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HomeMy WebLinkAbout2016-01-12 Form 460 - PS Fire SafetyRecipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period October 21 , 2015 from ________ _ December 31, 2015 through ________ _ 1. lype of Recipient Committee: All Committees -Complete Parts 1, 2, 3, and 4. D Officeholder, Candidate Controlled Committee 0 State Candidate Election Committee D Primarily Formed Ballot Measure Committee 0 Recall (AJsa Compltft Part 5) ~ General Purpose Committee 8 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee 3. Committee lnfonnation 0 Controlled 0 Sponsored /Also Complolo Pllrl 6) D Primarily Formed Candidate/ Officeholder Committee (Also Complefe Patt 7) l,D.NUMBER 881536 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE} Palm Springs Fire Safety Association PAC STREET AODRESS-(NO P.O. BOX) CITY STATE ZIP CODE Palm Springs CA 92262 MAILING AODRESS-(IF' 1:>IFFERE,NTT-NO. ANO STREET OR P.O. BOX CITY STATE ZIP CODE OPTIONAL: FAX I E-MAIL ADDRESS 4. Verification AREA CODE/PHONE AREA CODE/PHONE COVER PAGE Date Stamp CALIFORNIA 460 FORM Date of election if applicable: (Month, Day, Year) 2. Type of Statement: 0 Preeledion Statement liti! Semi-annual Statement 0 Termination Statement (0-'~ (Also file a Form 41 O Termination) D Amendment (Explain below) Treasu rer(s) NAME OF TREASURER Damien Myers MAILING ADORESS CITY Palm Springs NAME OF ASSISTANT TREASURER, IF ANY Brian Davis MAILING ADDRESS CITY Palm Springs OPTIONAL: FAX/ E•MAIL ADDRESS l" \ J ~ )Lt c;D ~1V .-1,:age . of __ I 8 -~j For Official Use Only . 0 Quarterly Statement 0 Special Odd-Year Report STATE CA ZIP CODE 92262 STATE . --ZIP CODE CA 92262 AREA CODE/PHONE AREA CODE/PHONE 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. certify under penally of perjury under the laws of the State of California that the foregoing is true and correct. 1/11 /16 Executed on By Dale Executed on By Date Executed on bate By Executed on By Dale . A.68istanl Treasurer Signature of Controling Officeholder, Candidate, State Measure Proponent or Responsible Officer of Sponsor Signature of Controlling Officeholder, Candidata, Slate Measure Propcnent Signature or Controlling 6ri'10eholder, Candidate, State Measure Proponent FPPC Fonn 460 (Jan/2016) FPPC Advice: advice@fppe.ca.aov (866/275-37721 Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Safety Association PAC Contributions Received 1. Monetary Contributions................................................... Schedule A, Line 3 $ 2. Loans Received................................................................ Schedule B. Lin& 3 3. SUBTOTAL CASH CONTRIBUTIONS.............................. Add Lines 1 + 2 $ 4. Non monetary Contributions............................................ Schedule c. Line 3 5. TOTAL CONTRIBUTIONS RECEIVED .................................... Add Lines 3 + 4 $ Expenditures Made 6. Payments Made................................................................ Schedulfl 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. Non monetary Adjustment... ...................................................... Schedule c. Line 3 11. TOTAL EXPENDITURES MADE ........................................ Add Lines B + 9 + 10 $ 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 I, Line 4 15. Cash Payments . . . .... .. . . . .... .. . . . . . . . . .. . . . . . . . . . .. ............... .. . Column A, Line B above 16. ENDING CASH BALANCE .................. Add lines 12 + 13 + 14, tnen sublract Une 15 $ If this Is a termination statement, Line 16 must be Z"ero. 17. LOAN GUARANTEES RECEIVED ................................ ScheduleB,Part2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents................................................ See Instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B abow $ Amounts may be rounded to whole dollars. Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) 2015.00 2015.00 2015.00 7428.52 0.65 2015.00 5414.17 SUMMARY PAGE Statement covers period October 21 , 2015 CALIFORNIA 460 FORM kom ________ _ December 31, 2015 2 8 through ________ _ Page ___ of __ _ Column B CALENDAR VEAR TOTA~ TO DATE $ $ $ $ 2,273.80 $ 2273.80 $ 2273.80 To calculate Column B, add amounts in Column A to the oorresponding 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.D. NUMBER 881536 I Calendar Year Summary for Candidates Running In Both the State Primary and I I General Elections 1/1 through 8/30 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* llf Subject to Voluntary Expanclture Umlt) Date of Election (mm/dd/yy) _ ___,! _ ___,! __ Total to Date $ ___ _ $ ___ _ *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/20161 FPPC Advice: advlce@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A Monetary Contributions Received SEE INSTRUCTIONS ON REVERSE IIAME OF FILER Palm Springs Fire Safety Association PAC 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•EMPLOVED, ENTER NAME OF BUSINESS) Schedule A Summary DINO •COM 00TH •PTY •sec DINO •COM DOTH OPTY •sec DINO •COM DOTH •PTY •sec DINO •COM 00TH OPTY •sec DINO •COM 00TH OPTY •sec SUBTOTAL$ Statement covers period October 21 , 2015 from ________ _ SCHEDULE J CALIFORNIA 460 FORM December 31, 2015 I 3 8 through_______ Page ___ of __ _ AMOUNT RECEIVED THIS PERIOD I.D. NUMBER 881536 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 • DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 1. Amount received this period -itemized monetary contributions. 0 (Include all Schedule A subtotals.) ......................................................................................................... $ _____ _ *Contributor Codes IND-Individual COM -Recipient Committee 2. Amount received this period-unitemized monetary contributions of less than $100 ........................... $ _____ _ 3. Total monetary contributions received this period. 0 (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ...................... TOTAL $ _____ _ (other than PTY or SCC) 0TH -Other (e.g., business entity) PTY -Political Party sec -Small Contributor Committee FPPC Form 460 (Jan/2016) FPPC Advice: advice@)fppc.ca.gov (866/275-3772) www fnnr ,.,. "'"' Schedule D Summary of Expenditures Supporting/Opposing Other Candidates, Measures and Committees SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Safety Association PAC DATE 10/15/15 10/15/15 10/15/15 NAME OF CANDIDATE, OFFICE, ANO DISTRICT, OR MEASURE NUMBER OR LETTER AND JURISDICTION, OR COMMITTEE Ginny Foat, Mayor i2I Support D Oppose JR Roberts, City Council Ill Support D Oppose Paul Lewin, City Council i2I Support D Oppose Schedule D Summary Amounts may be rounded to whole dollar&. TYPE OF PAYMENT I i2I Monetary Contribution I D Nonmonetary Contribution D Independent Expenditure i2I Monetary Contribution I D Nonmonetary Contribution 0 Independent Expenditure iia Monetary Contribution I D Nonmonetary Contribution D Independent Expenditure SCHEDULED Statement covers period from October 21 , 2015 CALIFORNIA 460 FORM DESCRIPTION (IF REQUIRED) I I I SUBTOTAL $ th h )ecember 31, 201!: j P 4 f 8 roug _______ age __ o __ AMOUNT THIS PERIOD $500.00 I $500.oo I $soo.oo l 1500 1.0. NUMBER 881536 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 • DEC. 31) $500.00 $500.00 $500.00 PER ELECTION TO DATE (IF REQUIRED) 1. Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.). ...................................................... $ 2000 2. Unitemized contributions and independent expenditures made this period of under $100 .................................................................................... $ _____ _ 3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enter on the Summary Page.) .......... TOTAL .. $ 2000 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-37721 www.fppc.ca.gov Schedule D (Continuation Sheet) lures 3 Other is and Committees NAME F FILER Palm Springs Fire Safety Association PAC DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR MEASURE NUMBER OR LETTER AND JURISDICTION, OR COMMITTEE Geoff Kors, City Council 10/15/15 Ill Support 0 Oppose D Support D Oppose D Support D Oppose D Support D Oppose Amounts may be rounded to whole dollars. Statement covers period CALIFORNIA 460 from October 21, 2015 FORM TYPE OF PAYMENT DESCRIPTION (IF REQUIRED) Ill Monetary Contribution D Nonmonetary Contribution D Independent Expenditure D Monetary Contribution D Nonmonetary Contribution D Independent Expenditure D Monetary Contribution D Nonmonetary Contribution D Independent Expenditure D Monetary Contribution D Nonmonetary Contribution D Independent Expenditure SUBTOTAL $ th h )ecember 31, 201: 5 8 roug Page ___ of ___ I.D. NUMBER 881536 AMOUNT THIS CUMULATIVE TO DATE PER ELECTION PERIOD CALENDAR YEAR TO DATE (JAN. 1-DEC. 31) (IF REQUIRED) $500.00 $500.00 $500.00 l FPPC Form 460 (Jan/2016) FPPC Advice: advlce@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULE Schedule E Payments Made Amounts may be rounded to whole dollars. Statement covers period October 21, 2015 from ________ _ CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE )ecember 31, 201E I 6 8 through_______ Page ___ of __ NAME OF FILER Palm Springs Fire Safety Association PAC CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. 1.0. NUMBER 881536 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 eve 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 ANO ADDRESS OF PAYEE OF COMMITTEE.ALSO ENlER 1.0. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Committee to Elect Ginny Foat Mayor Supporting Candidate Ginny Foat CTB $500.00 Committee to Elect JR Roberts Supporting Candidate JR Roberts CTB $500.00 Paul Lewin PS City Council Supporting Candidate Paul Lewin CTB $500.00 '"Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ $1500.00 Schedule E Summary 2000 1. Itemized payments made this period. (Include all Schedule E subtotals.) ............................................................................................................. $ _____ _ 15 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).) ............................................................................. $ _____ _ 2015 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 Schedule E (Continuation Sheet) Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Safety Association PAC Amounts may be rounded to whole dollars. Statement covers period October 21, 2015 from _______ _ Jecember 31, 20H through ______ _ CODES: If one of the following codes accurately describes the payment, you may enter the code. Otheiwise, describe the payment. SCHEDULE E (CONT.) CALIFORNIA 460 FORM 7 8 Page __ of __ 1.0.NUMBER 881536 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 eve 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-mai0 NAMEANOAODRESS OF PAYEE CODE (IF COMMITTEE, ALSO ENTER l,D. NUMBER) Geoff Kors for City Council CTB * Payments that are contributions or independent expenditures must also be summarized on Schedule D. OR DESCRIPTION OF PAYMENT AMOUNT PAID Supporting Candidate Geoff Kors $500.00 SUBTOTAL$ 500.00 FPPC Form 460 (Jan/2016) FPPC Advice: advfce@Jfppc.ca.gov (866/275-3772) Schedule I Miscellaneous Increases to Cash SEE INSTRUCTIOll(S_ ON REVERSE NAME OF FILER Palm Springs Fire Safety Association PAC DATE RECEIVED FULL NAMEANDAODRESS OF SOURCE (IF COMMITTEE, ALSO ENTER 1.D. NUMBER) Amounts may be rounded to whole dollars. Statement covers period October 21, 2015 ~om _______ _ Jecember 31, 20H through ______ _ DESCRIPTION OF RECEIPT SCHEDULE CALIFORNIA 460 FORM Page 8 I.D. NUMBER 881536 of 8 -- AMOUNT OF INCREASE TO CASH Attach additional information on appropriately labeled continuation sheets. SUBTOTAL$ Schedule I Summary 1. Itemized increases to cash this period ............................................................................................................................ $ _____ _ 2. Unitemized increases to cash of under $100 this period ................................................................................................. $ 0 ·65 3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).) ....................................... $ _____ _ 4. Total miscellaneous increases to cash this period. {Add Lines 1, 2, and 3. Enter here and on the O 65 Summary Page, Line 14.) ............................................................................................................................. TOTAL $ · FPPC Form 460 (Jan/2016) FPPC Advice: advice@lfppc.ca.gov (866/275-3772) r. .. Q\/l=RP.0 Recipient Committee Campaign Statement Cover Page Type or print in ink. Date Stamp f;jJ CALIFORNIA 2001/02 FORM 460 RECEIVED (Government Code Sections 84200·84216.5) . , , , OF PALH SPH1;., ~---------:=:;-:::;--r;:D;;a;te~o;f ;e,~ec;;;ti;on~iiff ;;ap;;;p~lic;a~broffil· 5 OCT 22 AM 8: 30 (Month, Day, Year) n Statement covers period from September 25, 2015 1 Page of 5 For Official use Only SEE INSTRUCTIONS ON REVERSE through October 20, 2015 1. Type of Recipient Committee: All Committees -Complete Parts 1, 2, 3, and 4. D Officeholder, Candidate Controlled Committee O State Candidate Election Committee Q Recall /Also Complete Pait SJ [iJ General Purpose Committee ® Sponsored O Small Contributor Committee O Political Party/Central Committee 3. Committee Information D Ballot Measure Committee 0 Primarily Formed 0 Controlled 0 Sponsored (Also Complete Part 6) D Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) LD. NUMBER 881536 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Palm Springs Fire Safety Association PAC STREET ADDRESS (NO P.O. BOX) 255 N. El Cielo Rd. PMB 281 CITY Palm Springs STATE CA ZIP CODE 92262 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE OPTIONAL: FAX I E-MAIL ADDRESS 4. Verification AREA CODE/PHONE 760 861 1230 AREA CODE/PHONE J Ml S HW/1r' ~, 1:1 u CITY CLERK 2. Type of Statement: [Kl Preelection Statement D Semi.annual Statement D Termination Statement D Amendment (Explain below) Treasurer(s) NAME OF TREASURER Damien Myers MAILING ADDRESS 255 N. El Cielo Rd. PMB 281 CITY Palm Springs NAME OF ASSISTANT TREASURER, IF ANY Brian Davis MAILING ADDRESS 255 N. El Cielo Rd. PMB 281 CITY Palm Springs OPTIONAL: FAX I E-MAIL ADDRESS STATE CA STATE CA ~. D Quarterly Statement D Special Odd-Year Report D Supplemental Preelection Statement • Attach Form 495 ZIP CODE 92262 ZIP CODE 92262 AREA CODE/PHONE 760 861 1230 AREA CODE/PHONE 909 855 5003 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. certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on 10/20/15 By Dale Executed on By Date Executed on By Date Executed on By Date ----- ~~-~~ <' Signature~-::.~ __ rer Signalure of Controlling Officeholder. Cardidate, State Measure Proponent or Res;,onsible Officer of Spoosa< Signature of Controlling Offic.eholde/, Cardidate, State Measure Proponent Signahre Of Controlling Officeholder, Candidate, State Measi.re Proponer11 FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC State of Callfornla Type or print in ink. SUMMARY PAGE Campaign Disclosure Statement Summary Page Amounts may be rounded to whole dollars. Statement c;overs period CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Safety Association PAC Contributions Received 1. Monetary Contributions ....................... , ... ..... ...•.. ..... Schedule A, Line 3 $ 2. Loans Received . .. .. ... .. . ..... .. .. .. .. . . . . .. ... .. ........ ........... Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 + 2 $ 4. Nonmonetary Contributions .. .. .. .. .. .. .. .. . . .... .............. Schedule c. Line 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. Non monetary Adjustment .......................................... Schedule c. Line 3 11. TOTALEXPENDITURESMADE ................................ AddLines8+9+ 10 $ Current Cash Statement 12. Beginning Cash Balance 13. Cash Receipts 14. Miscellaneous Increases to Cash Previous Summa,y Page, Line 16 Column A, Line 3 above Schedule I, Line 4 15. Cash Payments . .. .. .. .. ... .. .... .. .. .. .. .. ... . .. .. .... ..... ..... Column A, Line 8 above 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 If this is a termination statement, Une 16 must be zero. 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Pai12 Cash Equivalents and Outstanding Debts $ $ $ 18. Cash Equivalents See instructions on reverse $ 19. Outstanding Debts Add Line 2 + Line 9 in Column B abolll! $ ColumnA TOTAL THIS PERIOD (FROM ATTACHED SCHEDJLES) 19.80 19.80 19.80 7447.45 0.87 19.80 7428.52 from September 25, 2015 through October 20, 2015 Page 2 of 5 $ $ $ $ $ $ ColumnB CALENDAR YEAR TOTAL TO DATE 258.80 258.80 258.80 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). I.D. NUMBER 881536 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6/30 7/1 to Date 20. Contributions Received $ _____ _ $ ___ _ 21. Expenditures Made $ _____ _ $ ___ _ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Umltl Date of Election Total to Date {mm/dd/yy) $ $ ---$ ---$ ---$ $ *Since January 1, 2001. Amounts in this section may be different from amounts reported in Column B. FPPC Fonn 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule A Monetary Contributions Received SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Safety Association PAC Type or print in ink. Amounts may be rounded to whole dollars. DAlE RECEIVED FULL NAME. STREET ADDRESS ANO ZIP CODE OF CONTRIBUTOR I CONTRIBUTOR (IF COMMITTEE. ALSO ENTER 1.0. NUMBER) CODE * IF AN INDIVIDUAL, ENTER OCCUPATION ANO EMPLOYER (IF SELF-EMPLOYED, ENTER IIAME OF BUSINESS) Schedule A Summary •IND •COM 00TH OPTY •sec •IND •COM 00TH OPTY •sec •IND •COM 00TH OPTY •sec DINO •COM 00TH OPTY •sec DINO •COM 00TH •PTY •sec SUBTOTAL$ SCHEDULE A Statement covers period CALIFORNIA 460 FORM from September 25, 2015 through October 20, 2015 Page 3 of 5 AMOUNT RECEIVED THIS PERIOD I.D. NUMBER 881536 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TODATE (IF