, FPPC#1358370 [I IND ®COM 10/31 /13 500 500 ❑ OTH San Francisco, CA 94110 ❑ PTY ❑ SCC SUBTOTAL$ 3,375.00 *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 (866/275-3772) 1 Ism, I =I !-, Monetary Contributions Received Amounts may be rounded Statement covers period A, to whole dollars. 10/20/13 from through 12/31 /13 Page 6 Of t 2- NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 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 V IND Jonathan Friedman El Retired 11/21/13 Wf J OTH 500 500 San Rafael, CA 94901 PTY SCC IND COM E] OTH PTY EISCC E] IND EICOM OTH PTY SCC IND COM OTH El PTY EISCC E] IND EICOM E] OTH El PTY SCC *Contributor Codes Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business enti PTY — Political Party SCC — Small Contributor Committtel SUBTOTAL$ 500-00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule C Type or print in ink. SCHEDULE Amouniz may be rounded Nonmonetary Contributions Received to whole dollars. Statement covers period CALIFORNIA 460 from 10/20/13 FORM through 12/31/13 Page 7 of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 DATE FULL NAME, STREET ADDRESS AND CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF AMOUNT/ FAIR MARKET CUMULATIVE TO DATE PER ELECTION TO DATE RECEIVED ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) GOODS OR SERVICES VALUE CALENDAR YEAR (JAN 1 - DEC 31) (IF REQUIRED) Mark Kyle 6ZIND CM Attorney, Legal 10/22/13 25 Cottonwood Drive [:]OTH Operating Engineers San Rafael, CA 94901 El PTY Local Union #3 [:]SCC 6ZIND work done on 8 separate occasions EICOM same as above did legal work on 12/20/13 including: 10/22,10/23,10/24,10/29, E]OTH those 8 dates for 1650 4125 10/31,11/11,11/12,12/20 [:] PTY a total value of E1SCC []IND [ICOM []OTH Cl PTY [:JSCC [:]IND [:]Com []OTH El PTY I El SCC I i Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 1650.00 ]M-11-iiim'tj 1. Amount received this period — itemized nonmonetary contributions. 11650-00 (include all Schedule C subtotals.) ..................................................................................................................... $ 2. Amount received this period — uniternized nonmonetary contributions of less than $100 .................................... $ 0 3. Total nonmonetary contributions received this period. 11650.00 (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ...................... TOTAL $ Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (eg., business entity) PTY — Political Party SCC — Small Contributor Committee FPPC Form 460 (January/05) FPP C Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE 2 'IF TIFIT01nui mu 22114 Type or print in ink. Amounts may be rounded to whole dollars. A91111 111111 1 11� ipiq�1111 liq ii 11111 Statement covers period from 10/20/13 through 12/31/13 8 2. Page of- I.D. NUMBER 358370 CIVP campaign paraphemalia/misc. MBR member communications RAID 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 POO 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 MB information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID PM Cohen Public Affairs PO Box 150268 OFC 124.85 San Rafael, CA 94915-0268 four waters media, inc. 624 Todhunter Avenue CMP 115 West Sacramento, CA 95605 PM Cohen Public Affairs PO Box 150268 CMP 553.31 San Rafael, CA 94915-0268 Schedule E Summary 1. Itemized payments made this period. (include all Schedule E subtotals.) .............................................................................................................. $ (� � � t 2. Uniternized payments made this period of under $100 .......................................................................................................................................... $ 0 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ............................................................................... $ 0 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275-3772) Schedule E Type or print in ink. (Continuation Sheet) Amounts may be rounde Payments Made to whole dollars. I NAME OF FILER Maribeth Bushey Lang for San Rafael City Council 2013 Statement covers period • 10/20/13 through 12/31/13 MHMAEE��= Pae 9 gof I.D. NUMBER C58370 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CIVP campaign paraphemalia/misc. MBR member communications RAID radio airtime and production costs CNS campaign consultants MTC 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) VCT voter registration LIT campaign literature and mailings PRT print ads MB information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID United State Postal Services, Mission Rafael 910 D Street POS 1609.51 San Rafael, CA 94901-9991 United State Postal Services, Mission Rafael 910 D Street POS 226.86 San Rafael, CA 94901-9991 United State Postal Services, Mission Rafael 910 D Street POS 293.07 San Rafael, CA 94901-9991 United State Postal Services, Mission Rafael 910 D Street POS 226.66 San Rafael, CA 94901-9991 United State Postal Services, Mission Rafael 910 D Street POS 69.36 San Rafael, CA 94901-9991 Schedule E (Continuation Sheet) Payments Made NAME OF FILER Maribeth Bushey Lang for San Rafael City Council 2013 Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 10/20/13 through 12/31/13 Page 10 of I.D. NUMBER 358370 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CIVIP campaign paraphernalia/mise. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTU 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) VCT voter registration LIT campaign literature and mailings PRT print ads \/\EB information technology costs (intemet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID four waters media, inc. 624 Todhunter Avenue PRO 770 West Sacramento, CA 95605 GSI Connect 360 N. Sepulveda Blvd. PHO 348.08 El Segundo, CA 90245 United States Postal Service - Mission Rafael 910 D Street POS 39 San Rafael, CA 94901-9991 PM Cohen Public Affairs PO Box 150268 OFC 791.72 San Rafael, CA 94915-0268 PM Cohen Public Affairs PO Box 150268 CNS 2500 San Rafael, CA 94915-0268 FPPC Form 460 (January/05) FPPC Toll -Free Helpline; 866/ASK-FPPC (8661275-3772) Schedule E Type or print in ink. (Continuation Sheet) Amounts may be roundell Payments Made to whole dollars. NAME OF FILER Maribeth Bushey Lang for San Rafael City Council 2013 Statement covers period from 10/20/13 through 12/31/13 ---- - ------ - ------- --- --- I.D. NUMBER 358370 1 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CIVP 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 PCNL 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) NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENTAMOUNT PAID (IF COMMITTEE, ALSO ENTER I.D. NUMBER) I I GSI Connect 360 N. Sepulveda Blvd. PHO 173.11 El Segundo, CA 90245 Kate Colin reimbursement for share of costs for election night 1400 Fifth Street FND campaign party. Third share of room rental costs, 719 San Rafael, CA 94901 drinks, and food. PM Cohen Public Affairs PO Box 150268 CNS 1000 San Rafael, CA 94915-0268 SC Design mailer design work 50 Old Courthouse Square, Suite 203 LIT 239.25 Santa Rosa, CA 95404 four waters media, inc. 624 Todhunter Avenue CNS 3712.50 West Sacramento, CA 95605 I I'll 111,1111111111 Pill y q 1111pi I EMT 17th"711. H Schedule E Type or print in ink. SCHEDULE E (CONT.) (Continuation Sheet) Amounts may be rounded Statement covers period from Payments Made towholedollars. 10/20/13 FPage through 12/31/13 12 ofSEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Maribeth Bushey Lang for San Rafael City Council 2013 358370 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CIVP 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 FIND 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) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Elizabeth Johnson postage and office supply reimbursement POS 201.67 Lafayette, CA 94549 InnerWorkings, Inc. LIT 1442.51 San Rafael, CA 94903 InnerWorkings, Inc. LIT 3187.47 Jan maTael, uA J4yjuo Jordan Ross PRO 500.00 San Rafael, CA 94901 Elizabeth Johnson office expenses and misc. campaign expenses OFC reimbursement 116.99 Lafayette, CA 94549 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 5448.64 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772)