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Home My WebLink AboutForm 460 - Paramedic Services PAC (2018-06-30)Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from 1/1/2018 through 6/30/2018 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. ❑ Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure O State Candidate Election Committee Committee 0 Recall ® Controlled (Also Complete Part 5) 0 Sponsored (Aso Complete Part 6) ® General Purpose Committee O Sponsored ❑ Primarily Formed Candidate/ ® Small Contributor Committee Officeholder Committee O Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1075199 4. Committee for San Rafael Paramedic Services STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODEIPHONE San Rafael CA 94903 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL: FAX/ E-MAILADDRESS I have used all reasonable diligence in preparing and reviewing this statement and to the best of my certify under penalty of perjury under the laws of the State of California that the foregoing is true and Executed on 7/31/2018 / Data / Executed on 1 31 (ZG 1 Dat Executed on Date Executed on Date By By By D Date of election if applicable: (Month, Day, Year) JUL 3 1 201 CITY CLERK'S 0 FICE 2. Type of Statement: ❑ Preelection Statement Semi-annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Greg Knell COVER PAGE of 4 Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/ E-MAILADDRESS the and in the attached schedules is true and complete. I or By Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPpf Advira- advirpOfnnr ra vnv (AAA/27;47721 Campaign Disclosure Statement Amounts may be rounded Summary Page to whole dollars. Statement covers period from 1/1/2018 SUMMARY PAGE Expenditures Made through 6/30/2018 Page 2 of 4 SEE INSTRUCTIONS ON REVERSE 328.15 7. Loans Made....................................................................... Schedule H, Line 3 d. NAME OF FILER Add Lines 6+7 $ $ 0 I.D. NUMBER schedule F, Line 3 0 10. Nonmonetary Adjustment......................................................... 1075199 Contributions Received To olumnEAD ColuDmn B YEAR Calendar Year Summary for Candidates 328.15 $ (FROM ATTACHED SCHEDULES) TOTAL TO DATE Running in Both the State Primary and General Elections 0 1. Monetary Contributions................................................... Schedule A, Line 3 $ o $ 4 0 1/1 through 6/30 7/1 to Date 2. Loans Received................................................................ Schedule e, line 3 0 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add lines 1 + 2 $ G $ Received $ $ 0 4. Nonmonetary Contributions ............................................ Schedule C, Line 3 m 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED....................................Add Lines 3 + 4 $ 0 $ 0 Made $ $ Expenditures Made 6. Payments Made................................................................ Schedule E, Line 4 $ 328.15 $ 328.15 7. Loans Made....................................................................... Schedule H, Line 3 d. 8. SUBTOTAL CASH PAYMENTS .......................................... Add Lines 6+7 $ $ 0 9. Accrued Expenses (Unpaid Bills) .......................................... schedule F, Line 3 0 10. Nonmonetary Adjustment......................................................... Schedule C, Line 3 0 6 11. TOTAL EXPENDITURES MADE ........................................ Add Lines e + s + 10 $ 328.15 $ 328.15 Current Cash Statement 12. Beginning Cash Balance ............................ Previous summary Page, Line 16 $ 13. Cash Receipts........................................................... Column A, Line 3 above 14. Miscellaneous Increases to Cash .................................. Schedule I, Line 4 15. Cash Payments......................................................... Column A, Line 8 above 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ If this is a termination statement, Line 16 must be zero. 5153.17 .21 0 4825.12 17. LOAN GUARANTEES RECEIVED ................................ Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $6l 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ V To calculate Column B, add amounts in Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made" (if Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) I J $ `Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A Amounts may be rounded SCHEDULE A Monetary Contributions Received io wnoie aouars. Statement covers period • 1/1/2018 • 1 from • 6/30/2018 3 4 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER 1075199 DATE FULL NAME, STREETADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IFCOMMITTEE,ALSOENTERI.D.NUMBER) CODE OCCUPATIONAND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL $ Schedule A Summary 1. Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.).........................................................................................................$ 2. Amount received this period — unitemized monetary contributions of less than $100 ...........................$ 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.)......................TOTAL $ 9 $ Q `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 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www fnnr — —, Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE Amounts may be rounded to whole dollars. Statement covers peri from 1/1/2018 through 6/30/2018 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. SCHEDULE E Page of 4 .D. NUMBER 1075199 CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Secretary of State Breakpoint Greenbrae, CA Political Committee Annual Fee Remitance envelopes for donations 61111I11 $27815 ` Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ Schedule E Summary I 1. Itemized payments made this period. (Include all Schedule E subtotals.) 328.15 2. Unitemized payments made this period of under $100.................................................................................................. $ 0 3. Total interest paid this period on loans. Enter amount from Schedule B Part 1 Column e 0 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ........................... TOTAL $ 328.15 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov