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Home My WebLink AboutForm 460- Paramedic Services PAC (12-31); TerminateRecipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period I Date of election if applicable: from July 1, 2019 (Month, Day, Year) through December 30, 2019 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. ❑ Officeholder, Candidate Controlled Committee 0 State Candidate Election Committee 0 Recall (Also Complete Part 5) 0 General Purpose Committee 0 Sponsored ® Small Contributor Committee 0 Political Party/Central Committee 3. Committee Information ❑ Primarily Formed Ballot Measure Committee 0 Controlled 0 Sponsored (Also Complete Part 6) ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) I.D. NUMBER 1075199 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Committee for San Rafael Paramedic Services STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE San Rafael CA 94903 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/ E-MAIL ADDRESS 4. Verification 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 any Executed on 01/29/2020 Dale Executed on 01/29/2020 Date Executed on Date Executed on Date By By By COVER PAGE 1 of 4 JAN 2 9 20 1qr Official Use Only CITY CLERK'S OFRICE 2. Type of Statement: ❑ Preelection Statement 2 Semi-annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) ❑ Quarterly Statement ❑ Special Odd -Year Report 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 ZIP CODE AREA CODEIPHONE OPTIONAL: FAX/ E-MAIL ADDRESS the id herein 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) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Campaign Disclosure Statement Summary Page Amounts may be rounded to whole dollars. from Statement covers period July 1, 2019 SUMMARY PAGE Current Cash Statement 12. Beginning Cash Balance ............................ Previous summary Page, Line 16 $ 13. Cash Receipts........................................................... Column A, Line 3 above 14. Miscellaneous Increases to Cash .................................. schedule 1, Line 4 ( l 15. Cash Payments......................................................... Column A, Line 8 above n 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ lei 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). 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 through 12/31/2019 Page 2 of 4 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER 17 2 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTAL THIS PERIOD CALENDAR YEAR Running in Both the State Primary and (FROM ATTACHED SCHEDULES) TOTAL TO DATE General Elections 0 0 1. Monetary Contributions................................................... Schedule A, Line 3 $ $ 1/1 through 6/30 7/1 to Date 0 0 2. Loans Received................................................................ Schedule e, Line 3 0 0 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 +2 $ $ Received $ $ 0 0 4. Nonmonetary Contributions ............................................ schedule C, Line 3 21. Expenditures 0 0 Made $ $ 5. TOTAL CONTRIBUTIONS RECEIVED....................................Add Lines 3+4 $ $ Expenditures Made/l U Expenditure Limit Summary for State 6. Payments Made................................................................ Schedule E, Line 4 $ $ Candidates n G 7. Loans Made....................................................................... schedule H, Line 3 22. Cumulative Expenditures Made* 8. SUBTOTAL CASH PAYMENTS .......................................... Add Lines 6 + 7 $ �) $ 62 (If Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F, Line 3 �l Date of Election Total to Date 10. Nonmonetary Adjustment......................................................... schedule C, Line 3 ��. `L (mm/dd/yy) 11. TOTAL EXPENDITURES MADE ........................................ Add Lines 8 + 9 + 10 $ A $ 1. $ Current Cash Statement 12. Beginning Cash Balance ............................ Previous summary Page, Line 16 $ 13. Cash Receipts........................................................... Column A, Line 3 above 14. Miscellaneous Increases to Cash .................................. schedule 1, Line 4 ( l 15. Cash Payments......................................................... Column A, Line 8 above n 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ................................ Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ................................................ See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ lei 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). 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 wnole aollars. Statement covers period CALIFORNIAA July 1, 2019 from FORM 12/31/2019 3 4 through Page of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER 4:211 1. 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.D. 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 (866/275-3772) www.fppc.ca.gov Schedule E SCHEDULE E (CONT.) Amounts may be rounded to whole dollars. Statement covers periodFPage (Continuation Sheet) Payments Made fromduly 1, 2019 12/31/2019 4 through of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER aq �L 22 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)' OFC office expenses SAL campaign workers' salaries CVC civic donations PET petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals FND 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 CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) ......... s___ __ __..