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Home My WebLink AboutForm 460- Rachel Kertz for City Council 2020 (2022-12-31)Recipient Committee COVERPAGE Campaign Statement ' Cover Page 73 (Government Code Sections 84200-84216.5) Statement covers period Date of election if applicable 'Ji � 1 (Month, Day, Year) of Po Official Use Only from CITY CLERK'S OFF ICE SEE INSTRUCTIONS ON REVERSE through 3r1z� _ 11/03/2020 1. Type of Recipient Committee: All committees- complete Parts 1, 2, s, and 4. 2. Type of Statement: ❑x Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ Preelection Statement ❑ Quarterly Statement Q State Candidate Election Committee Committee ❑x Semi-annual Statement ❑ Special Odd -Year Report Q Recall (Also Complete Part S) Q Controlled � Sponsored ❑ Termination Statement ❑ Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 ❑ General Purpose Committee (Also Complete Part 6) ❑ Amendment (Explain below) Q Sponsored ❑ Primarily Formed Candidate/ Q Small Contributor Committee Officeholder Committee Q Political Party/Central Committee (Also Complete Part 7) 3. Committee Information COMMITTEE NAME (OR CANDIDATE'S NAME IF NO Rachel Kertz for City Council 2020 I.D. NUMBER STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Antelope CA 95843 ( MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE Treasurer(s) NAME OF TREASURER Chelsea Johnson MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE Antelope CA 95843 ( NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE 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 my knowledge t 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 or Resoonsibte Officer of Snonsor Executed on Date Executed on Date •--- • __-wr:r- - ----. By Signature of Controlling Officeholder, Candidate, State Measure Proponent By Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) 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) City Council Member City of San Rafael District 4 RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE Z17- 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? ❑ YES ❑ NO COMM ITTEEADDRESS STREET ADDRESS (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 STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE www.neifile.com COVER PAGE - PART 2 Page 2 of 6 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 Listnames 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 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement IIIIIIIII SUMMARYPAGE Amounts may be rounded Statement covers period • - Summary Page to whole dollars. t NIA �from 10/23/2022 •_ SEE INSTRUCTIONS ON REVERSE through 12/31/2022 Page 3 of 6 NAME OF FILER I.D. NUMBER Rachel Kertz for City Council 2020 1427074 Expenditures Made Column A 6. Payments Made ....................................................... Column B Calendar Year Summary for Candidates Contributions Received 7. Loans Made............................................................. TOTALTHISPERIOD CALENDARYEAR Primary Running in Both the State Prima and 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6 + 7 $ (FROMATTACHED SCHEDULES) 9. Accrued Expenses (Unpaid Bills) TOTALTO DATE 9 35.00 10. Nonmonetary Adjustment .......................................... schedule C, Line 0.00 General Elections 1. Monetary Contributions ........................................... Schedule A, Line 3 $ o .00 $ 0-00 111 through 6/30 7/1 to Date 2. Loans Received...................................................... schedule e, Line 3 0.00 16. 000.00 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 +2 $ 0.00 $ 16, 000.00 20. Contributions Received $ $ 4. Nonmonetary Contributions .................................... Schedule C, Line 3 0.00 0.00 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3+4 $ 0.00 $ 16,000.00 Made $ $ Expenditures Made 6. Payments Made ....................................................... schedule E, Line 4 $ 57.77 7. Loans Made............................................................. Schedule H, Line 3 0.00 8. SUBTOTALCASH PAYMENTS .................................... Add Lines 6 + 7 $ 57.77 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3 35.00 10. Nonmonetary Adjustment .......................................... schedule C, Line 0.00 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8+9+10 $ 92.77 Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 579.60 13. Cash Receipts ................................................... Column A, Line 3 above 0.00 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 0.00 15. Cash Payments .................................................. Column A, Line 8 above 57.77 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 521.83 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED..-. ..................... Schedule B, Part 2 $ 0.00 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instructions on reverse $ 0.00 19. Outstanding Debts ......................... Add Line 2 +Line 9 in Column B above $ 16,221.7S www.netfile.com $ 638.44 0.00 $ 638.44 221.75 0.00 $ 860.19 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* (If Su biect 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 B — Part 1 Loans Received SCHEDULE B - PART 1 Amounts may be rounded Statement covers period ---f CALIFORNIA to whole dollars. from 10/23/2022 FORM 4601 Schedule B Summary 1. Loans received this period...................................................................................................................... $ 0.00 (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period................................................................................,.,...................... $ (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 0.00 3. Net change this period. Subtract Line 2 from Line 1...........................................................•... NET $ 0.00 9 p ( Enter the net here and on the Summary Page, Column A, Line 2. (May Ce a n"atbm nnmW) *Amounts forgiven or paid by another party also must be reported on Schedule A. ** If required. www.neffile.com Mum (e) on Schedule E, Line 3) tContributor 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 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov through 12/31/2022 Page 4 of 6 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Rachel Kertz for City Council 2020 1427074 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OUTSTANDING AMOUNT O (c) AMOUNT PAID OUTSTANDING (e) INTEREST lfI ORIGINAL (gi CUMULATIVE OF LENDER OCCUPATION AND EMPLOYER BALANCE RECEIVED THIS OR FORGIVEN BALANCEAT PAID THIS AMOUNT OF CONTRIBUTIONS (IF COMMITTEE, ALSO ENTER ID NUMBER) (IF SELF-EMPLOYED, ENTER NAMEOFBUSINESS) BEGINNING THIS p ) PERIOD THIS PERIOD" CLOSE OF THIS p PERIOD LOAN TO DATE Rachel Kertz Candidate ❑ PAID CALENDARYEAR Candidate San Rafael, CA 94903 $ n_no $ 6,non _00 n nn/ $ 6.000.00 $ 0.00 ❑ FORGIVEN PERELECTION** RATE $ 6,000.00 $ 0.00 $ n_no 06/10/2021 $ 0_00 12/10/2020 $ DATE DUE t X❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE INCURRED Rachel Kertz Candidate ❑ PAID CALENDARYEAR Candidate San Rafael, CA 94903 $ n nn $ in,nno nn n nn/ $ 10 000.00 $ n_nn ❑ FORGIVEN PER ELECTION ** RATE $ 10.000.00 $ 0.00 $ n nn 07/22/2021 $ n.nn 01/22/2021 $ DATE DUE t X❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE INCURRED ❑ PAID CALENDARYEAR ❑ FORGIVEN PER ELECTION** RATE 5 $ $ $ $ DATE DUE t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE INCURRED SUBTOTALS $ 0.00$ 0.00$ 16,000.00$ 0.00 Schedule B Summary 1. Loans received this period...................................................................................................................... $ 0.00 (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period................................................................................,.,...................... $ (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 0.00 3. Net change this period. Subtract Line 2 from Line 1...........................................................•... NET $ 0.00 9 p ( Enter the net here and on the Summary Page, Column A, Line 2. (May Ce a n"atbm nnmW) *Amounts forgiven or paid by another party also must be reported on Schedule A. ** If required. www.neffile.com Mum (e) on Schedule E, Line 3) tContributor 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 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Rachel Kertz for City Council 2020 Amounts may be rounded to whole dollars. Statement covers period from 10/23/2022 through 12/31/2022 I Page 5 of 6 I.D. NUMBER CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment 1427074 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) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID CJ & Associates, Inc. PRO 57.77 Antelope, CA 95843 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.).................................................................................................. 2. Unitemized payments made this period of under $100........................................................................................................................ 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).)............................................................. 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ........................ www.netfile.com SUBTOTAL $ 57.77 57.77 0.00 $_ 0.00 ..... TOTAL $ 57.77 FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov Schedule F Accrued Expenses (Unpaid Bills) SEE INSTRUCTIONS ON REVERSE NAME OF FILER Amounts may be rounded Statement covers period to whole dollars. from 10/23/2022 through 12/31/2022 SCHEDULEF Page 6 of 6 I.D. NUMBER Rachel Kertz for City Council 2020 I 1427074 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 SUBTOTALS $ 186.75$ 35.00$ 0.00$ 221.75 summarized on Schedule D. 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 $ 35.00 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 on the Summary PaeColumn ALine 9 , , . ...... NET $ 35.00 Page, ).............................................................................................................,.......-................... Mey be a negaWe nu"er 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 AMOUNT PAID 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 0.00 35.00 0.00 35.00 Antelope, CA 95843 Loren Kertz OFC 43.00 0.00 0.00 43.00 San Rafael, CA 94903 Loren Kertz WED 143.75 0.00 0.00 143.75 San Rafael, CA 94903 * Payments that are contributions or independent expenditures must also be SUBTOTALS $ 186.75$ 35.00$ 0.00$ 221.75 summarized on Schedule D. 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 $ 35.00 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 on the Summary PaeColumn ALine 9 , , . ...... NET $ 35.00 Page, ).............................................................................................................,.......-................... Mey be a negaWe nu"er www.netfile.com FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov