2017-01-09 Form 460 - PS Fire Safety-~
.lJ R ec,p1ent omm1ttee Type or print in ink. ,V Date Stamp y 460 Campaign Statement CALIFORNIA
C
Cover Page
(Government Code Sections 84200-842 16.5 )
Statement covers period
from Ju ly 1, 2016
SEE INST RUCTIO NS ON REVERSE through December 31 , 2016
1. Type of Recipient Committee: All Committees -Complete Parts 1. 2, 3, and 4 .
J.
• Officeholder, Ca ndidate Controlled Committee D Ballot Measure Committee
0 State Cand id ate Election Committee 0 Primarily Fo rm ed
Q Recall 0 Cont rolled
(Also Comp/ele Pait. 5} 0 Sponsored
(Also Comp/ere Parr 6)
1K] General Purpose Committee
~ Sponsored D Primari ly Fo rmed Cand idate/
0 Small C ontributor Committee Officeho lde r Committee
O Political Party/Central Committee ( Also Complete Parr 7)
Committee Information I 1.D , NUM BER
881536
COMMITTE E NAME (OR CANDIDATES NAME IF NO COMM ITTEE)
Palm Springs Fi re Safety Association PAC
STRE ET ADDRESS (NO P.O . BOX)
C ITY
Temecula
STATE ZIP CODE
CA 92591
MAILING ADDRESS (IF DIFFE RENT) NO . AND STREET OR P.O. BOX
CI T Y STATE ZIP COD E
OPT IONAL, FAX I E-I.AI L ADDRESS
AREA CODE/PHONE
AREA CO DE/PHONE
4. Verification
2001/02
RECEIVED FORM
OFPhLHSPR! -Cl1Y Date of election if applicable:
.. ~age 1 of 5
2.
(Month . Day, Year) 2811 JAN -9 AH II: • ' For Offici al Use O nly
JAHES THOM PSC• i
I
CITY CLERK
Type of Statement:
D Preelection Sta tem e nt
Iii Semi-a nnual Statement
D Te rmination Sta tement
D Amendment (Explain be low)
Treasurer(s)
NAME OF TREASURER
Damien Myers
MAILING ADDRESS
CI T Y
Temecula
NAME OF ASSIS TA NT TREAS UR ER. IF ANY
Brian Davis
MAILING ADD RESS
C I TY
Winchester
OPTIONA L: FAX I E-MAIL ADDRESS
• • D
STATE
CA
STATE
CA
Qua rte rly Statement
Special Odd-Year Report
Supplemental Preelection
Sta te ment • A ttach Form 495
ZIP CODE
92591
ZI P COD E
92591
AREA CODE/PHONE
AREA CODE/P HONE
I have used all reasonable d ilige nce in preparing and reviewing th is statement and to the best of my k nowledge the Informat ion contained herein and in the attached schedu les is true and complete .
certify under pe na lty of perju ry under th e laws of the Slate of Ca liforn ia that the foregoi ng 1s true and correct .
Execut ed o n 01/09/2016 By
Dole
Execu l ed o n By
Date
Executed on
Date
By
faecuted on By
Date
~ ~sistanlTreasure,
Signature or Control•ng OfflOOhclder, Candidate, Slate Measu,e P roponenl or Responsible Officer ol Sponsor
S og,.,lu re cl Conlroll,ng 011 ,ceholder. Candtdate. Sta1e Me asure P,oponent
Signatu re of Cor1 1roling Olf,ceholder, C..-id<Sate , Slate Measure Proponent FPPC Form 460 IJune/01)
FPPC Toll-Free Helpline : 866 /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 4 6 0
FORM
SEE INS T RU CTIONS ON REVERS E
NAM E OF FILE R
Palm Springs Fire Safety Association PAC
Contributions Received
1. Monetary Contributions ......... ............. .......... ........... Schedu l e A, Line 3 S
2 . Loans Received ..... ...... .......... .......... ................ ....... Schedule B, Line 3
3. SUBTOTAL CAS H CONTRIBUTIONS ......................... Add Line s 1 + 2 S
4 . Non monetary Contri but ions ... ........ .............. ... ........ Sche d ule c. Line 3
5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Line s 3 + 4 $
Expenditures Made
6 . Payments Made .... .. ..... .... . . .. . . . . .... .. . .. . .. .. . ... .. .. .. . .. .. .. . Schedule E , Lin e 4 $
7 . Loans Made ............................................................. Schedule H. line 3
8 . SUBTOTA L CASH PAYMEN T S ..... .............. ......... ........ Add lines 6 + 7 $
9 . Accrued Expenses (Unpa id Bills) ............................... Schedule F. Line 3
10. Nonmonetary Adj ustment .......................................... Schedule c, Line 3
11 . TO TAL EXPENDITUR ES MAD E ............................... Add Unes a + 9 • 10 $
Current Cash Statement
12. Begi nn ing Cash Balance .. . . ...... .......... ... Previous Summa ry P age, Line 15 $
13. Cash Receipts ................................................... Column A, Line 3 above
14. M iscellaneous Increases to Cash ........ .............. ..... Schedul e I, Line 4
15.Cash Payments .................................................. ColumnA,UneB a bo ve
16. ENDING CASH BALANCE .......... Add Lmes 12 + 13 + 14, then s ubtra ct Line 1s $
If this is a tenninat;on state ment, Line 16 must be zero.
17. LOAN GUARANTE ES RECEIVED ........................... &hedule B. Pa rt 2 S
Cash Equivalents and Outstanding Debts
18 . Cash Equ ivalents ..... ...... ..... .......... .............. See instroclions on revers e $
19. Outstanding Debt s ......................... Add line 2 + Line 9 in Column e ab ove $
Column A
TOTAL THIS PERIOD
(FROMATTACHEDSCKEDULES)
0
0
0
5218 .98
1.30
5220 .28
from ___ J_u_l_y _1_, _2_0_1 _6 __
through December 31 , 2016 2 5 Page ___ of __ _
$
$
$
$
$
$
ColumnB
C AL ENDAR YEAR
TO AL TO D.~lE
229
229
229
To ca lculate Col um n 8 , add
amounts in Column A l o th e
c orrespond ing amo unts
fr om Co lumn B of yo ur last
re port . Some amounts in
Colu m n A may be negative
fi gures that should be
subtracted from prev ious
period amounts. It this is
the f i rst report being filed
fo r th is calenda r year, only
carry over the amou nts
from Lines 2 , 7 , and 9 (if
any ).
I.D. NUMB ER
881536
Calendar Year Summary for Candidates
Running in Both the State Primary and
General Elections
11 1 thro ugh 6/30 711 to Date
20 . Contr ibut ions
Received $ ____ _ $ ____ _
21. Expend itures Made $ ____ _ $ ____ _
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made"
(H S u bjectto Volunt uy Expendilure Ll mil)
Date of Election Total to Date
(m m/ddlyy)
$
$
$
$
__j___j __ $
___J $
"Since January 1, 200 1. Amou nts in th is sect ion may be
d ifferent from amounts reporte d in Colu m n B .
FPPC Form 460 (June/01)
FPPC Toll-Free Helpline: 866/ASK-FPPC
Schedule A
Monetary Contributions Received
SEE IN STRUCTIONS ON REVERSE
NAM E OF FI LER
Palm Springs F ire Safety Association PAC
Type or print in ink.
Amounts may be rounded
to whole dollars.
DATE
RECEIVED
fU LL NAME , STREET ADDRESS AND ZIP CODE OF CONTRI BUTOR CONTRIBUTO R IF AN INDIVIDUAL, ENT ER
OCCUPATION AND EMPLOYER
OF SELF-EMPLOYED. ENlER NAME
OF BUSI NESS)
tlFCOM ldlTTEE, ALSO B ffER 1.0 NUMBER) CODE *
Schedule A Summary
DINO •COM
D OTH
OPTY •sec
D INO •COM
0 0TH
O PTY •sec
D INO •COM
D OTH
O PTY •sec
•IND •COM
D OTH
0 PTY •sec
DINO •COM
0 0TH
0 PTY •sec
SUBTOTAL$
SCHEDULE A
Statement covers period
CALIFORNIA 460
FORM from ___ J_u_ly_1_, 2_0_1_6 __
through December 31, 2016 3 5 Page ___ of __ _
AMOUN T
RECEIVED THIS
PERIOD
I.D . NUMBER
881536
CUMULATIVE TO DATE
CALENDAR YEAR
(J AN . 1 -DEC. 31)
i'"' .. ~ .. ;: :~~ ~
PER ELECTION
TO DATE
(IF REQUIRED)
·contributor Codes
IND -Individual 1. Amount received this period -contributions of $100 or more.
(Include all Schedule A subtotals.) ........................................................................................................ $ _____ o_ COM -Recipie nt Comm ittee
(other than PTY or SCC)
OTH -Other 2 . Amount received th is 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
S.cheduleE
· Payments Made
Type or print in ink.
Amounts may be rounded
to whole dollars.
Statement covers period
from __ J_u_ly_1,_2_0_1_6 __
CALIFORNIA 460
FORM
SEE INSTRUCTIONS ON REVERSE through December 31 , 20ij 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
ClvP campaign paraphernalia/misc . MBR member communications RAD radio airtime and production costs
CNS campa ign consultants MTG meetings and appearances RFD returned contributions
CTB contri bution (explain nonmonetary)" OFC office expenses SAL campa ign workers' sa laries
CVC civ ic do nations F£T pet ition circulating "TB.. t.v . or cable airtime and prod uct ion costs
FIL cand id ate filing/ballot tees A-K) phone banks TRC candidate travel, lodging , and meals
FND f undra ising events POL polling and su rvey research TRS staff/spouse travel . lodging , and meals
NJ independent expend iture supporting/opposing othe rs (explain )" POS postage , delivery and messenger services TSF transfer between committees of the same candidate/sponsor
LEG legal defense PRO profess ional services (legal, accounting) VOT voter registrat ion
LIT campaign literature and mailings PRT print ads WEB informat ion technology costs (internet , e-mail)
NAME ANO ADDRESS OF PAYEE
!IF CO MMI TTEE ALSO ENTER I.D. ,ilJ MSER) 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
0 1. Payments madethis period of$100 or more. (Include all Schedule E subtotals.) .................................................................................................. $ _____ _
0 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).) ............................................................................... $ _____ _
0 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
S~hed ule I
'Miscellaneous Inc reases to Cas h
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Palm Springs Fire Safety Associat ion PAC
DATE
RECEIVED
FULL NAME AND ADDRESS OF SOURCE
(IF COMMITTEE, ALSO ENTER 1.0. N~MBER)
Type o r p ri nt in ink.
Amounts may be rounded
to w hole dollars.
Statement covers period
from ___ J_u-=-ly_1_,_2_0_1_6 __
th h December 31 , 2ru. roug 11
DESCRIPTION OF RECEIPT
I
SCHEDULE I
CALIFORNIA 460
FORM
P 5 of __ s_ age __
I.D.NUMBER
881536
AMOUNT OF
INCREASE TO CASH
Attach additional infom1ation on appropriately labeled continuation sheets. SUBTOTAL $
Sc hedule I Summ ary
1 . Increases to cash of $100 or more t his period ........................................................................................................... $ _____ _
2. Unitemized increases to cash under $100 this period ............................................................................................... $ _____ 1_._3 o_
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.) ........................................................................................................................... TOTA L $ _____ 1·_30_
FPPC Form 460 (June/01)
FPPC Toll-Free Hel p l ine: 866/ASK-FPPC