HomeMy WebLinkAboutForm 460- Firefighters' Association PAC (2016-05-23)Recipient Committee
Campaign Statement
Cover Page
SEE INSTRUCTIONS ON REVERSE
Statement covers period
from April 24, 2016
through May 23, 2016
1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4.
❑ Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure
O State Candidate Election Committee Committee
O Recall O Controlled
(Also Complete Part 5) O Sponsored
(Also Complete Pert 6)
0 General Purpose Committee
® Sponsored ❑ Primarily Formed Candidate/
O Small Contributor Committee Officeholder Committee
O Political Party/Central Committee (Also Complete Part l)
3. Committee Information
I.D. NUMBER
891308
San Rafael Firefighters Political Awarness Committee
STREET ADDRESS (NO P.O. BOX)
Preelection Statement
❑
Semi-annual Statement
999 5th Ave Suite 350
Termination Statement
(Also file a Form 410 Termination)
CITY
STATE
ZIP CODE
AREA CODE/PHONE
San Rafael
Ca
94901
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
PO BOX 2519
CITY
STATE
ZIP CODE
AREA CODE/PHONE
SAN RAFAEL
CA
94901
OPTIONAL: FAX/ E-MAIL ADDRESS
MAY 2 3 2016
Date of election if applicable
(Month, Day, Year)
June 7, 2016 11 CITY CLERK'S OFA{CE
2. Type of Statement:
W
Preelection Statement
❑
Semi-annual Statement
❑
Termination Statement
(Also file a Form 410 Termination)
❑
Amendment (Explain below)
Treasurer(s)
COVER PAGE
1 of 5
Official Use Only
❑ Quarterly Statement
❑ Special Odd -Year Report
NAME OF TREASURER
ANDREW ROGERSON
MAILING ADDRESS
1532 MATHIAS PL
CITY STATE ZIP CODE AREACODE/PHONE
ROHNERT PARK CA 94928
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 fore ' g is tr a and correct.
Executed on v 7, z G / ,6
Date
Executed on By
Date Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officer of Sponsor
Executed on By Dale Signature of Controlling Officeholder, Candidate, Stale Measure Proponent
Executed on By Date 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
Campaign Disclosure Statement Amounts may be rounded
Summary Page to whole dollars.
-
Statement covers period
from April 24, 2016
SUMMARY PAGE
Expenditures Made
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 instructions on reverse $
19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $
500.00 $
0 0
$ 500.00
0
500.00
500.00
0
0
500.00
0
$ 500.00
87,586
To calculate Column B,
0
May 23, 2016
2 5
SEE INSTRUCTIONS ON REVERSE
500
of your last report. Some
amounts in Column A may
through
Page of
NAME OF FILER
previous period amounts. If
this is the first report being
I.D. NUMBER
San Rafael Firefighters Political Awarness Committee
„
891308
Contributions Received
Column A
Column B
Calendar Year Summary for Candidates
TOTAL THIS PERIOD
(FROM ATTACHED SCHEDULES)
CALENDAR YEAR
TOTAL TO DATE
Running in Both the State Primary and
General Elections
1. Monetary Contributions................................................... Schedule A, Line 3
$ 0 $
0
2. Loans Received
0
0
1/1 through 6/30 7/1 to Date
................................................................ schedule B, Line 3
3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2
$ $
0
20. Contributions
Received $
4. Nonmonetary Contributions ............................................ Schedule c, Line 3
0
0
$
21. Expenditures
5. TOTAL CONTRIBUTIONS RECEIVED ................................... Add Lines 3+4
$ 0 $
0
Made $ $
Expenditures Made
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 instructions on reverse $
19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $
500.00 $
0 0
$ 500.00
0
500.00
500.00
0
0
500.00
0
$ 500.00
87,586
To calculate Column B,
0
add amounts in Column
A to the corresponding
amounts from Column B
0
500
of your last report. Some
amounts in Column A may
87,086
be negative figures that
should be subtracted from
previous period amounts. If
this is the first report being
0
filed for this calendar year,
only carry over the amounts
from Lines 2, 7, and 9 (if
„
any).
J
xpenditure Limit Summary for State
,andidates
22. Cumulative Expenditures Made*
(if Subject to Voluntary Expenditure Limit)
Date of Election Total to Date
(mm/dd/yy)
-Jl $
*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 D
SCHFr]III F In
.+ c.. y v1 L-nNe11U1Lu1 Wa MJIIUUIILb May ue rounoea
Statement covers period
Supporting/Opposing Other to whole dollars.
CALIFORNIA 460 '
Candidates, Measures and Committees
from April 24, 2016
FORM
SEE INSTRUCTIONS ON REVERSE
through May 23, 2016
Page 3 of 5
NAME OF FILER
I.D. NUMBER
San Rafael Firefighters Political Awarness Committee
891308
DATE
NAME OF CANDIDATE, OFFICE, AND DISTRICT, ORTYPE
OF PAYMENT
DESCRIPTION
AMOUNT THIS
CUMULATIVE TO DATE
PER ELECTION
MEASURE NUMBER OR LETTER AND JURISDICTION,
(IF REQUIRED.
CALENDAR YEAR
TO DATE
OR COMMITTEE
PERIOD
(JAN.1- DEC. 31)
(IF REQUIRED)
Committee to support San Rafael Libraries
Moneta
4/27/2016
Measure D
Contribut on
$500.00
$500.00
❑ Nonmonetary
Contribution
❑ Independent
0 Support ❑ Oppose
Expenditure
❑ Monetary
Contribution
❑ Nonmonetary
Contribution
❑ Independent
❑ Support ❑ Oppose
Expenditure
❑ Monetary
Contribution
❑ Nonmonetary
Contribution
❑ Independent
❑ Support ❑ Oppose
Expenditure
SUBTOTAL $
Schedule D Summary
1. Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.)....................................................... $ 5w-
2. Unitemized contributions and independent expenditures made this period of under $100.................................................................................... $
3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enter on the Summary Page.) .......... TOTAL.. $ 6
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule E
Payments Made
INSTRUCTIONS ON REVERSE
Amounts may be rounded
to whole dollars.
SCHEDULE E
Statement covers period
from April 24, 2016
through May 23, 2016 I Page 4 of 5
NAML UI- HLLK
I.D. NUMBER
San Rafael Firefighters Political Awarness Committee 1891308 7
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)
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CODE OR DESCRIPTION OF PAYMENT
AMOUNT PAID
Committee to support San Rafael Libraries -Yes on Measure D
PO BOX 150488, San Rafael Ca. 94915 FPIY_1 3& 3cbqCTB
500.00
* 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.) .........................
SUBTOTAL $
500
$ 0
............ $ 0
TOTAL $ 500
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule I Amounts may be rounded SCHEDULE I
Miscellaneous Increases to Cash to whole dollars.
SEE INSTRUCTIONS ON REVERSE
Statement covers period
from April 24, 2016
through May 23, 2016
• _ ,
�•1
• '
Page 5 of 5
NAME OF FILER
San Rafael Firefighters Political Awarness Committee
I.D. NUMBER
891308
DATE
RECEIVED
FULL NAME AND ADDRESS OF SOURCE
(IF COMMITTEE, ALSO ENTER I.D. NUMBER 1
DESCRIPTION OF RECEIPT
AMOUNT OF
INCREASE TO CASH
Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $
Schedule I Summary
1. Itemized increases to cash this period. 0
2. Unitemized increases to cash of under $100 this period. $ 0
3. Total of all interest received this period on loans made to others. Schedule H, Column (e).) $ 0
4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the
Summary Page, Line 14.) . TOTAL $ 0
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov