HomeMy WebLinkAboutForm 460- Yes on Measure D (2016-05-21)Recipient Committee
Campaign Statement
Cover Page
Statement covers period Date of election If applicable:
(Month, Day, Year)
MAY 26
from ____ 4_-2_4_-2_0_1_6 __
CITY CLERK'S
SEE INSTRUCTIONS ON REVERSE 5-21-2016 through ________ _
1. Type of Recipient Committee: All Committees -Complete Parts 1, 2, 3, and 4.
o Officeholder, Candidate Controlled Committee III Primarily Formed Ballot Measure
Committee o State Candidate Election Committee o Recall
(Also Complete P1W/5)
o General Purpose Committee o Sponsored o Small Contributor Committee o Political Party/Central Committee
3. Committee Information
NAME (OR
o Controlled o Sponsored
(Also Complete P1W/6)
o Primarily Formed Candidate/
Officeholder Committee
(Also Complete PIW/ 7)
I.D. NUMBER
1383895
Committee to Support San Rafael Libraries -Yes on Measure D
STREET ADDRESS (NO P.O. BOX)
1000 4th Street, Stet 600
CITY
San Rafael
STATE ZIP CODE
CA 94901
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
P.O. Box 150488
CITY
San Rafael
OPTIONAL: FAX I E·MAlL ADDRESS
4. Verification
STATE ZIP CODE
CA 94915
AREA CO DElPH ONE
(
AREA CODEIPHONE
(
6-7-2016
2. Type of Statement:
o Preelection Statement o Semi·annual Statement o Termination Statement
(Also file a Form 410 Termination)
o Amendment (Explain below)
Treasurer(s)
NAME OF TREASURER
Dirck W. Brinckerhoff
MAILING AODRESS
CITY
San Rafael
NAME OF ASSISTANT TREASURER. IF ANY
Jeffrey Schoppert
MAILING AODRESS
CITY
San Rafael
DPTIONAL: FAX I E-MAILAODRESS
~ Quarterly Statement o Special Odd-Year Report
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 perjury under the laws of the State of Califomia that the foregoing is true and correct !:llr-I,-_t_-______ -_
Executed on maL t 2~ "2,.,i::I (" BY _______ ~_......;,!JL="'~===::=====:_--------I Date / Signature of Treasurer or Assistant Treasurer
Executed on -----...,O""a"'te------
Executed on -----...,O""a"'te------
Executed on -----'O'::a::::te------
By -";:"Si~gn~at::-::ur::-e ~of~Co==n:::tm:mlli==ng:-;:O;;:;ffi==ce.::ho:;:ld;:::e'...,. C;:"an:::d""'ida:::te=-. S""ta:::te:OM:;:e::::as::::ure=Pm=p~on==e:::nt-:::or:;;R;:::es=po==n=-sib:;:le:-;:O;;:;ffi;::ce=-r oJf"'Spo=n==s=or-
By-----~Si~gn~aw::-::re::-o~f~Co==n:::~:mllin==g:-;:O;;:;ffi=ce.::ho:;:ld;:::e'...,.C;:"an:::d""'lda:::te=-.S""ta:::te:OM:;:e::::as::::ur=eD.pm=p=on==e:::nt-----
By-----...,S~ig~na~W~re-o~fC~o~n~~lIin==g~O~ffi==ce~ho~ld"'e'~.C~a::-nd~ld"'at~e,~S~ta"'ta~M~ea==s==ure~P~m==p::-on==e:::nt------
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
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
RESIDENTIAUBUSINESS ADDRESS (NO . AND STREET) CITY STATE ZIP
Related Committees Not Included in this Statement: Ustanycommittees
not included in this statement that are controlled by you or are primarily formed to receive
contributions or make expenditures on behaff of your candidacy.
COMMITTEE NAME 1.0. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
DYES
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COMMITTEE NAME 1.0. NUMBER
NAME OF TREASURER CONTROLLED COMMITTEE?
DYES o NO
COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIP CODE AREA CODE/PHONE
COVER PAGE -PART 2
~111!1!!!11~
6. Primarily Formed Ballot Measure Committee
NAME OF BALLOT MEASURE
San Rafael Special Library Services Parcel Tax Measure D
BALLOT NO. OR LETTER
D
JURISDICTION
City of San Rafael
III SUPPORT o 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 Ust names of
officeholder(s) or candidate(s) for which this committee is primarily formed.
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o OPPOSE
NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD o SUPPORT o 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
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 MADE. ....................................... AddUnes8+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 tennination 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 PERIOD
(FROM ATIACHEO SCHEDULES)
19,125.00
0
19,125.00
44.88
19,169.88
18,141.47
o
18,141.47
(7,849.28)
44.88
10.337.07
17,643.65
19,125.00
o
18,141.47
18,627.18
o
o
4,980.76
SUMMARY PAGE
Statement covers period CALIFORNIA 460
from ___ 4_-2_4_-_20_1_6 __ _ I FORM
5-21-2016 through _______ _ Page __ 3_ of L S"
Column B
CALENDAR YEAR
TOTAL TO DATE
$ 41,127.48
0
$ 41,127.48
381.88
$ 41,509.36
$ 22,500.30
o
$ 22,500.30
4,980.76
381.88
$ 27,862.94
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).
1.0. NUMBER
1383895
Calendar Year Summary for Candidates
Running in Both the State Primary and
General Elections
111 through 6/30 7/1 to Date
20. Contributions
Received $ $
21. Expenditures
Made $ $
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made"
(If Subject tD VDlunlary Expenditure Urnlt)
Date of Election
(mm/dd/yy)
~----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 A
Monetary Contributions Received
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Committee to Support San Rafael Libraries -Yes on Measure D
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR
(IF COMMITTEE. ALSO ENTER 1.0. NUMBER) CODE *
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYEO. ENTER NAME
OF BUSINESS)
See attached continuation sheets
Schedule A Summary
DIND
DCOM
DOTH
DpTY
Dscc
DIND
DCOM
DOTH
DpTY
Dscc
DIND
DCOM
DOTH
DpTY
Dscc
DIND
DCOM
DOTH
DpTY
Dscc
DIND
DCOM
DOTH
DpTY
Dscc
SUBTOTAL $
SCHEDULE A
Statement covers period
from ___ 4_-2_4_-_2_0_16 __ _
CALIFORNIA 460
FORM
through ___ 5_-2_1_-2_0_1_6 __ Page __ 4 __ of I~
AMOUNT
RECEIVED THIS
PERIOD
°
I.D. NUMBER
1383895
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
·Contributor Codes
IND -Individual
PER ELECTION
TO DATE
(IF REQUIRED)
1. Amount received this period -itemized monetary contributions.
(Include all Schedule A subtotals.) .......................................................... _ .............................................. $ ___ 1_8:.....,8_75_._00_ COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g .• business entity)
PTY -Political Party 2. Amount received this period -unitemized monetary contributions of less than $100 ........................... $ _____ 2_5_0._0_0
3. Total monetary contributions received this period.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ...................... TOTAL $ ___ 1_9:.....,1_2_5._0_0
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)
Monetary Contributions Received
Name of Filer
Committee to Support San Rafael Libraries -Yes on Measure D
Date Contrib
Received Full Name, Street Address and Zip Code Code
Albert J. Boro
4/27/2016 IND
San Rafael CA 94901
Marin Professional Firefighters Political
4/28/2016 Action Committee COM 22 Hop Ranch ct.
Santa Rosa CA 95403
San Rafael Firefighters PAC.
4/28/2016 1532 Mathias Place COM
Rohnert Park CA 94928
McCullough for City Council 2015
4/30/2016 COM
San Rafael CA 94901
Gary T. Ragghianti
5/1/2016 IND
San Rafael CA 94901
San Rafael Public Library Foundatiuon
51212016 1000 4th St. Ste. 600 OTH
San Rafael CA 94901
CPI (Cal-Pox Inc.)
51212016 103 Shoreline Pkwy. #100 OTH
San Rafael CA 94901
Damon Connolly for Supervisor 2014
5/4/2016 COM
San Rafael CA 94903
Barbara Heller
5/4/2016 IND
San Rafael CA 94903
Occupation and Employeer
Retired
ID #930791
ID #891308
Attorney
Self
County Supervisor
Marin County ID #1361168
Retired
Statement covers period
From: 4-24-2016
To: 5-21-2016
Amt Rcvd this
Period
$ 100.00
$ 500.00
$ 500.00
$ 2,500.00
$ 200.00
$ 5,000.00
$ 500.00
$ 250.00
$ 200.00
SUBTOTAL $ 9,750.00
Schedule A
California 460 Form
Page ~of '" 1.0. Number
1383895
Cumulatto Per Electn
Date to Date
$ 100.00
$ 500.00
$ 500.00
$ 2,500.00
$ 200.00
$ 5,000.00
$ 500.00
$ 250.00
$ 200.00
Schedule A (Continuation Sheet)
Monetary Contributions Received
Name of Filer
Committee to Support San Rafael Libraries -Yes on Measure D
Date Contrib
Received Full Name. Street Address and Zip Code Code
Pamela J. Nicolai
5/5/2016 IND
San Rafael CA 94903
Deborah Breiner Grund
5/8/2016 IND
San Rafael CA 94901
Resource Conservation PAC
5/9/2016 COM
San Rafael CA 94901
Gary Giacomini
5/11/2016 IND
Larkspur CA 94939
Virginia Mardesich
5/11/2016 IND
San Rafael CA 94901
Paul G. Sloan
5/11/2016 IND
San Rafael CA 94901
Diane angara
5/11/2016 . IND
San Rafael CA 94901
Alastair F. Cumming
5/11/2016 IND
San Rafael CA 94901
Service Employees International Union Local
5/12/2016 COM
555 Captol Mall . Ste . 1425
Schedule A
California 460 Form
Statement covers period
From : 4-24-2016
To: 5-21-2016
Page ...i!.... of ( ~
1.0. Number
1383895
Amt Rcvd this Cumulat to PerElectn
Occupation and Employeer Period Date to Date
Retired $ 200.00 $ 200.00
Attorney $ 100.00 $ 100.00 Self
ID #1347886 $ 350.00 $ 350 .00
Attorney $ 100.00 $ 100.00 Hanson Bridgett LLP
Retired $ 100.00 $ 100.00
Retired $ 100.00 $ 100.00
Retired $ 100.00 $ 100 .00
Vice President
Bill Moore & Associates $ 100.00 $ 100.00
ID #1296947 $ 5,000.00 $ 5,000 .00
SUBTOTAL $ 6 ,150.00
Schedule A (Continuation Sheet)
Monetary Contributions Received
Name of Filer
Committee to Support San Rafael Libraries -Yes on Measure D
Date Contrib
Received Full Name, Street Address and Zip Code Code
Daniel C. Dufficy
5/1212016 IND
San Rafael CA 94901
Jack Krystal
5/15/2016 IND
San Rafael CA 94901
Patricia Kendall
5/15/2016 IND
San Rafael CA 94903
Donald E. Leisey
5/16/2016 IND
San Rafael CA 94901
Joseph M. O'Hehir
5/19/2016 IND
San Rafael CA 94901
Gary O. Phillips
5/20/2016 IND
San Rafael CA 94901
San Rafael Police Association Political
5/2112016 Action Fund COM
San Rafael CA 94901
Occupation and Employeer
Insurance Broker
Marin Pacific Company, Inc.
Businessman
Diversified Realty & Services
Medical Group Administrator
Kaiser Permanente
Retired
CEO
WhistleStop
Mayor
City of San Rafael
ID #831553
Statement covers period
From : 4-24-2016
To : 5-21-2016
Amt Rcvd this
Period
$ 100.00
$ 225.00
$ 250.00
$ 100.00
$ 100.00
$ 1,200.00
$ 1,000.00
SUBTOTAL $ 2,975.00
Schedule A
California 460 Form
Page lof I~
1.0 . Number
1383895
Cumulat to Per Electn
Date to Date
$ 100.00
$ 225 .00
$ 250.00
$ 100.00
$ 100.00
$ 1,200.00
$ 1,000.00
Schedule C
Nonmonetary Contributions Received
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Amounts may be rounded
to whole dollars.
Committee to Support San Rafael Libraries -Yes on Measure D
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND
ZIP CODE OF CONTRIBUTOR
(IF COMMITIEE, ALSO ENTER 1.0. NUMBER)
IF AN INDIVIDUAL, ENTER
CONTRIBUTOR OCCUPATION AND EMPLOYER
CODE *
DIND
DCOM
DOTH
DPTY
Dscc
DIND
DCOM
DOTH
DpTY
DSCC
DIND
DCOM
DOTH
DpTY
DSCC
DIND
DCOM
DOTH
DpTY
DScc
(IF SELF-EMPLOYEO, ENTER
NAME OF BUSINESS)
Attach additional information on appropriately labeled continuation sheets.
Schedule C Summary
SCHEDULEC
Statement covers period CALIFORNIA 460
FORM from __ ....:4...,:-2=-4.:....-=2.::.0..:..;16=--__
through _----=-5--=2:...:1--=-2::..:0:....:1-=6~_ page __ i_ of~
DESCRIPTION OF
GOODS OR SERVICES
SUBTOTAL $
AMOUNTI
FAIR MARKET
VALUE
1.0. NUMBER
1383895
CUMULATIVE TO
DATE
CALENDAR YEAR
(JAN 1 -DEC 31)
'Contributor Codes
IND -Individual
PER ELECTION
TO DATE
(IF REQUIRED)
1. Amount received this period -itemized nonmonetary contributions.
(Include all Schedule C subtotals.) ...................................................................................................................... $ ____ --=0_ COM -Recipient Committee
(other than PTY or SCC)
OTH -Other (e.g., business entity)
PTY -Political Party
2. Amount received this period -unitemized nonmonetary contributions of less than $100 .................................. $ ____ 4.:....4.:..: . .::.88=--_
3. Total nonmonetary contributions received this period. SCC -Small Contributor Committee
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ..................... TOTAL $ ____ 4.:.,4:.:,.8=-:8=__
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
Amounts may be rounded
to whole dollars.
Committee to Support San Rafael Libraries -Yes on Measure D
Statement covers period
from __ 4_-_2_4_-2_0_1_6 __
5-21-2016 through _______ _
SCHEDULEE
CALIFORNIA 460
FORM
page~of~
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
CNS
CTB
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
NAME AND ADDRESS OF PAYEE
(IF COMMITIEE. ALSO ENTER 1.0. NUMBER)
PMCohen Public Affairs
23 Chestnut Ave.
San Rafael, CA 94901
four waters media, inc.
3093 Lassen Street
West Sacramento, CA 95691
PMCohen Public Affairs
23 Chestnut Ave.
San Rafael, CA 94901
MBR
MTG
OFC
PET
PHO
POL
pas
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
CODE OR
CNS
CNS
CNS
* Payments that are contributions or independent expenditures must also be summarized on Schedule D.
Schedule E Summary
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
VaT voter registration
WEB information technology costs (intemet, e-mail)
DESCRIPTION OF PAYMENT AMOUNT PAID
2,500.00
1,000.00
1,800.00
SUBTOTAL $ 5,300.00
1. Itemized payments made this period. (Include all Schedule E subtotals.) ............................................................................................................. $ ___ 1_8_,1_3_7_.2_7_
2. Unitemized payments made this period of under $100 .......................................................................................................................................... $ _____ 4_.2_0_
o 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.) ........................... TOTAL $ ___ 1_8_,1_4_1_.4_7_
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule E
(Continuation Sheet)
Payments Made
SEE INSTRucnONS ON REVERSE
NAME OF FILER
Amounts may be rounded
to whole dollars.
Committee to Support San Rafael Libraries -Yes on Measure 0
Statement covers period
4-24-2016 from ________ _
through __ 5_-_2_1-_2_0_16 __
SCHEDULE E (CONT.)
CALIFORNIA 460
FORM
Page~ of~
I.D. NUMBER
1383895
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
campaign paraphernalia/misc.
campaign consultants
contribution (explain nonmonetary)·
civic donations
candidate filing/ballot fees
fund raising events
CMP
CNS
CTB
CVC
FIL
FND
IND
LEG
LIT
independent expenditure supporting/opposing others (explain)·
legal defense
campaign literature and mailings
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE. ALSO ENTER I.D. NUMBER)
four waters media , inc.
3093 Lassen Street
West Sacramento, CA 95691
four waters media, inc. Subvendor: BreakPoint Sales
3093 Lassen Street 741 Via Casitas
MBR
MTG
OFC
PET
PHO
POL
P~S
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
CODE OR
LIT
$267.67
LIT
West Sacramento, CA 95691 Greenbrae, CA 94904
four waters media, inc. Subvendor: BreakPoint Sales $1,185.37
3093 Lassen Street 741 Via Casitas LIT
West Sacramento, CA 95691 Greenbrae, CA 94904
four waters media, inc. Subvendor: BreakPoint Sales $741 .63
3093 Lassen Street 741 Via Casitas LIT
West Sacramento, CA 95691 Greenbrae, CA 94904
four waters media, inc. Subvendor: BreakPoint Sales $745.63
3093 Lassen Street 741 Via Casitas LIT
West Sacramento, CA 95691 Greenbrae, CA 94904
* Payments that are contributions or independent expenditures must also be summarized on Schedule D.
RAD
RFD
SAL
TEL
TRC
TRS
TSF
VOT
WEB
radio airtime and production costs
returned contributions
campaign workers' salaries
t.v. or cable airtime and production costs
candidate travel, lodging, and meals
staff/spouse travel, lodging , and meals
transfer between committees of the same candidate/sponsor
voter registration
information technology costs (internet, e-mail)
DESCRIPTION OF PAYMENT AMOUNT PAID
437.00
342.67
2,215.37
741 .63
1,000.63
SUBTOTAL $ 4,737.30
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule E
(Continuation Sheet)
Payments Made
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Amounts may be rounded
to whole dollars.
Committee to Support San Rafael Libraries -Yes on Measure D
Statement covers period
from __ 4_-_2_4_-2_0_1_6 __ _
through __ 5_-_21_-_2_0_16 __
SCHEDULE E (CONT.)
CALIFORNIA 460
FORM
Page_JJ _ of~
1.0. NUMBER
1383895
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CMP
CNS
CTB
CVC
FIL
FND
IND
LEG
LIT
campaign paraphemalia/misc.
campaign consultants
contribution (explain nonmonetary)"
civic donations
candidate filinglbaiiot fees
fund raising events
independent expenditure supporting/opposing others (explain)"
legal defense
campaign literature and mailings
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE. ALSO ENTER I.D. NUMBER)
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
CODE OR
RAD radio airtime and production costs
RFD retumed 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 (intemet, e-mail)
DESCRIPTION OF PAYMENT AMOUNT PAID
four waters media, inc. Subvendor: Doteasy Technology, Inc. $300.00 https:/Iwww.facebook.com/SupportSanRafaeILibrarie
3093 Lassen Street 3602 Gilmore Wy. #210 WEB
West Sacramento, CA 95691 Burnaby, BC , Canada V5G 4W9
MarkSYS
3725 Cincinnati Ave., #200 POS
Rocklin, CA 95765
U.S. Postal Service
16757th Street POS
Oakland, CA 94615-0001
U.S. Postal Service
1675 7th Street POS
Oakland, CA 94615-0001
four waters media, inc. Subvendor: Cornerstone Printing, Inc. $962.49
3093 Lassen Street 50 Francisco St. #245 CMP
West Sacramento, CA 95691 San Francisco, CA 94133
* Payments that are contributions or independent expenditures must also be summarized on Schedule D.
s
Signs
300.00
2,190.63
1,622.19
1,880.65
1 ,212.50
SUBTOTAL $ 7 ,205.97
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Schedule E
(Continuation Sheet)
Payments Made
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Amounts may be rounded
to whole dollars.
Committee to Support San Rafael Libraries -Yes on Measure D
Statement covers period
from __ 4_-_24_-_2_0_16 __ _
through __ 5_-_2_1_-2_0_1_6 __
SCHEDULE E (CONT.)
CALIFORNIA 460
FORM
Page~ of~
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
CNS
CTB
CVC
FIL
FND
IND
LEG
LIT
campaign paraphemalia/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
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE. ALSO ENTER 1.0. NUMBER)
MBR
MTG
OFC
PET
PHO
POL
pas
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
CODE OR
four waters media, inc. Subvendor: Shervin Shah nazi $125.00
3093 Lassen Street 74 Glen Dr. CNS
West Sacramento , CA 95691 Sausalito, CA 94965
four waters media, inc. Subvendor: Shervin Shahnazi $105.94
3093 Lassen Street 74 Glen Dr. OFC
West Sacramento, CA 95691 Sausalito, CA 94965
four waters media, inc. Subvendor: Nate Ostiller $375
3093 Lassen Street 425 the Alameda CNS
West Sacramento, CA 95691 San Anselmo, CA 94960
four waters med ia, inc. Subvendor: Nate Ostiller $288.06
3093 Lassen Street 425 the Alameda OFC
West Sacramento, CA 95691 San Anselmo, CA 94960
• Payments that are contributions or independent expenditures must also be summarized on Schedule D.
RAD radio airtime and production costs
RFD retumed 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
VaT voter registration
WEB information technology costs (intemet, e-mail)
DESCRIPTION OF PAYMENT AMOUNT PAID
125.00
105.94
375.00
288.06
SUBTOTAL $ 894.00
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
SCHEOULEF
Schedule F
Accrued Expenses (Unpaid Bills)
Amounts may be rounded
to whole dollars. Statement covers period
from ___ 4,--2=.4_-_2_0_1...;..6 __
CALIFORNIA 460
FORM
SEE INSTRUCTIONS ON REVERSE
through __ 5-_2_1_-2_0_1_6 __ Page~ of~
NAME OF FILER I.D. NUMBER
Committee to Support San Rafael Libraries -Yes on Measure D 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
FNO fund raising events POL polling and survey research TRS staff/spouse travel, lodging, and meals
INO 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 CREDITOR CODE OR
(a) (b) (e) (d)
OUTSTANDING AMOUNT INCURRED AMOUNT PAID OUTSTANDING
(IF COMMITIEE. ALSO ENTER 1.0 . NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE
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
OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD
LIT $2,558.04 0 $2,558.04 0
printing
voter database $1,800.00 0 $1,800 .00 0
SUBTOTALS $ 4,358.04 $ o $ 4,358.04 $ 0.00
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 $1 00.) ............................................. .lNCURRED TOTALS $ ____ 4_4_5_.7_6_
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 $ ___ 8-,-,2_9_5_.04_
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 $ (7,849.28)
May be a negative 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 D
Amounts may be rounded
to whole dollars. Statement covers period
from __ 4_-2_4_-_2_0_16 __ _
through __ 5-_2_1_-2_0_1_6 __
SCHEDULE F (CO NT.)
CALIFORNIA 460
FORM
Page ~ of'':-
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
CNS
CTB
CVC
FIL
FND
IND
LEG
LIT
campaign paraphernalia/misc.
campaign consuHants
contribution (explain nonmonetary)"
civic donations
candidate filing/ballot fees
fundraising 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 437.00
West Sacramento, CA 95691
Subvendor: BreakPoint Sales $437.00 printing 741 Via Casitas
Greenbrae, CA 94904
four waters media, inc.
CNS 3093 lassen Street 2,500.00
West Sacramento, CA 95691
PMCohen Public Affairs
23 Chestnut Ave. CNS 5,500.00
San Rafael, CA 94901
SUBTOTALS $ 8,437.00 $
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
0 437.00 0
0.00 1,000.00 1,500.00
0.00 2,500.00 3,000.00
0.00 $ 3,937.00 $ 4,500.00
FPPC Form 460 (Jan/20i6)
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 D
Amounts may be rounded
to whole dollars. Statement covers period
from __ 4_-_24_-_2_0_16 __ _
through __ 5_-_2_1_-2_0_1_6 __
SCHEDULE F (CO NT.)
CALIFORNIA 460
FORM
page~ of~
1.0. NUMBER
1383895
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
CMP
CNS
CTB
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.
NAME AND ADDRESS OF CREDITOR CODE OR
(a)
OUTSTANDING
(IF COMMITIEE. ALSO ENTER 1.0. NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING
OF THIS PERIOD
PMCohen Public Affairs WEB 23 Chestnut Ave. 0
San Rafael, CA 94901
Subvendor: Facebook $384.40
1601 Willow Road
Menlo Park, CA 94025
Subvendor: Gateway Media, Inc. $ 61.36
2150 River Plaza Dr., Ste. 150
Sacramento, CA 95833
SUBTOTALS $ $
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
445.76 0 445.76
445.76 $ $ 445.76
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov