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HomeMy WebLinkAboutForm 460 - Rachel Kertz for City Council 2024COVER PAGE Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from 05/24/2024 through 06/30/2024 1. Type of Recipient Committee: All committees - complete Parts 1, 2, 3, and 4. 0 Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ❑ State Candidate Election Committee Committee ❑ Recall ❑ Controlled (Also Complete Part5) ❑ Sponsored (Also Complete Part 6) ❑ General Purpose Committee ❑ Sponsored ❑ Primarily Formed Candidate/ ❑ Small Contributor Committee Officeholder Committee ❑ Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER Applied For COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Committee to Re-elect Rachel Kertz for San Rafael City Council 2024 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Novato CA 94945 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREACODE/PHONE OPTIONAL: FAX/E-MAILADDRES N Date of election if appli (Month, Day, Year) 11/05/2024 2. Type of Statement: J U L 2 2024 ag 1 of 10 For Official Use Only CLERK'S ❑ Preelection Statement Z Semi-annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) ❑ Quarterly Statement ❑ Special Odd -Year Report Treasurer(s) NAME OF TREASURER Tamara Hull MAILING ADDRESS CITY STATE ZIP CODE AREACODE/PHONE Novato CA 94945 NAME OF ASSISTANT TREASURER, IF ANY n/a MAILING ADDRESS CITY STATE ZIP CODE AREACODE/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 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, City of San Rafael, District 4 RESIDENTIAL/BUSINESS ADDRESS (NO.ANDSTREET) CITY STATE ZIP Novato CA 94945 Related Committees Not Included in this Statement: Listanycommittees 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 STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/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 COVER PAGE - PART 2 Page 2 of 10 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 Amounts may be rounded SUMMARY PAGE Summary Pa a g to whole dollars. Statement covers periodCALIFORNIA , ' from 05/24/2024 • - 06/30/2024 Page 3 Of 10 SEE INSTRUCTIONS ON REVERSE through NAME OF FILER I.D. NUMBER Committee to Re-elect Rachel Kertz for San Rafael City Council 2024 Applied For Contributions Received TOTAL A THIS PERIOD Column B CALENDAR YEAR Calendar Year Summary for Candidates (FROM ATTACHED SCHEDULES) TOTAL TO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions................................................... schedule A, Line 3 $ 6,915.00 $ 6,915.00 O O 1/1 through 6/30 7/1 to Date 2. Loans Received................................................................ Schedule e, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 +2 6 915.00 $ $ 6,915.00 20. Contributions Received $ $ 4. Nonmonetary Contributions ............................................ schedule C, Line 3 0 0 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED................................Add Lines 3+4 $ 6,915.00 $ 6,915.00 Made $ $ Expenditures Made 6. Payments Made................................................................ Schedule E, Line 4 $ 183.29 $ 183.29 7. Loans Made....................................................................... Schedule H, Line 3 0 0 8. SUBTOTAL CASH PAYMENTS ....................................... Add Lines 6+7 $ 183.29 $ 183.29 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F Line 3 0 0 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 0 0 11. TOTAL EXPENDITURES MADE....................................Add Lines s+9+10 $ 183.29 $ 183.29 Current Cash Statement 12. Beginning Cash Balance ............................ Previous summary Page, Line 16 $ To calculate Column B, 13. Cash Receipts........................................................... Column A, Line 3 above 6,915.00 add amounts in Column 0 A to the corresponding 14. Miscellaneous Increases to Cash .................................. Schedule 1, Line 4 amounts from Column B 15. Cash Payments......................................................... Column A, Line s above -183.29 of your last report. Some amounts in Column A may 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 6,731.71 be negative figures that should be subtracted from If this is a termination statement, Line 16 must be zero. previous period amounts. If this is the first report being 17. LOAN GUARANTEES RECEIVED. ............................... Schedule e, Part2 $ 0 filed 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 $ 6,731.71 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column 8 above $ 0 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 S[_hP-Ci11IP- A Amounts may be rounded SCHEDULE A to wnoie aouars. Monetary Contributions ReceivedCALIFORNIA Statement covers period 460 from 05/24/2024 FORM through 06/30/2024 page 4 of 10 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Committee to Re-elect Rachel Kertz for San Rafael City Council2024 Applied For FULL NAME, STREET ADDRESS AND ZIP CODE OF IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR CONTRIBUTOR OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 6/14/24 Mary Sackett Z IND County Supervisor, County 250.00 250.00 250.00 ❑ COM ❑ OTH of Marin San Rafael, CA 94903 ❑ PTY ❑ SCC 6/17(/24 Katie Rice Z IND County Supervisor, County 250.00 250.00 250.00 ❑ COM ❑ OTH of Marin San Anselmo, CA 94979 ❑ PTY ❑ SCC 6/17/24 Bruce Raful Z IND Real Estate Appraiser, Self - 250.00 250.00 250.00 El COM El OTH Raful & Associates San Rafael, CA 94901 ❑ PTY ❑ SCC 6/18/24 Tamara Hull Z IND CPA, Self - Jannisse & Hull 250.00 250.00 250.00 ❑ COM ❑ OTH CPAs Novato, CA 94945 ❑ PTY ❑ SCC 6/19/24 Caran Cuneo Z IND Consultant, Marin Builders 100.00 100.00 100.00 ❑ COM ❑ OTH Association San Rafael, CA 94903 ❑ PTY ❑ SCC SUBTOTAL $ 1,100.00 Schedule A Summary 1. Amount received this period — itemized monetary contributions. 6,048.00 (Include all Schedule A subtotals.).........................................................................................................$ ' 2. Amount received this period — unitemized monetary contributions of less than $100 ...........................$ 867.00 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)......... ...........TOTAL $ 6,915.00 *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 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULE A (CONT.) Monetary Contributions Received to whole dollars. Statement covers period • _ , from 05/24/2024 .1 • through 06/30/2024 Page 5 of 10 NAME OF FILER I.D. NUMBER Committee to Re-elect Rachel Kertz for San Rafael City Council 2024 Applied For FULL NAME, STREET ADDRESS AND ZIP CODE OF IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR CONTRIBUTOR * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME) OF BUSINESS) PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 6/19/24 and Leigh Bakhtiari IND President, City Carpets 300.00 300.00 300.00 ❑ COM 6/22/24 ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC 6/19/24 Ranjiv Khush Z IND Project Director, The 100.00 100.00 100.00 ❑ COM ❑ OTH Aquaya Institute San Anselmo, CA 94960 ❑ PTY ❑ SCC 6/20/24 Eric Boales Z IND Manager, Wells Fargo 500.00 500.00 500.00 ❑ COM ❑ OTH San Rafael, CA 94903 ❑ PTY ❑ SCC 6/20/24 Windi Snarly 0 IND Human Resources, Wells 500.00 500.00 500.00 ❑ CoM ❑ OTH Fargo San Rafael, CA 94903 ❑ PTY ❑ SCC 6/20/24 Lisa Doran Z IND CPA, Self- Doran & 100.00 100.00 100.00 ❑ COM ❑ OTH Associates San Rafael, CA 94903 ❑ PTY SCC SUBTOTAL $ 1,500.00 '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 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULE A (CONT.) Monetary Contributions Received to whole dollars. Statement covers period from 05/24/2024through F 06/30/2024 of 10 NAME OF FILER I.D. NUMBER Committee to Re-elect Rachel Kertz for San Rafael City Council 2024 Applied For DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION CONTRIBUTOR * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME) (IF COMMITTEE, ALSO ENTER I.D. NUMBER) OF BUSINESS) PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 6/21/24 Kim Diamond IND Real Estate Development, 200.00 200.00 200.00 ❑ COM ❑ OTH KD Shae Development San Rafael, CA 94903 ❑ PTY ❑ SCC 6/24/24 Paul Jensen IND Retired 250.00 250.00 250.00 ❑ COM ❑ OTH San Rafael, CA 94903 ❑ PTY ❑ SCC 6/24/24 Michael Manowski ® IND CTO, Delta Dental 250.00 250.00 250.00 ❑ COM ❑ OTH Insurance San Rafael, CA 94903 ❑ PTY ❑ SCC 6/26/24 Resource Conservation PAC #123886 ❑ IND 250.00 250.00 250.00 ❑ COM ❑ OTH San Rafael, CA 94901 ❑ PTY SCC 6/26/24 Catherine Colin 0 IND Mayor, City of San Rafael 250.00 250.00 250.00 ❑ COM ❑ OTH San Rafael, CA 94901 ❑ PTY SCC SUBTOTAL $ 1,200.00 '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 Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULE A (CONT.) Monetary Contributions Received to whole dollars. Statement covers period • _ from 05/24/2024 • through 06/30/2024 Page 7 of 10 NAME OF FILER I.D. NUMBER Committee to Re-elect Rachel Kertz for San Rafael City Council 2024 Applied For FULL NAME, STREET ADDRESS AND ZIP CODE OF IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR CONTRIBUTOR * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME) (IF COMMITTEE, ALSO ENTER I.D. NUMBER) OF BUSINESS) PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 6/27/24 Bruce Burtch ❑� IND Retired 100.00 100.00 100.00 ❑ COM ❑ OTH San Rafael, CA 94901 ❑ PTY ❑ SCC 6/27/24 Millie Anderson Z IND Senior Placement, Self - 100.00 100.00 100.00 ❑ COM ❑ OTH Mom's New Pad Guerneville, CA 95446 ❑ PTY ❑ SCC 6/27/24 Laurie Dubin Z IND Retired 118.00 118.00 118.00 ❑ COM ❑ OTH Larkspur, CA 94939 ❑ PTY ❑ SCC 6/27/24 Melissa Prandi Z IND Property Management, 250.00 250.00 250.00 ❑ COM ❑ OTH Prandi Property San Rafael, CA 94901 ❑ PTY Management, Inc. ❑ SCC 6/27/24 Geza Kadar 0 IND Retired 200.00 200.00 200.00 ❑ COM ❑ OTH Santa Rosa, CA 95404 ❑ PTY El SCC SUBTOTAL $ 768.00 *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 Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULE A (CONT.) Monetary Contributions Received to whole dollars. Statement covers period from 05/24/2024 • through 06/30/2024 Page 8 of 10 NAME OF FILER I.D. NUMBER Committee to Re-elect Rachel Kertz for San Rafael City Council 2024 Applied For FULL NAME, STREET ADDRESS AND ZIP CODE OF IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR CONTRIBUTOR * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE (IF SELF-EMPLOYED, ENTER NAME) OF BUSINESS) PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 6/27/24 Mary De May 0 IND physician, University of 180.00 180.00 180.00 ❑ COM ❑ OTH California San Francisco Mill Valley, CA 94941 ❑ PTY ❑ SCC 6/27/24 Meredith Parnell ❑ IND Chief Program Officer, St. 100.00 100.00 100.00 El COMEl OTH Vincent de Paul San Anselmo, CA 94960 ❑ PTY ❑ SCC 6128/24 William Hamamoto © IND Retired 100.00 100.00 100.00 ❑ COM ❑ OTH San Rafael, CA 94903 ❑ PTY ❑ SCC 6/28/24 Richard Pushkin Z IND Research Physician, 100.00 100.00 100.00 ❑ COM ❑ OTH Madrigal Pharmaceuticals San Rafael, CA 94903 ❑ PTY ❑ SCC 6/29/24 Laura Duffy IND physician, Laura Duffy 100.00 100.00 100.00 ❑ COM ❑ OTH San Rafael, CA 94903 ❑ PTY El SCC SUBTOTAL $ 580.00 "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 Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULE A (CONT.) Monetary Contributions Received to whole dollars. Statement covers period CALIFORNIA from 05/24/2024 FORM through 06/30/24 Page 9 10 of NAME OF FILER I.D. NUMBER Committee to Re-elect Rachel Kertz for San Rafael City Council 2024 Applied For FULL NAME, STREETADDRESS AND ZIP CODE OF IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR CONTRIBUTOR * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE (IF SELF-EMPLOYED, ENTER NAME) (IF COMMITTEE, ALSO ENTER I.D. NUMBER) OF BUSINESS) PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 6/30/24 Carolyn Kertz ® IND Retired 200.00 200.00 200.00 ❑ COM ❑ OTH San Mateo, CA 94402 ❑ PTY ❑ SCC 6/30/24 Sandy Magid Z IND CPA, Self - Magid 250.00 250.00 250.00 ❑ COM ❑ OTH Accountancy Corp. Novato, CA 94945 ❑ PTY ❑ SCC 6/30/24 Stephen Isaacs ® IND Retired 100.00 100.00 100.00 ❑ COM ❑ OTH Greenbrae, CA 94904 ❑ PTY ❑ SCC 6/30/24 Paul Cohen Z IND Consultant, Self - PMCohen 100.00 100.00 100.00 ❑ COM ❑ OTH public Affairs San Rafael, CA 94901 ❑ PTY ❑ SCC 6/30/24 Lori Frugoli W1 IND District Attorney, County of 250.00 250.00 250.00 ❑ COM ❑ OTH Marin Novato, CA 94947 ❑ PTY SCC SUBTOTAL $ 900.00 '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 Schedule E Amounts may be rounded Payments Made to whole dollars. SEE INSTRUCTIONS ON REVERSE Committee to Re-elect Rachel Kertz for San Rafael City Council 2024 Statement covers period from 05/24/2024 through 06/30/2024 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. SCHEDULE E Page 10 10 of Applied For 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. SUBTOTAL $ 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.)...................... $0 183.29 ............ $ 0 TOTAL $ 183.29 FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov