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Home My WebLink AboutForm 460- Rachel Kertz for City Council 2020 (2022-06-30)Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Statement covers period from 12022 through (.13DtW1z 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. ❑x Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also Complete Ped 5) 0 Sponsored (Also complete Fart 5) ❑ General Purpose Committee 0 Sponsored ❑ Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee ('moo C-plefe Pad 7) 3. Committee Information I.D. NUMBER 1427074 4. COMMITTEE NAME (OR CANDIDATE'S NAME IF NO Rachel Kertz for City Council 2020 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Antelope CA 95843 ( MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS ( COVER PAGE Date of election if applk AUG - 1 202TFIC (Month, Day, Year) e 1 of For Official Use Only 11/°3/2020 C TY CLERK'S 0 2. Type of Statement: ❑ Preelection Statement ❑ Quarterly Statement ❑X Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement ❑ Supplemental Preelection (Also file a Form 410 Termination) Statement - Attach Form 495 ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Chelsea Johnson MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE Antelope CA 95843 ( NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and 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 sasurePopomntorResparmoaofkarolSponsor Executed on Dabs Executed on Data By Signalise of Conholling Officeholder, Candidate, State Measure Proponent By Signature ofcontrolling officehdder,Candidaie,State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Rachel Kertz OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City Council Member City of San Rafael District 4 RESIDENTIAVBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP San Rafael CA 94903 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 behalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEENAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE www.netfile.com COVER PAGE - PART 2 Page 2 of e 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any - NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑.SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE Attach continuation sheets if necessary FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement SUMMARYPAGE Amounts may be rounded Statement covers period CALIFORNIA Summary Page to whole dollars. from 01/01/2022 FORM SEE INSTRUCTIONS ON REVERSE through 06/30/2022 Page 3 of 8 NAME OF FILER I.D. NUMBER Rachel Kertz for City Council 2020 1427074 Expenditures Made Column A 6. Payments Made ................... Column B Calendar Year Summary for Candidates Contributions Received 13. Cash Receipts ........................... ........... Column A, Line 3 above 7. Loans Made............................................................. TOTALTHISPERIOD amounts in Column A to the CALENDARYEAR Running in Both the State Primary and 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ (FROM ATTACHED SCHEDULES) 9. Accrued Expenses (Unpaid Bills) TOTALTO DATE 15. Cash Payments .................................................. Column A, Line 8above 35.00 362.24 10. Nonmonetary Adjustment .......................................... schedule C, Line 0.00 General Elections 1. Monetary Contributions ........................................... schedule A, Line 3 $ 0.00 $ 0.00 period amounts. If this is the first report being filed 1/1 through 6130 7/1 to Date .. 2. Loans Received ............................................:. schedule e, Line 3 for this calendar year, only carry over the amounts arny) Lines 2, 7, and 9 (if 0.00 16, 000.00 3. SUBTOTAL CASH CONTRIBUTIONS .........::.......::...,. Addlines1+2 $ 0.00 $ 16,000.00 20. ContributionsReceived $ $ $ 16,256.75 4. Nonmonetary Contributions .................................... schedule C, Line 3 0.00 0.00 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ....................... ,.••• Add Lines 3+4 $ 0.00 $ 16,000.00 Made $ $. Expenditures Made 6. Payments Made ................... ........ ............ Schedule e, Line 4 $ 362.24 13. Cash Receipts ........................... ........... Column A, Line 3 above 7. Loans Made............................................................. schedule H, Line 3 amounts in Column A to the 0.00 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ 362.24 9. Accrued Expenses (Unpaid Bills) ............................... schedule F Line 3 15. Cash Payments .................................................. Column A, Line 8above 35.00 362.24 10. Nonmonetary Adjustment .......................................... schedule C, Line 0.00 figures that should be 11. TOTAL EXPENDITURES MADE ................................Add Lines 6 +9 + 10 $ 397.24 If this is a termination statement, Line 16 must be zero. $ 362.24 0.00 $ 362.24 256.75 0.00 $ 618.99 Current Cash Statement 12. Beginning Cash Balance ....................... Previous summary Page, Line 16 $ 1,160.27 To calculate Column B, add 13. Cash Receipts ........................... ........... Column A, Line 3 above 0.00 amounts in Column A to the corresponding amounts 14. Miscellaneous Increases to Cash ........................... schedule 1, Line 4 0.00 from Column B of your last 15. Cash Payments .................................................. Column A, Line 8above 362.24 report. Some amounts in Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 798.03 figures that should be subtracted from previous If this is a termination statement, Line 16 must be zero. period amounts. If this is the first report being filed 17. LOAN GUARANTEES RECEIVED ......................"". Schedule e, Part 2 $ 0.00 for this calendar year, only carry over the amounts arny) Lines 2, 7, and 9 (if Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ see instructions on reverse $ 0.00 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column B above $ 16,256.75 www.netfile.com 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 1 $ "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 SCHEDULEB-PART1 Schedule B — Part 1 Amounts may be rounded Statement covers period _ Loans Received to whole dollars. 01/01/2022 . - , • from through 06/30/2022 Page 4 of 8 SEE INSTRUCTIONS ON REVERSE NAME OF FILER ID.NUMBER Rachel Kertz for City Council 2020 1427074 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER a) OUTSTANDING �) AMOUNT (°) AMOUNT PAID Id) OUTSTANDING (e) INTEREST ) ORIGINAL l9 CUMULATIVE OF LENDER OCCUPATION AND EMPLOYER (IFSELF-EMPLOYED, ENTER BALANCE BEGINNING THIS RECEIVED THIS OR FORGIVEN BALANCE AT CLOSE OF THIS PAID THIS AMOUNT OF CONTRIBUTIONS (IF COMMITTEE, ALSO ENTER I -D. NUMBER) NAMEOFBUSINESS) ( PERIOD THIS PERIOD" PERIOD PERIOD LOAN TO DATE Rachel Kertz Candidate ❑ PAID CALENDARYEAR Candidate San Rafael, CA 94903 $ n on $ 6,nnn_nn o.on/ $ 6.000.00 $ 0.00 ❑ FORGIVEN PERELECTION"t RATE $ 6.000.00 $ 0.00 $ o.no 06/18/2021 $ 0.00 12/18/2020 $ DATE DUE DATE INCURRED t X❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC Rachel Kertz Candidate ❑ PAID CALENDARYEAR Candidate San Rafael, CA 94903 $ n_nn $ in, non nn n nn/ $ 10 .()00.0 $ 0 o ❑ FORGIVEN PER ELECTION *" RATE $ 10.000.00 $ 0.00 $ n nn 07/22/2021 $ n_nn 01/22/2021 $ DATE DUE t X❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE INCURRED ❑ PAID CALENDARYEAR ❑ FORGIVEN RATE PER ELECTION`~` t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED SUBTOTALS $ 0.00$ 0.00$ 16, 000.00$ 0.00 Schedule B Summary 1. Loans received this period .................................................... ...................... ....................... :.............. ::... $ (Total Column (b) plus unitemized loans of less than $100.) 0.00 2. Loans paid or forgiven this period$ 0.00 ..................................... (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 3. Net change this period. (Subtract Line 2 from Line 1.) ............... Enter the net here and on the Summary Page, Column A, Line 2. "Amounts forgiven or paid by another party also must be reported on Schedule A. *' If required. www.neifile.com ...................... NET $ 0.00 (May be a negative number) (Enter (B) on Schedule E, Line 3) tContributor 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 E Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Amounts may be rounded to whole dollars. Statement covers period from 01/01/2022 through 06/30/2022 I Page 5 of 8 I.D. NUMBER Rachel Kertz for City Council 2020 1 1427074 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) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 242.24 Schedule E Summary 1. Itemized payments made this period. Include all Schedule E subtotals. ............ $ 312.24 2. Unitemized payments made this period of under $100..........................................................................................................,............................ $ 50.00 3. Total interest paid this period on loans. Enter amount from Schedule B, Part 1, Column (e).) ........... $ 0.00 4. Total payments made this period. Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6. .........., TOTAL $ 362.24 FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov www.netfile.com NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I D NUMBER) CODE OR DESCRIPTION OF PAYMENT PRO AMOUNT PAID 35.00 CJ & Associates, Inc. Antelope, CA 95843 PRO 172.24 CJ & Assoc-iAtes, Inc. Antelope, CA 95843 CJ & Associates, Inc. PRO 35.00 Antelope, CA 95843 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 242.24 Schedule E Summary 1. Itemized payments made this period. Include all Schedule E subtotals. ............ $ 312.24 2. Unitemized payments made this period of under $100..........................................................................................................,............................ $ 50.00 3. Total interest paid this period on loans. Enter amount from Schedule B, Part 1, Column (e).) ........... $ 0.00 4. Total payments made this period. Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6. .........., TOTAL $ 362.24 FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov www.netfile.com Schedule E (Continuation Sheet) Amounts may be rounded Payments Made to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER Rachel Kertz for City Council 2020 Statement covers period from 01/01/2022 through 06/30/2022 SCHEDULE E Page 6 of 8 I.D. NUMBER 1427074 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 FIND 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) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 70.00 FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.netfile.com www.fppc.ca.gov Schedule F Accrued Expenses (Unpaid Bills) SEE INSTRUCTIONS ON REVERSE NAME OF FILER Rachel Kertz for City Council 2020 Amounts may be rounded to whole dollars. Statement covers period from 01/01/2022 through 05/30/2022 SCHEDULEF Page 7 of a I.D. NUMBER 1427074 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 camoaign 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. SUBTOTALS $ 78.00$ 70.00$ 35.00$ 113.00 Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) ........................ .......... INCURRED TOTALS $ 70.00 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) ................................. PAID TOTALS $ 35.00 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.)...................................................................................................................................... NET $ 35.00 May be a negative number FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.netfile.com www.fppc.ca.gov (TAA ( (c) (d) NAME AND ADDRESS OF CREDITOR CODE OR OUTSNDING AMOUNTIN CURRED AMOUNT PAID OUTSTANDING (IF COMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD CJ & Associates, Inc. PRO 35.00 0.00 35.00 0.00 Antelope, CA 95843 CJ & Associates, Inc. PRO 0.00 70.00 0.00 70.00 Antelope, CA 95843 Loren Kertz OFC 43.00 0.00 0.00 43.00 San Rafael, CA 94903 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTALS $ 78.00$ 70.00$ 35.00$ 113.00 Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) ........................ .......... INCURRED TOTALS $ 70.00 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) ................................. PAID TOTALS $ 35.00 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.)...................................................................................................................................... NET $ 35.00 May be a negative number FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.netfile.com www.fppc.ca.gov Schedule F (Continuation Sheet) Accrued Expenses (Unpaid Bills) NAME OF FILER Rachel Kertz for City Council 2020 Amounts may be rounded to whole dollars. Statement covers period from 01/01/2022 through 06/30/2022 SCHEDULE F (CONT.) Page 8 of 8 I.D. NUMBER 1427074 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 FIND 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) * Payments that are contributions or independent expenditures must also be summarized on Schedule D. NAME AND ADDRESS OF CREDITOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT (a) OUTSTANDING BALANCE BEGINNING OF THIS PERIOD (b) AMOUNTINCURRED THIS PERIOD (c) AMOUNTPAID THIS PERIOD (ALSO REPORT ON E) (d) OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD Loren Kertz San Rafael, CA 94903 WEB 143.75 0.00 0.00 143.75 SUBTOTALS $ 143.75$ 0.00$ 0.00 $ 143.75 FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov www.netfile.com