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Form 460 - Yes on Measure E (2013-10-22) AmendmentRecipient Committee Campaign Statement CoverPage (Government Code Sections 84200-84216.5) Type or print in ink. Statement covers period from 9/27/2013 SEE INSTRUCTIONS ON REVERSE through 10/22/2013 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. ❑ Officeholder, Candidate Controlled Committee Ballot Measure Committee 0 State Candidate Election Committee (g Primarily Formed 0 Recall 0 Controlled (Also Compete Part 5) 0 Sponsored (Aft Complete Part 6) ❑ General Purpose Committee 0 Sponsored Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also complete Part 7) 3. Committee Information I.D.NUMBER 1 1359556 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Committee For A Safer San Rafael - Yes On Measure E STREET ADDRESS (NO P.O. BOX) 1000 4th Street Suite 600 Date of election if applicable: (Month, Day, Year) 11/5/2013 Page I Of 6 For Official Use Only 2. Type of Statement: ® Preelection Statement f --j Quarterly Statement f --j Semi-annual Statement E] Special Odd -Year Report ❑ Termination Statement E] Supplemental Preelection ® Amendment (Explain below) I Statement - Attach Form 495 Added additional information to an in kind contribution (Schedule -Q) Updated summary page to reflect changes. Fixed Sch. E & F Typos. Treasurer(s) NAME OF TREASURER Jeffrey Schoppert MAILING ADDRESS P.O. Box 150166 CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94901 415-456-4000 N CITY STATE ZIP CODE AREA CODE/PHONE AME OF ASSISTANT TREASURER, IF ANY San Rafael CA 94901 415-456-4000 Will LaBranche MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX MAILING ADDRESS P.O. Box 150166 CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE San Rafael CA 94903 415-456-4000 OPTIONAL: FAX I E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS 415-456-1921 - 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to th t Of mv knowle e the * fo 7 tion contained herein and in the attached schedules is true and complete. I I certify under penalty of perjury under the laws of the State of California that the fore in is t nd co FyP_t-_tjttz_dnn___,_____ _____,___,__12/20/2013 By Date Executed on Date Executed on Date F:I=-..� a U Signature of er or Assistant Treasurer By Signature of C;onb-offing Officettolder, Carddate, state measure Proponent or Responsible Officer of S By Signature of Ca*DI#N Officeholder, Candidate, State Measure Proponent By Signature of Controffing Officeholder, Candidate, State Measure Proponent FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC State of California r Recipient Committee Campaign Statement Cover Page --- Part 2 i i• i i i i i 61111 M Type or print in ink. 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: 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? p YES ❑ NO COMMITTEE ADDRESS 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 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 6. Ballot Measure Committee NAME OF BALLOT MEASURE Measure E BALLOT NO. OR LETTER JURISDICTION ® SUPPORT E City of Sari Rafael ❑ 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 Committee List names of officeholder(s) or candidate(s) for which this committee is primarily formed NAME OF OFFICEHOLDER OR CANDIDATE OFFICE S! !' ■ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHTOR HELD ■ SUPPORT OPPOSE NAME OFFICEHOLDER ORCANDIDATE i ! !' !i �..i. OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHTOR HELD 0 SUPPORT OPPOSE Attach continuation sheets if necessary FPPC Form 460 (June 01) FPPC Toll -Free Helpline: 866/ASI -FPPC State of Califf is Campaign Disclosure Statement Type or print in ink. Amounts may be rounded Summary Page to whole dollars. Statement covers period from 9/27/2013 Expenditures Made 6. Payments Made ....................................................... Schedule E, Line 4 $ 7. Loans Made ............................................................. Schedule H, Line 3 through 10/22/2013 Page 3 of 6 SEE INSTRUCTIONS ON REVERSE 10. Nonmonetary Adjustment .......................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 + 9 + 10 $ $ NAME OF FILER 5000.00 10000.00 Date of Election Total to Date 646.28 I.D. NUMBER Committee For A Safer San Rafael - Yes On Measure E 30791.36 $ 41497.36 $ 1359556 22562.00 Column Column B Calendar Year Summary for Candidates Contributions Received amounts in Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative TOTALTHISPERIOD CALENDAR YEAR Running in Both the State Primary and 10648.92 (FROM ATTACHED SCHEDULES) TOTALTO DATE General Elections 1, Monetary Contributions ........................................... Schedule A, Line 3 13250.00 $ $ 41500.00 the first report being filed 0 0 1/1 through 6/30 7/1 to Date 2. Loans Received ...................................................... Schedule B, Line 3 any). 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 + 2 $ 13250.00 $ 41500.00 20. Contributions Received $ $ 4. Nonmonetary Contributions.................................... Schedule C, Line 3 646.28 646.28 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 + 4 $ 13896.28 $ 42146.28 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 10000.00 FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC Expenditure Limit Summary for State 25145.08 $ 30851.08 Candidates 0 0 25145.08 30851.08 22. Cumulative Expenditures Made* $ (K Subject to Voluntary Expenditure Limit} 5000.00 10000.00 Date of Election Total to Date 646.28 646.28 (mm/dd/yy) 30791.36 $ 41497.36 $ 22562.00 To calculate Column B, add L $ 13250.00 amounts in Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative $ $ 0 25163.08 10648.92 figures that should be subtracted from previous period amounts. If this is $ the first report being filed 0 for this calendar year, only carry over the amounts from Lines 2, 7, and 9 if ( *Since January 1, 2001. Amounts in this section may be different from amounts reported in Column B. any). 10000.00 FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC moue may Be rou a Nonmonetarj/ Contributions Received to whole dollars. Statement covers period CALIFORNIA 460'� from 9/27/2013 FOR 10/22/2013 4 6 through Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Committee For A Safer San Rafael - Yes On Measure E 1359556 DATE FULL NAME, STREET ADDRESS AND CONTRIBUTOR !FAN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER DESCRIPTION OF AMOUNT/ FAIR MARKET CUMULATIVE TO DATE. PER ELECTION TO DATE RECEIVEDZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE * (IF SELF-EMPLOYED, ENTER GOODS OR SERVICES VALUE CALENDAR YEAR (.JAN 1 - DEC 31) (IF REQUIRED) NAME OF BUSINESS) 10109/13 Northern California Car enters � pIND ®COM Use of Phones; 500.32 1500.32 265 Hegenberger Road, Suite 200 ROTH to 1019 Oakland, CA 94621 ❑ PTY 10110 to 10119 10/10 #1219354 ❑SCC 10/20 to 11/6/13 10122113 Ga Phillips Gary � RJtND PCOM CPA Hosted Event 145.96 1145.96 999 5th. Avenue, Suite 320 DOTH DZH Phillips LLP San Rafael, California. 94901 R PTY [:]SCC ❑IND ROOM ❑ OTH ❑ PTY ❑ SCC ❑ IND QCOM ❑OTH ❑ PTY ❑ SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL $ 646.28 Schedule C Summary 1. Amount received this period — nonmonetary contributions of $100 or more. {Include all Schedule C Subtotals.}..................................................................................................................... $ 2. Amount received this period -- unitemized nonmonetary contributions of less than $100 .................................... $ 3. Total nonmonetary Contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Lines 4 and 10.) ..................... TOTAL $ *Contributor Codes •— Individua (otherCOM —Recipient Committee PTY — Political Party SCC — Small Contributor Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee For A Safer San Rafael - Yes On Measure E Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 9/27/2013 through 10/22/2013 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. Page 5 Of 6 I.D. NUMBER 1359556 CNP 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 U. 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 ND 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 V\EB 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 TBWB Strategies 400 Montgomery Street, Suite 700 San Francisco, CA 94104 CNS See Schedule G 25142.00 Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 25142.00 Schedule E Summary 1. Payments made this period of $100 or more. (Include all Schedule E subtotals.) .................................................................................................. $ 25,142.00 2. Uniternized payments made this period of under $100 .......................................................................................................................................... $ 21.08 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ............................................................................... $ 0 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ............................. TOTAL $ 25,163.08 FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 866/ASK-FPPC Schedule F Type or print in ink. Accrued Expenses (Unpaid Bills) Amounts may be rounded to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER Committee For A Safer San Rafael - Yes On Measure E Statement covers period from 9/27/2013 10/22/2013 001=11MM Page 6 Of 6 RM CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphemalia/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 ND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candid ate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads VVE13 information technology costs (intemet, e-mail) NAME AND ADDRESS OF CREDITOR CODEOR(a) 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 TBWB Strategies 400 Montgomery Street, Suite 700 CNS 5000 30142 25142 10000 San Francisco, CA 94104 1111111111111 1111111111112 Pill "a -wit =_1 1-7-TUTWillilio l let 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 $ 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 $ 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and 5000 on the Summary Page, Column A, Line 9.) ............................ ................................................................................................................... INET$ may 67e i negabve number FPPC Form 460 (June/01) FPPC Toll -Free Helpline: 8661ASK-FPPC