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Home My WebLink AboutForm 460 - Paramedic Services PAC (2017-12-31)Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from 7/1/2017 through 12131/2027 1. Type of Recipient Committee: All Committees -Complete Parts 1, 2, 3, and 4. 3. D Officeholder, Candidate Controlled Committee D Primarily Formed Ballot Measure Committee o State Candidate Election Committee o Recall (Also Comple/e Part 5) ~ General Purpose Committee o Sponsored ® Small Contributor Committee o Political Party/Central Committee ® Controlled o Sponsored (Also Complete Part 6) D Primarily Formed Candidate/ Officeholder Committee (A/so Complete Part 7) I.D.NUMBER 1075199 Committee for San Rafael Paramendic Services ST REET ADDRESS (NO P.O. BOX) CITY San Rafael STATE ZIP CODE CA 94903 MAILING ADDRESS (IF DIFFERENT) NO. AND STR~rtORP.O. BOX CITY STATE ZIP CODE OPTIONAL: FAX I E-MAIL ADDRESS AREA CODE/PHONE AREA CODE/PHONE 4. Verification Date of election If appllcai:le: (Month, Day, Year) 2. Type of Statement: D Preelection Statement Ii2I Semi-annual Statement D Termination Statement (Also file a Form 410 Termination) D Amendment (Explain below) Treasurer(s) NAME OF TREASURER Greg Knell MAILING ADDRESS Same CITY NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY OPTIONAL: FAX I E-MAIL ADDRESS For Official Use Only D Quarterly Statement D Special Odd-Year Report STATE ZIP CODE AREA CODE/PHONE STATE ZIP CODE AREA CODEIPHONE I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowled certify under penalty of pe~ury under the laws of the State of California that the foregoing is true and corre herein and in the attached schedules is true and complete. I Executed on 1/26/2018 Date Executed on Date Executed on Date Executed on Date By By By By Signature of Controlling Ci/ficeh9l6er, candidate, SiSte Measure ProponenTorResponslble Officer of Sponsor Signature of Controlling Officeholder, Candidate, State Measure Proponent Signature of Controlling Officeholder, Candidate, Stete MeasureProponent FPPC Form 460 (Jan/2016) FPPC Advice: advicelli>foDc.ca.l!ov 1866/275-37721 Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Contributions Received 1. Monetary Contributions.... ............... ............ ............... ..... Schedule A, Line 3 2. Loans Received................. ............ ....... ............................ Schedule S, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 + 2 4. Nonmonetary Contributions............................................ Schedule C, Line 3 $ $ 5. TOTAL CONTRIBUTIONS RECEIVED ................................... .Add Lines 3 + 4 $ 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 I, Line 4 15. Cash Payments ......................................................... Column A, Line 8 above 16. ENDING CASH BALANCE .................. Add Lines 12 + 13 + 14, then subtrect Line 15 $ If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule S, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column S above $ Amounts may be rounded to whole dollars. ColumnA TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) 5202.58 .48 5153.06 o o o SUMMARY PAGE Statement covers period CALIFORNIA 460 FORM f 7/1/2017 rom ________ _ through 12/31/2027 2 4 Page of __ _ $ $ $ ColumnS CALENDAR YEAR TOTAL TO DATE o o o o o $ 50,00 o $ o o o $ 50.00 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 Unes 2,7, and 9 (if any). I.D. NUMBER 1075199 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 111 through 6130 711 to Date 20. Contributions Received $ _____ _ $---- 21. Expenditures Made $ ____ _ $---- Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (H Subject to Voluntary Expenditure Limit) Date of Election (mm/dd/yy) I Total to Date $---- $---- • Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/20i6) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov ScheduleA Amounts may be rounded to whole dollars. SCHEDULE A Statement covers period Monetary Contributions Received from 7/1/2017 CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE through 12131/2027 Page 3 of 4 NAME OF FILER DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR I CONTRIBUTOR (IF COMMITTEE . ALSO ENTER I,D. NUMBER) CODE 11 DIND DCOM DOTH DpTY Dscc DIND DCOM DOTH DpTY Dscc DIND o COM DOTH DpTY Dscc DIND o COM DOTH DpTY Dscc DIND DCOM DOTH DpTY Dscc Schedule A Summary IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) SUBTOTAL $ AMOUNT RECEIVED THIS PERIOD 1. Amount received this period -itemized monetary contributions. 0 (Include all Schedule A subtotals.) ......................................................................................................... $ _____ _ 2. Amount received this period -unitemized monetary contributions of less than $100 ........................... $ 0 3. Total monetary contributions rece ived this period. 0 (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.} ...................... TOTAL $ _____ _ 1.0. NUMBER 1075199 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 • DEC. 31) PER ELECTION TO DATE ·Contributor Codes IND -Individual (IF REQUIRED) 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/20I6) FPPC Advice: advice@fppc.ca.gov (866/275-3772) ,.nana, Inn," "'!I an" SCHEDULE E Schedule E Payments Made Amounts may be rounded to whole dollars. Statement covers period from 7/1/2017 CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE through 12131/2027 Page _4 __ of_4 __ NAME OF FILER 1.0. NUMBER 1075199 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 tundralsing 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 1.0. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAlO Secretary of State Annual Fee 50.00 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 50.00 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) ............................................................................................................. $ 50.00 2. Unitemized payments made this period of under $100 .......................................................................................................................................... $ 0 3. Total interest paid this period on loans. (Enter amount from Schedule S, 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 $ 50.00 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov