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Home My WebLink AboutForm 460 - Maribeth Bushey for City Council 2017 (2017-12-31)Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from July 1, 2017 through December 31, 2017 1. Type of Recipient Committee: All Committees -Complete Parts 1, 2, 3, and 4. III Officeholder, Candidate Controlled Committee o Primarily Formed Ballot Measure Committee o State Candidate Election Committee o Recall (Also Complete ParlS) o General Purpose Committee o Sponsored o Small Contributor Committee o Political Party!Central Committee 3. Committee Information o Controlled o Sponsored (Also Complet. Parl6) o Primarily Formed Candidate! Officeholder Committee (Also Complete Parl7) IF NO Maribeth Bushey for San Rafael City Council 2107 STREET ADDRESS (NO P.O. BOX) cm San Rafael STATE ZIP CODE CA 94901 MAILING ADDRESS (IF DIFFERENT) NO. AND ST RE ET OR P.O . BOX CITY STATE Z IP CODE OPTIONAL: FAX I E.MAILADDRESS 4. Verification AREA CODEJPHONE AREA CODEJPHONE Date of election if (Month, Day, 2. Type of Statement: o Preelection Statement o Semi-annual Statement bZI Termination Statement (Also file a Form 410 Termination) o Amendment (Explain below) Treasurer(s) NAME OF TREASURE R Mark Kyle MAILING ADDRESS CITY San Rafael NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY OPTlONAL: FAX ' E-MAIL ADDRESS o Quarterly Statement o Special Odd-Year Report STATE ZIP CODE CA 94901 STATE ZIP CODE AREACODEIPHONE AREA CODEJPHONE I have used all reasonable diligence in preparing and reviewing this statement and to the best certify under penalty of perjllry under the laws of the State of California that the foregoing is t ined herein and in the attached schedules is true and complete. I Executed on -'. I. Executed on -I ' ~_. ' - Executed on Date Executed on Date By l -Y -"';to .. X f Ar ... _ By , -).. . _ f{, ~ •. -- , ,If=-. By----------~~~lg~na=ru~re~o~f c~o=n~~u~ng~o"ffi~I~~oo~~e~~~c~an~d~~~at~e,~S~ta~te~M~e~as~ur=e~P=ro~po=M~n~t----------- By Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page -Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Maribeth Bushey OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) San Rafael City Council RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY ST ATE ZIP San Rafael CA 94901 Related Committees Not Included in this Statement: List any committees not Included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behaff of your candidacy. COMMITTI:E NAME 1.0. NUMBER NAME OF TREASURER CONTRO LLED CO MMITTEE? DYES o NO COMMITIEE ADDRESS STREET ADDRESS (NO P.O . BOX) CI TY STATE ZIP CODE AREA CODEIPHONE COMMITTEE NAME 1.0. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? DYES o NO CO MMITTE E ADDRESS STREET ADDRE SS (NO P.O . BOX) CITY STATE ZIP CODE AREA CODEIPHONE COVER PAGE -PART 2 2£ sa 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISOlcnON o SUPPORT o OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, If any. NAME OF OFFICEHOLDER, CANDIDATE , OR PROPONENT OFFICE SOUGHT OR HELD 1 DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee Llstnamesof officeholder(s) or candldate(s) for which this committee Is primarily formed. 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 CANDIDATE OFFICE 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 Form 460 (Jan/2016) FPPC Advice: advlce@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Maribeth Bushey Contributions Received 1. Monetary Contributions ........................... ,....................... Schedule A, Une 3 2. Loans Received ...... ,......................................................... Schedule B, Une 3 $ 3. SUBTOTAL CASH CONTRIBUTIONS .............. , ............... Add Lines 1 + 2 $ 4. Nonmonetary Contributions............................................ Schedule C, Une 3 5. TOTAL CONTRIBUTIONS RECEIVED .................................... Add Lines 3 + 4 $ Expenditures Made 6. Payments Made ................................................................ Schedule E, Line 4 $ 7. Loans Made....................................................................... Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS .......................................... Add Lines 6 + 7 $ 9. Accrued Expenses (Unpaid Bills) Schedule F. Line 3 10. Nonmonetary Adjustment.. ....................................................... Schedule C, Line 3 11. TOTAL EXPENDITURES MADE ........................................ Add Lines 8 + 9 + 10 Current Cash Statement 12. Beginning Cash Balance 13. Cash Receipts Previous Summary Page, Line 16 Column A, Une 3 above 14. Miscellaneous Increases to Cash .......................... . Schedule I, Line 4 15. Cash Payments ......................................................... ColumnA, Une 8 above 16 . ENDING CASH BALANCE .................. Add Linfls 12 + 13 + 14, thfln 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 raverse $ 19. Outstanding Debts .............................. Add Une 2 + Line 9 in Column B abova $ Amounts may be rounded to whole dollars. ColumnA TOTAL TH IS PERIOD (FROM ATIACHED SCHEDULES) 4,012.50 4,012.50 4.019 .96 4.019.96 7.46 0.0 SUMMARY PAGE Statement covers period CALIFORNIA 460 FORM from July 1, 2017 December 31 , 2017 I Page of __ _ through _______ _ $ $ $ $ $ $ ColumnS CALENDAR Y EAR TOTAL TO D ATE 4,012.50 4,012.50 4 ,019.96 350 4,019.96 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). 1.0 . NUMBER 1358370 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6130 711 to Date 20. Contributions Received $ _____ _ $---- 21. Expenditures Made $ _____ _ $---- Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subject to Voluntary expenditure Umlt) Date of Election (mm/ddlyy) --.-1--..1. __ --.-1--1 __ Total to Date $---- $---- '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 Monetary Contributions Received SEE INSTRUCTIONS ON REVERSE NAME OF FI LER Maribeth Bushey Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR I CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.D . NUMBER) CODE * IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Robert and Nola Barnett 7.17.17 San Rafael, CA Ghilotti Brothers 7 .20.17 San Rafael CA 94901 Scott Jones 7.27.17 San Rafael CA 94901 Jack Krystal 7.26.17 San Rafael CA 94901 7.3.17 Andrew McCullough San Rafael CA 94901 Schedule A Summary 01ND OeoM DOTH DpTY Oscc DIND DCOM 1ll0TH OPTY Oscc I2lIND o COM DOTH OPTY Oscc ~IND DCOM DOTH OPTY oscc ~IND DCOM DOTH DpTY Dscc retired General Steamship Agencies Diversified Capital Investments Syufy, Inc SUBTOTAL $ SCHEDULE A Statement covers period CALIFORNIA 460 FORM from July 1, 2017 through December 31, 2017 Page of __ _ AMOUNT RECEIVED THIS PERIOD 1,000 100 1,000 250 239 .70 2,589.70 I I.D.NUMBER 1358370 CUMULATIVE TO DATE CAlENDAR YEAR (JAN . 1 -DEC. 31) 1,000 100 1,000 250 239.70 PER ELECTION TO DATE (IF REQUIRED) ·Contributor Codes IND -Individual 1. Amount received this period -itemized monetary contributions . (Include all Schedule A subtotals.) ......................................................................................................... $ 4,012.50 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 ........................... $ 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 $ 4.012 .50 SCC -Small Contributor Committee FPPC Form 460 (Jan/20I6) FPPC Advice: advlce@fppc.ca .gov (866/275-3772) www.fppc.ca.gov Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER Maribeth Bushey Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR I CONTRIBUTOR (I F COMMITTEE. ALSO ENTER 1.0 . NUMBER) CODE * IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED. ENTER NAME OF BUSINESS) 8.21.17 8.31,17 8.29.17 7.18.17 8 .28.17 Jack Nixon San Rafael CA 94901 Stephanie Plante San Rafael, CA 94901 Gary Ragghianti San Rafael, CA 94901 Rosalie Weigle San Rafael CA 94901 Gary Phillips San Rafael , CA 94901 ·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 !;llIND DCOM DOTH OPTY OSCC IlIIND DCOM DOTH OPTY OSCC IlIIND OCOM DOTH OPTY OSCC I;tIIND DCOM DOTH OPTY OSCC ~IND OCOM DOTH DpTY OSCC retired CEO CPI Developers Attorney Ragghianti & Freitas Realtor Golden Gate Sotheby's International Realty Mayor City of San Rafael SUBTOTAL $ SCHEDULE A (CONT.) Statement covers period CALIFORNIA 460 FORM from July 1, 2017 through December 31, 2017 I Page of __ _ AMOUNT RECEIVED THIS PERIOD 95 .70 250 300 250 239 .70 I.D. NUMBER 1358370 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 . DEC. 3 1) 95.70 250 300 250 239.70 PER ELECTION TO DATE (IF REQUIRED) 1,135.40 [_ FPPC Form 460 (Jan/20I6) FPPC Advice: advlce@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER Maribeth Bushey Amounts may be rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR I CONTRIBUTOR (IF COMMITTEE, ALSO ENTER 1.0 , NUMBER) CODE * IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) 7.10.17 9.5.17 Don Magdanz San Rafael, CA 94901 Barbara Heller San Rafael, CA 94901 ~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 ~IND o COM DOTH DpTY Dscc i21IND o COM DOTH DpTY DSCC DIND o COM DOTH DPTY Dscc DIND DCOM DOTH DpTY DsCC DIND o COM DOTH DpTY Dscc retired retired SUBTOTAL $ SCHEDULE A (CONT.) Statement covers period CALIFORNIA 460 FORM from July 1, 2017 through December 31,2017 I Page of __ _ AMOUNT RECEIVED THIS PERIOD 47.70 239.70 1.0. NUMBER 1358370 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) 47.70 239.70 PER ELECTION TO DATE (IF REQUIRED) 287.40 I FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTI ONS ON REVERSE NAME OF FILER Maribeth Bushey Amounts may be rounded to whole dollars. Statement covers period from July 1, 2017 SCHEDULE E CALIFORNIA 460 FORM through December 31, 200 I Page ___ of __ _ 1.0 . NUMBER 1358370 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP CNS eTB eve FIL FND IND LEG LIT campaign paraphernalia/misc . campaign consultants contribution (explain nonmonetary)' civic donations candidate filing/ballot fees fund raising events independent expenditure supporting/opposing others (explain)' legal defense campaign literature and mailings NAME AND ADDRESS OF PAYEE (I F COMMITIEE, AlSO ENTER 1.0 . NUMBER) PMCohen Public Affairs 23 Chestnut Ave, San Rafael, CA 94901 four waters media, inc. 3093 Lassen Street West Sacramento, CA 95691 Dedita Design Peter Rieks 25 Tredegar Road, Reading, RG4 8QE, UK MBR MTG OFC PET PHO POL POS PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research RAD radio airtime and production costs RFD returned contributions SAL campaign workers' salaries TEL t.v. or cable airtime and production costs TRC candidate travel, lodging, and meals TRS staff/spouse travel, lodging, and meals postage, delivery and messenger services profeSSional services (legal, accounting) print ads TSF transfer between committees of the same candidate/sponsor VOT voter registration WEB information technology costs (internet, e-mail) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Campaign Consulting services CNS $1,500 Campaign media consulting services CNS $2,000 WEB Web design and development 169.96 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 3 ,669.96 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) $ 4,019.96 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 $ 4,019.96 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULEE Schedule E Payments Made Amounts may be rounded to whole dollars. Statement covers period from July 1, 2017 CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE through December 31, 20g I Page ___ of __ _ NAME OF FILER I.D.NUMBER Maribeth Bushey 1358370 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 eNS 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 filinglballot 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 COMMmEE.AlSO ENTER I,D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID PMCohen Public Affairs Campaign Consulting services 23 Chestnut Ave, San Rafael, CA CNS $1,500 94901 four waters media, inc. Campaign media consulting services 3093 Lassen Street West Sacramento, CA 95691 CNS $2,000 Dedita Design Web design and development Peter Rieks WEB 169.96 25 Tredegar Road, Reading, RG4 8QE, UK * Payments that are contributions or independent expenditures must also be summarized on SchedUle D. SUBTOTAL $ 3,669.96 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 $ 3,669.96 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E (Continuation Sheet) Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Maribeth Bushey Amounts may be rounded to whole dollars. Statement covers period from July 1, 2017 through December 31, 20j SCHEDULE E (CONT.) CALIFORNIA 460 FORM Page ___ of __ _ I.D. NUMBER 1358370 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP CNS CTB CVC FIL FND IND LEG LIT campaign paraphernalia/misc. campaign consultants contribution (explain nonmonetary)* civic donations candidate filing/ballot fees fund raising events independent expenditure supporting/opposing others (explain)' legal defense campaign literature and mailings NAME AND ADDRESS OF PAYEE (IF COMMITIEE, ALSO ENTER I.D. NUMBER) MBR member communications MTG meetings and appearances OFC office expenses PET petition circulating PHO phone banks POL polling and survey research POS postage, delivery and messenger services PRO professional services (legal, accounting) PRT print ads CODE OR RAD radio airtime and production costs RFD returned contributions SAL campaign workers' salaries TEL t.v. or cable airtime and production costs TRC candidate travel, lodging, and meals TRS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor VOT voter registration WEB information technology costs (internet, e-mail} DESCRIPTION OF PAYMENT AMOUNT PAID Maribeth Bushey repay loan for photographer and FPPC fee San Rafael * Payments that are contributions or independent expenditures must also be summarized on Schedule D. 350 SUBTOTAL $ FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov