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HomeMy WebLinkAboutForm 460- Rachel Kertz for City Council 2020; 10-27-22Recipient Committee jj Campaign Statement r atrrfp COVER PAGE ' Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Statement covers period from i Zz through to 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. ❑X Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure Q State Candidate Election Committee Committee Q Recall Q Controlled (Also Complete Part 5) O Sponsored (Also Complete Pert 6) ❑ General Purpose Committee Q Sponsored Q Small Contributor Committee Q Political Party/Central Committee ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1427074 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) 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 Date of election if appllca�T (Month, Day, Year) 2 IC2 �e — 1 - - - of _ (D or Official Use Only 03/03/2020 TTY CLERK'S OFFI iEJ 2. Type of Statement: ® Preelection Statement ❑ Quarterly Statement [ ] Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file a Form 410 Termination) ❑ Supplemental Preelection 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 CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX / E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS ( 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the Executed on IID1TcoG2 By rte Executed on �r L� By Mato Executed on By Date Executed on wtrww.netfile.com Signature of Controlling Officeholder, Candidate, State Measure Proponent Date By Signature ofControlling 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 Rachel Kertz OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City Council Member City of San Rafael District 4 RESIDENTIAL/BUSINESS 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 COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) COVER PAGE - PART 2 Page 2 of 6 6. Primarilv 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 UITY SIAIE LIF, cwt AKtA UUUt/F'hUNt Attach continuation sheets if necessary FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov www.netfile.com Campaign Disclosure StatementSUMMARY Amounts may be rounded Statement covers period CALIFORNIA Summary Page to whole dollars. from 07/01/2022 FORM • SFF INSTRUCTIONS ON REVERSE NAME OF FILER Rachel Kertz for City Council 2020 Contributions Received 1. Monetary Contributions ........................................... 2. Loans Received...................................................... 3. SUBTOTAL CASH CONTRIBUTIONS ..................... 4. Nonmonetary Contributions .................................... 5. TOTAL CONTRIBUTIONS RECEIVED ................... Expenditures Made 6. Payments Made ....................................................... Schedule E, Line 4 Column A 218.43 $ TOTALTHIS PERIOD Schedule H, Line 3 (FROM ATTACHED SCHEDULES) Schedule A, Line 3 $ 0.00 $ Schedule B, Line 3 9. Accrued Expenses (Unpaid Bills) ............................... 0.00 $ Add Lines 1 + 2 $ 0.00 Schedule C, Line Schedule C, Line 3 0.00 0.00 11. TOTAL EXPENDITURES MADE .................. --- ....... •••Add Lines 3+4 $ 0.00 $ 6. Payments Made ....................................................... Schedule E, Line 4 $ 218.43 $ 7. Loans Made............................................................. Schedule H, Line 3 0.00 14. Miscellaneous Increases to Cash ........................... Schedule t, Line 4 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 $ 218.43 9. Accrued Expenses (Unpaid Bills) ............................... Schedule F Line 3 $ -70.00 If this is a termination statement, Line 16 must be zero. 10. Nonmonetary Adjustment ........................................... Schedule C, Line 0.00 0.00 11. TOTAL EXPENDITURES MADE .................. --- ....... Add Lines a+9+10 $ 148.43 Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 798.03 13. Cash Receipts ................................................... Column A, Line 3 above 0.00 14. Miscellaneous Increases to Cash ........................... Schedule t, Line 4 0.00 15. Cash Payments .................................................. Column A, Line 8 above 218.43 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 579.60 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ 0.00 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 $ 16,186.75 www.netfile.com through 10/22/2022 Page 3 of 6 I.D. NUMBER 1427074 Column B Calendar Year Summary for Candidates CALENDAR YEAR TOTALTO DATE Running ry in Both the State Prima and General Elections $ 0.00 1/1 through 6/30 7/1 to Date 16,000.00 $ 16,000.00 0.00 $ 16,000.00 $ 580.67 0.00 $ 580.67 186.75 0.00 20. Contributions Received $ $ 21. Expenditures Made $ $ 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) $ 767.42 1 / J 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 SCHEDULEB-PART1 Schedule B — Part 1 Amounts may be rounded Statement covers period CALIFORNIA Loans Received to Whole dollars. 07/01/2022 I • FORM from through 10/22/2022 Page 4 of 6 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Rachel Kertz for City Council 2020 1427074 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER e) OUTSTANDING (b) AMOUNT (�) AMOUNTPAID (d) OUTSTANDING (e) INTEREST (1) ORIGINAL (gl CUMULATIVE OF LENDER OCCUPATION AND EMPLOYER BALANCE RECEIVED THIS OR FORGIVEN BALANCEAT PAID THIS AMOUNT OF CONTRIBUTIONS (IFCOMMITTEE, ALSO ENTER I.D.NUMBER) (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) BEGINNING THIS R PERIOD THIS PERIOD" CLOSE OF THIS p PERIOD LOAN TO DATE Rachel Kertz Candidate ❑ PAID CALENDARYEAR Candidate San Rafael, CA 94903 $ n nn $ 6,Ono _0n n.nn% $ 6.000.00 $ n.nn ❑ FORGIVEN PERELECTION"" RATE $ 6.000.00 $ 0.00 $ 0.00 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 $ 1n,non_0 n_nn% $ 10.000.00 $ 0 -nn ❑ FORGIVEN PERELECTION"" RATE $ 10.000.00 $ 0.00 $ no 07/22/2021 $ nn 01/22/2021 $ DATE DUE DATE INCURRED t© IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ PAID CALENDARYEAR ❑ FORGIVEN PERELECTION" RATE DATE DUE t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC 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.)............................................................... NET $ 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.netfile.com 0.00 (Maybe a negative number) ttamerkedon 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 Amounts may be rounded Statement covers period Payments Made to whole dollars. from 07/01/2022 SEE INSTRUCTIONS ON REVERSE _ through 10/22/2022 Page 5 of 6 NAME OF FILER I.D. NUMBER Rachel Kertz for City Council 2020 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) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CJ & Associates, Inc. Antelope, CA 95843 CJ & AspoCiates, Inc. Antelope, CA 95843 CODE OR DESCRIPTION OF PAYMENT PRO PRO * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ Schedule E Summary AMOUNT PAID 70.00 148.43 218.43 1. Itemized payments made this period. Include all Schedule E subtotals. ...... $ 218.43 2. Unitemized payments made this period of under $100 .......................................................................................................................................... $ o. 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 $ 218.43 FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov www.netfile.com * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Schedule F Summary SUBTOTALS $ 2s6.75$ 0.00$ 70.00$ 186.75 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.)...... 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.) 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.)................................................................ www.netfile.com INCURRED TOTALS $ _— 0.00 — .................... PAID TOTALS $ 70.00 .............................. ,.............. ..... NET $ -70.00 May be a negative number FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov ( SCHEDULEF Schedule F (d) Amounts may be rounded Statement covers periodCALIFORNIA 460 Accrued Expenses (Unpaid Bills) AMOUNTIN CURRED to whole dollars.from 07/01/2022 FORM (IF COMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING through 10/22/2022 Page 6 of 6 SEE INSTRUCTIONS ON REVERSE BALANCE AT CLOSE NAME OF FILER (ALSO REPORT ON E) OF THIS PERIOD I.D. NUMBER Rachel Kertz for City Council 2020 70.00 0.00 70.00 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. Schedule F Summary SUBTOTALS $ 2s6.75$ 0.00$ 70.00$ 186.75 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.)...... 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.) 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.)................................................................ www.netfile.com INCURRED TOTALS $ _— 0.00 — .................... PAID TOTALS $ 70.00 .............................. ,.............. ..... NET $ -70.00 May be a negative number FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov ( ( (c) (d) NAME AND ADDRESS OF CREDITOR CODE OR OUTSTAA NDING 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 70.00 0.00 70.00 0.00 Antelope, CA 95843 Loren Kertz OFC 43.00 0.00 0.00 43.00 San Rafael, CA 94903 Loren Kertz WEB 143.75 0.00 0.00 143.75 San Rafael, CA 94903 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Schedule F Summary SUBTOTALS $ 2s6.75$ 0.00$ 70.00$ 186.75 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.)...... 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.) 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.)................................................................ www.netfile.com INCURRED TOTALS $ _— 0.00 — .................... PAID TOTALS $ 70.00 .............................. ,.............. ..... NET $ -70.00 May be a negative number FPPC Form 460 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (866/275-3772) www.fppc.ca.gov