REQUIRED) •contributor Codes IND-Individual 1. Amount received this period-contributions of$100 or more. (Include all Schedule A subtotals.) ...... ------------------------------------·---·---------.. ........................... $ 0 COM -Recipient Committee (other than PTY or SCC) 0TH-Other 2. Amount received this period -unitemized 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 $ O PTY -Political Party sec-Small Contributor Committee FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC SCHEDULEE ScheduleE Payments Made Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from September 25, 2015 CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE through October 20, 2015 Page __ 4_ of __ 5_ NAME OF FILER Palm Springs Fire Safety Association PAC CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. I.D. NUMBER 881536 0\/P 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 R:J petition circulating TEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees P1-0 phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel. lodging, and meals to 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 UT campaign literature and mailings PRT print ads \1\£B infonmation technology costs (internet, e-mai1) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER 1.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Airport Park Postal Service Envelopes and Stamps 255 N El Cielo Rd OFC 14.80 Palm Springs, CA 92262 * Payments. that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ Schedule E Summary 1. Payments made this period of $100 or more. (Include all Schedule E subtotals.) .................................................................................................. $ _____ _ 2. Unitemized payments made this period ofunder$100 .................................................................. .. ........................................................ $ ____ 5 - 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 $ 5 FPPC Form 460 jJune/01) FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule I Miscellaneous Increases to Cash SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Safety Association PAC DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF COMMITTEE. ALSO ENTER 1.0. NUM8cR) Attach additionaf information on appropriately labeled continuation sheets. Schedule I Summary Type or print In ink. Amounts may be rounded to whole dollars. Statement covers period from September 25, 20\i through October 20, 201 5 DESCRIPTION OF RECEIPT SUBTOTAL$ 1. Increases to cash of $100 or more this period ...................................................... . . ................................... $ ____ _ 2. Unitemized increases to cash under $100 this period ............................................................................................... $ 0.87 3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).) ............................... $ _____ _ 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Line 14.) ........................................................................................................................... TOTAL $ o.a 7 SCHEDULE! CALIFORNIA 460 FORM 5 5 Page ___ of __ _ I.D.NUMBER 881536 AMOUNT OF INCREASE TO CASH FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC ~ COVER PAGE Recipient Committee Campaign Statement Cover Page Type or print in Ink. Da1e Stamp CALIFORNIA 460 {Government Code Sections 84200-34216.5) ¼ Statement covers period from July 01, 2015 Date of election If applicable: (Month, Day, Year) RECEIVE 'r Uf P/\lH $ 2015 SEP 22 AH • 2001/02 FORM 1 of 5 For Official Use Only SEE INSTRUCTIONS ON REVERSE through September 24, 2015 JtJiE S THOVtr' CITY CL En 1. Type of Recipient Committee: All Committees -Complete Parts 1. 2, 3, and 4. • Officeholder. Candidate Controlled Committee 0 State Candidate Election Committee O Ballot Measure Committee O Primarily Formed O Recall (Also Complete Patt 5) Ix] General Purpose Committee ® Sponsored 0 Small Contributor Commillee 0 Political Party/Central Committee 3. Committee Information 0 Controlled 0 Sponsored (Also Complete Part 6) D Primarily Formed Candidate/ Officeholder Committee (Also Ccmplate Patt 7) I.D. NUMBER 881536 COMMITTEE NAME {OR CANDIDATE'S NAME IF NO COMMITTEE) Palm Springs Fire Safety Association PAC STREET ADDRESS (NO P.O. BOX) 255 N. El Cielo Rd. PMB 281 CITY STATE ZIP CODE Palm Springs CA 92262 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE OPTIONAL: FAX I E-MAIL ADDRESS 4. Verification AREA CODE/PHONE 760 861 1230 AREA CODE/PHONE 2. Type of Statement: [ij Preelection Statement D Semi-annual Statement D Termination Statement D Amendment (Explain below) Treasurer(s) NAME OF TREASURER Damien Myers MAILING ADDRESS 255 N. El Cielo Rd. PMB 281 CITY Palm Springs NAME OF ASSISTANT TREASURER, IF ANY Brian Davis MAILING ADDRESS 255 N. El Cielo Rd. PMB 281 CITY Palm Springs OPTIONAL: FAX I E-MAIL ADDRESS STATE CA STATE CA D Quarterly Statement D Special Odd-Year Report 0 Supplemental Preelection Statement -Attach Form 495 ZIP CODE AREA CODE/PHONE 92262 760 861 1230 ZIP COOE AREA CODE/PHONE 92262 909 855 5003 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. certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. 9/21/15 By Executed on Date By Executed on Date By Executed on Dale By Executed on O;.ate ~-~~ s,giaiiif? ofTr1111surer or AssistantTreasurer signature of COrl~oning Officeholder. Candidate. StJte Measure Proponanlor Rasponsible Olf1cerofSponsor Signattre of Contmli~ Offioahcide<. Candidate. Stale Measure Propone,it Sig,ature ot Control~ng 0/llcaoolder. CandidJte, State Measure Proponent FPPC Form 460 (June/01} FPPC Toll-Free Helpline: 866/ASK-FPPC State of California t Type or print In Ink. SUMMARY PAGE Campaign Disclosure Statement Summary Page Amounts may be rounded to whole dollars. Statement covers period CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Safety Association PAC Contributions Received 1 . Monetary Contributions Schedule A. Line 3 $ 2. Loans Received Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS Add Lines 1 + 2 $ 4. Nonmonetary Contributions Schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED Add Unes 3 + 4 $ Expenditures Made 6. Payments Made Schedule E, Line 4 $ 7. loans Made Schedule H, line 3 8. SUBTOTAL CASH PAYMENTS Add l.irles 6 + 7 $ 9. Accrued Expenses (Unpaid Bills) Schedule F. Line 3 10. Nonmonetary Adjustment .......................................... Schedule C, lineJ 11. TOTAL EXPENDITURES MADE ................................ Add lines s + 9 + HJ $ Current Cash Statement 12. Beginning Cash Balance 13. Cash Receipts 14. Miscellaneous Increases to Cash 15. Cash Payments . Previous Summary Page, Line 16 Column A, Une 3 above Schedule /, line 4 Column A, line 8 above 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 If this is a tennination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED Schedule 8, 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 a/Jove $ ColumnA TOTAL THISPERIOO (FROMATTACHEDSCl1EOULES) 10 10 10 7381.27 76.18 10 7447.45 from July 01, 2015 through September 24, 2015 I Page 2 of 5 $ $ $ $ $ $ ColumnB CALENDAR YEAR TOTAL TO DATE 239 239 239 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 cany over the amounts from Lines 2, 7, and 9 (if any). I.D. NUMBER 881536 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* Ill SUlljKtto Voluntary Expenditure Limit} Date of Election Total to Date (mm/dd/yy) __j__J __ $ __J__j __ $ ___J__j __ $ ___J__J __ $ ___J__j __ $ __J__j __ $ *Since January 1, 2001. Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC t ScheduleA Type or print in Ink. SCHEDULE A Monetary Contributions Received Amounts may be rounded to whole dollars. Statement covers period CALIFORNIA 46 0 FORM from July 01, 2015 SEE INSTRUCTIONS ON REVERSE through September 24, 2015 Page 3 of 5 NAME OF FILER Palm Springs Fire Safety Association PAC DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP COOE OF CONTRIBUTOR I CONTRIBUTOR (IFCOMMITTEE,IJ.SOENTERI.O.NUMBER) CODE * Schedule A Summary 1. Amount received this period -contributions of $100 or more. •IND •COM DOTH OPTY •sec •IND •COM DOTH •PTY •sec •IND •COM DOTH OPTY •sec •IND •COM 00TH 0PTY •sec •IND •COM DOTH 0PTY •sec (Include all Schedule A subtotals.) .......................................................... . IF AN INDIVIDUAL, ENTER OCCUPATION ANO EMPLOYER (IF SELF•EMPLOVED, ENTER NAME OFBUSll'IESS) SUBTOTALS AMOUNT RECEIVED THIS PERIOD $ 0 2. Amount received this period -unitemized contributions of less than $100 ............................................. $ ------- 3. Total monetary contributions received this period. 0 (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ....................... TOTAL $ _____ _ 1.0. NUMBER 881536 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) •contriblllor Codes IND-Individual COM-Recipient Committee (other than PTY or SCC) 0TH-Olher PTY -Political Party sec -Small Contributor Committee FPPC Fonn 460 (June/01) FPPC Toll-Free Helpline: 866fASK-FPPC SCHEDULEE ScheduleE Payments Made Type or print In Ink. Amounts may be rounded to whole dollars. Statement covers period from July 01, 2015 CALIFORNIA 4 6 0 FORM SEE INSTRUCTIONS ON REVERSE through September 24, 2(ti Page _4_ of _5_ NAME OF FILER I.D. NUMBER Palm Springs Fire Safety Association PAC 881536 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. 0"1P campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions C1B contribution (explain nonmonetary)" OFC office expenses SAL campaign workers' salaries CVC civic donations PEr petition circulating Ta t.v. or cable airtime and production costs FL candidate filing/ballot fees FK) phone banks TRC candidate travel, lodging, and meals Fl',O fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals 11\0 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 V\eB information technology costs (Internet, e-mail) NAME AND ADDRESS OF PAYEE ~FCOMMITTEE,ALSO ENTER 1.0.NUMl!ER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID • Payments that are contributions or Independent expenditures must also be summarized on Schedule D. SUBTOTAL$ Schedule E Summary 1. Payments made this period of$100ormore. (Include all Schedule E subtotals.) ......... . . .............................. $ ___ _ 10 2. Unitemizedpaymentsmadethisperiodofunder$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$ 10 FPPC Form 460 (June/01) FPPC Toll-Free Helpllne: 868/ASK·FPPC ' Schedule I Miscellaneous Increases to Cash SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Safety Association PAC DATE RECEIVED FULL NAME ANO ADDRESS OF SOURCE (IF COMMITTEE. ALSO EIIITER 1.D. IIIUMBER) Attach additional information on appropriately labeled continuation sheets. Schedule I Summary Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from July 01, 2015 through September 24, 21if DESCRIPTION OF RECEIPT SUBTOTAL$ 1. Increases to cash of $100 or more this period ........................................................................................................... $------ 2. Unitemized increases to cash under $100 this period ......................................................................................... $ 76 •18 3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).) ................................. $ ------ 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the 76 18 Summary Page, Line 14.) ........................................................................................................................... TOTAL $ · SCHEDULE I CALIFORNIA 460 FORM Page _S_ of __ 5_ I.D.NUMBER 881536 AMOUNT OF INCREASE TO CASH FPPC Form 460 (June/01) FPPC Toll-Free HelpUne: 866/ASK-FPPC . . .,. Recipient Committee Campaign Statement Cover Page Type or print in ink. °.tt~/VEO C1T i' OF,, ALM SP;;: CALIFORNIA 46 0 2001/02 (Government Code Sections 84200-84216.5) Statement covers period from January 1, 2015 SEE INSTRUCTIONS ON REVERSE through June 30, 2015 1. Type of Recipient Committee: All committees -complete Parts 1, 2, a, and 4. D Officeholder, Candidate Controlled Committee O State Candidate ElecUon Committee O Recall (Also Comple/e Pait 5) 1K] General Purpose Committee © Sponsored O Small Contributor Committee O Political Party/Central Committee 3. Committee Information D Ballot Measure Committee O Primarily Formed O Controlled O Sponsored (Also Comp/8!11 Part 0) D Primarily Formed Candidate/ Officeholder Committee (AISO Complete Pait 7/ 1.0. NUMBER 881536 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Palm Springs Fire Safety Association PAC STREET ADDRESS (NO P.O. BOX) 255 N. El Cielo Rd. PMB 281 CITY Palm Springs STATE ZIP CODE CA 92262 MAILING ADDRESS (IF DIFFERENT} NO. ANO STREET OR P.O. BOX CITY STATE ZIP COOE OPTIONAL: FAX I E-MAIL ADDRESS 4. Verification AREA CODE/PHONE 760 861 1230 AREA CODE/PHONE Date of election if applicable: (Month, Day, Year) 20/S JUL 2 I AH /Or 1AH£s THOHPs0; CITY CL£11f • " FORM , ' . ' of __ _ For Official Use Only 2. Type of Statement: D Preelection Statement !xi Semi-annual Statement D Termination Statement O Amendment (Explain below) Treasurer(s) NAME OF TREASURER Damien Myers MAILING ADDRESS 255 N. El Cielo Rd. PMB 281 CITY Palm Springs NAME OF ASSISTANT TREASURER. IF AfoJY Brian Davis MAILING ADDRESS 255 N. El Cielo Rd. PMB 281 CITY Palm Springs OPTIONAL: FAX / E-MAIL ADDRESS D Quarterly Statement 0 Special Odd-Year Report O Supplemental Preelection Statement -Attach Form 495 STATE ZIP CODE AREA CODE/PHONE CA 92262 STATE CA ZIP CODE 92262 760 861 1230 AREA CODE/PHONE 909 855 5003 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. certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on 7/16/15 l:5iiii, EXOQ.lted or, Date Executed on Date Executed on Dale By By By By Signature of Con1roliing Officeholder. Carididaie,-Slatel.leasure Proponent or Responsible Officer or Sponsor Signature arcon1romng Officeholder. Candidate. stale MeasurePropooont Signature of Controlling Officeholder. Candidate. Stale Meas..., Proponent FPPC Form 410 (June/01) FPPC Toll-Free Helpline: 811/ASK-FPPC State of California Type or print In Ink. SUMMARY PAGE Campaign Disclosure Statement Summary Page Amounts may be rounded to whole dollars. Statement covers period CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Safety Association PAC Contributions Received 1. Monetary Contributions 2. Loans Received ............ . 3. SUBTOTAL CASH CONTRIBUTIONS 4. Nonmonetary Contributions 5. TOTAL CONTRIBUTIONS RECEIVED Expenditures Made 6. Payments Made 7. Loans Made 8. SUBTOTAL CASH PAYMENTS 9. Accrued Expenses (Unpaid Bills) Schedule A, Line 3 $ Schedule B, Line 3 Add Lines 1 + 2 $ Schedule C, Line 3 AddUnes3+4 $ Schedule E, Line 4 $ Schedule H, Line 3 Add Lines 6 + 7 $ Sclledu/e F, Line 3 10. Non monetary Adjustment .......................................... Schedule c, Une 3 11. TOTAL EXPENDITURES MADE ................................ Addt.mes8+9 + 10 $ Current Cash Statement 12. Beginning Cash Balance 13. Cash Receipts 14. Miscellaneous Increases to Cash 15. Cash Payments Previous Svmma,y Page, Line 16 Column A, Line 3 .above Schedule /, Line 4 Column A, line 8 above 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 If this is a termination statement, Line 16 must be zerv. 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 $ ColumnA TOTAL THIS PERIOD (FROIIIATTACHEDSCHEOIJLESI 229 229 229 7608.10 2.17 229 7381.27 from January 1, 2015 through June 30, 2015 Page 2 of 5 $ $ $ $ $ $ Columns CALENDAR YEAR TOTAL TOOATE 229 229 229 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 881536 Calendar Year Summary for Candidates Running In Both the State Primary and General Elections 111 through 6/30 711 to Date 20. Contributions Received $ _____ _ $ ___ _ 21. Expenditures Made $ ____ _ $ ___ _ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made• (If Subject to Voluntilry Expondlture Llrnltl Date of Election Total to Date (mmfdd/yy) ____J_/ __ $ _/_/ __ $ _/__J __ $ __j____j __ $ ____J__j __ $ __J____J __ $ .. Since January 1, 2001. Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule A Type or print in Ink. SCHEDULE A Monetary Contributions Received Amounts may be rounded to whole dollars. Statement covers period CALIFORNIA 46 0 FORM SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Safety Association PAC DATE RECEIVED FULL NAME. STREET AODRESS AND ZIP CODE OF CONTRIBUTOR I CONTRIBUTOR QFCOMI\UTTEE,ALSOENTEIHO.NUMBER) CODE * Schedule A Summary 1. Amount received this period-contributions of $100 or more. (Include all Schedule A subtotals.) .................... .. OIND •COM 00TH OPTY •sec OIND •COM 00TH OPTY •sec •IND •COM 00TH OPTY osec •IND •COM DOTH OPTY •sec O1ND •COM 00TH OPTY •sec 2. Amount received this period-unitemized 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.) ... from January 1, 2015 through June 30, 2015 Page 3 of 5 IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) SUBTOTALS AMOUNT RECEIVED THIS PERIOD $ 0 $~---- TOTAL$ 0 I.D. NUMBER 881536 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) *Contributor Codes IND-Individual COM -Recipient Committee (other than PTY or SCC) OTH-Other PTY -Political Party sec -Small Contributor Committee FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Safety Association PAC Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from January 1, 2015 th h June 30, 2015 roug SCHEDULEE CALIFORNIA 460 FORM Page ~-4-of ~-5- I.D. NUMBER 881536 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. Q\,P campaign paraphernalia/misc. CNS campaign consultants CTB contribution (explain nonmonetary)* eve civic donations FIL candidate filing/ballot fees FND fundraising events INJ independent expenditure supporting/opposing others (explain)* LEG legal defense LIT campaign literature and mailings NAME AND ADDRESS OF PAYEE (If COMMITTEE. ALSO ENTER I.D. NUMBER} Secretary of State Political Reform Division PMB 1467 Sacramento, CA 95812-1467 Airport Park Postal Service 255 N El Cielo Rd Palm Springs, CA 92262 MBR member communications MTG meetings and appearances OFC office expenses FET petition circulating A-IQ phone banks POL polling and survey research POS postage, delivery and messenger services ffiJ professional services (legal. accounting) FRT print ads RAD radio airtime and production costs RFD returned contributions SAL campaign workers· salaries lEL t.v. or cable airtime and production costs lRC candidate travel, lodging, and meals TRS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor VOT voter registration V"wEB information technology costs (internet. e-mail) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Government Code Section 84101.5 Statement of Organization Payment 50 a Post Office Box 149 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ Schedule E Summary 1. Payments made this period of $100 or more. (Include all Schedule E subtotals.) ................................................................... . . ................ $ ___ _ 2. Unitemized payments made this periodofunder$100 ..... ............................................. $ 30 3. Total interest paid this period on loans. (Enter amount from Schedule 8, 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 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC "' Schedule I Miscellaneous Increases to Cash SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Safety Association PAC DATE RECEIVED FULL NAME ANO ADDRESS OF SOURCE (IF COMMITTEE. ALSO ENTER 1.0. NUM6ER) Attach additional information on appropriately labeled continuation sheets. Schedule I Summary Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from January 1, 2015 through June 30, 2015 DESCRIPTION OF RECEIPT SUBTOTAL$ 1. Increases to cash of $1 00 or more this period ........................................................................................................... $ _____ _ 2. Unitemized increases to cash under $100 this period ............................................................................................... $ 2.17 3. Total of all interest received this period on loans made to others. {Schedule H, Column (e).) ................................. $ _____ _ 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Line 14.) ........................................................................................................................... TOTAL $ 2·17 SCHEDULE I CALIFORNIA 460 FORM Page __ 5_ of __ 5_ I.D. NUMBER 881536 AMOUNT OF INCREASE TO CASH FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC .. Statement of Organization Recipient Committee Statement Type 121 tnitial Not yet qualified liZI or .. , _ _. RECEi v ED.. REC ~ Amendment ' 0 F f" A ~T~nation -See Part 5in lhe 0 Ll5t~:1n;;;r20t5 FEB I I l 1stA•ita;b36 of # -----# _____ _ JAM£$ THOhf:.::c.:r~ I I --1 I GIT'( CLEFtKl~-- Date qualified as committee Date qualified as committee Date of Te ·on Uf a111>licableJ Date Starnp \,ii'' ., CALIFORNIA 41 Q FORM Far Official Use Onlv 1~~w1.~:::_~--~~~-::~-~~:, .. ~--~~=¥•milil~WJ!H~n~i!i!!!n11111~~11~~~~~~~~r~~~~~J~~;:t!~. ~:~ti.iili-1~1111 j:~I 11111rar:~ifi1ik~i~~JJr~~t~~tmt1ti~, NAME OF COMMITTEE NAME D F TREASURER Palm Springs Fire Safety Association PAC Damien Myers STREET AO ORE SS (NO P.O. BOX) STREET ADDRESS (NO P.O. BOX) 255 N. El Cielo Rd. PMB# 281 255 N. El Cielo Rd. PMB# 281 CITY STATE ZIPCOOE AREA CODE/PHONE CITV STATE ZIP CODE AREA CODE/PHONE Palm Springs CA 92262 (760 )861-1230 Palm Springs CA 92263 (760)861-1230 MAILING ADDRESS Of DIFFEREN11 NAME OF ASSISTANT TREASURER, IF ANY FAX/ £·MAIL ADDRESS STREU ADDRESS (~O P.O. BOXI J UR 150 ICTION WHERE COMMI rTE E IS ACTIVE CITY STATE ZIP CODE AREA COOE/PHDNE 'dt.~ NAME OF PRINCIPALOFFICER(S) Brian Davis Attach additional information on appropriately labeled continuation sheets. STREET AOORESS(NO P.O. BOX) 255 N. El Cielo Rd. PMB #281 CITY STATE ZIPCOOE AREA COOE/PHONE CA 92262 (909)855-5003 ~•ficath:u I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on O 1/08/2015 ""TE By ,<C~- F ~f TREASURER OR ASSISTANT TREASURER Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT .. ,----··~ . .. , .. , --·q ..... _: f"'""!'., - :.~~.., !~ .. {/) -··· '"T) r-!·1 r·:_J -·. . ,;1 ,' 1 f ~1 ~-~ · c:~) FPPC Fomt410 (Dec/2012) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Palm Springs Fire Safety Association PAC • AU committees must list the financial institution where the campaign bank account is located. NAME Of FINANCIAL INSTITUTION AREA CODE/PHONE Palm Springs Federal Credit Union (760)327-7474 AO DRESS CITY BANK ACCOUNT NUMBER 10952 STATE ZIP CODE CALIFORNIA 41 Q FORM 1.0. NUMBER 881536 425 N. Civic Drive Palm Springs CA 92262 Controlled Committee • List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and district number, if any, and the year of the election. • List the political party with which each officeholder or candidate is affiliated or check "nonpartisan." • If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR Of ELECTION Primarily Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURE{S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIOATE(SJ OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) PARTY D Nonpartisan D Nonpartisan CHECK ONE SUPPORT OPPOSE • • SU• O• FPPC Form 410 (Dec/2012) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Palm Springs Fire Safety Association PAC CALIFORNIA 41 Q FORM General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box: llJ CITY Committee • COUNTY Committee O STATE Committee PROVIDE BRIEF DESCRJPTJON Of ACTIVITV Support Candidates and Measures within the City during a single election Sponsored Committee List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR Palm Springs Fire Safety Association PAC Palm Springs Fire Safety Unit STREET ADDRESS NO. ANO STREET C:ITY STATE ZIP CODE 255 N. El Cielo Rd. PMB #821 Palm Springs CA 92262 Small Contributor Committee •--1'--I Date qualillied • This committee has ceased to receive contributions and make expenditures; • This committee does not anticipate receiving contributions or making expenditures in the future; • This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations; • This committee has no surplus funds; and • This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government Code Section 89519. --Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511 -89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5. FPPC Form 410 (Dec/2012) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov - I f-. Statement of Organization Recipient Committee Statement Type •Initial _ ftE:Cf]VEt> ¼if Y OF ,-AL H S fl''t t!.J,,-'1 li2I Amendment D Termination -See Part 5 R ~ EIVED AND FILED Date Stamp . ~ CALIFORNIA 41 Q FORM For Official Use Only Not yet qualified D or List I.D. numblll5 JAN 28 ttf·c&ru1'ttr: 881536 in th office of lhe Secretary cf State of the StatP. of C~lif!'.lrnia ----1/---1--- Date qualified as committee n JA1UJHClt1t'~b;i 08 06 -: -CLE:-RX --1--/ --I / __ Date qualified as comniittee Date of Termination JAN12 201~ (II appll<ab!&J -- ~-~~~~-~-,.~-~~;;: ,·:•·::~~~?~~~I~!m\li~~~~-~~~;li1f~~:;~~~~~~~: NAME OF COMMITTEE NAME OF TREASURER Palm Springs Fire Safety Association PAC Damien Myers STREET AO DRESS INO P.O. BOX) STREET ADDRESS (NO P.O. 60X) 300 N. El Cielo Rd. 255 N. El Cielo Rd. PMB 281 CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE Palm Springs CA 92262 760-641-0569 Palm Springs CA 92262 (760) 861-1230 MAILING ADORESS OF DIFFERENT} NAME OF ASSISTANT TREASURER, IF ANY 255 N. El Cielo Rd. PMB# 281 Palm Springs, Ca 92262 FAX/ E-MAIL ADDRESS STREET ADDRESS(NO P.O. BOX) damien.myers@palmspringsca.gov COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE CITY STATE ZIP CODE AREA CODE/PHONE Riverside NAME OF PRINCIPAL OFFtCER(S) Brian Davis Attach additional information on appropriately labeled continuation sheets. STREET ADDRESS /NO P.O. BOX) 255 N. El Cielo Rd. PMB 281 CITY STATE ZIP CODE AREACOOE/PHONE Palm Springs CA 92262 (909) 855-5003 3~: iidldiir,rf''>ff'H':::,,, . :r 1 •1-<: , , : . ____ _ __ -;-';, :;.:::r f;;!~~, :;:%;:)p"<;ht::':,_· ,-or·' _ _ _ ___ .---_ _ _ _ _ __ _ _ _ _ __ _ I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. 12/15/14 -~ -___ . .\- !"",_~-i Ex'!cutedon ____ ....,....,. ____ By £ ,._,__ ~ DATE ------,:=,.....'-'-------_....--"""""--S-IG_N_A_TU_R_E _OF_T_R-EA-SU_R_E_R O_R_A_S-SI-ST-AN_T_T-RE_A_SU_R_E_R --------------~ ---:.."':'. (/ .• (_ Executed on By OATE Executed on DATE By Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE,OR STATE MEASURE PROPONENT SIGNATURE OF CONTROlLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT -~--~ --~ , -•: :: ~-- c:·• '· -., 1 -. :::-~ ·~~: ... -:-...::: r..., •··. ?,') (.. __ Cl"".) -· lf~orm 2J1P (Dec/2012) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov .. Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Palm Springs Fire Safety Association PAC • All committees must list the financial institution where the campaign bank account is located. CALIFORNIA 41 Q FORM 1.0. NUMBER 881536 NAME Of flNANCIAt INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER Palm Springs Federal Credit Union 760-327-7474 10952 ADORESS CITY STATE ZIP CODE 425 N. Civic Drive Palm Springs CA 92262 4~•-'llt1RWJ1.1Ji~:'.~~Pi~li:t~-;;1ppliij1:t1.Jis,tj'lpnijii:•,_?•f1,\i::::r,i1;::ir,J\?.•.u+t'•>i<ni· Controlled Committee • List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and district number, if any, and the year of the election. • List the political party with which each officeholder or candidate is affiliated or check "nonpartisan." • If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. NAME OF CANDIDATE/OfFICEHOLOER/STAT£ MEASURE PROPONENT ELECTIVE OFFICE SOUGHT OR HELD (INCLU OE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION Primarily Fo1med Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S} NA ME OR M EASUR E(SI FULL TITlE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELO OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) PARTY D Nonpartisan D Nonpartisan CHECK ONE SUPPORT OPPOSE FPPC Form 410 (Dec/2012) F PPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov ,. . Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Palm Springs Fire Safety Association PAC CALIFORNIA 41 Q FORM General Purpose Commif:tee Not formed to support or oppose specific candidates or measures in a single election. Check only one box: 0 CITY Committee O COUNTY Committee • STATE Committee PftOVIDE BRIEF DESCRIPTION OF ACTIVITY Support Candidates and measures within the City during a single election Sponsored Commif:tee List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR Palm Springs Fire Safety Association PAC Palm Springs Fire Safety Unit STREET ADDftESS NO. AND STREET CITY STATE ZIP CODE 255 N El. Cielo Rd. PMB #281 Palm Springs CA 92262 Small Contributor Committee O _ _, __ Date qualified 5~ terfflli1llt!forflielf1.Urti.merit$· .· .·.· .. · · ay.sfgnlrigJheveriffcatwn;.th'e jr~~il~;~$l~i\ttr~asurer.~rld/o)" cilndldiite; <ffl!ie~o!der, qr l)rop~'ne~·~~tij~~~of th.fullm'J\hg~rtdltlons h.;;~ b~en met= • This committee has ceased to receive contributions and make expenditures; • This committee does not anticipate receiving contributions or making expenditures in the future; • This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations; • This committee has no surplus funds; and • This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. --There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government Code Section 89519. Leftover funds of ballot measure committees may be used for political, legislative or governmental purposes under Government Code Sections 89511-89518, and are subject to Elections Code Section 18680 and FPPC Regulation 18521.5. FPPC Form410 (Dec/2012) FPPC Advlce: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov