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Home My WebLink AboutForm 460 - Paramedic Services PAC (2018-12-31)Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers periodI Date of election If from July 1, 2018 (Month, Day, through Dec. 31, 2018 Dale Stamp [E0[E9 JAN 3 1 of 4 1. Type of Recipient Committee: All committees - complete Parts 1, 2, 3, and 4. 2. Type of State nt: r Officeholder, Candidate Controlled Committee ® Primarily Formed Ballot Measure ❑ Preelection S eCjt C LER t ��V1t�EFICEnt O Stale Candidate Election Committee Committee ® Semi-ennt LJ Spaciel Odd -Year Report O Recall ® Controlled ❑ Termination Statement (Aire cvrpkm Pods) O Sponsored (Also file a Forts 410 Termination) F-1General Purpose Committee Watt Coeyokta Part t) ❑ Amendment (Explain below) O Sponsored ❑ Primarily Formed Candidate/ O Small Contributor Committee Officeholder Committee O Political Party/Central Committee fano Ccrtrrla:o Pad> 3. Committee Information 1.D. 1 1( COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) 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-MAIL ADDRESS Treasurer(s) NAME OF TREASURER Greg Knell MAILING ADDRESS CITY STATE ZIP CODE AREACODE/PHONE San Rafael CA 94903 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE LP CODE AREA CODEIPHONE OPTIONAL FAX/E-MAILADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my kn edge the In a on ne roln d In the attached schedules Is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and • ct. Executed on January 31, 2019 By y — ro tent a Executed on Date By Sigrteturaq antrglmg Officeno d .. S Meesuto Proporronl a Responsible Officer q Sponsor Executed on Date By gnature of cinitowng Officeholder, Canawate, state M ousum Proponent Executed on Date By Signature of ControNirg Officeholder. Candidate, slate doasure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275.3772) www.fppc.ca,gov Campaign Disclosure Statement Amounts may be rounded to whole dollars. Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER SUMMARY Statement covens period CALIFORNIA from July 1, 2018 FORM 4A through Dec. 31, 2018 Page 2 of 4 Expenditures Made To calculate Column B, column A column B Contributions Received 0 $ 0 TTTACHIS PERIOD CALENDAR YEAR 0 0 8. SUBTOTAL CASH PAYMENTS .......................................... (FROM ATTACHED SCHEDULES) TOTAL TO DATE 9. Accrued Expenses (Unpaid Bills) ............. ........................... schedule F Line 3 0 0 1. Monetary Contributions................................................... Schedule A, Line 3 S S Add Lines 0+9+10 $ 0 $ 0 0 0 2. Loans Received ............................................. ................... Schedule B. Line 3 0 0 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 +2 S S 0 0 4. Nonmonetary Contributions ......................... ................... Schedule C, Line 3 0 0 5. TOTAL CONTRIBUTIONS RECEIVED ................................... Add Lines 3+4 $ S Expenditures Made To calculate Column B, 6. Payments Made .............................................. _......... _..... schedule E Line 4 S 0 $ 0 7. Loans Made....................................................................... Schedule w, Line 3 0 0 8. SUBTOTAL CASH PAYMENTS .......................................... Add Lines 6+7 $ 0 S 0 9. Accrued Expenses (Unpaid Bills) ............. ........................... schedule F Line 3 0 0 10. Nonmonetary Adjustment........................................................ schedule c, Line 3 0 0 11. TOTAL EXPENDITURES MADE ........................................ Add Lines 0+9+10 $ 0 $ 0 Current Cash Statement 12. Beginning Cash Balance ........................... Previous Summary Page, Line 16 S 13. Cash Receipts........................................................... Column A, Line 3 above 14. Miscellaneous Increases to Cash .................................. Schedule 1, Line 4 15. Cash Payments......................................................... Column A, Line 6 above 16. ENDING CASH BALANCE ....... _......... Add Lines 12 + 13 + 14, then subtract tine 15 $ ff this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule B. Pert 2 S Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ Seo instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2+ Line 9 in Column B above $ 4825.12 To calculate Column B, 21 add amounts in Column Ato the corresponding amounts from Column B of your last report. Some amounts in Column A may 4825.33 be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Unes 2, 7, and 9 Cif 0 any). V 11075199 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6/30 711 10 Date 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (N 9ublact to Votuntxry Expenditure UmN) Dale of Election Total to Date (mmlddiyy) -J-J $ —�—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 to whole dollars. Statement covers period from July 1, 2018 Dec.31,2018 4 7-1�U through of SEE INSTRUCTIONS ON REVERSENAME OF FILER DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE RECEIVED (IF COMMITTEE. ALSO ENTER I.O. NUMBER) CODE • (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 $ '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 (866/276-3772) www.fppc.ca.gov Schedule E Amounts may be rounded Statement covers period Payments Made to whole dollars. ,Jul 1, 2018 from y through Dec. 31, 2018 I page_of 4 1075199 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphemalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonelary)' 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 candidatefsponsor 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) Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.)............................................................................................................. $ 2. Unitemized payments made this period of under $100.......................................................................................................................................... $ 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column(e).)............................................................................. $ 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ........................... TOTAL $ FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov