HomeMy WebLinkAboutForm 460- Yes on Measure D (2016-04-23) AmendmentRecipient Committee
Campaign Statement
Cover Page
SEE INSTRUCTIONS ON REVERSE
Statement covers period
from ____ 1_-_1_-2_0_1_6 __
4-23-2016 through ________ _
1. Type of Recipient Committee: All Committees -Complete Parts 1, 2, 3, and 4.
o Officeholder, Candidate Controlled Committee IZl Primarily Formed Ballot Measure
Committee o State Candidate Election Committee o Recall
(Aho Complet. Pet/5)
o General Purpose Committee o Sponsored o Small Contributor Committee o Political Party/Central Committee
3. Committee Information
COMMITIEE NAME (OR NAME
o Controlled o Sponsored
(Aho Complet. pet/ 5)
o Primarily Formed Candidate/
Officeholder Committee
(Aiso Complet. Pet/7)
I.D .NUMBER
1383895
Committee to Support San Rafael Libraries -Yes on Measure 0
STREET ADDRESS (NO P.O. BOX)
1000 4th Street, Ste . 600
CITY
San Rafael
STATE ZIP CODE
CA 94901
MAILING ADDRESS (IF DIFFEREND NO. AND STREET OR P.O. BOX
P.O. Box 150488
CITY
San Rafael
OPTIONAL: FAX I E-MAIL ADDRESS
4. Verification
STATE ZIP CODE
CA 94915
AREA CODEIPHONE
(
AREACODEIPHONE
(
MAY 24
Date of election If applicable:
(Month, Day, Year)
ClTY CLERK'S
6-7-2016
2. Type of Statement:
o Preelection Statement o Semi-annual Statement o Termination Statement
o Quarterly Statement o Special Odd-Year Report
(Also file a Form 410 Termination)
I;z] Amendment (Explain below)
Amended to include consultant contract obligations in Schedule F
Continuation & 1 st pg., and resulting changes in Summary page
Treasurer(s)
NAME OF TREASURER
Dirck W. Brinckerhoff
MAILING ADDRESS
CITY
San Rafael
NAME OF ASSISTANT TREASURER, IF ANY
Jeffrey Schappert
MAILING ADDRESS
1000 4th Street, Ste. 600
CITY
San Rafael
OPTIONAL: FAX I E-MAIL ADDRESS
STATE ZIP CODE AREA CODE/PHONE
CA 94903 (
STATE ZIP CODE AREA CODE/PHONE
CA 94901 (
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.
certify under penalty of pe~ury under the laws of the State of Califomia that the foregoing is tru:ijn c~rrect.
Executed on .tfia., Vi . l.JEJ I ~ By L ...
Date , Signature ofTreasurer or AssistantTreasurer
Executed on By
Date
Executed on By
Date
Executed on By
Date
Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Ofllcer of Sponsor
Signature of Controlling Ofllceholder. Candidate. State Measure Proponent
Signature of Controlling Ofllceholder. 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
Summary Page
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Committee to Support San Rafael Libraries -Yes on Measure D
Contributions Received
1. Monetary Contributions ................................................... Schedule A, Une 3
2. Loans Received ................................................................ Schedule B, Une 3
3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Unes 1 + 2
4. Nonmonetary Contributions............................................ Schedule C, Une 3
5. TOTAL CONTRIBUTIONS RECEIVED .................................... Add Unes 3 + 4
Expenditures Made
$
$
$
6. Payments Made................................................................ Schedule E, Une 4 $
7. Loans Made....................................................................... Schedule H, Une 3
8. SUBTOTAL CASH PAyMENTS .......................................... Add Unes 6 + 7 $
9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F. Une 3
10. Nonmonetary Adjustment... ...................................................... Schedule C, Une 3
11. TOTAL EXPENDITURES MAD E. ....................................... Add Unes 8 + 9 + 10 $
Current Cash Statement
12. Beginning Cash Balance ............................ Previous Summary Page, Une 16 $
13. Cash Receipts ........................................................... Column A, Une 3 above
14. Miscellaneous Increases to Cash .................................. Schedule I, Une 4
15. Cash Payments ......................................................... Column A, Une 8 above
16. ENDING CASH BALANCE .................. Add Unes 12 + 13 + 14, then subtract Une 15 $
If this is a termination statement, Une 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 Une 2 + Une 9 in Column B above $
Amounts may be rounded
to whole dollars.
ColumnA
TOTAL THIS PERIOO
(FROM ATTACHED SCHEDULES)
Statement covers period
from ___ 1_-_1_-2_0_1_6 __ _
4-23-2016 through _______ _
SUMMARY PAGE
CALIFORNIA 460
FORM
2 4 Page ___ of __ _
1.0. NUMBER
1383895
Column B Calendar Year Summary for Candidates
CALENOAR YEAR
TOTAL TO DATE Running in Both the State Primary and
General Elections 22,002.48 22,002.48
" $ 1/1 through 6/30 7/1 to Date 0
22,002.48
337.00
22,339.48
4,358.83
o
4,358.83
9,330.04
337.00
14,025.87
o
22,002.48
o
4,358.83
17,643.65
o
o
9,330.04
0
$ 22,002.48
337.00
$ 22,339.48
$ 4,358.83
o
$ 4,358.83
9,330.04
337.00
$ 14,025.87
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).
20. Contributions
Received $ $
21. Expenditures
Made $ $
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made"
(If Subject to Voluntary Expenditure Umltl
Date of Election
(mmlddlyy)
---..1---.1 __
Total to Date
$-----
$-----
"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 INSTRUCTIONS ON REVERSE
NAME OF FILER
Committee to Support San Rafael Libraries -Yes on Measure D
Amounts may be rounded
to whole dollars. Statement covers period
from ___ 1'---..:...1-..:;:2'-'-0_16 __ _
through __ 4-_2....;,.3_-2_0_1_6 __
SCHEDULE F
CALIFORNIA 460
FORM
Page __ 3_ of __ 4_
I.D. NUMBER
1383895
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)" pas postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor
LEG legal defense PRO professional services (legal . accounting) VaT voter registration
LIT campaign literature and mailings PRT print ads WEB information technology costs (intemet, e-mail)
NAME AND ADDRESS OF CREDITOR
(IF COMMITIEE. ALSO ENTER 1.0. NUMBER)
four waters media, inc.
3093 Lassen Street
West Sacramento, CA 95691
Subvendor: BreakPoint Sales $267.67 + $1,185 .37
741 Via Casitas
Greenbrae, CA 94904
PMCohen Public Affairs Subvendor: Political Data, Inc.
23 Chestnut Ave. 12501 Imperial Hwy., Ste. 200
San Rafael, CA 94901 Norwalk, CA 90650
" Payments that are contributions or Independent expenditures must also be
summarized on Schedule D.
Schedule F Summary
CODE OR
DESCRIPTION OF PAYMENT
LIT
printing
voter database
SUBTOTALS $
(a) (b) (e) (d)
OUTSTANDING AMOUNT INCURRED AMOUNT PAID OUTSTANDING
BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE
OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD
0 $2,558.04 0 $2,558.04
0 $1,800.00 0 $1,800.00
o $ 4,358.04 $ o $ 4,358.04
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.) ............................................. .lNCURRED TOTALS $ ___ 12....:.,_83_0_.0_4_
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 un itemized payments on accrued expenses under $100.) ................................... PAID TOTALS $ ___ 3..:.-,5_0_0_.0_0_
3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and
on the Summary Page, Column A, Line 9.) ................................................................................................................................................................................... NET $ 9,330.04
May be a negaUve number
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule F
(Continuation Sheet)
Accrued Expenses (Unpaid Bills)
NAME OF FILER
Committee to Support San Rafael Libraries -Yes on Measure 0
Amounts may be rounded
to whole dollars. Statement covers period
from ___ 1_-1_-_2_0_16 __ _
th h 4-23-2016 roug _______ _
SCHEDULE F {CO NT.)
CALIFORNIA 460
FORM
Page __ 4_ of __ 4_
I.D. NUMBER
1383895
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CMP
GNS
GTB
CVC
FIL
FND
IND
LEG
LIT
campaign paraphernalia/misc.
campaign consultants
contribution (explain nonmonetary)"
civic donations
candidate filing/ballot fees
fund raising events
independent expenditure supporting/opposing others (explain)"
legal defense
campaign literature and mailings
MBR
MTG
OFC
PET
PHO
POL
POS
PRO
PRT
member communications
meetings and appearances
office expenses
petition circulating
phone banks
polling and survey research
postage, delivery and messenger services
professional services (legal, accounting)
print ads
* Payments that are contributions or Independent expenditures must also be summarized on Schedule D.
(a)
NAME AND ADDRESS OF CREDITOR CODE OR OUTSTANDING
(IF COMMITTEE. ALSO ENTER 1.0. NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING
OF THIS PERIOD
four waters media, inc. LIT 3093 Lassen Street 0
West Sacramento, CA 95691
Subvendor: BreakPoint Sales $437.00 printing 741 Via Casitas
Greenbrae, CA 94904
four waters media, inc. CNS 3093 Lassen Street 4,000
West Sacramento, CA 95691
PMCohen Public Affairs
23 Chestnut Ave.
San Rafael, CA 94901
CNS 7,500
SUBTOTALS $ o $
RAD radio airtime and production costs
RFD returned contributions
SAL campaign workers' salaries
TEL t.v. or cable airtime and production costs
TRC candidate travel, lodging, and meals
TRS staff/spouse travel, lodging, and meals
TSF transfer between committees of the same candidate/sponsor
VOT voter registration
WEB information technology costs (internet, e-mail)
(b) (e) (d)
AMOUNT INCURRED AMOUNT PAID OUTSTANDING
THIS PERIOD THIS PERIOD BALANCE AT CLOSE
(ALSO REPORT ON E) OF THIS PERIOD
437.00 0 437.00
1,500 1,500 2,500
2,000 2,000 5,500
3,937.00 $ 3,500 $ 8,437.00
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov