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Home My WebLink AboutForm 460 - Police Association PAC (2016-12-31)Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216 .5) SEE INSTRUCTIONS ON REVERSE S ta teme nt covers peri od from 09/25/2016 throug h _..:1;.::2:.!../.::.3.::.1:.../2:;,;0:.,;1:.,;6:...-__ _ 1. Type of Recipient Committee: All Committees -Complete Parts 1, 2, 3, and 4. o Officeholder, Candidale Controlled Committee o State Candida Ie Election Committee o Recall (Also CompJelB Pari 5) I]J General Purpose Committee ® Sponsored o Small Contributor Committee o Political Party/Central Committee 3. Committee Information o Primarily Formed Ballot Measure Committee o Controlled o Sponsored (Also CompJol<> Pa116) o Primarily Formed Candidatel Officeholder Committee (Al$o ~B Perl 7) 1.0 . NUMBER 831553 COMMlnEE NAME (OR CANOIOATE·S NAME IF NO COMMITIEE) San Rafael Police Association Political Action Comm~ttee STREET ADDRESS (NO P.O. SOX) 1520 Fifth Avenue CITY STATE ZIP CODE San Rafael CA 94901 MAILING ADORESS (IF DIFFERENT) NO. AND STREET OR P.O BOX P .O . Box 151557 CITY STATE ZIP CODE San Rafael CA 94915 -1557 OPTIONAL: FAX / E·MAlL AODRESS 4 . Verification AREA COOE/PHONE (415)485-)000 AREA CODE/PHONE Date o f election if appl (Month. Day, Year) JAN 2 0 2017 2. Type of Statement: o Preelection Statement 00 Semi-annual Statement o Termination Statement (Also file a Form 410 Termination) o Amendment (Explain below) Treasurer(s) NAME OF TREASURER MS. Bel:h Minka MAILING AOORESS 1520 F1fth Avenue CITY STATE San Rafael CA NAME OF ASSISTANT TREASURER. IF ANY Ms. Stacy E. Owens MAILING AOORESS 5940 College Avenue CITY Oakland OPTIONAL: FAX I E-MAIL ADDRESS STATE CA of 112 o Quarterly Slatement o Special Odd-Year Report o Supplemental Preelection Statement -Attach Form 495 ZIP CODE 94 901 Z IP CODe 94618 AREA CODE/PHONE (415)485 -3000 AREA CODE/PHONE (510)652-1000 I have used aI/ reasonable diligence in preparing and reviewing this statement ond to the best of my knowl under penalty of pe~ury under the laws of the State of California thaI the foregoing is true and correct . d herein and in the attached schedules is true end complete . I certify Executed on 01/17 /20 17 Date Executed on 01/17/2017 Date Exeruled on Dote Executed on o.ne By ____________ ~~~~~~~~~~~~~~~~~~------------S4gn<tluJe 01 ConlJoi ing Ofl\ceholCIN. Candidate. Slate Measur" Proponenl By------------~~~~~~w=~~~~~~~~~~~-----------S4gnalurt'01 CoObtliing Offoccl1c1~"'. Caildidate. Sial" Measure Pro ponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca .gov (866/275-3772) ._-_ . "'"--- --.. - 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) RESIDENTIALIBUSINESS ADDRESS (NO . AND STREET) CITY STATE ZIP Related Committees Not Included in this Statement: Lin any committees not included in this stlltement /hat are controlled by you or are primarily formed to racelve contributions or make eJtpenditures on behllif 01 your candidacy. COMMITIEE NAME 1.0. NUMBER NAME OF TREASURER CONTROLLED COMMITIEE? DYES 0 NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O . BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMIlTEE NAME 1.0 . NUM BER NAME OF TREASURER CONTROLLED COMMmEE? DYES O NO COMMITIEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COVER PAGE -PART 2 -~ 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BAlLOT NO. OR LETTER JURISDICTION o SUPPO RT o OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, jf any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD I DISTRICT NO . IF AN' 7. Primarily Formed Candidate/Officeholder Committee List names o( officeholder(s) or c:mdidate(s) lor which this committee Is prImarily form~. 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 CAN DIDAT E O FFICE 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 Fo"" 460 (Jan/2016) FPPC Advice : advice@fppc.ca,gov (866/275-3772) ______ c o. ___ _ SUMMARY PAGE Campaign Disclosure Statement Summary Page Amounts may be rounded to whole dollars. Statement covers period CALIFORNIA 460 FORM seE INSTRUCTIONS ON REVERSE NAME OF FILER San Rafael Police ASsociation Political Action committee ColumnA TOTAL 111 IS J>£RIOO Contributions Received (FROM AnACt1EDSCHEOULES) 1. Monetary Contributions ............ ...................... ......... Schedule A. Lme 3 S 8,429.20 2. Loans Received ...................................................... Schedule B. Une 3 0 .00 3. SUBTOTAL CASH CONTRI BUTIONS ....... ............. ..... Add Lines 1 + 2 $ 8,429 .20 4. Nonmonetary Contributions . ......... .......................... Schedule C. Line 3 50 .00 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3" ., S 8,479 .2 0 Expenditures Made 6. Payments Made....................................................... Schedule E, Lme 4 $ 1,132.38 7 . Loans Made ............................................................. Schedule H. Line 3 0 .00 8. SUBTOTAL CASH PAYMENTS .............................. Add Lines 6 + 7 S 1,132 .38 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F. Line 3 ____________ o~.oo 10. Nonmonetary Adjustment .......................................... Schedule C. Line 3 50 .00 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 .. 9 + 10 $ 1,182.38 Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page. Line 16 $ 49,939.71 13. Cash Receipts ................................................... Column A. Line 3 above 8,429 .20 14. Miscellaneous Increases to Cash ........................... Schedule I. Line 4 2 .10 1 5. Cash Payments.. ..................... ........................... Column A. Line 8 above 1,1.32.38 16. ENDING CASH BALANCE .......... Add Lines 12" 13" 14, then subtract Line 15 $ 57,238 .6) If this is a termina/ion statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ........................... Schedule B. Par12 $ 0.00 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ............................ ,,,......... See Instructions on reverse $ 0 .00 19 . Outstanding Debts ......................... AddLine2+Line9lnColumnBabove $ 0.00 from 09/25/2016 th ro ug h _--=1:..:2~/.::.3.::.1!..../ =-2 0::,;1:.,:6::....-__ Page __ ) _ .. _ of 112 ColumnB CALENDAR YEAR TOTAL. TO CATE S 27,720.01 0.00 $ 27,720.01 50.00 S 27,770.01 $ 7,209.59 0 .00 S 7,209 .59 0 .00 50.00 $ ______ 7.:..,~259 . 59 To calculate Column B, add amounts in Column A 10 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 Ihe firsl report being filed for Ihis calendar year, only carry over the amounls from Lines 2, 7 . and 9 (if any). 1.0. NUMBER 831553 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 111 through 8130 711 to Date 20. Contributions Received $ S 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made" II' SUbJoct to Va lunlary Expenditure Llmil) Date of Election (mm/ddlyy) ----~----~/----- Total to Date $------ $------ "Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (JanJ2D16) FPPC AdvIce: ildvice@fppc.ca.gov (866/275-3772) Schedule A Monetary Contributions Received SEE INSTRUCTIONS ON REVERSE NAME OF FILER San Ra.fael Police Association Political Action Committee FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR DATE RECEIVED (IF COMMITTEE. ALSO ENTER 1.0 NUMBER) ·09/30/2016 Elisha Aciams c/o: San Rafael Police Associatlon 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through ~ntermediary: San Rafael Police Association, 10/20/2016 Elisba Adams C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 union member's dues received through inte~diary: San Rafael Police Association, 11/05/2016 Elisha Adams C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 union member's dues received through int:erm~diary: San Rafael Police Association, " 11/15/2016 Elisha Adams C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fift:h Avenue San Rafael CA 94901 11 30 2016 Bllsha Adams C/o: San Rafael Police ASsociation 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through interm~diary: San Rafael Police Association, ~ Schedule A Summary 1, Amount received this period -itemized monetary contributions. Amounts may be rounded to whole dollars. IF AN INDIVIDUAL, ENTER CONTRIBUTOR OCCUPATION AND EMPLOYER CODE .. (IF SELF·EM~lOVEO. ENTER NAME OF eusINESS) 01ND Officer DeOM City of San Rafael DOTH OPTY osee @IND Officer DCOM City of San Rafael DOTH OPTY osee 01ND Officer DeOM City of San Rafael DOTH OPTY DSCC OOIND Officer oeOM City of San Rafael DOTH OPTY osce 01ND OffJ.cer City of San Rafael DeOM [lOTH DPTY OSCC SUBTOTAL $ SCHEDULE A Statement covers period CALIFORNIA 460 FORM from 09/25/2016 through 12/31/2016 LD. NUMBER B31553 AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED THIS PERIOD 16.30 16.30 16.30 16.30 16,)0 81.50 1 CALENDAR YEAR TO DATE (JAN 1 -DEC. 31) (IF REQUIRED) 376.21 376.21 376.21 376.21 376.21 'Contrlbutor Codes IND-Individual (Include all Schedule A subtotals.) ,., ............................ , ..... " .. , .... ,." .... , ...... ,', .... "., .... ,""., ... ,., ............... $ ___ ----'8"---'-,--"-0.:...:.75::....:.~1_"__.0 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 ... ,., ..... , ..... , .... " ..... $ _____ .:;3.:;5.:..4.:...1:..;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 $ ~~ __ ..;;8":"..;.4 ~2 ;;.9 ;..;. 2=0 SCC -Small Contributor Committee FPPC Form 460 (Janl2016) FPpe Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael ~olice Association Political Action committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF·EMPLOYED. ENTER NAME OF BUSINESSI QFCOM~lnEE..ALSOENITRIQ WU"l8EJ'l1 CODE * 12 15/2016 Elisha Adams c/o: San Rafael Police Association 1520 Fifth Avenue San Rafael. CA 94901 Union memb e r's dues received th~ough intermediary: San Rafael Po~ice Association. 1520 Fifth Aven u e San Rafael CA 94901 12/29/20lb Elisha Adams C/o : San Rafael Police Association 1520 Fifth Avenue San Ra(ael, CA 94901 Unic~ member's dues received through intermediary: San Rafael Pol~ce Association, 09/30/2016 1 ·Contributor Codes IND -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g .. business entity) PTY -Political Party see -Small Contributor Committee FiLth Fitch Fifth [RJIND DCOM DOTH OPTY Dsec IR]IND DeOM DOTH DPTY osee lKJlND DeoM DOTH oPTY oscc lKJlND oeOM DOTH oPTY osee [R]IND DCOM DOTH DPTY osee Officer City of San Rafael officer City of San Rafael Sergeant City of San Rafael Sergeant City of San Rafael Isergeant ICity of San Rafael SUBTOTALS Statement covers period ~om 09/25/2016 th rough _....;1:..;2:..:/....:3;,.:1:..:;/..,;:2;,.:0.,::1;,.:6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page _--=-5 _ of 112 1.0. NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULAnvE TO DATE CALENDAR YEAR (JAN. 1 • DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376.2l 16.30 376.21 16.30 376.20 1 I 16.30 376.20 16.30 376.20 B1. 50 I FPPC Form 460 (JanJ2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) ~~---- - - --, , Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FILER San Rafael ?olice Associacion Policical Action Comm i ttee DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IFCOIolMITIEE.ALSOENTER 1.0 NUMBER) CODE * 11 15/2016 Raul Aguilar OOIND C/o : San Rafael Police Associacion 1520 Fifth DCOM Avenue San Rafael. CA 94901 DOTH Union member' s dues received throuoh 0 PTY intermediary: San Rafael Police Association, 0 SCC 1520 F~f th Avenue San Rafael CA 94901 11 /30/2016 Raul Agu i l a r IRJIND C/o : San Rafael Police Association 1520 Fifch DCOM Avenue San Rafael, CA 94901 DOTH Union member's dues received througb 0 PTY IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SElI'-EMPlOVEO. eNlCR NAME OF BUSINESS) Sergeant City of San Rafael Sergeant City of San Rafael Statement covers period from 09/25/2016 th rough __ 1-,-2:;":/,-,3:..:1"",/..,;:2:..:0,,,1;,,:6 __ _ SCHEDULEA (CONT.) CALIFORNIA 460 FORM Page _--=-6 _ of 112 1.0. NUMBER B31553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN . 1 -DEC . 31) PER ELECTlON TO DATE (IF REQUIRED) 16 .30 376.20 16.30 376.20 intermediary, San Rafael Police Association, LISCC --~~~--4~-~'~~~llW~~~~~~~~~~L-----~---------4----------------------+-------------~--------------~----------------12/15/2016 Raul Aguilar IXlIND Sergeant 16" .)0 376.20 C/o: San Rafael Police Association 1520 Fifch oCOM City of San R.afael Avenue San Rafael, CA 94901 DOTH Union member' s dues received through 0 PTY iDcermediary: San Rafael Police Association, 0 sec 1 enue San Rafael CA 4 1 12/29/2016 Raul Aguilar ~IND-----r.s~e-r-g-e-a-n7t-----------------r----------1~6~.3~0~----------~3~776-.~20~-------- C/o : San Rafael Police Association 1520 Fi fth OX COM City of San Rafael Avenue San Rafael, CA 94901 OOTrl Onion membe!:' s dues received through 0 PTY intermediary: San Rafael Police Associat~on , OSCC 1520 Fifth Avenue, San Rafael. CA 94901 Ant any Augustyn OOIND C/o : San Rafael Police Association 1520 Fifth OX COM Avenue San Rafael, CA 94901 DOTH Onion member's dues received through 0 PTY interm7diary: San Rafael police Association, OSCC 'Contributor Codes INO -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g .. business entity) PTY -Political Party SCC -Small Contributor Committee o u::er Cicy of San Rafael SUBTOTAL $ 16 .30 376.20 81 .50 1 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ciI.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FILER San Rafael Police Association Political Action Committee DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (if CCMMITII:E. ALSO I:NTER 10. NUMBER) CODE * 10/20/20iG'-Anthony Augustyn OOINO C/o; San Rafael Police Association 1520 ~·:'fth oeOM Avenue San Rafael, CA 94901 DOTH Union member's dues received through [JPTY intermediary: San Rafael ?olice Association, OSCC 1520 Fifth Avenue San Rafael CA 94901 11/05/2016 Anthony Augustyn IKIIND C/o: San Rafael Police Association 1520 Fifth DeOM Avenue San Rafael, CA 94901 DOTH Union member's dues recelved through oPTY IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER IIF SELi<-EMPlOYED. ENTER NA...,e OF BIJ5INESS) Officer City of San Rafael Officer City of San Rafael Statement covers period from 09/25/2016 llirough __ ~1~2~/~3~1~/~2~0~1~6 ____ ___ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page __ 7",--_ of 112 1.0. NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16 .30 376.20 16 .30 376 .20 intermediary: San Rafael Police Association, OSCC .: ael , ~~~~~------~--------~~~--------------------4---------------+-----------------~----------------IK)INO O~:icer 16 .30 376.20 11/15/2016 Fifth 1l/30/2016 Fifth Avenue San Rafael, CA 94901 Union member's duee received through intermediary: San Rafael Police ASsociation, 1520 Fifth Avenue, San Rafael , CA 94901 t:. or.y Augustyn C/o : San Rafael Pol~ce ASSOclation 1520 Fifth Avenue San Rafael, CA 94901 Union membe.'s dues received through intermedia~: San Rafael Police Association, 'Contributor Codes INO -Individual COM -Recipient Committee (other than PTY or seC) OTH -Other (e.g .. business entity) PTY -Political Party sce -Small Contributor Committee oCOM City of San Rafael DOTH oPTY DSCC IRIIND DeOM DOTH o PTY o see IKIIND DeOM DOTH DPTY [JSCC Officer City of Sar. Rafael leer City of San Rafael SUBTOTAL $ 16.30 376.20 16.30 376.20 91. SO I FPPC Form 460 (JanJ2016) FPPC Advice: advice@fppc.ca.gov (866/275..3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FILER San Rafael Police Association Political Accion Committee DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IFCo~Mrrree.ALSOENTERI _D NUMBeR) CODE .. 12/29/2016 Ant:hony AUguSLyn IK)IND C/o: San Rafael Police Association 1520 Fifth Avenue oCOM San Rafilel, CA 94901 DOTH Union member's dues received through 0 PTY IF AN INDIVIOUAL. ENTER OCCUPAnON AND EMPLOYER (IF SELF-EUPL-OVEO, ENTER NAME OF eUSINESSI Officer City of San Rafael Sl<!tement covers period from 09/25/2016 ~rough __ ~1=2~/~3~1/~2~O~1=6 ____ __ SCHEDULE A (CONT.) CALIFORNIA 460' FORM Page 8 of 112 1.0 NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION fODATE (IF REQUIRED) 16.30 376.20 intermediary: San Rafael Police ASsociation, OSCC 1520 Fifth Avenue San~R~a~f~a~e~l~~C~A~~9~4~9~0~1 ______ -r~~ ______ ~~ ____ ~ ______________ ~ __________ ~~~--__ ------~~~~------------------ 09/30/2016 James Bellamy --IEJIND Corporal 16.30 376 .20 C/o: San Rafael ?olice Association 1520 Fifth DeOM City of San Rafael Avenue San Rafael, CA 94901 DOTH Union member's dues received through [JPTY intermediary: Sao Rafael Police Association , (JSCC , . 10/20/2016 Fifth 11./05/2016 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue, San Rafael , CA ~490l 11 15 2016 James Be amy C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Ratael Police Association, ·Contributor Codes INO -Individual COM -Recipient Committee (other than P1Y or seC) OTH -Other (e_g., business entity) PTY -Political Party sce -Small Contributor Committee IK)IND (JCOM DOTH OPTY OSCC [xJIND DCOM DOTH OPTY osee ~IND oeOM DOTH DPTY OSCC Corporal City of San Rafael Corporal City of San Rafael Corpora City of San Rafael SUBTOTALS 376.20 16' _ 30 376,20 1 .30 376.20 81.50 1 FPPC Form 460 (JanJ2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Commit~ee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF·EMPLOYED, ENTER NAME OF BUSINESS) ~FCOMMIITFf ,ALSOENTeRI D NUIoABER) CODe * 11 30/2016 James nellamy C/o: San Rafael Police ASSociation 1520 Fif~h Avenue San Rafael, CA 94901 Union member'S dues received through in~ermedia~: San Rafael Police Association, 1520 Fif~h Avenue San Rafael CA 94901 12/15/2016 James Bellamy C/o: San Rafael police Aeeociation 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 12/29/2016 James Bellamy C/o: San Rafael Police Association 1520 FiEch Avenue San Rafael, CA 94901 Union member's dues received through intermedia~: San Rafael Police ASsociation, 1 20 Fifch Av nue an Rafa 1 4 01 09/30/2016 Kelly Benitez C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received chrough intermediary: San Rafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 Ke y Benltez c/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary : San Rafael Police Association, 'Contributor Codes INO -Individual , San Rafael CA 9490 1 COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g .• business entity) PTY -Political Party SCC -Small Contributor Committee IRJINO DCOM DOTH DPTY Dsee ~IND DCOM DOTH OPTY osee [i]IND OCOM DOTH oPTY OSCC \XJfNO nCOM DOTH oPTY osee IRJIND oeoM DOTH oPTY oscc Corporal City of San Rafael Corporal City of San Rafael Corporal Cicy of San Rafael police Off icer City Of San Rafael SUBTOTAL $ Statement covers period rrom 09/25/2016 through _-,1::..:2:;.:/-,3:...:1:..:/-,2:...:0:...:1:...:6-,-__ SCHEOULEA (CaNT.) CALIFORNIA 460 FORM Page __ 9~_ of 112 1.0. NUMBER BlISS) AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 • DEC . 31) PER ELECTION TO DATE (IF REQUIRED) 16,30 376.20 16 ,)0 )76.20 16.30 376.20 16.30 269.10 16.30 269.10 81.50 1 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.C3.gov (8661275-3772) .. _. _ c ." _____ .. Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association political Action Committee Amounts may be rounded to whole dollars. DATE RECENED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED. EN~ NAMe OF BuSINESSI IIFCOMMlneE ALSO ENrER 1.0 NUM~) CODE * 11/05/2016 Kelly Benitez C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary : San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 94901 11/15/2016 Kelly Benitez C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, Fifth 12/15/2016 Fifth Fifth Avenue San Rafael, CA 94901 Union member's dues received through interm7dia ry: San Rafael Police Associa~ion, 'Contributor Codes IND -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g, business entity) P1Y -Political Party sec -Small ContnbutorCommittee lKJlND oeOM DOTH OP1Y osec !!lIND oeOM DOTH oP1Y osec !XlIND oCOM DOTH OPTY osee !!lIND nCOM DOTH oP1Y osee !!lIND oCOM DOTH UP1Y osee Police Officer City Of San Rafael Police Of ficer City Of San Rafael Poli ce Of f icer City Of San Rafael Police Offi.cer City Of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 ~rough __ ~1~2~/~3~1/~2~0~1~6 ____ __ SCHEDULE A (CaNT.) CALIFORNIA 460 FORM Page __ -=10,,--of 112 I.D.NUMBER a31553 AMOUNT RECEIVED THIS PERIOD CUMULATIVETO DATE CALENDAR YEAR (JAN. 1 -DEC . 31) PERELEcnON TO DATE (IF REQUIRED) 16 .10 269_10 16 ,30 269.10 16.30 269.10 16.30 269 .10 16_30 269.10 81. 50 I FPPC Form 460 (Jan'2016) FPpe Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER ~F SElF-(;MP~OYEO. ENTER NAME OF BUSINESS) (IFCOI..4MlnEE. ALSOENTER 1.0 NUMSERI CODE ... 09/30 2016 Todd Berringer C/o: San Rafael Police Association 1520 Fifth Avenue San ~fael, CA 94901 Union member'S dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 94 9 01 10/20/2016 Todd Berringer C/o: San Rafael Police ASeociation 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through interm7diary: San Rafael Police Association, 11/05/2016 11/15/2016 ·Contributor Codes INO -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g., business entity) PTY -Political Party SCC -Small Contributor Committee Fifth Fifth Fifth IK]INO oeOM [jOTH OPTY OSCC IKIIND DeOM UOTH OPTY osee ~IND DCOM DOTH npTY Dsec IKlIND DCOM DOTH OPTY nsec IKlIND DeOM nOTH DPTY OSCC Sergeant City of San Rafael Sergeant C~ty of San Rafael Sergeant City of San Rafael Sergeant Ci~y of San Rafael Sergeant City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 throug h __ 1_2-,/_3_1..:./_2_0_1_6 __ _ SCHEDULEA (CONT.) CALIFORNIA 460 FORM Page 11 of 112 I D.NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN, 1 • DEC, 31) PER ELEC1l0N TO DATE (IF REQUIRED) 16.30 :>76 _ 20 16_30 376.20 376.20 16,30 376.20 16.30 376.20 81.S01 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FILER San Rafael Police Associ ation Poli~ical Action Committee DATE RECEIVED FULL NAME , STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IFCQ.'-!IJ.JTTEE .ALSOENlERIP.NUMBERI CODE * 12/:2 9 / 2 0 16 Todd Berringer IRJINO C/o : San Rafael Pol ice Association 1520 Fifth 0 COM Avenue San Rafael, CA 94901 OaTH union member's dues received through 0 PTY interm7diary : San Rafael Pol~ce Associa~ion, O SCC 09/30/2016 Lynne Bracken lXJlND C/o : San Rafael Police Association 1520 Fifth DCOM Avenue San Rafael , CA 94901 DOTH union member 's dues received through 0 PTY intermediary: San Rafael Police Association, 0 SCC l~?-F ' 1 --=-10-=--/ 2~0~/-;-:2::-:0:-::1~6;--t-:Lynne Bracken ~ IND C/o : San Rafael Police Association 1520 Fifth X Avenue DCOM San Rafael, CA 91901 DOTH Union member ' s dues received through 0 PTY intermediary : San Rafael Police Association, OSCC IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SElF.EIoAPl.OYEO. ENTER NAME OF BUSINESS) Sergean t City of San Rafael Records Clerk Ci ty of San Rafael Records Clerk City of San Rafael Statement covers period from 09/25/2016 through 12/31/ . ...:2:c,:0:..;:1:.,:6 __ _ AMOUNT RECENED THIS PERIOD 16.30 12 .70 12.70 SCHEDULE A (CaNT.) CAL.IFORNIA 460 FORM Page 12 of 112 1.0 NUMBER 831553 376.20 294 .30 294.30 PERELEcnON TO DATE (IF REQUIRED) 1520 Fifth Avenue, San Rafael, CA 94901 ~~~~~~~L~ynn~~e~B~r~a~c~e~n~~~~~~~~~~~~~-------r--~---D----~~R~e~c~o~r~s~~~-----------1----------~1~2~.~7~0~----------2~9·4-.·3~O4------------------ C/o; San Rafael Police Association 1520 Fifth xlN City of Avenue oCOM San Rafael, CA 94901 DOTH Union member' s dues received through 0 PTY intermediary : San Rafael Police Association, OSCC ·Contributor Codes INO -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g ., business entity) PTY -Political Party SCC -Small Contributor Committee SUBTOTAL $ FPPC Form 460 (Jan/20161 FPPC Advice: advice@fppc.ca .gov (866/27S -3n2) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Po1ice Associ a t i on Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME , STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (I~COMMmEE.ALSOEIm:RI 0 NUMBeR) CODE * IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF S€LF-EMPLOYED. ENTER NAME OF BUSINESS) 11/15/2016 11/30/20~6 Lynne Bracken C/o, San Rafael ~olice Association 1520 Pifth Avenue San Rafael , CA 94901 Union member's dues received through intermediary, San Rafael Police Association, 1520 Fifth Avenue San Rafa 1 CA 94901 Lynne Bracken c/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary : San Rafael Police Association, 12/15/2016 Lynne Bracken c/o: San Rafael Police Association 1520 Fifth A.venue San Rafael, CA 94901 Union member's dues receIved through intermediary : San Rafael ~olice AssociatIon, 152 0 Fifth Avenu San Rafael 4 01 12/29/201E Lynne Bracken C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary : San Rafael Police Associat~on, 1520 Fifth Avenue, San Rafael, CA 94901 09 30 2016 Antonette Bu oc C/o: San Rafael ~olice Association 1520 Fifth Avenue San Rafael , CA 94901 Union member's dues rece~ved through intermedi ary : San Rafael Police II.ssociation, 'Contributor Codes IND -Individua l COM -Recipient Committee (other than PTY or SCC) OTH -Other (e .g ., business entity) PTY -Political Party SCC -Small Contributor Committee !&lIND OCOM DOTH oP"N osee IKIIND DCOM DOTH OPTY osee IXJIND DeOM DOTH OPTY osee !XlfND DCOM DOTH DP"N osee IK]IND DCOM DOTH OP"N OSCC Records Clerk City of San Rafael Records Clerk City of San Rafael Records Clerk City o~ San Rafael Records Clerk City of San Rafael CommunI t y Se rvIce 0 lcer City of San Rafael SUBTOTAL $ Statement cOllers period from 09/25/2016 through _....:1:.;:2:.-'./..:;3.::;1",-/;::.2 0.:..;1::..6~. SCHEDULE A (CaNT.) CALIFORNIA 460 FORM Page 13 of 112 1.0 NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 12.70 294.30 12.70 294,30 12 .70 294 _30 12.70 291 ,30 12,70 294.30 63 .50 1 FPPC Form 460 (JanJ2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) SCHEDULEA (CONT) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. Statement covers period CALIFORNIA 460 FORM NAME OF FILER San Rafael Police Associa~ion Political Action Committee DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IFCQMUITTEE.ALSOEtm:RID.NUMB:R) CODE * from 09/25/2016 ~rough __ ~1~2~/~3~1~/~2~0~1~6 ____ ___ Page 14 of 112 1.0 NUMBER 831553 IF AN INONIDUAL, ENTER AMOUNT CUMULATIVE TO DATE OCCUPAll0N AND EMPLOYER RECEIVED THIS CALENDAR YEAR (!FSELF.EMPLOYED.ENTERNAME PERIOD (JAN. 1 -DEC. 31) OF EWSINESS) PER ELECTION TO DATE (IF REQUIRED) -1~0~7T.2~O~/~2~0~176-'-An--to-n-e-t~~e~e-u'l'lO~C~k~---------------------------;--~=X~I-N-O-----+c~o~n-w~un~i~t-y~S~e~rv~i~c~e-O~f7f71"c~e~r~--------~1~2~.~7~0~----------=2=94~.3~O~------------------ C/o: San Rafael Police Association 1520 Fifth City of San Rafael 11/05/2016 1.!./lS/2C16 'li/J0/2016 12/lS/20iE Avenue oCOM San Rafael, CA 94901 DOTH Union member's dues received through 0 PTY intermediary: San Rafael Police Association, osce 1520 FiEth Avenue San Rafael CA 94901 Antonette Bullock [IDINO C/o: San Rafael Police Association 1520 Fifth oeOM Avenue San Rafael. CA 94901 DOTH Union member's dues received through DPTY interm7diary; San Rafael Police Association, []seC AntonettI! 8ullock ~IND C/o ; San Rafael Pol ice Association 1520 Fifth oeOM Avenue San Rafael, CA 94901 DOTH union member' e clues received through 0 PTY intermediary : San Rafael Police Association, osee I? Fi va an Rafael ell. 4 01 Antonette Bullock ~ C/o: San Rafael Police Association 1520 Fif~h X INO Avenue nCOM San Rafael, CA 94901 DOTH Union member's dues received through 0 PTY intermediary: San Rafael Police II.ssociation, OSCC 1520 Fifth Avenue, San Rafael, CA 94901 'Antonette Bu Oc C/o: San Rafael Police Association 1520 Fifth [IDINO Avenue oCOM San Rafael, CA 91901 DOTH Union member's dues received through 0 PTY intermed~ary: San Rafael Police Association, osee . 'I 'Contribulor Codes IND -Individual COM -Recipient Committee (other than PlY or SCC) OTH -Other (e .g., business entity) PrY' -Political Party SCC -Small Contributor Committee Community Service Officer City Ot San Rafael Community Service Officer City of San Rafael Community Service Officer City of San Rafael Commun~ty Serv~ce 0 lcer Clty of San Rafael SUBTOTAL $ 12 .70 294.30 12.70 294.30 12.70 29~.30 12.70 291.30 63.50 1 FPPC Form 460 (Jan/2016) FPPC Advice: advh:e@fppc.ca.gov (866/275-3n2) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Associa~ion Policical Accion Commi~tee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND liP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (If SEL.F·EIAPLOYED. ENTER NAME OF BUSINess) IIFCO~l.\fTTEE.ALSOENTERI 0 NUMDER) CODE * 12 29 2016 Antonet te Bullock C/o; San Rafael Police Association 1520 Fifth Avenue San Rafael, LA 94901 Union member's dues received through in~ermediary: San Rafael Police Association, ~~~~~~~15~2~O Fifth Avenue San Rafael LA 94901 09/30/2016 Mich'~"el Byers C/o: San Rafael Police Association 1520 FiEth Avenue San Rafael, LA 94901 Onion member's dues received through intermediary: San Rafael PoIJ.ce Association, . , 10/20/2016 Michael Byers C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received throU9h intermediary: San Rafael Police Association, 1520 Fi Ave e San Rafae A 94 01 11/05/2016 Michael Byers C/o : San Rafael ~olice Association 1520 Flfth Avenue San Rafael, CA 94901 Union member's dues rece~ved through intermediary ; San Rafael Police Association, 1520 fifth Avenue San Rafael, CA 94901 MJ.c ae ayers C/o : san Rafael police Association 1520 Fifth Avenue San Rafael, CA 94901 Onion member's dues received through incermediary: San Rafael Police Association, 152 Q FiJ'th Ayenlle..........S.an Rafael CA 94..'llU ·Con\libutor Codes IND -Individual COM -Rec:ipient Commitlee (other than PTY or SCC) OTH -Other (e.g ., business entity) PTY -Political Party SCC -Small Contnbutor Commitlee !&lIND oeOM DOTH oPTY osee !&lIND oCOM DOTH oPTY osee IKIIND DCOM DOTH DPTY Dsce !&lIND DCOM DOTH oPTY OSCC (R1IND DCOM DOTH OPTY OSCC Community Service Officer Cicy of San Rafael Police Officer City of San Rafael Police officer City of San Rafael Police Officer City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 th roug h _....;1;..;2;;.:/....;3;.;;1,-,/....;2;.;;0....;1;.;;6 __ _ SCHEDULEA (CONT.) CALIFORNIA 460 FORM Page 15 of 112 1.0 NUMBER 8)1553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC 311 PER ELECTION TO DATE (IF REQUIRED) 12 .70 294 .30 16.30 376.20 16.30 376.20 16 .30 376 .20 16.30 76 .20 FPPC Form 460 (JanJ2016) FPPC Advice : advic:e@fppc:.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Ratael police Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SElF·EIoIPLOYEO. ENTeR NAME OF BUSINESS) (IFCOMMITIEEALSOENTERIO.NOMBER) CODE * 11/30/2016 Mfchael Syers C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael. CA 94901 Union member's dues received through intermedi ary : San Rafael Police Association, 1520 F ifth Avenue San Rafael CA 94901 12/15/2016 Michael Byers C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 union member's dues received through interm~diary: San RafaE!l Police Association, 12/29/2016 09/30/2016 'Contributor Codes INO -Individual COM -Recipient Committee (other t/1an PTY or SCC) OTH -Other (e.g., bUSiness entity) PTY -Potitical Party SCC -Small Contributor Committee Fifth Fifth Fifth OOINO DCOM DOTH OPTY OSCC !K]IND DCOM DOTH OPTY OSCC IXJIND DeOM DOTH OPTY OSCC IRJIND DCOM DOTH OPTY osee IKJINO oCOM DOTH OPTY OSCC Police Off1cer City of San Rafael Police Officer City of San Rafael Police Officer City of San Rafael Dispatcher City of San Rafael Dl.spatc er City of San Rafael SUBTOTALS Statement covers pE!riod from 09/25/2016 throug h _....;1:....2..:./..:;3..:..1.:../..:..2-'01::..6'--__ SCHEDULE A (CaNT.) CALIFORNIA 460 FORM PagE! _--,,-,16=--. of 112 I.D.NUMBER B)lSS) AMOUNT RECEIVED THIS PERIOD CUMULATIVETO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376.20 16.30 376.20 16.30 376.20 12,70 294.30 12,70 294,) 0 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.C3.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER san Rafael Police Association Policical Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF·EMPlOYEO . ENTER NAME OF !lUS!NESS) (I, CQMMmEE. ALSOENlER I D NUMBER) CODE ... 11 OS/2016 11/15/2016 11/30/2016 12/15/2016 Shelly Cade C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary : San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 94901 Shelly Cacie C/o : Sao Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through i~termediary: San Rafael Police Association, Fifth Fift:h Fifth ·Contributor Codes INO -I ndividual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e .g .. business entity) PTY -Political Party SCC -Small Contributor Committee OOIND oCOM DOTH oPTY DSCC IRJIND DeOM DOTH DPTY osee OOIND DeOM DOTH OPTY OSCC OOIND DeOM C]OTH OPTY Dsec [gJIND DCOM DOTH DPTY osee Dispatcher City of San Rafael Dispatcher City of San Rafael Dispatcher City of Sa ~ Rafael Dispatcher Cit:y of San Rafael Dl.spatc er Ci:y of San Rafael SUBTOTAL $ Statement covers period from _____ 09/25/2016 th rough __ 1.'-'2""/-.:3:...;1",,/...;;;2,-0...;;1,,,6 __ _ seHEDULEA (CONT.) CALIFORNIA 460 FORM Page _--=-17,--of 112 I D NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC . 31) PER ELECTION TO DATE (IF REQUIRED) 12 .70 294-30 12 .70 294,30 12. '10 294.30 12.70 294 .30 12.70 294.30 63.5 °1 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dolla rs . NAME OF FILER San Rafael Police Aesociation Political Action Committee DATE RECEIVED FUll NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR pFCOMMmE". AL$O ENTER 1.0. NUMBER) CODE .. 09 30 2016 Joseph Camins IRJIND C/o, San Rafael Police Associacion 1520 Fifth Avenue oCOM San Rafael, CA 94901 DOTH Union member's dues rece i ved through 0 PTY intermediary: San Rafael Police Association, OSCC 1520 F~fth Avenue San Rafael CA 94901 10/20/2016 Joseph Carnine IR]IND C/o; San Rafael Police Association 1520 Fifth oCOM Avenue San Rafael, CA 94901 DOTH Union member's dues recei ved through 0 PTY IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER IIF SEJ..F,EMFLOYEO. EIITER NM1E OF 8USINESS) Officer City of San Rafael Officer City of San Rafael Statement covers period from 09/25/2016 th rough _....:1:..;2:..</...:3;.:1:..:./..;:2;..:0..:;1..::6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 18 of 112 I.D .NUMBER 831553 AMOUNT RECEJVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC 31) PERELEcnON TO DATE <IF REQUIRED) 16.30 376 .20 16.30 376 .20 intermediary: San Rafael Police Association, OSCC . -~'~----~---------'~~----------------~r-------~~~--------~~=~~----------------GUINO Officer 16 .30 376 .20 11/05/2016 Fifth 11/15/2016 Fitch 11 30 2016 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 'Contributor Codes INO -Individual COM -Recipient Committee (other tI1an PTY or SCC) OTH -Other (e.g., business entity) PTY -Political Party see -Small Contributor CommIttee DCOM City of San Rafael DOTH DPTY OSCC @INO oCOM DOTH oPTY OSCC !R]IND OCOM DOTH DPTY OSCC Officer Cicy of San Rafael o lcer City of San Rafael SU8TOTAL$ 16.]0 376.20 16.30 376.20 81.50 1 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca,gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole do[(ars. NAME OF FILER San Rafael Police Associacion Political Action Committee DATE RECEIVEO FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COM!.4IrrEE./l1.SO ENTER 1.0 NUM~R) CODE * 12/15/2016 Joseph Camins !KIIND C/o: S8n Rafael police Association 1520 Fifth DCOM Avenue San Rafael, CA 94901 DOTH Union member's dues received through D PTY intermediary: San Rafael Police Association, []SCC 1520 Fifth Avenue San Rafael CA 94901 12/29/2016 Joseph earnins IKlINO C/o: San Rafael Police ASsociation 1520 Fifth DCOM Avenue San Rafae!. CA 94901 nOTH Union member's dues received through oPTY intermediary : San Rafael Police Association, OSCC 09jj0!2016 Trevor Carney IKJIND C/o: San Rafael Police Association 1520 Fifth DCOM Avenue San Rafael, CA 9"901 DOTH Union member' B dues received chrough D PTY IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER ~F SELF.EMPLOYED. EN1eR NAt.!E OF BUSINESS) Officer C~ty of San Rafael Officer City of San Rafael Police Off icer City Of San Rafael Statement cOllers period from 09/25/2016 through __ 1::,;2:;,,:/,-,3:...,:1:.,:/...:2:...,:0;,,:1:...,:6 __ _ SCHEDULE A (CaNT.) CALIFORNIA 460 FORM Page 19 of 112 I.D.NUMBER aJlSSJ AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -OEC 31) PER ELECTION TO DATE (IF REQUIRED) 16.]0 376.20 16 .30 ]76 .20 16.30 360.90 intermediary: San Rafael Police Association, []SCC 1 20 Fift Av n ~t~+'~~~29~UO~ ____ -,~ ________ -4~~ __ ~~~ ____________ ~ ________ ~~~+-________ -,~~~r-______________ ___ 10/20/2016 Trevor Carney !:&lIND Police Officer 16.30 360.90 C/o: San Ratael Police Association 1520 Fifth DCOM City Of San Rafael Avenue San Rafael, CA 94901 0 OTH Union member's dues received through 0 PTY intermediary: San Rafael Police Associar:::ion, OSCC 1520 Fifth Avenue, San Rafael, CA 94901 revor Carney IKJ INO C/o: San Rafael Police Association 1520 Fifth Avenue DeOM San Rafael, CA 94901 DOTH Union member's dues received through D PTY in;erm7diary: San Rafael Police Association, DSCC ·Contribulor Codes INO -Individual COM -ReCipient Committee (other than PTY or SCC) OTH -Other (e.g., business entity) PTY -Political Party SCC -Small Contributor Committee SU8TOTAL$ 16.30 360. 0 FPPC Form 460 (Jan/2016) FPPC Advice: adllice@fppc.ca.goy (8661275 -3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Polit~cal Action Committee Amounts may be rounded to whole dollars. SCHEDULEA (CONT.) r-----SS~~atre;nmue;n~t~c~o~v~e~rsscp;erlrl~o~d~---I~~IP.~~~~ from __ --'-09"'/:....2:...:5:...:;/....:2;....0..::1..:.6 __ _ through ___ 1_2-.:/_3_1...:./_2_0_1_6 __ _ 831553 DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF·EMPlOYEO. ENTER NAME OF eUSINESS) AMOUNT RECEIVED THIS PERIOD CUMULATNETO DATE CALENDAR YEAR (JAN. 1 . DEC. 31) PER ELEC110N TO DATE (IF COMMIl TEE. ALSO ENTER 1.0. NUMBER) 11 2016 Trevor Carney C/o: Sil:l Rafael Police Association 1520 Fifl:h Avenue San Rafael. CA 94901 Union member's dues received I:hrough intermediary: San Rafael Police Association, Fifl:h Fitl:h Fifth arpenter C/o: San Rafael Police ASSocia tion 1520 F if th ·Contributor Codes INO-Individual COM -Recipient Committee (other than PTY or SeC) OTH -Other (e.g .. business entity) PTY -Political Party SCC -Small Contributor Committee CODE· I&]IND DCOM L]OTH DPTY osee [KJIND DeOM DOTH OPTY osee IXJIND DCOM DOTH DPTY Dsce IXJIND DCOM DOTH D PTY osce IKJIND DeOM DOTH D PTY osec c e c er City Of San Rafael Police Officer City Of San Rafael Police Of ficer City Of San Rafael Police Officer City Of San Rafael r City of San Rafael SUBTOTAL $ (IF REQUIRED) 16 .30 360.90 360,90 16,30 360,90 16.30 360.90 81. SO I FPPC Form 460 (JanI2016) FPPC Advir::e: advice@fppc.ca.gov (866127S-3n2) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FI LER San Rafael Police Associa~ion Political Action Committee DATE RECEIVED FULL NAME, STREET ADDRESS AND liP CODE OF CONTRIBUTOR CONTR)BurOR ~F ce.'" MITIEE. ALSO ENTE}l1 0 NUMB ER) CODe "* IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF·SMPLOYEO. ENTER NAME o~ HUSINESSj !0/20/2016 Ja~C~k~C~a-~~e~n~t~e-r------------------------------~--~-X-I-N-D-----+O~f~fF~~'c~e~r-- c/o: San Rafael Police Association 1520 Fifth City of San Rafael Avenue DCOM San Rafael, CA 94901 DOTH union member' e dues received through 0 PTY in~ermediary: San Rafael Police Association, OSCC 152 0 Fifth Avenue San Rafael CA 94901 11/05/2016 Jack Carpenter IRIIND C/o: San Rafael pol ice As socia t ion 1520 Fit" th 0 COM Avenue San Rafael, CA 94901 DOTH union member's dues received chrough 0 PTY intermediary, San Rafael Police Association, osce 11/15/2016 Jack Carpenc.er IXJIND C/o: San Rafael Police ASsociation 1520 Fifth DeOM Avenue San Rafael, CA 94901 DOTH Union member's dues received through 0 PTY intermediary: San Rafael Police Association, osce __ --;-_..,.-__ :--1-'1 .. 51..0_);:i.l' v u San Raf 1 A 4 01 11/30/2016 Jack Carpenter IR]IND C/o: San Rafael Police Association 1520 Fifth ~~ O~ San Rafael, CA 94901 DOTH Union member's dues received through 0 PTY inc.e=ediary; San Rafael Police Association, OSCC 1520 Fifth Avenue, San Rafael, CA 94901 Jac Carpenter OOIND C/o : San Rafael Police Association 1520 Fifth X ~~ O~ San Rafael, CA 94901 DOTH Union member's dues received through 0 PTY interme~iary: San Rafael Police Association, []SCC ·Contributor Codes IND-Individual COM -Recipient Committee (other than PTY or seC) OTH -Other (e .g ., business entity) PTY -Political Party SCC -Small Contributor Commit1ee Officer Ci~y of San Rafael Officer City of San Rafael Officer City of San Rafael o locer City of San Rafael SU8TOTAL$ Statement covers peri od from 09/25/2016 through _--=1:..::2,",-/..=.3=.;1 /:...:2:...;0;.:1;.;;6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 21 of 112 1.0. NUMBER 831553 AMOUNT RECEIVED nilS PERIOD CUMULATIVETO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16 .30 376.20 16 .30 376 .20 16.30 376.20 16.)0 376.20 11>. )0 376.20 81 .5°1 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc .. ca.gov (866/275..3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Comrnitcee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER IIF SElFEMPlOYED, ENrcR NAME OF BUSINESS] IIF COMMITIEE. AL.SOENTERI.D NUMBERI CODE * 12 29/2016 Jack Carpenter C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fifch Avenue San Rafael CA 94901 09/30/2016 David Casalnuovo C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through incerm7diary: San Rafael Police Association, 10/20/2016 David Casalnuovo C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association. 1 20 Fifch Aven e San f el 4 01 11/05/2016 David Casalnuovo c/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 Davl Casa nuovo C/o: San Rafael Police Association 1520 Fifth Avenue San ~fael, CA 94901 union member's dues received through intermediary; San Rafael Police Association, ·Contributor Codes INO -Indillidual COM -Recipient Committee (other than PlY or seC) OTH -Other (e_g., business entity) PlY -Political Party see -Small Contributor Committee iKllNO oCOM DOTH o PlY osee !KIIND oeOM DOTH oPTY osee lKllND DeOM DOTH DPTY osee IKIIND DCOM DOTH OPTY OSCC !!lIND OCOM UOTH OPTY osee Officer City of San Rafael Officer Cicy of San Rafael Officer City of San Rafael Officer City of San Rafael o lcer Cicy of San Rafael SU8TOTAL$ Statement cOllers period "om 09/25/2016 th rough _....:1:..;2:..:/-=3:...:1:..!./-=2:...:0-=1-=6 __ _ SCHEDULEA (CONT.) CALIFORNIA 460 FORM Page 22 of __ 112 1.0. NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 311 PER ELECTION TO DATE (IF REQUIREDI 16_30 376.20 16.)0 376.20 16. )0 376,20 16.30 )76.20 16,30 376.20 81. 50 I FPPC Form 460 (Jan/2016) FPPC Adllice: advice@fppc.ca.goll (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dolla rs. NAME OF FILER San Rafael Police Association Political Action Committee DATE RECEIVED 11/30/2016 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF co.IAMITTE!.ALSOENTERIO NUMBER) CODE" David Casalnuovo IKIINO C/o: San Ra(ael Police Assodation 1520 Fifth oeOM Avenue San Rafael, CA 94901 DOTH Onion member's dues recei ved through 0 PTY intermediary: San Rafael Police Association, osce ~~~~~~~1~5~2~0~Fifth Avenue San Rafael CA 94901 12/15/2016 David Casalnuovo ~ INO C/o; San Rafael police Association 1520 Fifth DeOM Avenue San Rafael, CA 94901 DOTH Union member's dues received through 0 PTY IF AN INDIVIDUAL, ENTER OCCUPAnON AND EMPLOYER (IF SElF-EMPLOVEO. ENTER NAME OF IhJSINESS) Officer City of San Rafael Officer City of San Rafael Statement covers period from 09/25/2016 ~rough __ ~1~2~/~3~1~/~2~0~1~6~ __ ___ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page ____ 2L. of. ...!lL I.D.NUMBER 831!>!>3 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN . 1 -DEC _ 31) PER ELECTION TO DATE !IF REQUIRED) 16 .30 376 .20 16 .)0 376 .2 0 12/2912016 intermediary: san Rafael Police Association, []SCC ~0 .~·~~~~~~w-~~~~~~~L-____ -+ ________ ~~~ __________________ 4-____________ -+ ______________ -+ ______________ __ David Casalnuovo IiU INO Officer C/o: San Rafael Police Association 1520 Fifth oeOM City of San Rafael Avenue San Rafael, CA 94901 DOTH Onion member' s dues received through 0 PTY intermediary; San Rafael Police Association, osec . n Rat 1 4 09/30/2016 Edward Chiu IRl NO C/o; San Rafael Police Association 1520 Fifth OX ~OM Avenue San Rafael , CA 94901 DOTH Union member's dues received through 0 PTY intermediary; San Rafael Police Association, OSCC 1520 fifth Avenue, San Rafael, CA 94901 10 IE war l.U IRJINO C/o: San Rafael Police Association lS20 fifth Avenue oeOM San Rafael, CA 94901 DOTH Union member's dues received through 0 PTY intermediary: San Rafael Police Association, DSCC 'Contributor eodes INO -Individual COM -Recipient Committee (other than PTY o( SeC) OTH -Other (e _g _. business entity) PTY -Political Party see -Small Contributor Committee Officer City of San Rafael o J.cer City of San Rafael SUBTOTAL $ 16 _30 376.20 16_30 376,20 16_30 376,20 81.50 1 FPPC Form 460 (Jani2016) FPpe Advice: advic.e@fppc .c.a.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police ASsociation Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF·EMPLOVEO. EIflER NAME OF 6US!NESS) (IF COIo!MITTEE. ALSO ENTER 1.0 . NUMBERI CODE * 11/05/2016 Edward Chiu C/o: San Rafael Police Association 1520 Fifth Avenue San ~fael, CA 94901 Union member'S dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 94901 11/15/2016 Edward Chiu C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through interm7diary: San Rafael Police Association, 12/15/2016 ·Contributor Codes INO -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e .g ., business entity) PTY -Political Party SCC -Small Contributor Committee Fifth Fifth Fifth OOINO oeOM DOTH oPTY osce OOINO oeOM DOTH oPTY oscc I2UIND oeOM DOTH oPTY Osee IKlIND oeOM DOTH oPTY oSCC iRllND oCOM DOTH OPTY osce Of fi cer City of San Rafael Officer City of San Rafael Officer Cicy of San Rafael Officer City of San Rafae~ o l.cer City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 throug h _-,1",2::..:/'-.:3:....:1,-,/-,,2:....:0:..::1;...;6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 24 of 112 1.0. NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. , • DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16 .30 376 .20 16 ,30 376,20 16.30 376.20 16 .30 376.20 16.30 376 .2 0 81. 50 I FPPC Form 460 (JanJ2016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME . STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF·E.\I.PLOYEO. ENTER NAME OF BUSINESS) IIF COMIAIll"EE. AlSO EIlTER 1.0 NUIABERI 09/30/2016 Robert Cleland C/o: San Rafael Police Association 1520 Fifth Avenue San ~fael, CA 9~901 Union member's dues received through intermediary : San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 94901 10/20/2016 Robert Cleland C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through inte~ediary : San Rafael Police Association, 11/05/2016 Robert Cleland C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 9490~ Union member's dues received chrough inte~ediary : San Rafael Police Association, ~ Ftfth Avenue. San R~~ 1 11/15/2016 Robert Cleland C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through in~ermediary: San Rafael ?olice Association, 1520 pifth Avenue, San Rafael, CA 94901 Ro ert C e an C/o : San Rafael Police Association 1520 Fifch J\venue San Rafael , CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 'Contributor Codes IND -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g .. business entity) PTY -Political Party sec -Small Contributor Committee CODE ,. OOIND oeOM DOTH oPTY osee IRJIND DeOM DOTH OPTY OSCC IgjIND DeOM DOTH oPTY osce Officer City of San Rafael Officer City of San Rafael Officer City of San Rafael '--~::-77- IRlIND officer nCOM City of San Rafael DOTH DPTY osee !!lIND oeOM DOTH OPTY OSCC o .l.cer City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 through __ ~1~2~/~3~1~/~2~0~1~6~ __ ___ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page _-=:..:25~ of 112 I.D.NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN . 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376 .20 16.30 376 .20 16.30 376 .2 0 376.20 16.30 37 .20 81.S01 FPPC Form 460 (Jan/2016) FPPC Advice: advicc@fppc.ca.goll (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Accion Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODe OF CONTRIBUTOR CONTRIBlJTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF·EMPlOYED. EIflER NAME OF BUSINESS) (IFCO~MlnE"-ALSoEN~RI 0 NUMBERI CODE * 12 15 2016 Robert: Cleland C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Onion member's dues received through intermediary' San Rafael Police Association, 1520 Fifth Ave n ue San Rafael CA 94901 12/29/2016 Robert Cleland C/o: San Rafael Police Assoc~ation 1520 Fifth Avenue San Rafael, CA 94901 unio~ member's dues received through interm:diary : San Rafael Police Association, 09/30/2016 Chr1stopher Coale C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received ehrough intermediary: San Rafael Police Association, 1520 Fife v n A 4 1 10/20/:2016 Christopher Coale C/o: San Rafael Police Association 1520 Fifth Avenue ·Contributor Codes IND -Individual COM -Recipient Committee (other than PlY or SCC) OTH -Other (e.g .. business entity) PTY -Political Party SCC -Small Contributor Committee IRJIND DeOM DOTH DPTY osee I29IND DeoM DOTH oPTY osee IXlINO oeoM DOTH DPTY osee [XJIND oeOM DOTH oPTY osec !KlIND DeOM DOTH DPTY osee Officer City of San Rafael Officer Cicy of San Rafael Sergeant Ci~y of San Rafael Sergeane City of San Rafael Sergeant City of San Rafael SUBTOTAL $ Statement covers period from __ " 09/25/2016 through _...;1;;.;2;;..:/...:J;.;1~/...:2:..:0-=1-=6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 26 of 11:2 LD. NUMBER 8Jl553 AMOUNT RECEiVED THIS PERIOD CUM ULATIVE TO DATE CALENDAR YEAR (JAN. , -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376.20 16 .30 376.20 16 .30 376.20 16.30 376.20 16.30 )76 .20 81.50 1 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER IIF SELF·E.I.IPlOYED. ENTER NAME OF aUS'N CSS) (IFCCMMlnEE. ALSO ENTER 1,0 NUM8ER) CODE * 11 IS 2016 11/30/2016 12/15/2016 12/29/2016 ·Contribulor Codes IND -I ndividual COM -Recipient Committee (other than PTY Dr SCC) OTH -Other (e.g., business entity) PTY -Political Party SCC -Small Contributor Committee Association 1520 Fifth Fi.fth Fifth Fifth Fifth /F!IND DCOM DOTH DPTY OSCC OOIND [jCOM DOTH DPTY OSCC IXJIND oCOM DOTH oPTY OSCC IRJIND DeOM DOTH DPTY osee !K]INO DCOM DOTH DPTY osee Sergeant City of San Rafael Sergeant City of San Rafael Sergeant City of San Rafael Sergeant City of San Rafael O~~l.cer City of San Rafael SUBTOTAL $ Statement covers period from 09/25/:2016 through __ ~1~2~/~3~1~/~2~0~1~6 ____ ___ SCHEDULE A (CaNT) CALIFORNIA 460 FORM Page 27 of _~ 1.0 . NUMBER 631SS3 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAA (JAN . , • DEC . 31) PERELECnON TO DATE (IF REQUIRED) 16 .30 376.20 16.30 376 .20 16.]0 376.20 16.30 376.20 16.30 376.20 81. SO I FPPC Form 460 (Janl2016) FPPC Advice: adv!ce@fppc.ca.gov (866/275-3772) -• -~. < .• -. - -~. - . Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I D. NUMB€R) CODE * IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOVER (IF SELF·EMPLOYED, ENTEIt NAME OF BUSINESS) 10/20/2016 TholT.as Collins C/o : San Rafael Police Association 1S20 Fitth Avenue San Rafael, CA 94901 /KlINO DCOM DOTH DpTY Osee Officer Ci~y of San Rafael Statement covers period from 09/25/2016 th roug h _....;1::,;2",/,-,3:.,:1",,/..,:2:.,:0;,.::1;,.::6 __ SCHEDULE A (CaNT) CALIFORNIA 460 FORM Page 28 of 112 LD. NUMBER 8JlSS3 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 . DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16.)0 376.20 Onion member's dues received through in~ermediary; San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 94901 11/05/2016 Thomas Collins ---+~~-----------------+--------~~~--------~~~~---------------!KlINO Officer 16.)0 376.20 C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Onion member's dues received through intennediary; San Rafael Police ASSOCiation, 11/15/2016 11/30/2016 ·Contributor Codes INO -Individual 'F COM -ReCipient Committee (other than PTY or seC) OTH -Other (e.g., business entity) PTY -Political Party SCC -Small Contributor Committee Fifth Fifth Fifth DCOM City of San Rafael DOTH oPTY osce !KlIND oeOM DOTH DPTY osce !KlINO oCOM DOTH oPTY osee [KlIND DeOM DOTH npTY osee Officer City of San Rafael Officer City of San Rafael o J.cer City of San Rafael SU8TOTAL$ 16.30 376.20 16.)0 376.2Q 16.)0 376.20 81,50 1 FPpe Fonn 460 (Janf2016) FPPC Advice: advice@fppc.ca.goll (866/275-3772) -i'._._ ~ ~ _ ~ __ ,_ Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FI LER San Rafael Police Association Political Action committee Amounts may be rounded to whole dollars. DATE RECENED FU Li NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF 5aF·EMPLQYED. ENTER NAME OF aUSINESS) (IF COMMmEE, ALSO ENP£R I 0, NUMBER> CODE * 12/29 2016 '':'ho"mas Collins C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael ~olice ASsociation, 1520 Fifth Avenue San Rafael CA 4901 09/30/2016 Jenna Cocca c/o San Rafael Police Associacion 1520 Fifth Avenue San Rafael, CA 94901 Union membe~'s dues received through intermediary: San Rafael Police Association, 10/20/2016 11/05/2016 11 15 2016 'Contributor Codes IND -I ndividual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g .• business entity) PTY -Political Party SCC -Small Contributor Committee Po.l:ce Association 1520 Fl.Eth 94901 Police Association 1520 Fifth Association, 4 IKIIND oCOM DOTH DPTY OSCC !!lIND DCOM DOTH DPTY OSCC IXJIND DeOM DOTH DPTY OSCC IKlIND DCOM DOTH DPTY [JSCC IRIIND DCOM DOTI-l DPTY OSCC Office" City of San Rafael Communications Dispatcher City of San Rafael Communications Dispatcher City of San Rafael Communicat1ons Dispatcher City of San Rafael COmmun1cat10nS 01spacc er City or San Rafael SUBTOTAL $ Statement covers period from _. __ 0_9....:/_2_S---,-/_2_0_1_6_ th rough __ 1_2....:/'---3_1....;/_2_0_1_6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page :2 9 of _----'1"'1"'2"-- LD. NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376.20 12.70 222.30 12.70 222.30 12.70 222.30 12.70 222.30 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRI8UTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF S~LF-EI.IPLoYED. ENTER NAME OF eU$lNESS) QFCC!.l!AmEaAlSOENTERI.O NUM8ER) CODE * 11 30 2016 Jenna Cotta c/o San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 94901 1i/15/2016 Jenna Cotta 12/29/2016 c/o San Rafael police Association 1520 fifth Avenue San Rafael, CA 94901 Uoion meIDber's dues received through interm7~iary: San Rafael Police Association, 09/)0/2016 Ryan De Marta C/o: San Rafael Police ASsociation 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through 1ntermediary: San Rafael Po11ce Association, 1520 Fifth Avenue, San Rafael, CA 94901 10 20 2016 Ryan De Marta C/o: San Rafael Police Association 1520 Fifth Avenue San Rafa~l, CA 94901 Union member's dues received through inte~ediary: San Rafael Police Association, 'Contributor Codes I NO -Individual 2 . eOM -Recipient Committee (olher than PTY or SCC) OTH -Other (e.g., business entity) PTY -Political Party SCC -Small Contributor Committee IKJIND nCOM DOTH OPTY osee !!lIND OCOM DOTH OPTY osee IKIIND OCOM DOTH OPTY OSCC IKJIND OCOM DOTH OPTY OSCC jIDlND DCOM DOTH OPTY OSCC Communications Dispatcher City of San Rafael Communications Dispatcher City of San Rafael Communications Dispatcher City of San Rafael Officer City of San Rafael o tlCer City of San Rafael SUBTOTAL $ Statement covers pe rlod from 09/25/2016 ~rough __ ~1~2~/~3~1~/~2~0~1~6 ____ __ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page )0 of 112 to. NUMBER 8315S3 AMOUNT RECENED THIS PERIOD CUMULATtVETO DATE CALENDAR YEAR (JAN. 1 • DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 12.70 222. )0 12.70 222.30 12.70 222.30 16.)0 376.20 16.)0 376.20 FPPC Form 460 (Jan/2016) FPPC Advice: adllice@fppc.ca.gov (8661275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael ?olice Association Policical Act~on committee Amounts may be rounded to wnole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL , ENTER OCCU PATION AND EMPLOYER (IF SElf-EMPLOYED. EN1l:R NAME OF DUSINESS) (fl'COM!.4ITTEE .... l50ENn:RID NUMBERI CODE * 11/05/2016 Ryan De Marta C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Vnioa member's dues received through intermediary: San Rafael Police Association, 1520 F i fth Avenue San Rafael CA 94 01 11/15/2016 Ryao De Marta 11/30/2016 12/15/2016 C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received chrough intermediary : San Rafael Police Association, . F Fifch Fifth /XJIND DCOM DOTH DPTY f1SCC IEJIND DeOM DOTH OPTY oscc IKJIND DCOM DOTH DPTY OSCC IR]IND DCOM DOTH OPTY osce Off~cer city of San Rafael Officer C~ty of San Rafael Officer City of San Rafael Officer City of San Rafael Statement covers period from 09/25}2016 through _ 12/31/2016 SCHEDULE A (CaNT.) CALIFORNIA 460 FORM Page _--=.:31=---of 112 1,0 . NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC , 31) PER ELECTION TO DATE (IF REQUIRED) 16 .30 376.20 16.30 376.20 16.30 376 .20 16,30 376 .20 ~~~~~~~~~~~------~--~--IN-D-----1~O~~l~ce~r~----------------~----------~6 ·.30~--------~3~7~6-.~2~O~----------------- <'lfth City of San Rafael 12 29 2016 ·Contributor Codes INO -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e .g ,. business entity) PTY -Political Party SCC -Small Contributor Committee oCOM DOTH oPTY OSCC SUBTOTAL $ 81. 50 I FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3n2) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Associacion Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR I (IFCCMMITrEE. AlSO ENTER I.D NUMBER) CODe * IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELf·EM~lOYEO. ENTER NAME OFBIJS!NESS) 09/30/2016 Christian Diaz C/o: San Rafael Police Association 1520 FiEch Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 4901 10/20/2016 Christian Diaz C/o, San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union mel!IDer'S dues received t::hrough int::erm~diary: San Rafael Police Assoc~ation, 11/15/2016 ·Contributor Codes I NO -Individual COM -Recipient Committee (other than PTY or Sec) OTH -Other (e.g., business entity) PTY -Political Party SCC -Small Contributor Committee Fifth Fifth Fifth IKIIND DeOM DOTH OPTY o sec !!lIND o eOM DOTH OPTY osee ®IND OCOM DOTH OPTY OSCC IKlIND OCOM DOTH OPTY OSCC IR]IND oeOM DOTH OPTY osee Police Corporal Cit::y of San Rafael Police Corporal C~ty of San Rafael Police Corporal City of San Rafael Police Corporal City of San Rafael SU8TOTAL$ Statement covers period from 09/25/2016 ~rough ___ 1_2~/~3~1~/_2~0~1~6 ____ ___ SCHEDULE A (eONT.) CALIFORNIA 460 FORM Page 32 o f 112 I.D.NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (.JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376.20 16,30 16.30 376.20 16.30 3"76.20 1 .30 376.20 81.50 1 FPPC Form 460 (JanI21l16) FPPC Advice: advice@fppt.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Policical Action Commiccee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS ANO ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SElF·EMPLQVE!l. EIflER NAME OF 6US!NESS) (IFCCW.MITTEE .Al.SOENTeRI.D.NUM6El1I CODe ... 12 15 2016 12/29/2016 09/30/2016 10/20/2016 Christl.an Oiaz c/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary : San Rafael Police Association, 1520 Fifth Av nue Sao Rafael CA 94901 Christian Diaz C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary : San Rafael Police Association, Fifth Fifth Fifth ·Contributor Codes IND-Individual COM -Recipient Committee (other than Pl'\' or SCC) OTH -Other (e.g ., business entity) PTY -Political Party SCC -Small Contributor Committee IRJIND oCOM DOTH oPTY OSCC IKJ IND DCOM DOTH oPTY Dsec IKl IND DeOM DOTH DPTY osee IRlIND DeOM DOTH oPTY osee IKJIND oCOM DOTH DPTY osce Police Corporal City of San Rafael Police Corporal City of San Rafael Officer City of San Rafael Officer City of San Rafael o lcer City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 through _...;;.1;:.:2,-,/...;;3;..;;1;.:./...;;2;..;;0..::1..::6 __ _ SCHEDULEA (CONT.) CALIFORNIA 460 FORM 1.0. NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CAlENDAR YEAR (JAN . 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16 .30 376 .20 16 ,30 376 .20 16.30 376.20 16.30 376.20 16.30 376.20 Bl.50 1 FPPC Form 460 (Janl2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Poli~ical Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SElF. EMPLOYED. ENTER "'AMi: (lFCCMMmEE.ALSOENT8H.D. HUMBER) CODE .. 11 15 2016 Christopher Duncan C/o: San Rafael ~olice Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary : San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 4901 11/30/2016 Christopher Duncan 12/15/2016 C/o : San Rafael Police Association 1520 Fif~h Avenue San Rafael, CA 94901 Union member's dues received through intermediary : San Rafael Police Association, .'" Fifth 12/29/2016 Christopher Duncan C/o : San Rafael ~olice Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 09 30 2016 Scott E r.l.e C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 union member's dues received through intermediary ; San Rafael Police Association, ·Contributor Codes INO -Individual . 4 COM -Recipient Committee (olher than PTY or SCC) OTH -Other (e.g., business entily) PTY -Political Party SCC -Small Contributor Comm ittee IR)IND oCOM DOTH oPTY osee ~IND OCOM DOTH OPTY OSCC IR)IND oeOM DOTH OPTY osee IK)IND o COM DOTH DPTY OSCC IKJIND DCOM DOTH OPTY OSCC OF 8US4NESS) Officer City of San Rafael Officer City of San Rafael Officer City of San Rafael Officer City of San Rafael Sergeant City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 throug h _....:1::..;2:..:/....:3;...;1;..:;/....:2:....;0..;;;1..;;;6 __ _ SCHEDULE A (CaNT.) CALIFORNIA 460 FORM Page _-=-34=--of l.l.2 1.0. NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376 .20 16 .30 376 .2 0 16.30 376.20 16.30 376 .20 16.30 376.20 81 .50 1 FPPC Form 460 (Janl2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FILER San Rafael Police Association Political Action Committee DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE. ALSO ENTEl'I I 0 NUMBER) CODE * 10/20 2016 Scott Eberle IRJIND C/o: San Rafael Police ASsociation 1520 Fifth oCOM Avenue San Rafael, CA 94901 DOTH Union member' s does rece i ved through 0 PTY incermeciiary: San Rafael Police Association, OSCC 1520 Fifth Avenue San Ra fael CA 94901 11/05/2016 Scott Eberle IRJIND C/o: San Rafael Police Association 1520 Fifth DCOM Avenue San Ra fael, CA 94901 DOTH union member'S dues rece i ved through 0 PTY interm~diary: San Rafael Police Associacion, OSCC 11/15/2016 Scott Eberle IRJIND C/o, San Rafael Police Association 1520 Fifch o COM Avenue San RafaeL CA 94.901 DOTH Union member's does received chrough 0 PTY IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF saF·E/.IPLOYEO. ENTeR NAI..1E OF BUSINESS) Sergeant City of San Rafael Sergeanc City of San Rafael Sergean: City of San Rafael Statement covers period hom 09/25/2016 throug h __ 1_2-,/_3_1-,1_2_0_1_6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 35 of _-,1",1=..:2=-- 1.0. NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULAnve TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376.20 16.30 376.20 16.30 376.20 intermediary; San Rafael Police Associat~on, [JSCC ~~77~~~~1520 Fifth Avenue. San Rafael~~A~~~~ ______ ~ __________ ~~~ ______________________ -+ __________ ~~~r-__________ ~~~+-________________ __ 11/30/2016 Scott Eberle oolND Sergeant 16.30 376.20 C/o: San Rafael Police Association 1520 Fifth X City of San Rafael Avenue nCOM San Rafael, CA 94.90l [J OTH Union member's dues received Chrough [J PTY intermediary: San Rafael Police Association, [JSCC 1520 Fifth Avenue, San Rafael, CA 94901 12 15 2016 Scott E: er e 001 0 C/o: San Rafael Police Association 1520 fifth X N Avenue [J COM San Rafael, CA 94901 [JOTH Union member's dues received chrough DPTY intermediary : San Rafael Police ASsocia~ion, [JSCC ·Contributor Codes IND -Individual . 949Q1 COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g, business entity) PTY -Political Party SCC -Small Contributor Committee Sergeant City of San Rafael SUBTOTAL $ 16.30 :1 76.20 81. SO I FPPC Form 460 (Jan/2016) FPPC Advice: adv1ce@fppc.ca.gov (8661275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME. OF FILER San Rafael Police Associacion Policical Action Committee DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE. ALSO ENTER I 0 NUMBER) CODE ... 12 29/2016 Scon Eberle IKIINO C/o : San Rafael Police Association 1520 Fifth ~~ O~ San Rafael. CA 94901 nOTH Union member's dues received through 0 PTY inc.ermediary : San Rafael Police Association, osee 1520 Fifth Avenue San Rafael CA 94901 09/30/2016 Sandra Felix Ahumada IRIIND C/o: San Rafael Police Association 1520 Fifth oCOM Avenue San Rafael, CA 94901 DOTH Union member's dues received through 0 PTY interm7diary: San Rafael Police Association, OSCC IF AN INDIVIDUAL , ENTER OCCUPATION AND EMPLOYER (IF saF·EMPLOVEO. ENTER NAME Of BUSINESS) Sergeant City of San Rafael Police Officer City Of San Rafael Statement covers peri ad ITom 09/25/2016 th rou gh _...:1:..:2;.:../.=.3.::.1 :....;/2::..:0:..:1:..:6~ __ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page _._.li....-of 112 1.0. NUMBER 831553 AMOUNT RECENED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN . 1 -OEC 31) PER ELECnON TO DATE (IF REQUIRED) 16 .30 376.20 16.30 110 .10 ~~------+---------~~--~~------------+---------~--+-----------~~---------------09/30/2016 Kevin Finerty IRJ IND Police Officer 16.]0 207.90 C/o: San Rafael Police Association 1520 Fifth UCOM City Of San Rafael Avenue San Rafael, CA 94901 DOTH Uni on member'S dues rece i ved through 0 PTY intermediary: San Rafael Police Association , OSCC ~77~~~~~~~~' ~~n 4 01 10/:20/2016 Kevin Finerty IRJIND C/o: San Rafael police Association 1520 Fifth X Avenue oeOM San Rafael, CA 94901 DOTH union member's dues rece i ved th rough 0 PTY intermediary: San Rafael Police Association, osee 1520 Fifth Avenue, San Rafael, CA 94901 11 05 2016 Kevln Fl.nert y IvIIND C/o, San Rafael Police Association 1520 Fifth ~ Avenue DeOM San Rafael, CA 94901 DOTH Union member' s dues received through U PTY intermediary: San Rafael Police Association, LJsce ·Contributor Codes IND -Individual COM -Recipient Committee (olher than PTY or SCC) OTH -Other (e.g., business entity) PTY -Political Party SCC -Small Contributor Committee Police Officer City Of San Rafael SUBTOTAL $ 16.30 207 .90 16.30 207.90 81. 50 I FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (B66/275-3n2) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to whole do liars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDlVlDUAL, ENTER OCCUPAnON AND EMPLOYER (IF SElF-EMPLOYED. ENlER NAME OF 5USINESS) (IFCOMMITT~E.ALSOENTERI.D NUMIlERI CODE * 11/1~,!2016 Kevin Finerty C/o: San Rafael Police Association 1520 FiEth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 F ifth Av enue San Rafael CA 94901 11/30/2016 Kevin Finerty C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through ~nterm7diary: San Rafael Police Association, 12/15/2016 Kevin Finerty C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues receJ.ved through intermediary: San Rafael Police Association, 1 ·lft A a 12/29/2016 Kevin Finerty c/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 09 30 2016 Scott F1S er C/o: Sil~ Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through interm7 dlary: San Rafael Police Association, ·Contributor Codes INO -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g., business entity) PTY -Political Party SCC -Small Contributor Committee !KlIND oeOM DOTH UPTY osee !KlINO OCOM DOTH OPTY osec IXIINO OCOM DOTH OPTY oscc !KlIND oeOM DOTH OPTY OSCC !KlIND OCOM DOTH D PTY OSCC Police OffJ.cer City Of San Rafael Police Officer City Of San Rafael Police Officer City Of San Rafael Police OffJ.cer City Of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 th ro ugh _-=1:..;:2"-/.::.3=-1/<....:2:.,;0:..;:1:..;:6'--__ SCHEDULEA (CONT.) CALIFORNIA 460 FORM Page 37 of 112 LD.NUMBER 831553 AMOUNT RECENED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 207.90 16.30 207.90 16.30 207,90 16.30 207.90 16, 0 81. SO I FPPC Form 460 (Jan/2016) FPPG Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Assoc:iat:ion Polit:ical Acr:ion commit:r:ee Amounts may be rounded to whole dollars. DATE RECE IVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF saF·E!.4pl.OYEO. ENTER NAME Of B(JSI"'ESS) (IFCOMMrnE€.ALSO~1 0 NUMe6l) CODE * 10/20/2016 Scot:!: Fisher C/o : San Rafael Police ASsociation 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary · San Rafael Police Association, 1$20 Fifth Avenue San Rafael CA 94901 11/05/2016 Scott Fisher 11/15/2016 11 /30/ 2016" C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 union member's dues received through intermediary: San Rafael Police Association, " F FiEth Fifth Avenue San Rafael, CA 94901 Union member'S dues received through intermediary: San Rafael Police Associar.ion , 1520 fifth Avenue, San Rafael , CA 94901 12 15 2016 Scott f~sher C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police A9Bociat~on , 'Contributor Codes INO -Individual 2 F · COM -Recipient Committee (other than PTY or seC) OTH -Other (e.g., business entity) PTY -Polillcal Party sec -Sma!) Contributor Committee OOIND OCOM DOTH OPTY OSCC !R]IND DCOM DOTH OPTY osee IXJIND nCOM DOTH DPTY osce IRJIND DCOM DOTH OPTY OSCC !!lIND OCOM DOTH OPTY OSCC <,alice Officer City Of San Rafael Police Officer City of San Rafael Police Officer City of San Rafael Police Officer City Of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 through __ 1:....2,-,/....:3....:1...:./....;2:....0..;.1....:6 __ _ SCHEDULE A (CaNT.) CALIFORNIA 460 FORM Page 36 of 112 1.0 . NUMBER 631553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN . 1 • DEC . 31, PER ELECTION TO DATE (IF REQUIRED) 16.30 16.30 201.30 16 .30 201.30 16 .30 201 .30 15 .30 201.30 81. 50 I FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FILER San Rafael ?ol~ce Association ~olitical Action Committee DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE. ALSO EI>JTER I 0 NUMBER) CODe * 12/29/2016 Scoel Fisher IKIIND C/o : San Rafael Police ASSoc1ation 1520 Fifth Avenue DeOM San Raiael, CA 94901 DOTH Jnion member' e dues received through LJ PTY intermeaia~: San Raiael Police Association, DSCC 1520 Fifth Avenue San Rafael CA 94901 09/30/2016 Anna Fulgado IKIINO C/o : San Rafael Police Association 1520 Fifth DCOM Avenue San Rafael, CA 94901 DOTH Union member's due 5 rece i ved throug~ 0 PTY interm~diary : San Rafael Police Association, osce 10/20/2016 Anna Fulgado ~IND C/o, San Rafael Police Association 1520 Fifth DeOM Avenue San Rafael, CA 94901 DOTH Union member's dues received .:hrough OPTY IF AN INDIVIDUAL, ENTER OCCUPAnON AND EMPLOYER QF S~LF·EMPLOYED. ENT8l NAME OF BU$1NESS) Police Officer City Of San Rafael Dispatcher City Of San Rafael Dispatcher City Of San Rafael Statement covers period from 09/25/2016 through ___ l~2~/~3~1~/_2~O~1~6 ____ ___ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 39 of 112 1.0. NUMBER 831553 AMOUNT RECENEO THIS PERIOD CUMULAnvETO DATE CALENDAR YEAR (JAN. 1 -DEC . 31) PERELEcnON TO DATE (IF REQUIRED) 16.30 201.]0 12 .70 282.30 12_ 70 262.30 lntermediary: San Rafael Police Association, OSCC __ ~~~~~~~~~-Q~F~l~'f~t~h~A~V~~~~~CA~~9~4~9~ ______ ~ __________ ~~ __ ~~ _______________ +-____________ ~+---------~~~~------------------- 1.1/05/2016 Anna Fulgado OOIND Dispatcher 12-70 2B2.30 C/o; San Rafael Police Association 1~:l0 Fifth OX COM City Of San Rafael Avenue San Rafael, CA 94901 DOTH union member's dues recei ved through 0 PTY intermediary : San Rafael Poli.ce Association, OSCC 1520 fifth Avenue, San Rafael, CA 94901 Anna Fu ga 0 OOIND C/o ; San Rafael Police Association 1520 Fifth X Avenue OCOM San Rafael, CA 94901 LJOTH Union member's dues recei ved through 0 PTY intermediary: San Rafael Pol~ce Association, [JSCC ·Contributor Codes INO-Individual COM -Recipient Committee (other than PTY or seC) OTH -Other (e_g .. business entity) PTY -Political Party SCC -Small Contribulor Committee Dlspatc er City Of San Rafael SUBTOTAL $ 12 .70 282 .30 FPPC Form 460 (JanI2016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael police Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF·EMPLOYED. EI>1TER NAME OF BUSINESS) (IF CQMMmE.E, AlSO ENTER I.D. NUMB~R) CODE * 11/30/2016 Anna Fulgado C/o : San Rafael Police Associa tion 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, ~~~~~~~15'-O Fifth Avenue San Rafael CA 94901 12/15/2016 Anna-Fulgado C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, .12/29/2016 09/)0/2016 ·Contributor Codes I NO -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g., business entily) PTY -Polit ical Party sec -Small Contributor Committee Fifth Fifth Fifth IKIIND oeOM DOTH oPTY osee !KIIND oCOM DOTH o PTY osec \XJIND OCOM DOTH DPTY osce IR]IND DCOM DOTH DPTY osee I!)IND DeOM DOTH OPTY osec Dispatcher City Of San Rafael Dl.spatcher City Of San Rafael Dispatcher City Of San Rafael Police Officer City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 through __ 1",2",/'-.:3:....:1:..:/--,2:....:0-=1:....:6 __ _ SCHEDULE A (CaNT.} CALIFORNIA 460 FORM Page 40 of 112 1.0 . NUMBER 831553 AMOUNT RECEIVED THIS PERIO~ CUMULAnvE TO DATE CALENDAR YEAR (JAN. 1 -DEC . 31) PERELEcnON TO DATE (IF REQUIRED) ~2.70 282 .30 12 .70 282.30 12.70 282 .)0 16.30 376.20 6.30 376 .20 FPPC Form 460 (Jan/2C16) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to whole do liars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR !F AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF·EMPLOYED, ENTER NA~E OF BUSINESS) (IF COMMITTEE, AlSO ENTER I D. NUt.!BER) CODE * 11 OS/2016 Christopher Fuller C/o; San Rafael Police Association 1520 Fifth Avenue San Rafael, LA 94901 Union member's dues rece1ved through intermediary: San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 94901 11/15/2016 Christopher Fuller C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through interm7diary: San Rafael Police Association, 11/)0/2016 Christopher Fuller C/o; San Rafael Police Associacion 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary' San Rafael ~olice Association, 1520 Fifch Avenue San Rafael CA 4 01 12/15/2016 Chris copher Fuller c/o: San Rafael Police AssociaLion 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 rcifth Avenue, San Rafael, LA 94901 C rlstop er Fu ier c/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 15?~r~th Ayenue ·Contributor Codes IND -Indwidual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g., business entity) PTY -Political Party SCC -Small Contributor Committee IRIIND [JCOM DOTH oPTY OSCC IRIIND oCOM DOTH oPTY OSCC IiIIND LJCOM DOTH OPTY OSCC IRIIND OCOM DOTH OPTY OSCC IKJIND OCOM DOTH OPTY USCC Police Officer City of San Rafael Police Officer Ci~y of San Rafael Police Officer Cicy of San Rafael Police Officer City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2G16 ~rough __ ~1~2~/3~1~/2~0~16~ ____ ___ SCHEDULE A (CaNT.) CALIFORNIA 460 FORM Page 41 of __ -=1::..:1::..:2=-- 1.0. NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 • DEC. 311 PER ELECTION TO DATE (IF REQUIREDI 16.30 376.20 16.30 376.20 16.30 376.20 16.30 376.20 16.30 ]76.20 81,50 1 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to whole doUars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDNIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF·EMPLOYED. ENTER NAME OF euslNEssl (IF COMMI TrEE. ALSO ENTER to NUMBERI CODE * 09/30/2016' Salvatore Garanzini C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 94901 10/20/2016 Salvatore Garanzini 11/0 5 /2016 c/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, Fifth 11/15/2016 Salvatore Garanzini C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 Sa vatore Garanz~n~ C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary, San Rafael Police Association, ·Contributor Codes INO -Ind ividual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g" business entity) PTY -Political Party SCC -Small Contributor Committee IK]IND DCOM DOTH DPTY Dsce IKIIND DeOM DOTH OPTY osee IXlIND DCOM DOTH DPTY osce !RlIND DCOM DOTH OPTY osee IKIIND DCOM DOTH OPTY osee Officer City of San Rafael Officer City of San Rafael Officer City of San Rafael Officer C1ty of San Rafael o l-cer City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 through _' 12 /31/2016 SCHEDULE A (CaNT.) CALIFORNIA 460 FORM Page 42 of 112 I D,NUMBER 83155) AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN, 1 -DEC, 31) PERELEcnON TO DATE (IF REQUIRED) 16.30 376.20 16.30 376,20 16.30 3 7 6,20 16.30 376,20 16,30 )7 .20 81. 50 I FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc,ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FI LER San Rafa e l ~olice As60cia~ion Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (tFCOM'-1ITTE;:' ALSO ENTEIl 1.0 N\!I.IBER) CODE * IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (I F SELf·EMPlOYED. EN'TCR NAME OF BUSINESS) 09/30/2016 ·Contributor Codes INO -Individual COM -Recipient Committee (other Ihan PTY or SCC) OTH -Other (e .g ., business entity) PTY -Political Party SCC -Small Contributor Committee Fifth Fifth Fift.h Fifth Fi fth (RJIND DCOM DOTH OPTY OSCC !!lIND nCOM DOTH DPTY osee IKJINO oCOM DOTH oPTY Osee IKJIND oCOM DOTH oPTY OSCC IK)IND DCOM UOTH OPTY OSCC San Rafael Officer Cit.y of San Rafael San Rafael San Rafael SUBTOTAL $ Statement cOllers period from __ --'-0"""'9/:....2.;..;5'-'/...;:2...;:0...;:1...;;;6 __ _ through __ 1;0;2;;..:/'-'3:....:1'-'/...;:2...;:0...;:1;.;;6'--__ AMOUNT RECEIVED THIS PERIOD 16 .30 16.30 Bl .50 1 83~S S3 CUMULATIVE TO DATE CALENDAR YEAR (JAN . 1 -DEC. 31) 376 .20 376.20 SCHEDULE A (CaNT.) PER ELECTION TO DATE (IF REQUIRED) FPpe Form 460 (Jan/2016) FPPC Adllice: adllice@fppc.ca.goll (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL . ENTER OCCUPAnON AND EMPLOYER (IF SElf·EMPLOYEO. ENTER NAME OF BUSINESS) (IF COMMlnee. ALSO ENTER I 0 NUMBER) CODE * 11/15 2016 Michael Garrison C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary , San Rafael Police Associa~ion, 1520 fifth Avenue San Rafael CA 94901 11/)0/2016 Michael Garrison C/o : San Rafael Police Association 1520 FiEch Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, '. 12/:5/2016 Michael Garrison c/o : San Rafael Police Association 1520 Fifch Avenue San Rafael , CA 94901 Union member's dues recelved through intermediary: San Rafael police Association, 20 Fifth Av nue San R fael CA 4 01 12/29/2016 Michael Garrison C/o : San Rafael Police Associacion 1520 Fifch Avenue San Rafael, CA 94901 Union member's dues received through intermediary : San Rafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 Ll a Gav lC C/o: San Rafael Police Association 1520 Fifth Avenue San Raf~el , CA 94901 Union member's dues received through lnterm7diary : San Rafael Police Association, ·Contributor Codes INO -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e ,g .. business enUty) PTY -Political Party SCC -Small Contributor Committee IKJIND DCOM DOTH DPTY nscc IKJ INO OCOM DOTH OPTY OSCC ~INO DCOM DOTH DPTY OSCC ~INO DeOM DOTH OPTY OSCC IIDINO DCOM DOTH OPTY osee Officer City of San Rafael Officer City of San Rafael officer City of San Rafael Officer City of San Rafael SUBTOTAL $ Statement cove rs period rrom 09/25/2016 through _--=1=-2..:./--=3:..:1:.:./-=2:..:0-=1:..:6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page~ of 112 I.D.NUMBER 831S53 AMOUNT RECEIVED THIS PERIOD CUM ULATIVETO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376.20 16 .30 376 .20 16.30 376 .20 16.30 376 .20 81.50 1 FPPC Form 460 (JanI2D16) FPPC Advice: advice@fppc.CC1.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRII3UTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER IIF SElf·EMPlOYED, ENTER NAME OF BUSINESS) ~F CCloIMllTEE. Al.SOENrd< I,D NU!.46ER) CODE * lO/2C/2C16 Lilah Gavlick C/o: San Rafael Police Association 1520 <ifth Avenue San Rafael, CA 94901 Onion member's dues received through intermediary: San Rafael Police Association, 1520 <ifth Avenue San Rafael CA 94901 11/CS/2016 Lilah Gavlick 11/15/2016 11/30/2016 C/o: San Rafael Police Association 1520 <ifth Avenue San Rafael, CA 94901 Union member's dues received through interm~diary: San Rafael Police Association, rifth Fif~h Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Ra(ael Police Association, 1S20 Fifth Avenue, San Rafael, CA 94901 L~ a Gav J.C C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police A~~ociation, . 1 9Conlributor Codes INO -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g" business entity) PTY -Polilica I Party SCC -Small Contributor Committee IR)INO DeOM DOTH DpTY DSCC [glIND DeOM DOTH OPTY OSCC IR]INO oCOM DOTH OPTY OSCC IR]IND DCOM DOTH OPTY DSCC [KlIND DCOM DOTH OPTY OSCC Police Officer City of San Rafael Pol ice Off icer City of San Rafael Police Officer City of San Rafael Police Officer City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 throu gh _....;1;;.;2;:.:/-=3-=1~/.::2..:.0.::.1.:..6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 45 of 112 I D.NUMBER 831:'~3 AMOUNT RECEIVED THIS PERIOD CUMUl.ATIVETO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER EI.ECnON TOCATE (IF REQUIRED) 16.30 376.20 376.20 16.30 376.20 16.30 376.20 6_30 376 .20 81.50 1 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) - - -_. -i' __ •• _ ~ ~ ~,_ Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael police Association Political Action committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET AODRESS AND ZIP CODE OF CONTRIBUTOR CONTRI8UTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SElF·EMPLOYED. EN'~ NAME OF 8UStNESS) 09/30/2016 10/20/2016 (If CCMMITTEE, ALSO ENTEA I D. NUMBER) CODE * Fifth Fifth Fifth Fifth Fifth IK]IND OCOM DOTH OPTY osce !!lIND oCOM DOTH D PTY o see ~INO DeOM DOTH oPTY osee ~IND oCOM DOTH oPTY osce IRJIND DCOM DOTH D PTY O SCC Corporal City of San Rafael Corporal City of San Rafael City ot San Rafael :City of San Rafael SCHEDULEA (CONT.) r-----SShta~~;m~e~n!t~co~v;.e~rs;rp;e~rl~o~d~--lI~ .. ~~"~ from ______ 09-'/....;2_S...:,/_2_0_l_6 ____ __ th ro ugh __ ....;1::..;2:.,,/...:.3:...:1"'/.,:2:.,:0;,::1;,::6'--__ _ AMOUNT RECEIVED THIS PERIOD 1 16.30 16.30 16.30 831553 CUMULATNETO DATE CALENDAR YEAR (JAN. 1 • DEC 31) ]76,20 376.20 376.20 PER ELECTION TO DATE (lr-REQUIRED) SUBTOTAL $ B1.5 01 ·Contributor Codes INO -Individual 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/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FILER San Rafael Police Association Political Action Committee DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIDUTOR CONTRIBUTOR IIFCOMMITrEE. AlSO ENTER I 0 NVM~RI I CODE * i 11/30/2016 Justin Graham C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member'S dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue S a n Rafael CA 94901 12/15/2C16 Justin Graham C/o, San Rafael Police Association IS2e Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 12/29/2016 Justin Graham C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member'S dues received through intermediary: San Rafael Police Association, --:-."...,.:-:-..,."..,,....,...,:--1-:U2...0_E.·U.!..t'-~ a F 4 01 09/30/2016 Lori Hendricks C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94935 Union member'S dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 Lorl. Hen rl.C S C/o: San Rafael Police Association 1520 Fifth ·Contributor eodes IND -I ndividual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g., business entity) PTY -Political Party see -Small Contributor Committee 94935 I IXJIND oeOM DOTH oPTY OSCC IXJINO oeOM DOTH oPTY osce IXJINO oeOM DOTH oPTY oSCC fiU INO oeOM DOTH oPTY OSCC IXJINO oeOM DOTH [JPTY osce IF AN INDNIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SElF· EMPLOYED. ENTER NAME OF 8USWESS) Corporal City of San Rafael Corporal City of San Rafael Corporal City of San Rafael ~ispat:cher City of San Rafael Dl.spatc er City of San Rafael SU8TOTAL$ Statement COVE!~ period from 09/25/2016 through _....:.1:..:2::..:/....:.3:.:1::..:/....:2:.:0:..:1:..:6" __ SCHEDULE A (CaNT.) CALIFORNIA 460 FORM Page 47 of 112 I D NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUM ULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376,20 16.30 376.20 16.30 376.20 1.2.70 294,30 12.70 294.30 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAMEOFFILER San Rafael Police Association Political Action Committee DAlE RECEIVED FUll NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRI8UTOR (IFCC~MI1TEE.ALSOENTERI.D.NUMB~RI CODE * 11 05 2016 Lori Hendn-eks [KJINO C/o: San Rafael Police Association 1520 Fifth OX COM Avenue San Rafael, CA 94935 [] OTH Union member's dues reeei vee through 0 PTY intermediary: San Rafael Police Association, []SCC 1520 Fifth Avenue San Rafael LA 94901 11/15/2016 Lori Hendrick.s ~ IND C/o: San Rafael Police Association 1520 Fifth DCOM Avenue San Rafael, LA 94935 DOTH Union member's dues recei veci through 0 PTY incermediary: San Rafael Police Associacion, OSCC ·F ~ 11/]0/2016 Lori Hendricks !ilINO C/o: San Rafael Police Association 1520 Fift::h DeOM Avenue San Rafael, CA 94935 DOTH Union member's dues received through 0 PTY IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF· EMPLOYED. ENTER NAME OF Il"US'NESS) Dispatcher City of San Rafael Dispat:cher City of San Rafael Dispatcher City of San Rafael Statement covers period from 09/25/2016 through 12/31/2016 SCHEDULE A (CaNT.) CALIFORNIA 460 FORM Page 46 of 112 10. NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTlON TO DATE (IF REQUIRED) 12.70 294.30 12.70 294.30 12.70 294.]0 intermediary: San Rafael Police Associacion, OSCC . A ue, San Ra~l~~-24~0~1~ ____ ~ __________ -+~ __ ~~ ________________ +-________ ~~77+-________ ~~~~r-____________ __ 12/15/2016 Lori Hendricks fX]INO Dispatcher 12.70 294.30 : C/o: San Rafael Police Association 1520 Fifth OX COM Cicy of San Rafael Avenue San Rafael, CA 94935 DOTH Onion menlber' s dues rece i ved through 0 PTY intermediary: San Rafael Police Association, []SCC l~LO Fifth Avenue, San Rafael, CA 94901 12 29 2016 Lon. Hen n.c s !RI C/o: San Rafael Police Association 1520 Fifth X INO Avenue OCOM San Rafael, CA 94935 DOTH Union member's dues received through [] PTY intermediary: San Rafael Police Association, (]SCC ·Contributor Codes I NO -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g., business entity) PTY -Political Party SCC -Small Contributor Committee D~spatc er City of San Rafael SUBTOTAL $ 12.70 294.30 63.50 1 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to who Ie dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODe OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF·EMPLOYED. ENTER NAME OF BUSINESS) (IF COMMITTEE, AlSQ ENTER I 0 NUMBER I CODE * 09/30/2016 Robert Henkle C/o : San Rafael police Associa~ion 1520 Fifth Avenue San Rafael, CA 94901 Union member 's dues received ~hrough intermediary : San Rafael Police Association, ~77~~~--rlS20 Fifth Avenue San Rafael CA 4 01 10/20/2016 Robert Henkle C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through inte~diary, San Rafael Police Association, -11/05/2016 11/15/2016 ·Contributor Codes IN D -Individual COM -ReCipient Committee (olher than PTY or seC) OTH -Other (e .g .. business entity) PTY -Political Party sec -Small Contributor Committee Fiftb Fifth Fifth IR]IND DeOM DOTH OPTY Osee OOINO DeOM D OTH OPTY osee IXJIND oeOM DOTH OPTY osee IKJIND OGOM DOTH OPTY osee OOIND oeOM DOTH UPTY osee Officer City of San Rafael Officer City of San Rafael officer City of San Rafael Officer City of San Rafael o J.cer City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 ~rough ~~1~2~/~3~1~/~2~0~1~6 ____ ___ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 4 9 of _..:.1.:..12=-- !.D. NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATNETO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELEcnON TO DATE (IF REQUIRED) 16 .30 376 .20 16 .30 376.20 l6.JO 376.20 16.30 376 .20 16 .30 376 .20 81.50 1 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FI LER San Rafael Police Association Poli~ical Action Committee Amounts may be rounded to whole dolla rs. DA.TE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAl. ENTER OCCUPATION AND EMPLOYER (IF SELF·EI.!PLOYEO. ENTER Ni\.\.IE OF BUSINESS) (IFCOMMIITEE. ALSO ENTflH D. NUMBER) CODE * 12 15/2016 Robert Henkle C/o ; san Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Associu~ion, 1520 Fifth Avenue San Rafael CA 94901 12/29/2016 Robert Henkle 09/30/2016 10/20/2016 C/o : San Rafael Police Association 1520 F~fth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, Avenue San Rafael, CA 94901 Union member's dues received through intennediary : San Rafael Pol :ce Association, -.~~~~~~1~52~0~F~L~·fth Avenue, San Rafael, CA 94901 J . A exan er Ho m C/o : San Rafael Pol~ce Association 1520 Fifth Avenue San Rafael, CA 94901 Onion member 's dues received through intermediary: San Rafael Police Association, 'Contributor Codes INO -IndiVidual "'F COM -Recipient Committee (other than PTY or SeC) OTH -Other (e.g .. business entity) PTY -Political Party SCC -Small Contributor Committee IRJIND DCOM DOTH DPTY osee IKJIND DeOM DOTH DPTY osec !K)INO DeOM DOTH DPTY osee ~IND DeOM DOTH DPTY OSCC IKIIND DCOM DOTH OPTY osee Officer City of San Rafael Officer City of San Rafael Corporal City of San Rafael Corporal City of San Rafael Corpora City of San Rafael SUBTOTAL $ Statement covers peri ad from 09/25/2016 ~rough __ ~1~2~/~)~1~/~2~0~1~6 ____ ___ SCHEDULE A (CONT.) CAL.IFORNIA 460 FORM Page so of 112 1.0 . NUMBER 831 553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -OEC 31) PER ELECTION TO DATE (IF REQUIRED) 16 .30 3/6.:10 16 .30 376 .20 16 .30 3?6.20 16.30 316 .20 16.30 376 .20 81.50 1 FPPC Form 460 (JanJ2016) FPPG Advice: advlce@fppc.ca.gov (866/275-3n2) .. ---. ~ .... ---~ --- Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL . ENTER OCCUPATION AND EMPLOYER QF SELF-EMI"lOVEO. ENTER NAME OFeusIN~ QF CC!!MmEE. ALSOENTEl'I 1.0 . NUMSER) CODE * 11 15 2016 J. Alexander Wolm Ic/o: San Rafael police Association 1520 Fifth Avenue San Rafael, CA 9~901 Onion member's dues received through intermediary : San RaEael Police Association, 1520 Fifth Avenue San Rafael CA 94901 11/)0/2016 J. Alexander Holm C/o ; San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received th:ough interm~diary; San Rafael ?olice Association, 12/15/2016 12/29/2016 09 3D 2016 ·Contributor Codes INO -Individual COM -ReCipient Committee (other than PTY or SCC) OTH -Other (e .g., business entity) PTY -Political Party sec -Small Contributor Committee Fifth Fifth Fifth IRJINO DCOM DOTH DPTY osee ~INO DCOM DOTH DPTY oscc !X}INO DeOM 'lOTH DPTY oscc IRJIND oeOM DOTH DPTY osec IRJIND DeOM DOTH OPTY oscc Corporal City of San Rafael Corpora l City of San Rafael Corporal City of San Rafael Corporal City of San Rafael Sergeant City of San Rafael SUBTOTAL $ Statement cOllers period from 09/25/2016 through __ ~1~2~/~)~1~/~2~0~1~6~ __ ___ SCHEOULEA (CONT.) CALIFORNIA 460 FORM Page S1 of 112 1.0. NUMBER 831 55 3 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16 .30 376.20 16.30 376 .20 16 .30 376.20 16 .30 376.20 1 .30 ]76 .20 81 .50 1 FPPC Form 460 (Janf2016) FPPC Advice: advice@fppc.cil.gDv (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Policical Accion Commi~tee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF· EMPLOYED, ENTER NAME OF eusiNESS) (IF COM MmeE. ALSO ENTER I D. NUM~ CODE * 10 20 2016 11/05/2016 11/15/2016 11/30/2016 12 15 2016 Lisa Holton C/o : San Rafael police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael police Association , 1520 Fifth Avenue San Rafael CA 94901 Lisa Holton C/o : San Rafael Police Association 1520 Fifch Avenue San Rafael, CA 94901 Union member's dues recelved through intermediary: San Rafael Police Association , I Lisa Holton C/o: San Rafael Police Association 1520 FiEth Avenue San Rafael, CA 94901 Union member's dues received chrough intermediary: San Rafael Police Association, . 1 4 Lisa Holton C/o: San Rafael Police Association 1520 Fifth Avenue San Kafael, CA 94901 Onion member's dues received through intermediary : San Rafael Police Association , 1520 Fifth Avenue, San Rafael, CA 94901 L~sa Ho ton C/o: San Rafael Police Association 1520 fifth Avenue San aafael, CA 94901 Un ion member's dues received through intermediary: san Rafael Police Association, 'Contributor Codes INO -Individual COM -Recipient Committee (olher than PTY or SCC) OTH -Other (e .g .. business entity) PTY -Political Party SCC -Small Contributor Committee IX)INO DCOM DOTH OPTY OSCC !!lIND OCOM DOTH OPTY osce ~IND DeOM DOTH OPTY osce IRJIND DeOM DOTH DPTY osce IRJIND neOM DOTH OPTY OSCC Sergeant City of San Rafael Sergeant City of San Rafael Sergeant City of San Rafael Sergeant City of San Rafael Sergeant City of San Rafael SUBTOTAL $ Statement covers period hom 09/25/2016 through ___ 1~2~/~3~1~/~2~0~1~6 ____ ___ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page ___ 5_2_ of 112 1.0 . NUMBER 831 55 3 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376.20 16 .30 376 .20 16.30 376.20 16.30 )76,20 16.30 376.20 81. 50 I FPPC Form 460 (JanI2016) FPPC Advic:e: advic:e@fppc.ciI.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (lfCOMMITTEE.AI..SOENTCR 1.0 NUMBER) CODE * IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOVER (If SELF-EMPlOYED. ENTER NAME OF BUS!NESS) 12/29/20'16-Lisa Holton C/o : San Rafael Police Association 1520 Fifch Avenue San Rafael, CA 9i901 Un i on member's dues received chrough intermediary: San Rafael Police A~sociation, 1520 Fifth Avenue San Rafael CA 9~901 09/30/2016 Kyle Hornste i n C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Associat~on, 10/20/2016 Kyle Hornstein C/o: San Rafael Police Associacion 1520 Fifth Avenue San Rafael, CA 94901 Union men~er's dues received through intermediary: San Rafael Police ASsociacion, 1 20 Fifth Av nue S n R 1 11/05/2016 Kyle Hornstein C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through 1ntenmediary : San Rafael police Association, 1520 F1fth Avenue San Rafael, CA 94901 Ky e HornBte~n C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 9i901 Union member's dues received through intermediary: San Rafael Police Association, ·Contributor Codes IND -Individual COM -Recipient Committee (other than PTY or SeC) OTH -Other (e .g., business entity) PTY -Political Party SCC -Small Contributor Committee !&lIND DCOM DOTH DpTY DSCC ~IND DCOM DOTH DPTY DSCC OOIND DeOM DOTH DPTY Dsce !&lIND DCOM DOTH DPTY osee !&lIND DeOM DOTH DPTY DSCC Sergeant City of San Rafael Corporal City of San Rafael Corporal City of San Rafael Corporal City of San Rafael Corpora_ City of San Rafael SUBTOTALS Statement covers period from 09/25/2016 tnrou gh _....:1:..::2;.:../..::.3.::.1'-'/2::..;0:..:1:...:6'---__ SCHEDULE A (CaNT.) CALIFORNIA 460 FORM Page 1.0. NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR VEAR (JAN 1 -DEC. 31) PER EI.ECnON TO DATE (IF REOUIRED) 16.30 3 76 .20 16 .30 376 .20 16.30 376 .20 16.30 376.20 16.30 376.20 81.50 1 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police ASsociacion Policical Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STIlEET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED. ENTER NAME (IF COMMInEE. ALSOENTCR I D NUMBER) CODe * 'n Rafael Police Associacion 1520 Fifth Fifth Fifth Fifth Fifth OOIND DeOM DOTH oPTY osee !K)IND oeoM DOTH oPTY osee IX)IND OCOM DOTH npTY osee ®IND DCOM DOTH oPTY nscc !K)IND DCOM nOTH OPTY oscc OF BUSlNESS) Cicy of San Rafael Sergeant City of San Rafael City of San Rafael SCHEDULE A (CONT.) ~--~SSi~~tee,m~enrrt~c;o~v~e~~sop;eririoodd----lI~II"~~~ from 09/25/2016 through _....;1;;.;2;;.:/....;3;..:1:..:./..:2;..:0..:1..:6 __ _ Page __ ~ of 112 AMOUNT RECEIVED THIS PERIOD 16 ,)0 16.30 16.30 1.0 NUMBER B31553 CUMULATIVE TO DATE CAlENDAR YEAR (JAN. 1 . DEC. 31) 376,20 376.20 376 .20 PER ELEcnON TO DATE (IF REQUIRED) SUBTOTAL $ ·Contributor Codes IND -Individual eOM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g., business entity) PTY -Political Party see -Small Contributor Committee FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca .gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FILER San Rafael Police Associa~ion Policical Accion Comm~ttee DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR ~FCCMMlnEE. ~50ENTER 1.0 NUMBER) CODE * 'Contributor Codes INO -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e .g .. business entrty) PTY -Political Party SCC-Small ContributorCommittee !!lIND DCOM DOTH OPTY Osee I!lIND DCOM DOTH DPTY DSCC IKJIND DCOM DOTH OPTY osce ~fND oCOM DOTH OPTY OSCC \RlIND DCOM DOTH DPTY DSCC IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF· EMPLOYED. ENTER NAME Of BUSINESS) City of San Rafael Sergeant: City of San Rafael Sergeant City of san Rafael Sergeanc City of San Rafael ty of San Rafael SUBTOTAL $ Statement covers peri od SCHEDULEA (CO NT.) -~WII!!~'" from __ ----.:co~9!.../;;:.2;;:.S'-/2=_O=_1::.;6=__ __ _ through _---'1:..:2:..</--'):..:1:.!./-=2:.:0~1:.:::6 __ _ AMOUNT RECEIVED THIS PERIOD 16.30 16.30 81. 50 I B31553 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) 376.20 376.20 PER ELECTION TOOATE (IF REQUIRED) FPPC Fonn 460 (JanJ2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FILER San Rafael Police Association policical Ac~ion Committee DATE RECENED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRI8UTOR CONTRISUTOR {IF COUMrT lEE, I\L.SO ENTER 1.0 NUMBeR) CODE ... 09 )0/2016 Daisy Huerta iR]IND C/o: San Rafael Police Association 1520 Fifch Avenue DeOM San Rafael, CA 9'1901 DOTH union member' 5 dues received through 0 PTY IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER Ilf SELF· EMPLOYED. ENTER NI\UE OF BUSINESS) Call Taker Records specialist Cicy Of San Rafael Statement covers period from 09/25/2016 through __ ~12~/~)~1~/~2~0~1~6 ____ ___ SCHEDULEA (CONT.) CALIFORNIA 460 FORM Page 56 of 112 1.0. NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULAnVE TO OATE CALENDAR YEAR (JAN 1· DEC . 31) PER ELECTION TO DATE (IF REQUIRED) 12.70 134..10 intermediary: San Rafael Police Associacion, [JSCC 1520 Fifth Avenue San~R~a~f~a£e:l~CA~~9~4~9~0~l~ ____ -+~~ ______ ~~ ____ ~ ________________ ~ ______ --~~~r---------~~~~---- 09/]0/2016 Scott Ingels IRJINO Corporal 16.30 376.20 C/o: San Rafael Police Association 1520 Fifch DCOM City of San Rafael Avenue San Rafael, CA 9'1901 DOTH Union mEmber's dues received through 0 PTY intermed~ary: San Rafael Police Associacion, []See 10/20/2016 Fifth 11/05/2016 Fifth 11 15 2016 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermed1ary: San Rafael Police Association, ·Contributor Codes INO -Individual COM -Recipient Committee (other Ihan PTY or SCC) OTH -Olher (e.g., business enlily) PTY -Polilical Party SCC -Small Contributor Committee IXJIND DeOM DOTH DPTY osee IKJINO DCOM DOTH [JPTY [Jsee IKIIND DCOM DOTH DPTY []SCC Corporal City of San Rafael Corporal City of San Rafael Corpora City of San Rafael SUBTOTAL $ 16,30 376.20 16.30 376.20 16.30 376. 0 77.9°1 FPPC Form 460 (Janl2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FILER San Rafael Police Association Political Action committee DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IIF COI.IMmEE.ALSO€NTER I 0 , NU~BSR) CODE * 11/30/2016 Scott Ingels I&JINO C/o; San Rafael Police ASllociat':'on 1520 Fifth oeOM Avenue San Rafael, CA 94901 DOTH Union member's dues received through 0 PTY IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER ~F SELF·EMPlOYEO. ENTER NAME OF BUSINIOSSI Corporal City of San Rafael SCHEDULE A (CaNT.) Statemen t c-;;ov~e~rs;-;;;;:~I-'II!!IIIIIIII!!!I1!11~'" from 09/25/2016 th rough __ 1_2....:/_3_1-,/_2....;0,-,-1....;6 __ _ AMOUNT RECEIVED THIS PERIOD 16.30 CUMULATIVE TO DATE CALENDAR YEAR (JAN, 1 -DEC. 31) 376 .20 _---"-'--of 112 PER ELECTION TO DATE (IF REQUIRED) intermediary, San Rafael Police Associacion, DSCC ~~~~~~~15~2~n,.Fifth Avenue, San Rafael. c~. ~9~4~9~0~1 ___ ~-=~ ___ ~ ____ ~~ _________ -+ _____ ~~~ _______ ~~~~ ______________ _ 12/15/2016 SCOl:\.: Ingels IRJIND Corporal 16 .)0 376.20 C/o; San Rafael Police Association 1521) Fifth oCOM City of San Rafael Avenue San Rafael, CA 94.901 DOTH Onion member' s dues rece i ved th1:"ough 0 PTY intermediary; San Rafael Police ASsociation, osee 1520 Fifth Ayenue San Rafael. C8 12/29/2016 Scott Ingels !XJIND C/o ; san Rafael Police Association 1520 Fifth oCOM Avenue San Rafael, CA 94.901 DOTH Union member' s dues received t!1rough 0 PTY intermeciiary: San Rafael Police ASsociation, []SCC 2 -' Avenue, San Rafael CA 9490. 09/30/2016 Rebecca Jensen fKllND c/o San Rafael Police Association 1520 Fifth X Avenue DCOM San RaEael. CA 94901 DOTH union member's due s rece i ved through 0 PTY intermediary: San Rafael Police Association, osee 1520 Fitch Avenue, San Rafael, CA 94901 Re ecca Jensen lRJ c/o San Rafael Police Association 1520 Fifth INO Avenue DCOM San Rafael, CA 94901 DOTH union member's due6 received througb OPTY incerm7~iary: San Rafael Police Association, osee 'Contfibutor Codes IND -Individual COM -Recipient Committee (other than PTY or SeC) OTH -Other (e.g ., business entity) PTY -Political Party sec -Small Contributor Committee Corporal Cicy of San Rafael Records Clerk City of San Rafael Recor s C ex-k City of San Rafael SUBTOTAL $ 16.30 376.20 12.70 294.30 12.70 294.30 FPPC Form 460 (Janl2016) FPPC Advice: advice@fppc.ca,gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to whole dollars. Statement covers period from 09/25/2016 th rough __ 1 __ 2,-,/....:3:....;1....:./_2....:0_1....:6 __ _ SCHEOULE A (CONT) CALIFORNIA 460 FORM Page_--=.;58~ of 112 I.D.NUMBER 831553 DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRlaUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF S8..F·EMPLQY8). ENTER NAME OFBUSItlESS) AMOUr-rr RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TODATF (IF COMMrrTEE. ALSOEtliE'll 0 NUMBER) CODE * (IF REQUIRED) 1l/05/2016 1l/15/20lli 11/JO/2016 Rebecca Jensen c/o San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary; San Rafael Police Association, 1520 Fi fth Avenue San Rafael CA 94901 Rebecca Jensen c/o San Rafael police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, .~ 12/15/2016 Rebecca Jensen c/o San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union lOellwe:::-' s dues received through intermedia:::-y: San Rafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 Re ecca Jensen c/o San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 'Contributor Codes INO -Individual 1:' •. COM -Recipient Committee (other than PTY or SCC) OTH -Other (e .g ., business entity) PTY -Political Party SCC -Small Contributor Committee OOINO o COM DOTH DPTY osec ~IND DCOM DOTH DPTY osce Records Clerk City of San Rafael Records Clerk City of San Rafael 12.70 294.30 12 .70 294.30 ----~~--~~~~--------~--------~~~--------~~~~---------------IXJIND Records Clerk 12 .70 291.30 DeOM City of san Rafael DOTH DPTY osec lRJlND DCOM Don~ LJPTY osee ~INO DCOM DOTH DpTY osee Records Clerk City of San Rafael Recor s City of SU8TOTAL$ 12.70 294.30 12.70 294,30 6].50 1 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Associacion Poli~ical Ac~ion Committee Amounts may be rounded to whole dollars. Statement covers period from 09/2S/2G15 through ___ l_2~/_3_1~/_2_0_1_6 ____ ___ seHEDULEA (CONT.) CALIFORNIA 460 FORM Page 59 of_..:1.:.12::....- 1.0 NUMBER 831553 DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER AMOUNT CUMULATIVETO DATE OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR PER ELECTION TO DATE (IF COMt.fIITEE. AlSO ENTER I D. NUMB9l) CODE * (IF SElF-EMPI.OYEO. E/IlTER NAME PERIOD (JAN, 1 -DEC . 31) (IF REQUIRED) 09 30/2016 Rebecca Kuga C/o: San Rafael Police Associacion 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues recelved through in~ermediary , San Rafael Police Associacion, -:-::-7::-:-~:-:-::--~15,,;2~O,,-FiJth Avenue, San Raesel, CA 94901 10/20/2016 Rebecca Kuga C/o, San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary . San Rafael Police Association, 11/05/2016' 11/15/2016 ·Contributor Codes INO -Individual . F eOM -Recipient Committee (other than PTY or seC) OTH -Other (e .g ., business entity) PTY -Political Party sec -Small Contributor Committee Fifch Fifth Fifth !RJ IND DeOM LJOTH DPTY Dsee OFB~IN~~ ______ ~ __________ ~-=~ __________ ~~~4-________________ _ YS8 Supervisor 12.70 294._30 City of San Rafael ----~~~~--~--------------4_--------~~~4_----------~~~I-------------------!RlIND YSBSupervisor 12.70 294.30 DeOM City of San Rafael DOTH DPTY osee IKIINO oeOM DOTH OPTY oscc IKJIND oeOM DOTH OPTY osee !RJIND DeOM DOTH LJPTY osee 'iSS Supervisor City of San Rafael YSB Supervisor City of San Rafael YSB Superv].sor City of San Rafael SUBTOTAL $ 12,70 294 .30 12.70 294. .30 12.70 294 .30 63.50 1 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/27S-ln2) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SEIJ'..EMPLOYCD. ENTER NAME OF BUSINESS) (lFCOIo.4MITI(E.ALSOENTERI.D NUMBER) CODE ... 12/15/201 6' 'Rebecca I<uga C/o: San Rafael Police Association 1520 Fif~h Avenue San Rafael, CA 94901 Union member's dues received through incermediary: San Rafael Police Association, 1520 Fifth Avenue San Ra fael CA 94901 12/29/2016 Rebecca Kuga C/o: San Rafael Police Association 1520 Fif~h Avenue San Rafael, CA 94901 Un~on member's dues received through interm7diary: San Rafael Police Association, 09/30/2016 Marc Laplante C/o, San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association. . ve e an Rafael CA 4 01 10/20/2016 Marc Laplante C/o: San Rafael Police Associa~ion 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, ~~~~~~~1~520 Fifth Avenue. San Rafael, CA 94901 11/05/2016 Marc 'Lap ante C/o: San Rafael Police Association 1520 fifth Avenue San Rafael, CA 94901 Union member's dues received through ~ntermediary : San Rafael Police Assoc ia~ion. 'Contributor Codes INO -Individual COM -Recipient Committee (olher than PTY or SCC) OTH -Other (e.g " business entity) PTY -Political Party see -Small Contributor Committee !!lIND DeOM DOTH DPTY DSCC [RlIND DeOM DOTH DPTY oscc OOIND DCOM DOTH DPTY Dsce !&:lIND OCOM DOTH DPTY osee IK)IND DCOM DOTH [JPTY osce YSB Supervisor City of San Rafael Y'SB Supervisor City of San Rafael officer Ci~y of San Rafael officer City of San Rafael o lcer City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 through ___ l~2~/~3~1~/~2~0~1~6~ __ ___ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page _-"..:60~ of 112 I.D.NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN . 1 • DEC, 31) PER ELECTION TO DATE (IF REQUIRED) 12 .70 294 .30 12 .70 294 ,30 16 .30 376,20 16.30 376 ,20 16.30 37 .20 FPPC Fonn 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAMEOF FILER San Rafael Police Association Political Accion Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF·EMP!.OYl::D. ENTER NAME OF BU5!NESS) (IF COMMIns:. ALSO ENTER 10 NUMBER) CODe * 11/15/2016 Marc Laplante C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received chrough intermediary : San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 94901 11jJO 2016 Marc Laplante C/o; San Rafael Police ASsociation 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 12/15/2016 12/29/2016 ·Contributor Codes IND -Individual . 1. COM -Recipienl Committee (other than PTY or SCC) OTH -Olher (e.g ., bUSiness entity) PTY -Polihcal Party SCC -Small Contributor Committee Fifth Fifth ,ifth IKJIND DCOM DOTH OPTY OSCC IKJIND DCOM DOTH npTY osee IXlIND DCOM DOTH DPTY OSCC !X]IND DeOM UOTH DPTY osce [RJIND DeOM DOTH DPTY DSCC Officer Cicy of San Rafael Officer City of San Rafael Officer City of San Rafael Officer City of San Rafael Statement covers period from 09/25/20lG through _-'1;;.;2;:.;/-'3-'1:..:/...:2:...;0;.:1:...;6'--__ SCHEDULE A (CaNT.) CALIFORNIA 460 FORM Page_~61~ of 112 1.0. NUMBER B31~~3 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 • DEC. J1) PER ELECTION TO DATE (IF REQUIRED) 16,)0 ]76.20 16 .30 376.20 16.30 376.20 16.30 376 .20 FPPC Form 460 (JanJ2016) FPPC Advice: advice@fppc.ca .gov (866/27S·3n2) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FILER San Rafael Police Association Political Action Committee DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMInEe. ALSOEfolTER I,D, NUM~) CODE * 10/20/2016 Anndora Le e IRJIND oCOM DOTH oPTY osee C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intennediary: San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 94901 11/05/2:016 Annciora Lee IRJIND oeOM DOTH oPTY osec C/o: San Rafael Police Association 1520 Fifth 11/15/2016 Fifth lXJlND oCOM DOTH oPTY osee 11/)0/2016 Anndora Lee !K)IND C/o: San Rafael Police Association 1520 Fifth DCOM Avenue Sao Rafael, CA 94901 DOTH Union member's dues received through [J PTY intermed~ary: San Rafael police Association, [JSCC 1520 Fifth Avenue, San Rafael CA 94901 Ann ora Lee IKl N C/o: San Rafael Police Association 1520 Fifth X I D Ave:lue oCOM San Rafael, CA 94901 DOTH Onion member's dues received through 0 PTY IF AN INDIVIDUAL, ENTER OCCUPATION ANO EMPLOYER (IFSELF·EM~lOYEO. ~NTER NAt.4E OF BliSlNESSJ Dispatcher City of San Rafael Oispatcher City of San Rafael Dispatcher City of San Rafael Dispatcher City of San Rafael Ol.Spatc er City of San Rafael Statement covers period from 09/25/2016 th rough __ 1_2-,/_3_1..,:./_2_0_1_6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 62 of 112 I,D,NUMBER 83155) AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO OATE CALENDAR YEAR (JAN. 1 • DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 12.70 294.]0 12.70 294,)0 12.7 0 294.]0 12.70 294.)0 12.70 294,)0 intermediary, San Rafael Police Association, [JSCC v Sag Rafael, CA 94~DJ============================================~==============~~===============================; 63.50 1 'Contributor Codes IND -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g .. business entity) PTY -Political Party see -Small Contributor Committee SUBTOTALS FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (B66/275-3n2) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FUU NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF·EMPLOYED. t:::NTER NIIME OF BUSINESS) IIFCOMM!TTEE. ALSO ENn:R to. NUMBERI COOE • 12 29 2016 Anndora Lee C/o: San Rafael police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues t"eceived through intermediary; San Rafael Police Association, 1520 fifth Avenue San Rafael CA 94901 09/30/2016 Judy Lee 10/20/2016 11/05/2016 C/o : San RaEael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Onion member's dues received through interm7diary: San Rafael Police Association, Fifth Fifth Avenue San Rafael , CA 94901 Onion member's dues ceceived thcougb intermediary : San Rafael Police Association, 1520 .itth Avenue , San Rafael, CA 94901 11 lS 2016 Judy Lee C/o: San Rafael Police ~sociation 1520 Fifth Avenue San Rafael, CA 94901 union member's dues received through intermediary: San Rafael Police Association, 'Contribulor Codes IND -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e .g., business entity) PTY -Political Party SCC -Small Contributor Committee OOIND oCOM DOTH oPTY oscc OOIND oCOM DOTH oPTY OSCC @IND DCOM DOTH OPTY osec iKllND DeOM DOTH DPTY osee !!lIND DCOM DOTH OPTY osce Disoatcher City of San Rafael Records Specialist Ci~y of San Rafael Recot"cis Specialist City of San Rafael Records Specialist City of San Rafael Recor Ci ty of SUBTOTAL $ Statement covers period ~om 09/25/2016 through ___ 1~2~/~3~1~/_2_0_1_6 ____ ___ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page _-",-63,,--of 112 I.D.NUMBER B3lSS3 AMOUNT RECEIVED THIS PERIOD CUMULATNETO DATE CALENDAR YEAR (JAN . 1 . DEC . 31) PER ELECTION TO DATE (IF REQUIRED) 12.70 294 .30 12 .70 294 .)0 12.70 294.30 12.70 294.30 2 .70 294 .30 63.50 1 FPPC Form 460 (JanJ2016) FPPC Advice: advlce@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FILER San Rafael Folice Associacion Political Action Committee DATE RECE(VED 11/30 2016 FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE. ALSO Etm;.R 1.0 NUM8ER) CODE * Judy Lee OOIND C/o : San Rafael Folice Association 1520 Fifth J\venue DCOM San Rafael, CA 94901 DOTH Union member' s dues received through 0 PTY iotermediary: San Rafael Police Association, Osee IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER ~F SELF·EMPLOYED, ENTER NAME OF BUS1N~SS) Records Specialisc City of San Rafael Statement covers period from 09/25/2016 throug h _....:1:..:2"-,/....:3:..:1::.:./-.:2:..:0....:1,,,6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 64 of _..::.1.:..12=--- 1.0. NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 12.70 294.30 1520 Fifth Avenue San Rafael CA 94901 12/1S/~2~O~1~6~~J~U~d~Y~L~e~e~~~~~~~~~~~~~~~~----~-~IN-D----~~R~e-c-o-r~d-s-S~p-e-~-~~·a~l~i~s~t------~r-----~1~2~.~7~0~--------~2~94~.3~O~------------------ C/o: San Rafael Police Association 1520 Fifth DeOM City of San Rafael Avenue San Rafael, CA 94901 DOTH Union member' s dues rece i ved through 0 PTY :.nterm7diary: San Rafael Police Association, osee 12/29/2016 09/30/2016 10 20 2016 ·Contributor Codes INO -Individual COM -Recipient Committee (other than PTY or seC) OTH -Other (e,g .• business entity) PTY -POlitical Party see -Small Contributor eommiL1ee Fifth FiEch Fitch !K)IND oeOM DOTH DPTY LJsee IK]IND DeOM DOTH DPTY Dsce !!lIND oeOM nOTH DPTY usce Records Specialist City of San Rafael Sergeant City of San Rafael Sergeant City of San Rafael SUBTOTAL $ 12.70 294.30 16.30 376.20 16.30 376.20 FPPC Form 460 (Jan/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts milY be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRI8UTOR IF AN INDIVIDUAl, ENTER OCCUPATION AND EMPLOYER [IF SELF,EMPLOYEO, ENTEl'I NAME OF BUSINESS) (IFCCIoIMInEE. ALSO ENTER 1.0 . NUMBER) CODE * 11 OS/2016 Rogelio Leon C/o : San Rafael Police Association 1520 Fifth Avenue ,San Rafael, CA 9~901 . union member's dues received through intermediary: San Rafael Police Association, --=-::-;-:=-=-=-=-=-=--+~1",,5..!C2.>!.0;"F~.i. fth Avenue San Rafael CA 4 01 11/15/2016 Rogelio Leon C/o: Sa~ Rafae~ police Association 1520 Fifth Avenue san Rafael, CA 94901 Union member's dues received through lnterm7diary: San Rafael Police Association, 11/30/2016 Rogelio Leon C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 9~901 Union member's dues received through intermediary: San Rafael Police Association, -2 , '. Avenue, San Rafael, CA 949Q' 12/15/2016 Rogelio Leon C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 union member's dues received through i ntermediary : San Rafael Police Association, 1520 Fifth Avenue, San Rafael , CA 94901 12 29 20 1 6 Roge lO ~eon C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 9~901 Union member's dues received through interm7diary : San Rafael Police Association, ·Conlribulor Codes INO -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e .g " business entity) PTY -Polilica I Party SCC -Small Contributor Committee I&)IND DCOM DOTH DPTY osec .. [RJINO DCOM DOTH oPTY OSCC IRJIND oCOM DOTH OPT'( OSCC IKIIND DCOM DOTH OPTY OSCC OOIND OCOM DOTH OPTY oscc Sergeant City of San Rafael Sergeant City of San Rafael Sergeant Cicy of San Rafael Sergeant City of San Rafael Sergeant City of San Rafael SU8TOTAL$ Statement covers perl od from __ O ~/2S/2016 ~rough_~1~2~/~J~1~/~2~0~1~6 __ ___ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page _....:::;65:::...-of 112 I.IJ. NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN . 1 • DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 15 .30 376,20 16.30 376.20 16 ,JO 375 .20 16,)0 376.20 16,]0 376.20 81.50 1 FPPC Form 460 (Jiln/2CJ16) FPPC Advice: advice@fppc.ca ,gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FILER San Rafael Police Association Political Action Committee DATE RECEIVEO FULL NAME. STREET ADDRESS AND ZIP COOE OF CONTRIBUTOR CONTRIBUTOR ~FCCMMlnEE.ALSOENn:R 1.0 NUMBER) CODE * 09 30/2016 Kevin Macdougald IflIND C/o: San Rafael Police Association 1520 Fifth DeOM Avenue San Rafael, CA 94901 DOTH Union member's dues received through 0 PTY intermediary : San Rafael Police Association, []SCC 1520 Fifth Avenue San Rafael CA 94901 10/20/2016 Kevin Macdougald @IND C/o: San Rafael Police Association 1520 Fifth DeOM Avenue San Rafael, CA 94901 DOTH Union member's dues received through 0 PTY intermediary: San Rafael Police Association, osce 11/05/2016 Kevin Macdougald (KlIND C/o: San Rafael Police Association 1520 Fifth OCOM Avenue San Rafael. CA 94901 DOTH Union member's dues received through 0 PTY IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF S8.F-EMPi.OYEO. ENTER NAME OF BUSINESS) Officer City of San Rafael officer City of San Rafael Officer City of San Rafael Statement covers period ~om 09/25/2016 through __ ~1~2~/~1~1~/~2_0~1~6 ____ ___ SCHEDULE A (CONT) CALIFORNIA 460 FORM Page 66 of_~1~12~ 1.0. NUMBER 831553 AMOUNT RE.CEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 376.20 16.30 376 .20 16.30 376.20 intermediary: San Rafael Police Association, OSCC IS20 Fift ~ __ ~4~0~1 ______ -+ __________ ~~~ ______________________ r-________ ~~~~ __________ ~~~~ ________________ ___ 11/15/2016 Kevin Macdougald IRlIND Officer 16.30 J 76.20 C/o: San Rafael Police Association 1520 Fitth OX COM City of San R.afael Avenue San Rafael, CA 94901 DOTH Union member's dues received through 0 PTY intermediary : San Rafael Pol~ce Association, OSCC 1520 Fifth Avenue, san~~R~a~f~a~e~l~,~C~A~_9~4~9~0~1~ ______ r-__________ ~,~~~ ______________ ----4-----------,,~~----------~~~~------------------- 1 3 2016 Kev~n Mac ouga .. ' !R)INO at ~cer 16.30 376.20 c/o: San RaEael Police Association 1520 Fifth X City of San Rafael Avenue DCOM San Rafael, CA 94901 DOTH Union member's dues received through 0 PTY ~n~er;ediary: San Rafael Police Association, i]SCC ·Contributor Codes INO -Individual COM -ReCipient Committee (other than PTY or seC) OTH -Other (e.g .. business entity) PTY -Political Party SCC -Small Contributor Committee SUBTOTAL $ 81. SO I FPPC Fonn 460 (Jan/2016) FPPC Advice: advic:e@fppc .ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FILER San Rafael Pol i ce AesociaLion Political Ac~ion Committee DATE RECENED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (W COM MmEE, Al.SO ENTER I.D. NUMBER> CODE" 12/15/2016 . Kevin Macdougald !R]INO C/o: San Rafael Police Association 1520 Fifth DCOM Avenue San Rafael, CA 94901 DOTH Union member' s dues recei ved through U PTY IF AN INDIVlDUAL. ENTER OCCU PATION AND EMPLOYER ~F SELf·EMPLOYEO. ENTER NA"-lE OF SUS'NCSS) Officer City of San Rafael intermediary: San Rafael Police Association , osee -:-.".-.,.:::-=--r=-:::-::-c:--l--t:-1""52,,,o F i f th Avenue, San Ra f ael , CA 94 ~O.l~ __ -+--:=-___ +-,...,...,,..,....,. _____ _ 12/29/2016 Kevin Macdougald IRJIND Officer C/o: San Rafael Police Association 1520 Fifth DeOM City of San Rafael Avenue San Rafael, CA 9t,.901 DOTH Union member's dues received r.hrough DPTY intermediary: San Rafael Police Association, osee 09/3 0/2016 10/20/2016 11 05 2016 ·Contributor Codes INO -Individual COM -Recipient Commiltee (other than PTY or SCC) OTH -Other (e.g., bUS iness entity) PTY -Political Party see -Small Contributor Committee Fifth Fifth Fifth IKlIND DCOM DOTH oPTY osce !KlINO DeOM DOTH oPTY oSCC !KlINO DeOM DOTH OPTY DSCC Officer City of San Rafael Officer City of San Rafael o l.cer City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2~n_6 ___ _ throug h _--=1:.:2:.!/-=3:.:1:.!./-=2:.:0-=1..::6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page_~67~ of 112 1.0. NUMBER 831553 AMOUNT RECE IVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) H .30 376.20 16 .30 376.20 16.30 376.20 16.)0 376 .20 16.30 )76.20 81. 50 I FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275 -Jn2) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCU PATION AND EMPLOYER pF SELF·~P1.0YEO. ENTER NAME OF BUSINCSSJ (If COM MmEE. ALSO ENTER I,D. NUMBER) 11/15/2016 Carlos Maldonado C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1 520 Fifth Avenue San Rafael CA 94901 11/30/2016 Carlos Maldonado 12/15/2016 C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through inte~ediary, San Rafael Police Association, "F d Fifth 12/29/2016 Carlos Maldonado C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermed~ury: San Rafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 Ml.c ae Mat 1S C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, ·Contributor Codes IND -Individual iJL.~ fth Ayeoll COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g., business entity) PTY -Political Party see -Small Contributor Committee CODE * !&lIND DCOM l]OTH npTY osce !&lIND OCOM DOTH OPTY OSCC IKIIND OCOM nOTH OPTY OSCC !&lIND DCOM DOTH OPTY osce IKJIND OCOM [lOTH OPTY OSCC Officer City of San Rafael Officer City of San Rafael Officer City of San Rafael Officer City of San Rafael Corpora City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2 016 ~rough __ ~1~2~/~3~1~/~2~0~1~6~ __ ___ SCHEDULEA (CONT.) CALIFORNIA 460 FORM Page _.....:::.6B=---of 112 LD.NUMBER 8315S3 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376_20 16.30 376.20 16_30 376.20 16.30 376.20 16.30 376.20 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION ANO EMPLOYER (IF 5 ELF· EMPLOYED, ENTel NAME OF BUSINESS) (IFCO.l!MmEE,AtSOENl1:RI.O NUMBER) CODE * 10/20/2016' Michael Math~s C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary; Sen Rafeel Police Association, 1520 Fifth Avenue San Rafael CA 94901 11/05/2016 Michael Mathia C/o; San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Pal1ce Association, 11/15/2016 11/30/2016 ·Contributor Codes IND-Individual COM -Recipient Committee (other than PTY or SeC) OTH -Other (e .g., business entity) PTY -Political Party SCC -Small Contributor Committee Fifth Fi[ch Fifth ®IND DCOM OO-rn DPTY oSCC ~IND DCOM DOTH DPTY osee Ii]IND DCOM DOTH DPTY osee IRJIND DCOM DOTH OPTY osce OOIND DCOM DOTH oPTY osee Corporal City of San Rafael Corporal City of San Rafael Corporal City of San Rafael Corporal City of San Rafael Coroora City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 ~rough ___ l_2~/_3_1~/~2~0~1~6 ____ ___ SCHEDULE A (CaNT.) CALIFORNIA 460 FORM Page 69 of 112 1.0. NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC . 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376.20 16 .30 376.20 16.30 376.20 16.30 376,20 16.30 37 .20 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FilER San Rafael Police Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED rUll NAME, STREET ADDRESS AND ZIP CODE OF CONTRfBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER IIF S€LF·EMPi.OVEO. ENTl:R NAME OF BUSINfSS) (IFCOMMITIEE.ALSOENTERID NUMBeR) CODe .. 12/29/2016 Michael -Mathis C/o; San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Onion member's dues received through intermediary: San Rafael Police Association, 1 20 Fifth Avenue San Rafael CA 94901 09/30/2016 Kelly Mauel C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Onion member's dues received through intermediary: San Rafael Police Association, 10/20/2016 Fifth 11/05/2016 Fifth Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, ·Contributor Codes INO-Individual eOM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g., business entity) PTY -Political Party see -Small Contributor Committee IK)INO DeOM DOTH DPTY osee I8)INO oeOM DOTH oPTY osce IXJIND oeOM DOTH DPTY osee IXJIND DeOM DOTH oPTY oscc IRJINO oCOM DOTH OPTY osec Corporal City of San Rafael Communications Dispatcher City of San Rafael Communications Dispatcher City of San Rafael Communications Dispatcher City of San Rafael Commun1.catl.ons Dl.Spatc er Cicy of San Rafael SUBTOTALS Statement covers period ITom 09/25/2016 th ra ugh __ 1"-2::..:/:....:3:....:1'-'./:....:2:....:0,,,1:..=6 __ _ SCHEDULE A (CaNT.) CALIFORNIA 460 FORM Page _---'-70:0....-of 112 . io. NUMBER 831~~] AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 • DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376.20 12 .70 294.30 12.70 294.30 12.70 294.30 12.70 294 .30 FPPC Form 460 (Janl2D16) FPPC Advice: advice@fppc.ca.gov (866/275,3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Po1ice Association ?olitical Action Committee Amounts may be rounded to whole dollars. DATE RECENED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRISUTOR IF AN INDNIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF· EMPLOYED. ENTEFI NAIo!E OF 8(JSINES$) (IF CCMMITIEE. ALSO ENTER 10 NUMBI;:I1) CODe ... 11 30 2016 Kelly Mauel C/o, San Rafae l Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary· San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 94 01 12/15/2016 Kelly Mauel c/o, San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 union member's dues received through intermediary· San Rafael Police ASsociation, 12/29nOl6 09/30{2016 10/20 /20 16 ·Contributor Codes IND-lndividual COM -RecipJent Committee (other than PTY or SeC) OTH -Other (e .g., business entity) PTY -Polilical Party SCC -Small Contributor Committee Fift:h Fifth Fifth 1KI1ND OCOM DOTH oPTY OSCC (KJIND DCOM LJOTH oPTY oSCC ~IND DCOM DOTH oPTY OSCC IKJIND DCOM DOTH OPTY DSCC IKJIND OCOM DOTH OPTY osee Communica~ions Dispatcher City of San Rafael Communications Oisoatcher City of San Rafael" Communicat:ions Dispatcher. City of San Rafael Officer City of San Rafael O,_lcer City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 through _....;1:..;2:..:/....;3:..:1,-,/..:2;.:0;.::1;.::6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 71 of 112 I.D.NUMBER 831553 AMOUNT RECENED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN . 1 " DEC . 31) PER ElECnON TO DATE (IF REQUIRED) 12.70 294.30 12.70 294.30 12.70 294.30 16.30 J76.20 16 .30 3 76 .20 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS ANO ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF· EMPLOYED. ENTER NAME OF eUSINESS) (IrCOMMJTTEE.AlSOEIflCRIO NUMBER) CODE ... 11/05/2016 Phillip Melodia C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 94901 11/15/2016 Phillip Melodia C/o: San Rafael Police Association 1520 Fifth Avenue Sao Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 12/15/2016 ·Contributor Codes IND -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g .. business entity) PTY -Political Party SCC -Small Contributor Committee Fifth F'ifch Fifth /KlIND OCOM DOTH OPTY OSCC OOIND oCOM DOTH OPTY OSCC [KJIND OCOM DOTH OPTY OSCC IKJIND OCOM nOTH OPTY OSCC IK)IND OCOM DOTH OPTY oscc Officer City of San Rafael Officer City of San Rafael Officer City of San Rafael Officer City of San Rafael o l.cer City of San Rafael SUBTOTALS Statement covers period from 09/25/2016 through ~_1_2..;./~3~1...:./_2_0_1_6_~_ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page ____ 72;;... of 112 1.0 NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC . 31) PER ELECTION TOCATE (IF REQUIRED) 16.30 376 .20 16.30 376.20 16,30 376.:20 16.30 376.20 16,)0 376,20 81. 50 I FPPC Form 460 (Jan/2016) FPPC Advice: adv!ce@fppc.ca.gov (8661275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FUll NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER ~F S8..F·EMPLQVEO. ENTER NAME OF BUSINESS) <,F COMM'ITEE. ALSO ENTER 10 NLlMGER) CODE * 09 3D 2016 Beth Minka C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 9490, Union member's dues received through intermediary: San Rafael Police ASsociation , 1520 Fifth Avenue San Rafael CA 94901 10/20/2016 Beth Minka C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Associat i on, 11/05/2016 Fifth 11/15/2016 FiEch Fifrh Avenue San Rafael, CA 94901 Union member's dues received through incerm~diary, San Rafael Police Association, ·Contributor Codes INO-Indivldual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e .g ., business entity) PTY -Political Party SCC -Small Contributor Commit1ee IR]IND DCOM DOTH DPTY OSCC IRJIND DCOM DOTH OPTY oscc ~IND oeOM DOTH OPTY OSCC ~IND DCOM DOTH OPTY OSCC IKJIND DCOM DOTH DPTY DSCC Ad ministrative Technician City of San Rafael Administracive Technician City of San Rafael Administrative Techn1cian City of San Rafael Administrative Technician City of San Rafael A m~n1stratlve Tec lC}an City of San Rafael SUBTOTAL $ St9tement covers period from 09/25/2016 ~rough __ ~1~2~/~3~1~/~2~O~1~6 ____ ___ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 7) of 1.12 I.D.NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC . 31) PER ELECTION TO DATE (IF REQUIRED) 12.70 294.30 12.70 294.)0 12 .70 294.30 12.70 294.30 12 .70 294 .30 63.5°1 FPPC Form 460 (Jan/2016) FPPC Advice: adv1ce@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Folitical Action Committee Amounts may be rounded to whole dolla rs. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRI8UTOR CONTRIBUTOR (1I'"CCMMlnEE.ALSOEIIT£RI .O NUMBER I CODE ., IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELf-EMPLOYEO. ENTCR NAt.!E OFIltISINESS) 12 15/2016 Beth Minka C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through inte rm e diary: San Rafael Police Aseociation, 1520 Fif th Avenue San Rafael CA 94901 12/29/2016 Be th Minka 09/30/2016 10/20/2016 C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through interm7diary: San Rafael Police Association, Fifth Fifth Avenue San Rafael, CA 94901 union member's dues received through intermediary : San Rafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 11/05/2016 Lynn Murp y C/o: San Rafael ~olice Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Raf.a~1 Police Association, 'Contributor Codes INO -Individual COM-RedpientCommittee (other than PTY or seC) OTH -Other (e.g., business entity) PTY -Political Party see -Small Contributor Committee \!JIND DCOM DOTH OPTY osee ~IND DCOM UOTH OPTY osee IKJINO DCOM LJOTH OPTY osee /iJIND DCOM DOTH DPTY Dsce IKJIND DeOM DOTH DPTY osec Administrative Technician City of San Rafael Administracive Technician City of San Rafael Menta l Health Outreach Provider City of San Rafael Mental Health Outreach Provider City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 through __ ~1~2~/~3~1~/~2~0~1~6~ __ ___ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page _---'-74=__ of 112 I.D.NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN 1 -DEC . 31) PER ELECTION TO DATE <IF REQUIRED) 12 .70 294.30 12.70 294 .30 12.70 294.30 12 .70 294 .30 1 2.70 2 4,30 63.50 1 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772, Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police ASsociacion Political Accion Comm~ttee Amounts may be rounded to whole dolla rs . DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR I" AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER <IF SElJ'-EMPlOVEO. ENTER NAME OF BUSINESS) (IF COMMmEE.ALSO EtHER I D_NUMBER) CODE * 11/15/2016 Lynn Murphy C/o : San Rafael Police Association 1520 Fifth }l.venue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael police Association , ~~~~~~~1~5~20~F~i=Ch Avenue San Rafael CA 94901 11/30/2016 Lynn MUL~hy C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 12/15/2016 12/29/2016 09 30 2016 ·Contributor Codes INO -Individual 'r. eOM -Recipient Committee (other than P1Y or SCC) OTH -Other (e,g,. business entity) PTY -Political Party SCC -Small Contributor Committee Fifth Fifth Fifth IK)IND OCOM UOTH OPTY oscc IKJIND DCOM UOTH ljPTY oscc ~IND OCOM DOTH OPTY osce !RJIND OCOM DOTH DPTY osce lKIlND DCOM DOTH DPTY OSCC Mental ~ealth Outreach Provider City of San Rafael Mental Health Outreach Provider City of San Rafael Mental Health Oucreach Provider City of San Rafael Mental Health Outreach Provider City of San Rafael SUBTOTALS Statement covers period trom 09/25/2016 through ___ 1~2~/~J~1~/~2~0~1~6 ____ ___ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 75 of~ 1.0,NUMBER 831553 AMOUNT RECENED THIS PERIOD CUMULA1WETO DATE CALENDAR YEAR (JAN. 1 -DEC, 31) PER ELECTION TO DATE (IF REQUIRED) 12.70 294.30 12 _70 294.30 12.70 294.30 12.70 294,30 12.70 294,] 63 .50 1 FPPC Form 460 (Janf2016) FPPC Advice: advice@fppc.ca.gov (886/27S-3n2) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Comm i ttee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND liP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE. ALSO ENTEllI 0 NUMB€R) CODE * IF AN INDIVIDUAL , ENTER OCCUPATION AND EMPLOVER (IF SELF·EMPLOYEO . ENTER NAt..1E OF BUSINESS) : 0 20/2016 Jorge Navarro C/o: San Rafael Police Association 1S20 Fifth Avenu e San Rafael , CA 94901 Un i on member's dues received through intermedia ry : San Rafael Police Association, 1520 Fifth Ave nue San Rafael CA 94901 11/05/2016 Jorge Navarro 11/1 5 /2016 C/o: San Raf ael police Association 1520 Fi fth Avenue San Rafael, CA 94901 Union member's dues received through i nterm~diary: San Rafael Police Association, Fifth 11/30/2016 Jorge Navarro C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Unlon member's dues received through intermediary : San Rafael Police Association , 1520 Fifth Avenue , San Rafael, CA 94901 12 15 2016 Jor ge Navarro C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermedi ary: San Ra fae l Poli ce Association, ·Contributor Codes INO -Individual COM -Recipient Committ.ee (other than PTY or SCC) OTH -Other (e .g., bus iness entity) PTY -Political Party see -Small Contributor Committee OO IND oeOM DOTH o PlY OSCC IEJINO OeOM D OTH o PlY OSCC IX]IND DeOM D OTH O P1Y DSCC IK)INO DCOM DOTH o PlY osee IRJIND oCOM DOTH oPTY oSCC Evidence Technician Ci ty of San Rafael Ev i d ence Technician City of San Rafael Evidence Techni cian City of San Rafael Evidence Techni cian City of San Rafael SUBTOTAL $ Statement covers period hom 09/25/2016 llirough __ ~1~2~/_3~1~/~2~0~1~6 ____ ___ SCHEDULEA (CONT.) CAL.IFORNIA 460 FORM Page 76 of 112 1.0 NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVe TO DATE CALENDAR VEAR (JAN. 1 -DEC . 31) PER ELECTION TO DATE (IF REQUIRED) 12.70 294 .30 12.70 2 94 .30 12.70 294 .30 12 .70 294.30 12.70 29 4 ,30 63.50 1 FPPC Form 460 (JanJ2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Associa~ion Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION ANO EMPLOYER IIF SElf-EMPLOYEO, ENTER NAM€ OF BUS4NESSI (If CCMMIITEE.AlSO ENTER 1.0. NUMBER) CODE ... 12 29 2016 Jorge Navarro C/o : San Rafael police Association 1520 Fifch Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police ASsociacion, 1520 Fifth Avenue San Rafael CA 94901 C9/.30/2016 Alexis Nielsen C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police ASsocia~ion, _.....,...-----, __ -+ ........ 0 . 10/20/2016 Alexis Nielsen C/o : San Rafael Police Association lS2C Fifth Avenue San Rafael, CA 94902 Union member's dues received through intermediary: San Rafael Police ASsocia~ion, 1520 ift 4 11/05/2016 Alexis Nielsen C/o; San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received th~Ou9h intermediary: San Rafael Police Ascociation, 1520 FiEth Avenue, San Rafael, CA 94901 11 15 2016 A_eXiS I'lle sen C/o : San Rafael Police Association 1520 Fifth Avenue San Ra:~el, CA 94901 Un i on member's dues received through ~ntermediary: San Rafael Police AssociatiOQ, 'Contributor Codes INO -I ndividual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e,g .. business entity) PTY -Political Party SCC -Small Contributor Committee IK]IND oeOM DOTH OPTY osec [gJIND oeOM DOTH DPTY osec ~IND oeOM DOTH OPTY osec ~IND DCOM DOTH DPTY oscc !KIIND DeOM DOTH UPTY USCC Ev~dence Technician City of San Rafael Lead Communications Dispatcher City of San Ratae! Lead Communications Dispa.tcher City of San Rafael Lead Communications Dispatcher City of San Rafael Lea Commun~cationE Dispatcher City of San Rafael SUBTOTALS Statement covers period from 09/25/2016 th ro ugh _...:1;.:2;.:../~3.:.1 /:....;2:..:0:..:1;.:6~ __ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 77 of _...:1~1:.;2~ I.D.NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVETO DATE CALENDAR YEAR (JAN 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 12 .70 294.30 12 .70 294.30 12,70 294.30 12.70 " 294.30 12.70 294.30 63 .50 1 FPPC Form 460 (JanJ2016) FPPC Advice: advice@fppc.ca.goll (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action committee Amounts may be rounded to whole dollilrs. DATE I FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRI8UTOR RECEIVED ! (IFCOMMITTEi:.ALSOENTEJHD NUMB~R) CODE" IF AN INDIVIDUAL. ENTER OCCUPATiON AND EMPLOYER (IF sar·EMPlOYED. ENTfll NAME OF BUSINESS) 11/30/2016 Alexis Nielsen C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 94901 12/15/2016 Alexis Nielsen C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 12/29/2016 09/30/2016 fo ·Contributor Codes INO -Individual COM -Recipienl Committee (other than PTY or SeC) OTH -Other (e.g .. business entity) PTY -Political Party SCC -Small Contributor Committee Fifth FJ.fth Fifth ~INO oeOM DOTH OPTY osec [hlINO DeOM DOTH OPTY osee ~INO D COM DOTH OPTY osee ~INO DeOM DOTH OPTY osee ~INO DeOM UOTH OPTY osec Lead Communications Dispatcher City of San Rafael Lead Commun i cations Dispatcher City of San Rafael Lead Communications Dispatcher City of San Rafael Officer City of San Rafael o }.cer City of San Rafael SUBTOTAL $ Statemenf covers period from 09/25/2016 through ___ 1~2~/~3~1~/~2~O~1~6~ __ ___ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 78 of.........!..U I.D.NUMBER anSS3 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 • DEC . 31) PER ELECTION TO DATE (IF REQUIRED) 12.70 294 .30 12 .70 294 .30 12.70 294 .30 16,30 376.20 16 .30 376 .20 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866f275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRlBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF S£Lf·EMP!.OYEO. ENTER NAME OF IlIJSINESSI (IFCow.~Irn:e.ALSOENTER 10 NUMeER) CODE. 11/05 2016 Leslie O'Toole C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary : Sao Rafael Police Association, 1520 Fifth Avenue San Rafael CA 94901 11 15/2016 Leslie O'Toole C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Un~on member's dues received through intermediary: Sao Rafael Police Association, --:-11:-/"'"'3:-0""'/'"'2'"'0-:-16'" t~~L~j g~ Toole C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fif A 4 I 12/15/2016 Leslie O'Toole C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael. CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 Les l.e O'TOO e C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael. CA 94901 Union member's dues received through intermediary : San Rafael Police Association, ·Contributor Codes INO -Individual 'F 4 COM -Recipient Commitlee (other than Pll' or seC) OTH -Other (e.g., business entity) ?TV -Political Party SCC -Small Contributor Committee OOIND oCOM DOTH oPTY osee IZ]INO o COM DOTH OPTY nsce ~IND oeOM DOTH OPTY osee ~IND oeOM DOTH UPTY osce OOI ND DeOM DOTH OPTY osce Officer City of San Rafael Officer City of San Rafael Officer City of San Rafael Officer City of San Rafael o l.cer City of San Rafael SUBTOTAL $ Statement covers period from 09/:25/2016 throu gh _....:1:..:2:..:/..::3:..:1~/.=2.::.0.::.1 =..6 __ _ SCHEOULEA (CaNT.) CALIFORNIA 460 FORM Page 79 of 112 /.D. NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN . 1 -DEC . 31) PER ELECTION TO DATE (IF REQUIRED) 16 .30 376 .20 16.30 376 .2 0 16.30 376.20 16 .301 376.20 1 .30 376,20 81. 50 I FPPC Form 460 (JanI2016) FPPC Advice : advice@fppc .ca.gov (B661275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Associa~ion Policical Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCU PATION AND EMPLOYER (IF SELF .. EM~lOYEO. ENTER NAME 01' BUSINESS) (lfCOW..ImEE.ALSOENTERI,I),NUMBER) CODE * 09/30/2016 Sr"J .. an Patterson C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, LA 94901 Union member's dues received through intermediary: San Rafael Police Association, IKJIND DeOM DOTH OPn' osee Officer City of San Rafael Statement cOllers period from 09/25/2016 through __ 1_2....:/_3_1...:./_2...;.0_1_6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 80 of 112 I.D,NUMBER 831553 AMOUNT RECEIVED TAIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 • DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376 ,20 ~77~~~~~15~2~0~F~if~h Avenue San Rafael CA 4901 10/20/2016 Brian PaLLerson ----~~~----------------~--------~~~--------~~~~---------------IK)IND Officer 16.30 376.20 C/O! San Rafael Police Association 1520 Fifth Avenue San Rafael, LA 94901 Union member's dues received through interm7diary: San Rafael Police Association, 11/05/2016 11/15/2016 11 30 2016 ·Contributor Codes INO -Individual COM -Recipient Committee (other than PTY or SeC) OTH -Other (e .g .. business entity) PTY -Political Party sec -Small Contributor Committee Fifth Fifth Fifth DCOM City of San Rafael DOTH OPn' o see IXJ IND D eOM DOTH DPiY OSCC IKIIND D COM DOTH OPTY osee OOIND oeOM DOTH OPTY osce Offi cer City of San Rafael Officer City of San Rafael o l.cer City of San Rafael SUBTOTAL $ 16,)0 376.20 16.30 376.20 16.30 76.20 81. 501 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FILER San Rafael ~olice Association Political Action Committee DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IFCCMMmEE.ALSQ£NTERI.O NUMBER) CODE ... 12/1-5/2016 Bnan Patterson IK]IND C/o: San Rafael police ASsociation 1520 Fifth DCOM Avenue San Rafael, CA 94901 LJ OTH Union member' s dues received through 0 PTY intermediary: San Rafael Poll.ce Association, o sec 1520 Fifth Avenue San Rafael CA 94901 12/29/2016 8rian Patterson IRIIND C/o, San Rafael Police ASsociation 1520 Fifth oCOM "venue San Rafael, CA 94901 DOTH Union member's dues received through 0 PTY IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SEU'·EMPLOY€O. ENTER NAME OF SUSINESS) Officer City of San Rafael Officer City of San Rafael intermediary: San Rafael Police Association, osec ~079~/3~0~/~2~0~1~6~~BU~f~fY~P~'axs~o~yeoue, -~il-~~~~~~~~-------r--~--IN-O----~-O~£~f-i-ce--r----- C/o: San Rafael Police ASsociation 1520 Fifth U" COM City of San Rafael Avenue San Rafael, CA 94901 DOTH union member's dues received chrough 0 PTY intermediary: San Rafael Police Association, OSCC o h Av e, San Rafael 0 10/20/2016 Buffy Paxson IRJINO C/o: San Rafael Police ASSociation 1520 Fifth OX COM "venue San Rafael, CA 94901 DOTH Union member' s dues received through 0 PTY incermediary : San Rafael Police Association, OSCC 1520 Fifth Avenue, San Rafael CA 94901 11 OS 2016 Bu,:~y Paxson IRJINO C/o: San Rafael police ASsociation 1520 Fifth X ~~ o~ San Rafael, CA 94901 DOTH Union member's dues received through 0 PTY inte~ediary: San Rafael Police Association, osce 'Contribulor Codes INO -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g., business entily) PTY -Political Party SCC -Small Contributor Committee Officer City of San Rafael o ).cer City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 ~rough __ ~1~2~/~3 ~1~/2~0~1~6 ____ __ SCHEDULEA (CaNT.) CALIFORNIA 460 FORM Page 81 of 112 I.D.NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULAnVETO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIREO) 16 .30 376.20 16 .30 376.20 16.30 376.20 16 .30 376.20 16 .30 376.20 81 .50 1 FPPC Form 460 (Jan/2016) FPPC Advice: advlce@fppc.ca.gov (8661275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FILER San Rafael Police Association political Action Committee DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR ~FCCMlIAllTEE .ALSOENTERI.O NU!.ISERI CODE * 11/15/2016 Buffy Paxson [KJIND C/o: San Rafael Police Association 1520 Fifth Avenue DCOM San Rafael, CA 94901 DOTH union member's dues received through 0 PTY intermediary: San Rafael Police Association, osec IF AN INDIVIDUAL, FNTER OCCUPATION AND EMPLOYER (If sar.ELlPlOYEO. ENTER NAME OF BUSINESS) Officer Cicy of San Rafael 1 20 Fifth Avenue San R~a~f~a=e~l~CA~~9~4~9~O~1~ ____ -+~~ ______ ~ 11/)0/2016 BuHy Paxson .. ' ~IND Officer C/o: San Rafael Police Association 1520 Fifth oeOM City of San Rafael Avenue San RafaeL CA 94.901 DOTH Union member's dues received through oPTY intermediary: San Rafael Police Association, oSCC 12/15/2016 Buffy Paxson OOINO C/o, San Rafael Police Associal:ion 1520 Fl fth 0 COM Avenue San Rafael, CA 94901 DOTH Union member's dues received through 0 PTY incermediary, San Rafael Police Association, osec 15 . a a 1 4 01 12/29/2016 Buffy Paxson ~IND C/o : San Ratael ~olice Associatlon 1520 Fifth X Avenue oeOM San Rafael, CA 94901 DOTH union member's dues rece~ved through LJPTY inl:ermediary, San Rafael Police Association, OSCC ~n7"",.,,~~~1~52~0~Fifth Avenue, San Rafael, CA 94.901 09 30 2016 JeSS.1Ca · Perry [KJ C/o: San Rafael Police ASsociation 1520 Fifch X INO Avenue DCOM San Rafael, CA 94901 DOTH Onion member's dues received through D PTY inte~ediary : San Rafael Police Association, osee ·Contributor eodes INO -Individual COM -Recipient Committee (other than PTY or SeC) OTH -Other (e.g., business entity) PTY -Political Party see -Small Contributor Committee Officer City of San Rafael Officer City of San Rafael o leer City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 through 12/ 31 ~.O 1:..:6'--__ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 82 of 112 1.0 . NUMBER a)1~~3 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN . 1 . DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376 .20 16.30 376 .20 16.30 376.20 16.30 316 ,20 16 .30 37 .20 81.5°1 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FUl.L NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF S ELF-EMPlOYED. eNTER NAME OF BUSINESS) (IF CCMMlnEE. ALSO ENTER I 0 NUMBER) CODE * 10 20 2016 Jessica Perry C/o: San Rafael Police Associacion 1520 Fifth Avenue San Rafael, CA 94901 Onion member's dues received through intermediary: San Rafael Jolice Association, 1520 Fifth Avenue San Rafael CA 94901 11/05/2016 Jessica Perry C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through inte~diary: San Rafael Police Association, 11/15/2016 Jessica Perry c/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenu RaE el CA 4 01 11/30/2016 Jessica perry C/o; San Rafael Police Association 1520 Fif~h Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12 15 2016 Jess:lca Perry C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, , 2JL.~ . .fth AyeDll~ ·Contributor Codes INO -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g., business entity) PTY -Political Party SCC -Small Contributor Committee IRJIND DCOM DOTH DPTY oscc IKJIND DCOM DOTH DPTY DSCC I.K]IND DCOM DOTH DPTY DSCC I.K]INO DCOM DOTH DPTY DSCC !;KlINO DCOM DOTH OPTY OSCC Officer City of San Rafael Officer City of San Rafael Officer City of san Rafael officer City of San Rafael O!_lCer City of San Rafael SUBTOTALS Statement covers period ~om 09/25/2016 throug h __ 1_2-'./_3_1-'./_2_o_1_6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 83 of_-=1.=;12=-- I.D.NUMBER 631553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. J1) PER ELEcnON TO DATE (IF REQUIRED) 16.:;0 376.20 16.30 376.20 16.30 376.20 16,30 376.20 16.30 376.20 81. 50 I FPPC Form 460 (JanJ2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Associa~ion Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS ANO ZIP COOE OF CONTRIBUTOR CONTRIBUTOR IF AN INOIVIDUAL. ENTER OCCUPATION AND EMPLOYER IIF SEl.F·EM?I.OYEO. ENTEl NAMe Of8USINESS) (IFCCMMIrn::E,AlSOENTalIO NUMBel) 12 29/2016 Jessica Perry C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael , CA 94901 Union member 's dues received through in~ermediary : San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 94901 09/30/2016 Aaron !?iombo :D/20/2016 -:11 / 0 5 / 2 0 16 C/o: San Rafael Police Association 1520 Fifch Avenue San Rafael, CA 94901 Union member 's dues received through intermediary; Sa~ Rafael Police Association, Fifth Fifth Avenue San Rafael , CA 94901 Union member's dues received through intermediary : San Rafael Police Association, 1520 Fifth Avenue San Rafael , CA 94901 11 15 2016 Aaron p~o 0 C/o: San Ra:ael Pol i ce Association 1520 Fifth Avenue San Rafael, CA 94901 UnioD member's dues r e ceived through intermediary : San Rafael Police Association, 'Contributor Codes IND -Individual i COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g .. business entity) PTY -Political Party sec -Small Conlribulor Committee CODE ... OOIND DeOM DOTH DPTY osee IKJ!ND DeOM DOTH DPTY osee OOIND DeOM DOTH OPTY osee IK)IND oeOM DOTH DPTY osee IKJIND DCOM DOTH OPTY o see Officer City of San Rafael Police Corporal City of San Rafael Police Corporal City of San Rafael Police Corporal City of San Rafael Po 1ce Corpora City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 th rough __ 1_2....:/_3_1...:./_2_0_1_6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 84 of 112 LD .NUMBER 83155 3 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN . 1 -DEC. 31) PERELEcnON TO DATE (IF REQUIRED) 16 .30 376.20 16 . )0 376 .20 16.30 376.20 16. JO 376.20 16.30 376.20 81.50 1 FPPC Form 460 (JanI2016) FPPC Advice : advice@fppc.ca .gov (866/275..:3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODe OF CONTRIBUTOR CONTRIBUTOR (Ir-COMMmEE, ALSO ENTER 1.0 NUM6...."R) CODE ... SCHEDULE A (CONT.) Statement covers period from 09/25/2016 CALIFORNIA 460 FORM th rough _....;;1;.;:2~/=-):;:.:1 /:....:2:...:0:..::;1:..::;6 __ _ Page as of 112 I.D.NUMBER AMOUNT RECEIVED THIS PERIOD 8J1SSJ CUMULAnvETO DATE CALENDAR YEAR (JAN . 1 -DEC. 31) PER ELECTION TOOATE <'F REQUIRED) IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER III' SE\.f·Et.4PlOYED, ENTER NAME OF BUSINESS) ~11~)~0~2~0~1~6~~A~a-r-o-n~p~i~o-mbo'-----------------------------------~-~--'N-D-----4~P~O·l~iC~e~C~o~rp~ora'1~--------1---------~1~6~.~J~0+---------~J~7~6~.2~0~------------------ C/o: San Rafael Police Association 1520 Fifth Cicy of San Rafael Avenue DeOM San Rafael, CA 94901 DOTH Union member's dues received t:hrough 0 PTY intermediary: San Rafael Police Association, OSCC 1520 Fifth Avenue San Rafael CA 94901 12/15 /2 0 1 6 Aaron <'iombo @IND C/o: San Rafael Police Association 1520 Fifth DeOM Avenue San Rafael, CA 94901 DOTH union member's dues received through 0 PTY intermediary : San Rafael Police Association, osee 12/29/2016 Aaron Piombo IlJIND C/o: San Rafael police Association 1520 Fifth DCOM Avenue San Rafael, CA 94901 DOTH Union member':!l dues received through 0 P"n' intermediary: San Rafael Police Association, osee -::"":""7::-:--;-:"""C::":""""C:--1-"J,22 0 'f h Ave nan Ra f a 1 4 0 1 09/30/2016 Allyson Powell IKIIND C/o: San Rafael Police Association 1520 Fifch X ·Contributor Codes I NO - I ndivid ual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g., business entity) P"n' -Political Party sec -Small Contributor Committee Fitch oCOM DOTH oPTY osee @IND DeOM DOTH OPTY osce Police Corporal Cicy of San Rafael Police Corporal City of San Rafael Communications Dispatcher City of San Rafael Communlcatlons Dlspatc er City of San Rafael SUBTOTAL $ 16 .)0 376 .20 16 .30 376 .20 12 .70 294.30 12 .70 294.30 .=o=J FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FILER San Rafael Police Association Political Action Committee DATI' RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONmlBUTOR (l~coM>.\mEe.ALsoENTERI.D.NIft.lBERI CODE * IF AN INDIVIDUAL. ENTER OCC UPATION AND EMPLOYER (IF SELF·EMPI.OYEO. ENTER NAME Of BUSINESS) ~1~1~0~5'/2~0~1~6--t7A'1'ly-s~o~n~p~o~w-e~l~l~------------------------------+--UO-IN-D---r.C~o-m-m~un~i~c~ations Dispatcher C/o : San Rafael Police Association 1520 Fifth City of San Rafael Avenue DCOM San Rafael. CA 94901 DOTH Union member's dues received through 0 PTY i~termediary: San Rafael Police Association, OSCC 1~20 Fifth Avenue San Rafael CA 94901 11/15/2016 Allyson Powell UOINO C/o : San Rafael Police Association 1520 Fifth OCOM Avenue San Rafael. CA 94901 DOTH Union member's dues received through OPTY interm7diary: San Rafael police Association, OSCC 11/30/2016 Fifth 12/15/2016 Allyson Powell C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, -'~~T-'-~~~lr52~0~F~ifth Avenue, San Rafael, CA 94901 A yson Powell'- c/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through lnte~diary: San Rafael police ASsociation, ·Contributor Codes INO-Individual COM -Recipient Committee (other than PlY or seC) OTH -Other (e .g ., business entity) PTY -Political Party SCC -Small Contlibutor Committee ~IND oCOM DOTH oPTY osce IKJIND OCOM DOTH DpTY osce !!lIND DCOM DOTH OPTY osee Communications Dispatcher City of San Rafael communications OisDatcher City of San Rafael- Communications Dispatcher City of San Rafael Communlcatlons Dlspatc er City of San Rafael SUBTOTAL $ Statement cOllers period from 09/25/2016 throug h _....;1;:.:2:..:/....;3;..:1:-'./...::2;..:0..::1;..:6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page_~86~ of 112 1.0. NUMBER 831553 AMOUNT RECENED THIS PERIOD CUMULA1WETO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (tF REQUIRED) 12.70 294.30 12 .70 294 .30 12.70 294.30 12.70 294.30 12.70 294.30 63.50 1 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Associacion Political Action Committee Amounts may be rounded to whole dollars. DATE RECElVED FULL NAME. STREET ADDRESS AND Z.IP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF·EMPLOYEe. ENTCR NAME OF BUSINESS) (IF COMMITTEE, ALSO ENTEA I 0 NUMBER) CODE * 09/30/2016 Dennis Prince C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Unioo member 's dues received through intermediary : San Rafael Police Associ ation, 15 2 0 F ifth Avenue San Rafael LA 94901 10/20/2016 Dennis Prince C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through interm~diary, San Rafael Police Association, 11/05/2016 11 ·Contribulor Codes INO -Individual COM -Recipient Committee (ether than PTY or SCC) OTH -Other (e.g., business entity) PTY -Political Party SCC -Small Contributor Commil1ee Fitch Fi fth Fifth ~IND DeOM DOTH DPTY Dsec OO IND DeOM D OTH DPTY osee lKIlNO D eoM DOTH DPTY DSCC OOIND DeoM DOTH D PTY Dsec OOIND DeoM DOTH O PTY DSCC Offi cer City of San Rafael Off icer City of Sa n Rafael Officer City of San Rafael Officer City of San Rafael o i cer City of San Rafael SU8TOTAL$ Statement covers period from 0 9 /25/2016 through _....:1:;.:2::..!/....:):..:1~/-=2:.:0:.:1-=6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 87 of _ 112 1.0 . NUMBER 8)1553 AMOUNT RECEIVED THIS PERIOD CUMULATIVETO DATE CALENDAR YEAR (JAN . 1 -DEC . 31) PER ELECTION TO DATE (IF REQUIRED) 16 ,)0 376 .20 16 .30 376.2 0 16.30 3 76.20 . 16.30 376.20 6 .30 376 .20 B1. SO I FPPC Form 460 (Jan/2016) FPPC Advice: ildvlce@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action committee Amounts may be rounded to whole do liars. DATE RECEIVED FULL NAME , STREET ADDRESS AND liP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER ~F SElf-EMPLOYED, E/IffER NAME OFB~NESSI ~FCO"'MrnEE.ALSOE"'1EI'!ID NUMBERI COOE ., 12/15/2016--Dennis Prince C/o : San Rafael Police Association 1520 Fifch Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 F i fth Avenue San Rafael CA 91901 12/29/2016 Dennis Prince 09/30/2016 10/20/2016 C/o : San Rafael Pol i ce Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermedi ary: San Rafael Police Association, Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary : San Rafael Police Association, 1520 Fifth Avenue , San Rafael, CA 94901 1 1 05 2016 Glno Rantlssl c/o San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through interm7d~ary : San Rafael Police Association, 'Contributor Codes IND -Individual COM -Recipient Committee (other than PTY or SCC) On-I -Other (e ,g., business entity) PTY -Political Party SCC -Small Contributor Committe e OOINO DCOM Dom OPTY osce !KlIND DeOM DOTH DPTY osee IIIIND DeOM DOTH OPn' osee [KlIND DeOM DOTH OP1Y osee [KlIND DCOM DOTH OP1Y osee Officer City of San Rafael Officer City of San Rafael Officer City of San Rafael Officer City of San Rafael o ).cer Cicy of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 through _-'1;;..;.2"'-/..;;.3..;;;1.;../..;.2-'-01;.:..6'--__ SCHEDULE A (CONT) CALIFORNIA 460 FORM Page BB of_..!.1~12:::...- 1.0. NUMBER B31SS3 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC 31) PER ELECTJON TO DATE (IF REQUIRED) 16.30 376.20 16.30 376 .20 16 .30 376.20 16.30 376,20 16 .3 0 376.20 81.50 1 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc,ca.gov (8661275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF·EMPLCM::D, ENTER NAME (IFCOMIAITTEE. ALSO ENTER I 0 NUM8EI11 CODE * ·Contributor Codes INO -Individual COM -Recipient Committee (other than PlY or SCC) OTH -Other (e .g ., business entity) PTY -Political Party SCC -Small Conlributor Committee Police Association 1520 Fifth 94901 Fifth IKIIND DCOM DOTH oPTY osec IKlIND DeOM DOTH oPTY osec IKJIND oeOM DOTH o PlY USCC IKIIND oeOM DOTH oPTY osee IK)IND oeOM nOTH o PlY osee OF BUSINESSI San Rafael City of san Rafael SUBTOTAL$ Statement covers period SCHEDULEA (CONT.) "'-'!IIIIIIP~"" from __ --=-0 9,-,1,-,2:..;:5,-,-1-=2....:.0-=2..:..6 __ _ throug h __ 1_2-,-1_3_2..:./_2_0_1_6 __ _ AMOUNT RECEIVED THIS PERIOD 16 . 16 .30 16.30 16.30 81,50 1 831553 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC . 31) 376 .20 376 .20 376.20 376.20 PER ELECTION TO DATE (IF REQUIRED) FPPC Form 460 (Jan/2016) FPPC Advice : advice@fppc.ca .gov (B66/27S-3n2) ~ - -1 _-_. ___ •• _ Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL . ENTER OCCUPATION AND EMPLOYER IIF SELf·EMPLOVEO. ENTER NAME or SUSINESS) ~FCCMMlnEE.ALSOENrERI .o .NuMeER) CODE * 10/20/2016 Ronda Reeee C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1!>20 Fifth Avcaue San Rafael CA 94901 11/05/2016 Ronda Reese 11/l.5/2016 C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Associatlon, . 1 Fifch 11/30/2016 Ronda Reese C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary, San Rafael Police Association, 1520 Fifch Avenue, San Rafael, CA 94901 Ron a Reese C/o: San Rafael Police Association 1520 Firth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Pollce Association, ·Contributor Codes INO -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g .. business entity) PTY -Political Party SCC -Small Contributor Committee OOIND DCOM DOTH DPTY osce OOIND D COM DOTH OPTY osce ~IND DeoM DOTH DPTY OSCC IXJIND DCOM DO~ DPTY osec OOIND DCOM DOTH DPTY OSCC Corporal City of San Rafael Corporal City of San Rafael Corporal City of San Rafael Corporal City of San Rafael Corpora City of San Rafael SUBTOTAL $ Stateme nt covers perf ad from 09/25/20)6 through __ ~1~2~/~3~1~/~2~0~1~6~ __ ___ SCHEDULEA (CaNT.) CALIFORNIA 460 FORM Page _.....::..90,,--of 112 1.0. NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATNETO DATE CALENDAR YEAR (JAN . 1 • DEC. 31) PER ELECTION TOOATE (IF REQUIRED) 16.30 376 .20 16 .30 )"16 .20 l.6.30 )"16 .20 16.30 3"16.20 16.30 3"16 .20 81. 50 I FPPC Form 461l (JanJ21l16) FPPC Advice: advice@fppc.ca.gov (866/275..3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FILER San Rafael Police Associacion Policical Accion Committee DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRI!3UTOR CONTRIBUTOR II.FCOMMlna:.ALSO EtlTER I D NUMBER I CODE * 12/29 2016 Ronda Reese IKIIND DeOM [JOTH DPTY Dsce C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received tht"ough intermediary: San Rafael Police Associacion, 1520 Fifth Avenue San Rafael CA 94901 09/30/2016 Peg9Y Ruge !KIIND DeOM DOTH [JPTY OSCC 10/20/2016 C/o, San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Associacion, Fifth IKIIND ~~ n~ San Rafael, CA 94901 0 OTH Union member's dues t"eceived through n PTY IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOVER (IF SELi'-EMPLOYEO. ENTER NAME OF IlUSINES$) Corporal City of San Rafael Lead Communications Dispatcher City of San Rafael Lead Communications Oispatchet" City of San Rafael Statement covers period from 09/25/2016 through _....;1:..:2:..!/-=3:..:1:..:;/-=2:..:0;.::1;.::6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 91 of _-,1",1..,2,,-- 1.0. NUMBER 83155) AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR VEAR (JAN 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376.20 12.70 294.30 12.70 294.30 incermediary: San Rafael Police Associacion, [JSCC ~~~~~~~1~1~.~~i~F~h Ayenue. San Rafael, CA 9490)~ ___ r-_____ ~_~~ __ ~~~ ____ +-_____ ~~~ _____ ~~~~ _________ _ 11/05/2016 ?eg9Y Ruge !XjIND Lead Communications 12.70 294.30 C/o: San Rafael Police Association 1520 Fifch DCOM Dispatcher Avenue City of San Rafael San Rafael, CA 94901 0 OTH On; on member' a dues rece i ved through 0 PTY intermediary: San Rafael Police Association, osee 1520 Fifch Avenue. San Rafael, CA 94901 11 15 2016 E'eggy Rl.Jge [KlIND C/o: San Rafael Police Association 1520 Fi fth OX COM Avenue San Rafael, CA 94901 DOTH union member's due s rece i ved ~hrough 0 PTY intermediary: San Rafael Police Association, osee ·Contributor Codes INO -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g .. business entity) PTY -Political Party SCC -Small Contributor Committee Lea Commun~cat~ons Dispatcher City of San Rafael SUBTOTAL $ 12.70 294.30 FPPC Form 460 (Janf2016) FPPC Advice: advice@fppc.r::a.gov (866/27S-3n2) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FILER San Rafael Police Association Political Accion Commictee DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP COOE OF CONTRIBUTOR CONTRIBUTOR (IF COMMmE€.ALSOENTER I,O,NLiMBER) CODE '* 11/30/2016 Peggy Ruge OOIND C/o: San Rafael Police Association 1520 Fifth oeOM Avenue San Rafael, CA 94901 DOTH Union member's dues received through OPTY intermediary : San Rafael Police Associat:ion , OSCC 1520 Fifth Avenue San Rafael CA 91901 12/15/2016 Peggy Ruge IKJIND C/o: San Rafael Police Associat:ion 1520 Fifth OCOM Avenue San Rafael, CA 94901 DOTH Union member' 5 dues received through 0 PTY intermediary: San Rafael ~olice Association, osee 12/29/2016 Peggy Ruge IXJIND C/o: San Rafael Police Associacion 1520 Fi~th OCOM Avenue San Rafael, CA 94901 DOTH Union member I s dues received through 0 PTY intermediary: San Rafael Police Association, osee IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER Qf SELF· EMPLOYED. ENTER NAME OF BlJSiNESS) Lead Communications Dispatcher City of San Rafael Lead communications Dispatcher City of San Rafael Lead Communications Oisoatcher City of San Rafael Statement covers period from 09/25/2016 through _-=1:..:2c.:../..::.3..::.1 '---/2=-0:....:1:..:6'-----__ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 92 of 112 I.D .NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVETO DATE CALENDAR YEAR (JAN, , • DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 12.70 294.30 12.70 294.30 12.70 294.30 1520' v uSn R 4 1 09/30/2016 Thomas Sabido -------r--~--IN-D----~r-O~f~f~i-c-e-r----------------~----------~1~6~.~J~0~----------~3~76~.2~O~------------------ C/o: San Rafael Police Association 1520 Fifth OIKl COM City of San Rafael Avenue San Rafael, CA 94901 DOTH Union member' s dues rece i ved through 0 PTY intermediary: San Rafael Police Association, osee 1520 Fifth Avenue, San Rafael. CA 94901 10 20 2016 Thomas Sa l. a IKI NO C/o: San Rafael Police Associatl.on 1520 Fifth X , Avenue DCOM San Rafael. CA 94901 0 OTH Union member' B dues received through 0 PTY interm7diary: San Rafael Police Association, osce ·Contributor Codes IND -Individual e OM-RecipientCommiltee (other than PTY or seC) OTH -Other (e .g ., business entity) PTY -Political Party see -Small Contributor Committee 0. lcer City of San Rafael SUBTOTAL $ 16 .30 376.20 70,70 1 FPPC Form 460 (JanJ2016) FPPC Advice : advice@fppc .ca.gov (866/275-37721 # --. -• -• _. Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Folice Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRI8UTOR CONTRIBUTOR ~fCOMMmeE.ALSOENTERI.O NUMBER) CODE * IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF·EMPlOYED. ENTER NAMt' OF BUSINESSI 11/05/2016 Thomas Sab1do C/o: San Rafael Police Associ ation 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1 5 20 Fifth Avenue San Rafael CA 94901 11/15/2016 Thomas Sabido C/o: San Rafael police Association 1520 Fifth Avenue San Rafael , CA 94901 Union member's dues received through intermed ~ary: San Rafael Police Associat10n, 11/)0/2016 12/15/2016 ·Contributor Codes !NO-Individual eOM -Recipient Committee (other than pry or SCC) OTH -Other (e .g .• business entity) PTY -Political Party SCC - Small Contributor C ommitte e Fifth Fifth Fifth IRI IND o COM DOTH OPTY osee !!lIND DCOM DOTH DPTY OSCC ~IND DCOM DOTH DPTY osee OOIND DeoM DOTH OPTY osee !K1IND DeOM DOTH UPTY OSCC Office,,' City of San Rafael officer City of San Rafael Officer City of San Rafael Officer City of San Rafael o 1cer City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 ~rough ___ l_2~/~3_1~/_2~0_1_6 ____ ___ SCHEDULEA (CaNT.) CALIFORNIA 460 FORM Page 9 3 of 112 1.0. NUMBER 931 553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN . 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIREDI 16 .30 376 .20 16.30 376.20 16 .30 376 .20 16 .30 376 .20 J. . 376.20 91. 50 I FPPC Form 460 (JanJ2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FILER San Rafael Police Association Political Action Committee DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IFCOMMIITEE. ALSO am:R I D NUI.IBER) CODE * 09/30/2016 Anthony Scalercio IRIIND c/o: San Rafael Police A.ssociation 1520 f'ifch oeOM Avenue San Rafael, CA 94901 DOTH Union member' s dues recel. ved through 0 PTY intermediary : San Rafael Police A6sociacion, OSCC ~~~~~~~l~~fjfth Avenue San Rafael CA 94901 10/20/2016 Anthony Scalercio !!lIND C/o: San Rafael Police A.ssociacion 1520 Fifth oeOM Avenue San Rafael, CA 94901 DOTH Onion member' s dues received t.hrough 0 PTY interm~diary: San Rafael Police Association, OSCC 11/05/2016 Anthony Scalercio IX]IND C/o: San Rafael Police Association 1520 Pi ",th 0 COM Avenue San Rafael, CA 94901 DOTH Onion member's dues received through 0 PTY IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER IIF SEI,F·EJ,IPLOYEO, ENTER NAME OF eUSINESS) Office:r City of San Rafael Officer City of San Rafael Officer City of San Rafael Statement covers period rrom 09/25/2016 through _....;1:;..2;;.;/...;3...;1,,-/...;2..;.0.:;.1.;;..6 __ _ SCHEDULE A (CaNT.) CALIFORNIA 460 FORM Page _--=-94~ of 112 I.D.NUMBER B31553 AMOUNT RECEIVED THIS PERIOD CUMULATlVETO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376.20 16.30 376.20 16 .30 376.20 intermediary: San Rafael Police Association, OSCC --:-~,.."....",...,,...,....,,--+-!l.5.~E.iE th Ayenue. ~~-""-..!d:l_.z.:L.z.;!.01!....-__ --l _____ -+~-;;-;---:-: _________ +-____ ---:-~-::-::+-____ ----::-::-:::-::-::-t-_______ _ 11/15/2016 Anthony Scalercio IRJIND Officer 16,30 376.20 C/o; San Rafael Police ASsociation 1520 Fifth X City of San Rafael Avenue oeOM San Rafael, CA 94901 D OTH Onion member's dues received through 0 PTY intermediary : San Rafael Police Association, OSCC -'>T-~~~~~1~5~20 Fifth Avenue, San Rafael, CA 94901 11 30 2016 Antnony S ca ercl.O 00 C/o; San Rafael Police Association 1520 Fifth X INO Avenue OCOM San Rafael, CA 94901 OOTH Union member' s dues received through 0 PTY in~e~ediary: San Rafael Police Association, OSCC ·Contributor Codes IND -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g .• business entity) PTY -Political Party SCC -Small Contributor Commil1ee o lcer City of San Rafael SUBTOTAL $ 16.30 376.20 91. 50 I FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275..3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police ASsociacion poli~ical Accion Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF· EMPLOYED. ENTER NA1.lE OFBLIS'NESS) (IF CO.'>IMIITEE. ALSO ENTER 1.0. NUMBERI CODE ... 12 15/2016 Anthony Scalercio C/o: San Rafael ~olice Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael ~olice Association, 1520 Fifch Avenue San Rafael CA 94901 12/29/2016 Anthony Sca1ercio C/o: San Rafael Pol~ce Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael ?olice Associacion, . 4 09/30/2016 George SchkKore C/o: San Rafael Police ASBociat~on 1520 Fifth Avenue San Rafael, CA 94901 Unlon member's dues received through intermediary: San Rafael Police Associacion, 1520 Fift:h Av n 10/20/2016 George Schikore C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 11 05 2016 George Sc k ore C/o: San Rafael Police Association 1520 Fifch Avenue San Rafael, CA 94901 Union member's dues received chrough ~ncermediary: San Rafael Police Association, ·Contributor Codes IND -Individual Pi ftb Ayenue, San Ra~ 4 COM -Recipient Committee (other than PTY or SCC) OTH -Other (e,g., business entity) PTY -Political Party SCC -Small Contributor Committee IR]INO DCOM DOTH DPTY DSCC IKJIND DCOM DOTH DPTY osee IX]INO DCOM DOTH DPTY osce IRJINO DCOM DOTH DPTY Dsec IR]INO DCOM DOTH DPTY OSCC officer Cicy of S~~ Rafael Officer City of San Rafael Officer City of San Rafael Officer City of San Rafael O_~kcer Cicy of San Rafael SUBTOTALS Statement covers period from 09/25/2016 ~rough __ ~l~2~/~3~1~/~2~0~l~6 ____ __ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 95 of_-,-1,,-12~ I.D.NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVETO DATE CALENDAR YEAR (JAN. 1 • DEC. 31) PER ELECTlON TO DATE (IF REQUIRED) 16 .30 376.20 16.30 16,30 376,.20 16.30 376.20 16.30 376.20 81. 50 I FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275·3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police ASsociation Political Action Committee Amounts may be rounded to whole dol la rs. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOVER (IF SELF·EMPLOYED, ENTER NAME OF6US1NESS) (IFCOMMITIEE.ALSOENTERI.D.NuMe~RI CODE * 11 15/2016 George Schikore C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through i.ntermediary: San Rafael Police Association, Ij20 Fifth Avenue San Rafael CA 94901 11/30/2016 George Schikore C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 12/15/2016 12/29/2016 09 30 2016 'Contributor Codes I ND -Individual COM -Recipient Committee (other than PTY or seC) OTH -Other (e.g., business entity) PTY -Political Party see -Small Contributor Committee Fifth Fifth Fifth !!lIND DCOM DOTH OPTY osee [KIIND OCOM DOTH OPTY DSCC IRlIND DCOM DOTH OPT'( osee IRlINO DCOM DOTH DPTY DSCC IR]INO DCOM DOTH OPTY osee Officer City of San Rafael Officer Cicy of San Rafael Officer Cicy of San Rafael Officer City of San Rafael o _l.cer Cicy of San Rafael SUBTOTAL $ Statement covers peri od from 09/25/2016 through _....:1:..:2;.:../..:.3..:.1.:.../.:..20.:..1:...6:....-__ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page _-=-96~ of 112 1.0 NUMBER 631553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 . DEC J1) PER ELECTION TO DATE (IF REQUIRED) 16.30 376.20 16.30 376.20 16.30 376.20 16.30 376.20 1 .3 376.20 B1. 50 I FPPC Fonn 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) SCHEDULEA (CaNT.) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. Statement covers period CALIFORNIA 460 FORM NAME OF FILER San Rafael Police Association Political Action Committee DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR COfllTRISurOR (IFCCMMITTEf.ALSOEN'dHO NUt0.4eER) CODE * from 09/25/2016 through __ 1_2..;../_3_1/;....2_0_1_6 __ _ 1.0. NUMBER 831553 IF AN INDIVIDUAL. ENTER AMOUNT CUMULATIVE TO DATE OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR PER ELECTION TO DATE (IF REQUIRED) (IF SElf·EMPlOYED. EIITER NAME PERIOD (JAN . 1 -DEC . 31) ~10~/'2~0~/T.2-'0~1~6.-rJ~u~s~t~~~·n~s~c~hr~a~e~d~e7.r~----------------------------r-~------~~O~f7fTi=c=er=--Q-f-a-~-I-NE-SS~)------~----------~1~6~.~3~04-----------3~7~6~.2~O~------------------IKlIND C/o; San Rafael Police Association 1520 Fifth City of San Rafael AVC:1Ue oCOM San Rafael, CA 94901 DOTH Union member's dues received through D PTY intermediary: San Rafael Police Association, DSCC 1520 Fifth Avenue San Rafael CA 94901 11/05/2016 Justin Schraeder IKIIND C/o: San Rafael Police Association 1520 Fifth DeOM Avenue San Rafael, CA 94901 DOTH union member's dues received through D PTV interm7diary : San Rafael Police Association, Dsce 11/15/2016 Fifth 11/30/2016 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary : San Rafael Police Association, ~~~~~~~1S~2~0 Fifth Avenue, San Rafael, CA 94901 12 1S 2016 JustIn' 'sc rae er c/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermedlary : San Rafael Police ASsociation, 'Contributor Codes lNO -Individual COM -Recipient Committee (other than PlY or SCC) OTH -Other (e .g ., business entity) PTY -Political Party SCC -Small Contributor Committee IKlIND DeOM DOTH DPTV DSCC IKlIND DeOM DOTH DPTV DSCC IR]IND DeOM DOTH DPTY osce Officer City of San Rafael Officer City of San Rafael Officer City of San Rafael Of l.cer City of San Rafael SUBTOTAL $ 16 .30 376 .20 16.30 376 .20 16.30 376.20 16.30 376.20 81. 50 I FPPC Form 460 (JanJ2016) FPPC Advice : advice@fppc_ca .gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Polit~cal Act~on Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL . ENTER OCCUPATION AND EMPLOYER (If sa.,<.EMPlOVEO. E~ NAME o~ BUSiNESS) (IFCOMMrTTEE. ALSO ENl"ER 1.0 . NUMOERI CODE * 12/29 2016 Justin Schraeder C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through inte rmediary: San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 94901 09/30/2016 Wanda Spaletta C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 tJ:\ion member's dues received through ~ntermediary: San Rafael Police Association, 10/20/2016 11/05/2016 'Contributor Codes IND -Individual . ~ COM -Recipient Committee (other than PTY or seC) OTH -Other (e .g ., business entity) PTY -Political Party SCC -Small Contributor Committee Fifth Fifth Fifth OOIND oeOM DOTH oPTY oSCC @IND oeOM DOTH oPTY osee lKJlND DeOM DOTH DPTY osee lKJlND oeoM DOTH oPTY osee IKJIND oeoM DOTH oPTY oscc Officer City of San Rafael Sergeant City of San Rafael Sergeant City of San Rafael Sergeant: City of San Rafael Sergeant City of San Rafael SUBTOTAL $ Statement covers period from 09/25/2016 through ... _ ':.2/31/2016 SCHEDULE A (CaNT.) CALIFORNIA 460 FORM Page 98 of.. 112 LD.NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATNETO DATE CALENDAR YEAR (JAN. 1 . DEC . 31) PER ELECTION TO DATE (IF REQUIRED) 16 .)0 376.20 16.30 376 .20 16.30 376.20 16.30 )76 .20 1 ,3 )76 .20 81.5°1 FPPC Form 460 (JanI2016) FPPC Advice: advice@fppc.ca.gov (8661275--3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael ~olice Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER IIF SELF·EMPLOYED. ENTER NAME Of aUSINESS) QF COM foIlTTEE. ALSO ENTER I O. NUMBER I 11/30/2016 'iWanda Spalecta C/o: San Rafael Police Association 1520 Fifch Avenue San Rafael, CA 94901 Union member's dues received chrough intermediary: San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 94901 12/15/2016 Wanda Spaletta C/o: San Rafael Police Association 1520 Fifch Avenue San Rafael, CA 94901 Union member's dues received chrough incermediary: San Rafael Police ASsociation, 12/29/2C16 wanda Spa1etta C/o: San Rafael Police Association 1520 Fifch Avenue San Rafael, CA 94901 Union member's dues received chrough incermediary: San Rafael Police Association, -;--;-:-""""''''-_''''-1-''1:1 P . f h Av n Ra flO 1 09/30/2016 Lynecte Starnes C/o: San Rafael Police Associacion 1520 Fitch Avenue San Rafael, CA 94901 Union member's dues received chrough intermediary: San Rafael Police Association, 1520 Fi ft h Avenue, San Rafael, CA 94901 10 20 2016 Lynet te Starnes C/o: Sa n Raf ael Police Association 1520 Fifth Avenue San Rafael, CA 94901 union member'6 dues received through intermediary, San Rafael Police Associarion, 'Contributor Codes INO -Individual , h 4 COM -Recipient Committee (other than PTY or seC) OTH -Other (e.g., business enllty) PTY -Political Party see -Small Contributor Committee CODE * OOIND oCOM DOTH oPTY oscc OOIND DCOM DOTH DPTY .OSCC ®IND oCOM DOTH OPTY OSCC ®IND OCOM DOTH oPTY osee IIDINO oCOM DOTH oPTY oscc Sergeant City of San Rafael Sergeant City of San Rafael Sergeant City of San Rafael Community Service Officer City of San Rafael Cammun1ty S e~1ce 0 1cer Cit y of San Rafael SUBTOTAL $ Stateme nt covers period ~om C9/25/2016 th rough _....;1:..2:..:/....;3:...:1:..:c/....;2:...:0....;1;..:6" __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 99 of _. 112 I.D.NUMBER e31SS) AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 376.20 16.30 376.20 16.30 376.20 12.70 294.30 12.70 2.94.30 FPPC Form 460 (Jan/2016) FPPC Advice: advlce@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Assoc~ation Poli~ical Action Committee 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 I CODE * IF AN INDNIDUAL. ENTER OCCUPAilON AND EMPLOYER (IF SEI.F-EMP~OVCD. ENTER NAIolE OF BuSINESS) 11 OS/2016 Lynette Starnes C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary : San Rafael Police Association, 1~20 Fifth Avenue San Rafael CA 94901 11/15/2016 Lynet te Starnes 11/30/2016 C/o: San Rafael i'olice Association 1 520 Fifth Avenue San Rafael, CA 9490] Union member's dues received through intermediary : San Rafael Police Association, 1 Fifth 12/15/2016 Lynette Starnes C/o: San Rafael Police Associat~on 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 12 29 2016 Lynette Starnes C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 'Contributor Codes INO -Individual COM -Recipient Committee (olher than PTY or SCC) OTH -Other (e .g., business entity) PTY -Political Party sec -Small Contributor Committee IKIIND DCOM DOTH UPTY OSCC [IDINO oCOM DOTH oPTY oscc lKllND OCOM DOTH oPTY oSCC IK)INO DeOM UOTH DPTY OSCC OO IND oeOM DOTH oPTY Dsce Community Service Officer City of San Rafael community Service Officc;- City of San Rafael Community Service Ofticer City of San Rafael Community Service Officer City of San Rafael Commun~ty Serv~ce 0 ~cer City of San Rafael SUBTOTAL $ Statement covers period ~om 09/25/2016 th ro ugh __ 1::..:2::..!/~3:..:1:..!/..:2:..:0:..:1:..:6~ __ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page _--=-10::.,:0::... of 112 1.0. NUMBER 8J155J AMOUNT RECEIVED THIS PERIOD CUMULATNETO DATE CALENDAR YEAR (JAN . 1 -DEC. 31) PER ELECTION TO DATE (tF REQUIRED) 12.70 294 .30 12 .70 294.30 12 .70 294 .30 12.70 294.30 12.70 294.30 63 .5°1 FPPC Form 460 (Janl2016) FPPC Advice: advice@fppc.ca .gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Policical Accion Committee Amounts may be rounded to whale dallars. DATE RECEiVED FULL NAME. STREET ADDRESS AND ZIP CODe OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOVER (IF SaF·El\.IPLOVEO. ENTER NAME OF eUS1N ESS) (tFcOt.CIoIIn£e. ALSO IONTER I 0 NUM~I CODe * 09 30 2016 Chrlstopher Sweeney C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael , CA 94901 Union member's dues received through intermediary: San Rafael Police Associacion. 1520 Fifch Avc~ue San Rafael CA 94901 10/20/2016 Christopher Sweeney C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael. CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 11/05/2016 Christopher Sweeney C/o: San Rafael Police Associa~ion 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary : San Rafael Pol :.ce Association, 1520 F 'fth Aven e San Rafael A 4 1 11/15/2016 Christopher Sweeney C/o: San Rafael Police Association :~20 Fifth Avenue San Rafael , CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue, San Rafael. CA 94901 C lSCOp er Sweeney C/o : San Rafael police Association 1520 Fifth 'Contributor Codes IND -Individ ual COM -ReCipient Committee (other than PTY or seC) OTH -Other (e.g .• business entity) PTY -Political Party SCC -Small Contnbutor Committee IR]IND DeOM DOTH DPTY osee IRJIND o cOM DOTH DPTY osee ~IND D eOM DOTH DPTY o see IR]IND o eoM DOTH DPTY osee IR]IND oeOM DOTH oPTY osee Officer City of San Rafael Officer City of San Rafael Officer City of San Rafael Officer City of San Rafael o J.cer City of San Rafael SUBTOTAL $ Statemcntcovers period from 09/25/2016 throug h _....;1....;2..:../_3_1/:....2.;....0-,-1....;.6 __ _ SCHEDULE A (eONT.) CALIFORNIA 460 FORM Page_--=-lO=lo.. of 112 1.0. NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN . 1 • DEC . 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376.20 16 .30 376 .20 16 .30 3 7 6 .2 0 16 .30 376 .20 16.30 376 .20 FPPC Farm 460 (Jan/2016) FPPC Advice : advice@fppc .ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Act~on Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SElf. E"IPLOYED. ENTER NAA4 F OF BUSINESS) (IF CO.'.1 MlnEE. ALSO ENTER 1.0 NUMBER) CODE * 12 15/2016 Christopher Sweeney C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through i~termediary: San Rafael ?olice ASsociation, 1~20 Fifth Avc~ue San Rafael CA 94901 12/29/2016 Christopher Sweeney C/o: San Rafael Police Association 1520 F~fth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael police Association, 09/30/2016 10/20/2016 ·Contributor Codes INO-Individual COM -Recipient Committee (other than PTY or seC) OTH -Other (e.g., business entity) PTY -Political Party SCC -Small Contributor Committee Fifth Fifth Fifth I!lIND DeOM DOTH DPTY Dsce IRJIND DeOM DOTH OPTY USCC OOIND DCOM DOTH DPTY osee IKJ IND D COM D OTH D PTY o see IKJIND oeOM DOTH DPTY osec Officer City of San Rafael Office r City of San Rafael Civilian Supervisor City of San Rafael Civilian Suoervisor City of San-Rafael C~v~ ~an Suoervlsor City of San-Rafael SUBTOTAL $ Stateme nt covers period hom 09/25/2016 through _....:1:..;2,-,/....:3....:1:..:./....:2....:0....:1....:6 __ _ SCHEDULE A (CaNT.) CALIFORNIA 460 FORM Pi:lge _--=10::..:2=-of 112 I.D.NUMBER B3155 3 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376.20 16.30 376.20 12.70 294.30 12,70 294.30 12.70 294.30 FPPC Fonn 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3n2) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Poli~ical Ac~ion Commi~tee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED. ENTER NAME or-BUSINESS) (IF COIolMilTEE.AlSOEN7~R 1.0. NUMBER) CODE * 11/15/2016 CharlyTaylor C/o, San Rafael Police Association 1S20 Fifth Avenue San Rafael, CA 94901 Union member's d~cs received through intermediary : San Rafael Police Association, 1520 Fi fth Avenue San Rafael CA 94901 11/30/2016 Charly Taylor C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through interm7~iary: San Rafael Police Association, 12/15/2016 12/29/2016 09 30 2016 ·Contributor Codes I ND -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g., business entity) PTY -Political Party s ee -Small Contributor Committee Fifth Fifth Fifth OOIND neOM DOTH DPTY osee IKJIND DeoM UOTH DPTY oscc fRIlND neOM DOTH DPTY osec IIIIND oeOM nOTH DPTY osee IK]INO DeoM DOTH OPTY osee Civilian Supervisor City of San Rafael Civilian supervisor City of San Rafael Civilian Superv1sor City of San Rafael Civilian superv1sor" City of San Rafael o leer City of San Rafael SUBTOTALS Statement covers period from 09/25/2016 through __ 1_2..:../_3_1.;../_2_o 1_6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page 103 of 112 1.0. NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN 1 -DEC 31) PER ELECTION TO DATE (IF REQUIRED) 12.70 294.30 12.70 294.30 12.70 294.30 12.70 294.30 16.30 376.20 FPPC Form 461l (JanI21l16) FPPC Advice: advice@fppc,ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association political Action Commictee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SEI.F·E/J.PLOVED. ENTER NAME OF 8USlNESS) 10 11 (IFCOMWnEE, ALSO ENn;:R I 0 NUMBER) 2016 Henry rre C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through interm7diary: San Rafael Police Association, Fifth Fifth Henry Tirre C/o; San Rafael Police Association 1520 F~fth Avenue San Rafael, CA 94901 Union member's dues received through 'inte~edia~: San Rafael Pol~ce Association, 1520 Fif~h Avenue San Rafael CA 94901 Henry T~rre c/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues rece1ved throuah intermed ia ry : San Rafael Police As~ociation, CODE * IR]IND DCOM DOTH OPTY osce IK]IND DCOM DOTH o PlY osee IXlIND DeOM DOTH DPTY D sec IXlIND DeOM D OTH O PTY o sec IRJIND oeOM DOTH OPTY oscc San Rafael San Rafael Officer City of San Rafael J.cer City of San Rafael SCHEDULEA (CONT.) ~----SS~~~~~mue~n~t~c~o~v~e~~~p;erirl~o~d~---'~~~~~~~ from 09/25/2016 through 12/31/2016 Page 1 0'1 of __ ...;1::.;1.::.;2=--- 1.0 NUMBER AMOUNT RECEIVED THIS PERIOD 1 16.30 16.30 16.30 1 831553 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) ) 376.20 376.20 376.20 3 PER ELECTION TO DATE (IF REQUIRED) SUBTOTAL $ 81. 50 I 'Contributor Codes I ND -Individ ual eOM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g., business entity) PTY -Political Party SCC -Small Contributor Committee FPPC Form 460 (JanJ2016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) _ &--. -.. --~ - - ---~- Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael ~olice Associaeion Po11t~cal Aceion Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR tF AN INDIVIDUAL. ENTER OCCUPATION AND EMPLOYER (IF SElf· EMPLOYED, ENTER NAME or 6LSNESSI (IF COMMJTTEc. AlSOENTElHO NUM6ERI CODE * 12/29/2016 Henry Tirre C/o : San Rafael Police Associaeion 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary : San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 94901 09/30/2016 Michael Vergara C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through interm~diary; San Rafael Police Association, 10/20/2016 Michael Vergara C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 union member's dues received through intermediary: San Rafael ,'alice Association, 1520 Fi h Avenu a R 1 11/05/2016 Michael Vergara C/o: San Rafael Police Associaeion 1520 F~fth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue, San Rafael, CA 94901 Ml.c ae Vergara C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 'Contributor Codes INO -Individual . Av 4 COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g., business entity) PTY -Political Party SCC -Small Contributor Committee !E)IND UCOM DOTH OPTY OSCC !K)IND DCOM DOTH DPTY oSCC IX)IND DCOM DOTH oPTY oscc IRJIND DOOM DOTH DPTY DSCC IK)IND DCOM DOTH UPTY OSCC Officer City of San Rafael Sergeant City of San Rafael Sergeant City of San Rafael Sergeant City of San Rafael Sergeant City of San Rafael SUBTOTAL $ Statement covers period hom 09/25/2016 th roug h _--=1:...:2-,--/-".-3-",1/,--,2:...:0:...:1--=6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page _-=10,,-,5,-of 112 I.D.NUMBER 831553 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN . 1 • DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376.20 16 .30 376.20 16.30 376.20 11;.30 376,20 16.30 376.20 91. 50 1 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/27S-3n2) Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER San Rafael Police Association Political Action Committee Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL. ENTeR OCCUPATION AND EMPLOYER IIF SELF·EMPU)Y£D. ENTER NAME Of BUS1NESS) (IF COMMITTEE. AlSO ENTER 1.0. NUM8~R) 11 30/2016 Michael Vergara C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 94901 12/15/2016 Michael Vergara C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through interm7diary: San Rafael Police Association, 12/29/2016 09/30/2016 'Contributor Codes INO -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g., business entity) PTY -Political Party SCC -Small Contributor Committee Fifth Fif t h Fifth CODE .. I&]IND DCOM DOTH DPTY osee IKIIND DCOM DOTH D PTY osce [RJIN D oeOM DOTH OPTY osee OOIND DeOM DOTH DPTY osee IRlfND DCOM DOTH DPTY osee Sergeant City of San Rafael Sergeant City of San Rafael Sergeant City of San Rafael Officer City of San Rafael o .leer City of San Rafael SU8TOTAL$ Statement covers peri od from 09/25/2016 ~rough __ ~1~2~/~3~1~/~2~0~1~6 ____ ___ SCHEDULE A (CaNT.) CALIFORNIA 460 FORM Page 106 of 112 LD. NUMBER 83155J AMOUNT RECEIVED THIS PERIOD CUMULATNETO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELEcnON TO DATE (IF REQUIRED) 16.)0 376.20 16.30 376.20 16.30 )76.20 16.30 )76,20 16.30 376.20 81. 50 I FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. NAME OF FILER San Rafael Police Association Political Action committee DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRI8UTOR CONTRJ8UTOR (iF Co.l.1MITTEE, ALSO ENTER I D. NUMeER) CODE * 11/05/2016 Mark Wllklnson ~IND DCOM DOTH DPTY Dsec C/o ; San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, ~~~~~~~lS20 Fifth Avenue San Rafael CA 94901 11/15/2016 Ma r ~ Wilkinson C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary, San Rafael Pol~ce Association, ~INO DCOM DOTH OPTY osce 11/30/2 016 Mark Wilkinson IRJINO C/o : San Rafael Police Association 1520 Fifth D eOM Avenue San Rafael, CA 94901 DOTH Union member's dues received throu9h 0 PTY IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF·E.\APLOYEO, ENTER NAME OF BUSINESS) Officer City of San Rafael Of ficer City of San Rafael Officer City of San Rafael Statement covers period from 09/25/2016 th ro ugh __ 1"'2"'/'-'3:..;1:..:/...:2:..;0:..::1:.:6'--__ SCHEDULEA (CaNT.) CALIFORNIA 460 FORM Page 107 of_..:.1.::.;12=-- I.D.NUM8ER 8Jl5S3 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 . DEC . 31) PER ELECTION TO DATE (IF REQUIRED) 16.30 376.20 16 .30 376.20 16 .30 3 7 6.20 intermediary: San Rafael Police Association, o see 1520 Fifth v a f~~~~~4~A-______ ~---------4~~--------------------4_------------__ +_----------------~----------------- 12/15/2016 Mark wilkinson 00 NO Officer 16.)0 )76.20 C/o: San Rafael Police Association 1520 Fifth OX ~OM City of San Rafael Avenue San Rafael , CA 94901 DOTH Onion member's dues recei vea l:.hrough 0 PTY intermediary : San Rafael Police Association, [Jsee 1520 Fifth Avenue , San Rafael, CA 94901 Mark I'll. k~nson !Kl i 0 C/o: San Rafael Police Associa~ion 1520 Fifth X N ·eontributor Codes INO -Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g., business enlity) PTY -Political Party SCC -Small Contributor Committee DCOM DOTH DPTY osee o ~cer City of San Rafael SUBTOTAL$ 16 .30 376.20 81.50 1 FPPC Form 460 (Jan/Z016) FPpe Advice: advice@fppc.ca.gov (866/275-3772) Schedule A (Continuation Sheet) Monetary Contributions Received Amounts may be rounded to whole dollars. Statement covers period from 09/25/2016 throug h _....;1;;.;2;;.:/....;3;.:1:..:./...::2;.:0..::1",6 __ _ SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page lOB of 112 ._ .. ____ ~-------------------------------------------------------------------------L--------------------____ ~~~~~----------~ NAME OF FILER 1.0. NUMBER San Rafael Police Association Political Action Committee nATE RECEIVED FULL NAME. STREET AODR ESS AND ZI P CODE OF CONTRIBUTOR CONTRIBUTOR (IFco~!.\mEE .AtSOENTERID.NUMB9'i) CODE * 09/30/2016 Bianca Wilmott C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fifth Avenue San Rafael CA 94901 10/20/20i6 Bianca Wilmott C/o : San Rafael Police Associa~ion 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 11/05/2016 Bianca Wilmott C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police Association, 1520 Fi a 4 11/15/2016 Bianca Wilmotc C/o: San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary : San Rafael Police Association, 1520 Fifth Avenue , San Rafael, CA 94901 11 )0 2016 Bianca Wllmott C/o : San Rafael Police Association 1520 Fifth Avenue San Rafael, CA 94901 Union member's dues received through intermediary: San Rafael Police ASSOCiation, 'Contributor Codes IND -Individual .. COM -Recipient Committee (other than PTY or SCC) OTH -Other (e .g ., business entity) PTY -Political Party see -Small Contributor Committee OOIND oeoM DaTI-! oPTY osee OOIND oeoM DOTH oPTY osee OOINO o eOM DOTH DpTY osec !&lIND DeoM DOTH DPTY osee lK)INO oeOM DOTH OPTY OSCC IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SEtF·fMPU)YED. ENTER NAME OF IlUSINE$S) Police Officer City Of San Rafael Police Officer City of San Rafael Police Officer City Of San Rafael Police Officer City Of San Rafael SUBTOTAL $ AMOUNT RECEIVED THIS PERIOD 16.30 16 .)0 16.30 16.30 16,30 81. 50 I 811SS) CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC 31) 32B.30 32B.30 328.30 32B.30 328.30 PER ELECTION TO DATE (IF REQUIRED) FPPC Fonn 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule C Nonmonetary Contributions Received seE INSTRUCTIONS ON REVERSE NAME OF FILER Amounts may be rounded to whole dol la rs. San Rafael Pol~ce Association Political Action committee DATE RECEIVED FULL NAME. STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR IIF COMMITTEE. AlSO ENTER 10. NUMSER I IF AN INDIVIDUAL . ENTER CONTRIBUTOR OCCUPATION AND EMPLOYER CODE * OIND DeOM DOTH DPTY osee DIND oeOM DOTH o PlY osee DIND DeOM DOTH DPTY o see DIND oeOM DOTH DPTY osee (If SE\.F-€MPlOYEO. ENTER NAME OF BUSINESS) Attach additional information on appropriately labeled continuation sheets. Schedule C Summary 1. Amount received this period -itemized nonmonetary contributions. SCHEOULEC Statement covers period CALIFORNIA 460 FORM from 0 9 /2 5/2016 through 12/31/2016 DESCRIPTION OF GOODS OR SERVICES SUBTOTAL $ AMOUf'IT1 FAIR MARKET VALUE I.D.NUMBER B31553 CUMULAT IVE TO DATE CALENDAR YEAR (JAN 1 -DEC 31) 'Contribulor Codes INO -Individual PER ELECTION TO DATE (IF REQUIRED) (Include all Schedule C sUbtotals .) ..................................................................................................................... $ ____ --=-0.:....:.0..:,0 COM -Recipient Committee (other than PTY or seC) OTH -Other (e.g .• business entity) PTY -Political Party 2 . Amount received th is period -unitemized nonmonetary contributions of less than $100 .................................... $ ___ . __ -"-s ~o ,-,. 0=0 3. Total nonmonetary contributions rece ived this period. SCC -Small Contributor Committee (Add Li nes 1 and 2 . Enter here and on the Summary Page, Column A , Lines 4 and 10.) ...................... TOTAL $ ______ 5_0_.0"-0 FPPC Form 460 IJanl2D16) FPPC Advice : advice@fppc .ca .gov (866/275-3772) SCHEDULE E Schedule E Payments Made Amounts may be rounded to whole dollars, Statement covers period from 09/25/2016 CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE through _...;;1....;;2..:../..;;,3,;;.,1""/2_0_1_6'--__ Page ~ of ~ NAME OF FILER _________________________________________________________________ L-________________________ +_-I.~D-. -NU-M~BE~R----------~ San Rafael Pol~ce Associacion Po11tical Action Committee 8nSS) CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. OIJP campaign paraphernalia/misc. M3R member communications RAD radio airtime and production costs eNS campaign consultants MTG meetings and appearances RFD returned cOrltributions ClB contnbution (explain nonmonetary)" OFC office expenses SAL campaign workers' salaries cve civic donations PET petition circulating Ta t.v. or cable airtime and production costs FlL candidate tiling/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FI'D fund raising events POL polling and survey research TRS staff/spouse travel, lodging, and meals lID independent eJCpenditure 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 (intemet, e-mail) NAME ANO ADDRESS OF PAYEE (IF COlll'>llnEE.ALSOENTER 1.0 NUMBERI CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Donot" Stack, LLC WE~ 24.90 5940 College Avenue, Su i te F Oakland, CA 94618 Donot" Stack, LLC WEB 51. )] 5 940 College Avenue, Suite F Oakland, CA 94618 Donor Stack, LLC WEB 50.9B 5940 College Avenue, Suite F Oakland, CA 94618 * Payments that are contributions or Independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 127,21 Schedule E Summary 1. Itemized payments made this period, (Include all Schedule E subtotals,) .. .,,, .... _,_,,.' ... ,,., .. __ ..... " .. _"."" .. "" .. " .... , .. "." ....... " ..... ,, .......................... $ ___ -=..1:...:, 1:..:.3-=..2:.,:.3:..::.8 2. Unitemized payments made this period of under $1 00 ...................................................... _ ................ , ,., ..... " .... "_, ........... _" ...... " ... _,,, ......... _ ....... $ __________ ---'o=-:.:....::o'-=-o 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ...... " ...................... " ...... __ .................. _,_ .... _, .... _".,,' $ _____ "--0 _:....::0:..:.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 $ ______ --=1..!,.,.=.13::.:2=-.:.:3:..::.B FPPC Form 460 (Jan/2016) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) , _ ~ _.c: _ ._ ~ _ _ _ __ Schedule E (Continuation Sheet) Payments Made SEe INSTRUCTIONS ON....:.R.:..::E:...:V-=E"'R:.::S-=E ______ _ NAME OF FILER San Rafael Police Association Political Action Commitcee Amounts may be rounded to whole dollars. Statement covers period from 09/25/2016 through 12/31/2016 SCHEDULE E (CONT.) CALIFORNIA 460 FORM 1.0 NUMBER 831553 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. 0vP CNS CTB evc FIL FI\O m LEG UT campaign paraphernalia/misc. campaign consultants contribution (explain nonmonetary)" civic donations candidate filing/ballot fees fundraising events independent expenditure supporting/opposing others (explain)" legal defense campaign literature and mailings NAME AND ADDRESS OF PAYEE (IF CCMMITrEE. AlSO ENTER '-0, NUMBER) Donor Stack, LLC 5940 College Avenue, Suice F Oakland, CA 94618 The Henry Levy Group 5940 College Avenue Oakland, CA 94618 M3R MTG OFC PET PHD POL POS Ff!O PfIT 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 WEB PRO • Payments that are contributions or Independent expenditures must also be summarized on Schedule D. RAD RFD SAL TEl... me TRS TSF VOT IlVEB radio airtime and production costs returned contributions campaign workers' salaries Lv. or cable airtime and produdion 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 51.62 953.55 SUBTOTAL $ 1,005.17 FPPC Form 460 (Jan/2016) t:Dcr Tnll_t:.aa L.lal .... ll~a· DI::I:J/\ C:Ll' _t:'CDr laCC::J?7J:._ "177..,\ Schedule I Miscellaneous Increases to Cash Amounts may be rounded to whole dollars. Statement covers period from 09/25/2016 SC HEDULE I CALIFORNIA 460 FORM through 1 2/31/2016 Page ~ of 112 SEEINSTRuCnONSONREVER~S~E~ ____________________________________________________________ ~ ______________________ ~ __________________ ~ NAME OF FILER San Raf a el Police Association Political Action Committee DATE RECE IVED FULL NAME AND ADDRESS OF SOURCE (If COMMllTEE. ALSO ENTER 1.0 NUMBER) Attach additional information on appropriately labeled continuation sheets . Schedule I Summary DESCRIPTION OF RECEIPT SUBTOTAL $ 1. Itemized increases to cash this period .............................................................................................................. , .... n •• $ __________ o::..;.:..:o,-=-o 2. Un itemized increases to cash of under $100 this period , ............................................................................................ $ _________ ::..2:.;:' 1;.=.0 3, Total of all interest received this period on loans made to others . (Schedule H, Column (e).) ................................ $ ____ ---=-0:.;:.0:.::0 4. Total misce ll aneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Line 14.) ....................................... , ................ , .............................................................. TOTAL $ ____ ......;:,2,;..;.1:..;.0 1.0 . NUMBER 831553 AMOUNT OF INCREASE TO CASH FPPC Form 460 (Jan/20161 FPPC Advice: advice@fppc.ca .gov (866/275-3772) - - -I 1 .•• ___ • ~ ___ _