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2017-11-22 Form 497 - PS Fire Safety~ ).i~- \IJ~~ RECEIVED :n 'i OF P :,..LH SH'.ir-Jl;, 497 Contribution Report Amounts may be rounded to whole do11arf11l NOV 22 PM 2: 39 !"!"NA!""M"!"'E"!'!OF!"!F~ILE~R-------------------,--Date_o_f ____ .. -;:· .... --,-C~E,--O~r~l'."'"ri'."'"S:_?w._. :!!!!\ ~t!P~.-~:_"".!':·'- Palm Springs Fire Safety Association PAC This Filing '··' 1 • CALIFORNIA 497 FORM AREA CODE/PHONE NUMBER 1.0. NUMBER /ifapp/lcable) (760) 861-1230 Report No. _____ _ 44719 Johnston Dr •Amendment to Report No. ____ _ -=- ----------------ST.-'A-JE ___ Z_IP_C_O_DE ____ -11 (explain below) Temecula CA 92592 No. of Pages ___ _ 2. Contribution(s) Made DATE FULL NAME, STREET ADDRESS ANO ZIP CODE OF RECIPIENT CANDIDATE AND OFFICE OR MADE (IF COMMITTEE, ALSO ENTER 1.P, NUMBER) MEASURE AND JURISDICTION 11-1a1m ::springs t-orwara Yes on Measure u ~u11 Yes on Measure u 400 East Tahquitz Canyon .. 11/16/17 Palm Springs, CA 92262 ' Reason for Amendment:---------------------------------- 1y AMOUNTOF DATE OF ELECTION CONTRIBUTION (IF Al'PllCABLE) $2500 11/7/17 . FPPC Form 497 (Jul/2016) FPPC Advice: advlce@fppc.ca.gov (866/275-3772) www.fppua.gov 497 Contribution Report Amounts may be rounded to whole doHars. . -:-r~· NAME OF FILER Date of Palm Springs Fire Safety Association PAC This Filing HU NOV -2 AH 8• 11 AREACODEJPI-IONE NUMBER LD. NUMBER (lfapp//cable) CALIFORNIA 497 FORM ••· I • ( 881536 Report No. ul· FldE Or 'fr-;[ Cl·, y CLU-' STREET ADDRESS .,------------------=ST.-c-A=cTE=----z"'"1p-c'"'O,...D--E-----i1 (explain below) Temecula CA 92592 No. of Pages---- 1 2. Contribution(s) Made DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF RECIPIENT CANDIDATE ANO OFFICE OR MADE (IF COMMITTEE,ALSO ENTER I.D. NUMBER) MEASURE AND JURISDICTION ~ c.;onnect Po11t1ca1 ljroup Lisa Mluu1e1on ana t;nnsty -# \=Ll PO Box 12062 Holstege Newport Beach, CA 92658 Palm Springs City Council {O-:IJ-J7 Reason for Amendment: ------------------------------------ AMOUNTOF DATE OF ELECTION CONTRIBUTION (IF APPLICABLE) $7469.58 11/7/2017 FPPC Form 497 (Jul/2016) FPPC Advice: advlce@fppc.ca.gov (866/275-3772) www.fppc.ca.gov C ,Recipient Committee Campaign Statement Cover Page Date Stamp ,A v,-, RECEIVED CALIFORNIA FORM DVERPAGEl 460 .-----------r-----------.. n Y OF P,1HM S1":{i.-ilJt>age __ SEE INSTRUCTIONS ON REVERSE Statement covers period Oct 22, 2017 from ________ _ Dec 31, 2017 through ________ _ 1. Type 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 /Also Comp,lete Pall 5) ~ General Purpose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee 3. Committee Information 0 Controlled 0 Sponsored (Am Complete Part 6/ 0 Primarily Formed Candidate/ Officeholder Committee (AlSO Comprllle Part 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) 44719 Johnston Dr CITY Temecula STATE ZIP CODE CA 92592 MAILING ADDRESS (IF DIFFERENT) NO, ANO STREET OR P.O. BOX CITY STATE ZIP CODE OPTIONAL: FAX/ E-MAIL ADDRESS 4. Verification AREA CODE/PHONE 7608611230 AREA CODE/PHONE Date of election if applicable: (Month, Day, Year) 2118 JAN IO AH 8: 2 For Official Use Only 11/7/2017 uF FICE oi: n;c en 'i' c~-•. ". 2. Type of Statement: D Preelection Statement ~ Semi-annual Statement D Termination Statement (Also file a Form 410 Termination) D Amendment (Explain below) Treasurer(s) NAME OF TREASURER Damien Myers MAILING ADDRESS 44719 Johnston Dr CITY Temecula NAME OF ASSISTANT TREASURER, IF ANY Brian Davis MAILING ADDRESS 35970 Bordeaux Pl CITY Winchester OPTIONAL: FAX I E-MAIL ADDRESS D Quarterly Statement D Special Odd-Year Report STATE ZIP.CODE CA 92592 STATE ---ZIP CODE CA 92591 AREA CODE/PHONE 7608611230 AREA CODE/PHONE 9098555003 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 Slate of California that the foregoing is true and correct 01/01/2018 Executed on Date Executed on Date Executed on Dale Executed on Date By By By By ~--~ • Signab.Jre ofTreasu sislanlTreasurer Signature Qf Conlrolling Officeholder, Candidate, Slate Measure Proponent c:,r Responsi>le Officer of Sponsor Signature of Controlling Officeholder, Candidate, State Measure Proponent Signature 'of Controlling Officeholder, Candidele, State Measi.-e Propcoent FPPC Form 460 (Jan/2016) FPPC Advice: advlce@lfppc.ca.gov I 866/275-3772) '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 .............................................................. . 3. SUBTOTAL CASH CONTRIBUTIONS Schedule B, Line 3 Add Lines 1 + 2 4. Nonmonetary Contributions............................................ Schedvle c. Line 3 5. TOTAL CONTRIBUTIONS RECEIVED........................ . .. Md Lines 3 + 4 Expenditures Made 6. Payments Made................................................................ Schedule E:, Line 4 7. Loans Made....................................................................... Schedule H, Line 3 8. SUBTOTALCASHPAYMENTS ................................. AddLines6+7 9. Accrued Expenses (Unpaid Bills) Schedule F, Line 3 10. Non monetary Adjustment.. ..................................................... Schedule c, Line 3 11. TOTAL EXPENDITURES MADE. ...................................... Add Lines 8 + 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 1. 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, Line 16 must be zero. 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 $ Amounts may be rounded to whole dollars. Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) 0 0 10,090.42 a 10,090.42 10,090.42 11064.14 0.11 10,090.42 973.83 SUMMARY PAGE Statement covers period Oct 22, 2017 CALIFORNIA 460 FORM from __________ _ Dec 31, 2017 2 6 through ________ _ Page ___ of __ _ Column B CALENDAR YEAR TOTAL TO DATE 10,000 $ 10,000 $ $ 10,000 $ 14,248.43 $ 14,248.43 $ 14,248.43 ·-- 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 th is is the fl rst report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). LO. NUMBER 881536 I Calendar Year Summary for Candidates Running in Both the State Primary and General Elections I "' ~,o,gh SDO 7/1 to Date 20. Contributions Received $ $ I 21 . Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made• (If Subject to Voluntary E1<penditure Limit) Date of Election (mm/dd/yy) Total to Date $ ___ _ $ ___ _ «Amounts in this section may be different from amounts reported in Column B. F PPC form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A Monetary Contributions Received SEE INSTRUCTIONS ON REVERSE NAME OF 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 I.D. NUMBER) CODE • IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Schedule A Summary •IND •COM 00TH OPTY •sec •IND •COM DOTH •PTY •sec •IND •COM 00TH •PTY •sec •IND •COM •Olli •PTY •sec •IND •COM •Olli OPTY •sec SUBTOTAL$ Statement covers period Oct22,2017 from ________ _ Dec 31, 2017 through _______ _ SCHEDULE A CALIFORNIA 460 FORM 3 6 Page ___ of __ _ 1.0. NUMBER 881536 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 1. Amount received this period -itemized monetary contributions. (Include all Schedule A subtotals.) ........................................ . ········································ ............ $ 0 *Contributor Codes IND -Individual COM -Recipient Committee (other than PTY or SCC) 0TH -Other (e.g., business entity) PTY -Political Party 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 $ _____ _ SCC -Small Contributor Committee FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca,gov ·schedule D Summary of Expenditures Supporting/Opposing Other Candidates, Measures and Committees SEE INSTRUCTIONS ON REVERSE NAME OF FILER DATE 10/30/17 11/16/17 NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR MEASURE NUMBER OR LETTER AND JURISDICTION, OR COMMITTEE Conect Political Group PO Box 11899 Newport Beach, CA 92658 121 Support D Oppose Palm Springs Forward Yes on Measure D 400 E Tahquitz Canyon Palm Springs CA 92262 f2I Support D Oppose D Support D Oppose Schedule D Summary Amounts may be rounded to whole dollars. TYPE OF PAYMENT li2I Monetary Contribution D Nonmonetary Contribution D Independent Expenditure --- 121 Monetary Contribution D Nonrnonetary Contribution D Independent Expenditure --- D Monetary Contribution D Nonrnonetary Contribution D Independent Expenditure DESCRIPTION (IF REQUIRED) SUBTOTAL $ SCHEDULED Statement covers period f Oct22,2017 CALIFORNIA 460 FORM rom ________ _ through Dec 31, 2017 Page 4 AM0UNTTHIS PERIOD 7,469.58 2,500 I.D. NUMBER CUMULATIVE TO DATE CALENDAR YEAR (JAN, 1 • DEC. 31) of 6 PER ELECTION TO DATE (IF REQUIRED) 1. Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.} .............. . . $ 9,969.58 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 .. $ 9 ,969 -58 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov · Schedule E 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 Oct 22, 2017 from _______ _ through Dec 31, 2017 SCHEDULE E CALIFORNIA 460 FORM 5 6 Page ___ of __ _ I.D. NUMBER 881536 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP CNS CTB eve Fil FND IND LEG LIT campaign paraphernalia/misc. campaign consultants contribution (explain nonmonetary)* civic donations candidate filing/ballot fees fundraising events independent expenditure supporting/opposing others (explain)* legal defense campaign literature and mailings NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Damien Myers 44719 Johnston Dr Temecula, CA 92592 Greg Lyle 9792 Onyx St Yucapia, CA 92399 MBR MTG OFC PET PHO POL POS PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads CODE OR Meals TAC Meals TRC "' Payments that are contributions or independent expenditures must also be summarized on Schedule D. Schedule E Summary RAD radio airtime and production costs RFD returned contributions SAL campaign workers' salaries TEL t.v. or cable airtime and production costs TRC candidat~ travel, lodging, and meals TRS staff/spouse travel, lodging, and meals TSF transfer between committees of the same candidate/sponsor VOT voter registration WEB information technology costs (internet, e-mail) DESCRIPTION OF PAYMENT AMOUNT PAID 33.98 84.86 SUBTOTAL$ 1. Itemized payments made this period. (Include all Schedule E subtotals.) ............... . ··········································································· $ 118.84 2.00 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).) ............................................................................. $ _____ _ 120.84 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 Fonm 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov · Schedule I Miscellaneous Increases to Cash SEE INSTRUCTIONS ON REVER_S_E NAME OF FILER Palm Springs Fire Safety Association PAC DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF COMMITTee, ALSO EaNTEaR I.D. NUMeEaR) Attach additional information on appropriately labeled continuation sheets. Schedule I Summary Amounts may be rounded to whole dollars. Statement covers period Oct 22, 2017 from _______ _ Dec 31, 2017 through ______ _ DESCRIPTION OF RECEIPT SUBTOTAL$ 1. Itemized increases to cash this period ............................................................................................................................ $ _____ _ 2. Unitemized increases to cash of under $100 this period ................................................................................................. $ 0 · 11 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 11 Summary Page, Line 14.) ............................................................................................................................. TOTAL $ · SCHEDULE I CALIFORNIA 460 FORM 6 6 Page __ ·of __ _ I.D. NUMBER 881536 AMOUNT OF INCREASE TO CASH FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fnnc.ca.env · .. Retipien.mmittee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE • Date Stamp 1'•: ECEI Y ::U •~~;;;;;~~;;-.;~;---r-;;::::--:;-:-:--:::---_.;;.·~· ·~·:' _j,, P ·* L '·' c: '" r :-: '> .. I , 1 , '_. , ,·•. r 1 ~· • , ·,I_., Statement covers period Date of election If appllcil]lp:OI., T 2 3 A'1 8: 2 2 Sep 24, 2017 from ________ _ (Month, Day, Year)2 il I · l, I Oct 21, 2017 11/7/2017 :.: : F lCf l(k : \ ~ ;-: l l i .. ,n 1_ through ________ _ 1. Type of Recipient Committee: All Committees -Complete Parts 1, 2, 3, and 4. 2. Type of Statement: CALlf'.ORNIA FORM D\/1::;i.-DJ! 460 Page 1 of 6 I For Official Use Only D Officeholder, Candidate Controlled Committee 0 State Candidate Election Committee D Primarily Formed Ballot Measure Committee ~ Preelection Statement D Semi-annual Statement D Termination Statement 0 Quarterly Statement 0 Recall (Nso Camp!ste P8t1 5) ~ General Purpose Committee QJ Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee 3. Committee Information 0 Controlled 0 Sponsored (~Comple/$P9/t6) D Primarily Formed Candidate/ Officeholder Committee {Also Ciimplele l'll!t l) 1.D.NUMBER ·881536 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Palm Springs Fire Safety Association PAC STREET ADDRESS (NO P.O. BOX) 44719 Johnston Dr CITY Temecula STATE ZIP CODE CA 92592 MAILING ADDRESS (IF DIFFERENT) NO.AND STREET OR P.O. BOX CITY STATE ZIPCOOE OPTIONAL: FAX/ E-MAIL ADDRESS 4. Verification AREA COOEIPHONE 7608611230 AREA CODE/PHONE (Also file a Form 410 Termination) 0 Amendment (Explain below) Treasurer(s) NAME OF TREASURER Damien Myers MAILING ADDRESS 44719 Johnston Dr CITY Temecula NAME OF ASSISTANT TREASURER, IF ANY Brian Davis MAILJNGADDRESS 35970 Bordeaux Pl CITY Winchester OPTIONAL: FAX/ E-MAIL ADDRESS • Special Odd-Year Report STATE ZIPCODE CA 92592 STATE ZIP CODE CA 92591 AREA CODE/PHONE 7608611230 AREA CODE/PHONE 9098555003 I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowl!Jdge 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 correct. Executed on Executed on Executed on Executed on 10/22/2017 zL ~- < Signature of Tmasu~ Treasurer By Date Date By Date By Oate By Signalura of Controlling Ollk:eholdef Candidate, Stakl Measure Proponent or Responaible Officer Of Sponsor S,gnat..-e of ControJnng Officeholder. Candidate, State Measure Proponent Signature of Controlling Officeholder,l';andidato. Slale Measure Proponent FPPC Form 460 [Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Ca.;,paig!lsclosure Statement Summary Page • Amounts may ~e rounded IMARYPAGE 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, Une 3 5. TOTAL CONTRIBUTIONS RECEIVED ................................. AddLines3+4 $ Expenditures Made 6. Payments Made................................................................ Schedule E, Line 4 $ 7. Loans Made ....................................................................... ScheduleH, Une3 8. SUBTOTAL CASH PAYMENTS.......................................... Add Lines 6 + 7 $ 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F. Line 3 10. Nonmonetary Adjustment... ................................. '.' ....... '.' ........ Schedule C, Line 3 11. TOTAL EXPENDITURES MADE .................................. Add Lines B + 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 B above $ to whole dollars. Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) 0 0 0 4103.01 0 4103.01 4103.01 15,166.99 0.16 4103.01 11064.14 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, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents................................................ See instructior1s Ori reverse $ 19. Outstanding Debts.............................. Add Line 2 + Line 9 in Column B above $ Statement covers period Sep 24, 2017 from ________ _ CALIFORNIA 460 FORM Oct 21, 2017 2 6 through ________ _ Page ___ of __ _ $ $ $ $ $ $ Column B CALENDAR YEAR TOTAL TO DATE 10,000 10,000 10,000 4158.01 4158.01 4158.01 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). LO.NUMBER 881536 Calendar Year Summary for Candidates Running in Both the State Primary and General ElectiQns · ·, 1 /1 through 6/30 7/1 to Date 20. Contributions Received $ _____ _ $ ___ _ 21. Expenditures . Made $ _____ _ S---- Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (If Subject to Voluntary Expenditure limlll Date of Election (mm/ddfyy) l Total to Date $ ___ _ $ ___ _ *Amounts in this section may be different from amounts reported in Column B . .. FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule. Monetary Contributions Recei\red SEE INSTRUCTIONS ON REVERSE NAME OF FILER . Palm Springs Fire Safety Association PAC Amounts m. rounded to whole dollars. DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR I CONTRIBUTOR (IF COMMITTEE. ALSO ENTER 1.0. NUMBER) CODE * IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Schedule A Summary •IND •COM 00TH •PTY •sec •IND •COM 00TH 0PTY •sec •IND •COM DOTH •PTY •sec •IND •COM 00TH OPTY •sec •IND •COM DOTH •PTY •sec SUBTOTAL$ Statement covers period Sep 24, 2017 from ________ _ Oct 21, 2017 through _______ _ .CHEOULE A CALIFORNIA 460 FORM 3 6 Page ___ of __ _ I.D. NUMBER 881536 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR {JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) *Contributor Codes IND -Individual 1. Amount received this period -itemized monetary contributions. (Include all Schedule A subtotals.) .................................................. . . ................... ., ........ $ 0 COM -Recipient Committee (other than PTY or SCC) 0TH -Other (e.g., business entity) PTY -Political Party 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 $ _____ _ sec -Smalt Contributor Committee FPPC Form 460 (Jan/2016) FPP~ Advice: advlce@fppc.ca.gov (B66/275-3772) www.fppc.ca.gov · Sch~dule' Summarv of E dit ures Other i and Committees NAME OF FILER NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR DATE MEASURE NUMBER OR LETTER AND JURISDICTION, OR COMMITTEE Lisa Middleton, City Council 10/6/17 12) Support D Oppose 9/27/17 Christy Holstege, City Council 0 Support 0 Oppose D Support 0 Oppose Schedule. D Summary • Amounts may be rounded to whole dollars. ~ lYPE OF PAYMENT li2I Monetary Contribution D Nonmonetary Contribution D Independent Expenditure li2I Monetary Contribution D Nonmonetary Contribution D Independent Expenditure D Monetary Contrbution D Nonmonetary Contribution 0 Independent· Expenditure • SCHEOULE-D Statement covers period CALIFOF<NI/\ 460 from Sep 24, 2017 FORM through Oct 21, 2017 Page 4 of 6 I.D. NUMBER CUMULATIVE TO DATE PER ELECTION DESCRIPTION AMOUNT THIS CALENDAR YEAR TO DATE (IF REQUIRED) PERIOD (JAN. 1 -DEC 31) (IF REQUIRED) $2000 $2000 $2000 $2000 $4000 $4000 SUBTOTAL $ 1. Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.) ....................................................... $ $4000 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 .. $ -· $4ooo FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule, Payments Made SEE INSTRUCTIONS.ON REVERSE NAME OF FILER Palm Springs Fire Safety Association PAC Amounts may be ro.d to whole dollars. Statement covers period Sep 24, 2017 from ________ _ through Oct 21, 2017 .SCHE:PlJLE: E CALIFORNIA 460 FORM - 5 6 Page ___ of~~- I.D. NUMBER 881536 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 eve civic donations PET petition circulating TEL t.v. or cable airtime and production costii 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 AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER 1.0. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Staples -32120 Highway 79 Temecula, CA 92592 Clipboards, Pens, Paper OFC 103.01 Lisa Middleton for Palm Springs City Council 2017 Supporting Candidate Lisa Middleton CTB $2000 Christy Holstege for PSCC Supporting Candidate Christy Holstege CTB $2000 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.} ................................... . ················· .. ······················· .. ··· ............ $~--- 2103.01 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).) ............................................................................. $ ·------ . . . . 2103.01 4. Total payments made this penod. (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 . Sch'"edule, • Amounts may be rounded • SCttEDULE; I Statement covers period CJ\LIH)RNIA 460 Sep 24, 2017 FORM from through Oct 21, 2017 6 6 Page ___ of ___ ---···-··'--··-··-._,,,, , .. _._.._. .. ..,.,_ NAME OF FILER 1.D. NUMBER Palm Springs Fire Safety Association PAC 881536 - DATE FULL NAME AND ADDRESS OF SOURCE DESCRIPTION OF RECEIPT AMOUNTOF RECEIVED PF COMMITTEE, ALSO ENTER I.D. NUMBER) 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 · 16 3.-Total of all interest received this period on loans made to others. (Schedule H, Column (e).) ....................................... $ _____ _ 4. Total miscellaneous increases t<;> cash this period. (Add Lines 1, 2, and 3. Enter here and on the 0 16 Summary Page, Line 14.) ·····························•········.························· .. -·-···...................................................... TOTAL $ · FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fnnr.ca.irov 497 Contribution Report Amounts mav be rounded to whole dollars. ., ... ·. :ti\~ NAME OF FILER Date Of 10/9/17 Palm Springs Fire Safety Association PAC This Fillno 21 7 OCT / Q AM 8: 22 AREA CODE/PHONE NUMBER 1.0. NUMBER (lfeppllcBbJe) CALIFORNIA 497 FORM • . • I • (760) 861-1230 881536 Report No. ,:_,fTiCE Gr Tr-:E Ci l ' LLl STREET ADDRESS 44719 Johnston Dr •Amendment to Report No. ____ _ "'"'Cl,:::::TY-,-----------------S-t-AT_E ___ ZI_P_CO_D_E ___ --11 (explain below) Temecula CA 92592 No. of Pagee ___ _ 1 2. Contribution(s) Made DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF RECIPIENT CANDIDATE AND OFFJCE OR MADE (IF COMMITTEE, ALSO ENTER 1.D. NI.IM!lER) MEASURE AND JURISDICTION Lisa M1aa1eton Ltsa M1Ua1eton i/.,,.. PO Box4109 Palm Springs City Council --S/27'J1-9' Palm Springs CA 92263 li:J/tJ/17 ' ~ Reason for Amendment:----------------------------------- ~~ AMOUNTOF DATE OF ELECTION CONTRIBUTION (IF APPLICABLE) $2000 11ll/2017 FPPC Form 497 (Jul/2016} FPPC Advice: advlce@fppc.ca.gov (866/275·37n) www.fppc.ca.gov 497 Contribution Report Amounts may be rounded to whole dolla r1. NAME OF FILER Palm Springs Fire Safety Association PAC AREA CODE/PHONE NUMBER (760) 861-1230 STREET ADDRESS 44719 Johnston Dr CITY Temecula 2. Contribution(s) Made 1.0. NUMBER (lf-,,pllcable) 881536 STATE CA ZIPCOOE 92592 DATE FULL NAME, STREET ADDRESS AIIID ZIP CODE OF RECIPle4T MADE (IF COMMITTEE, ALSO l!N'IER 1.0. NUMBeR) ll.innsty Holstege 9/27/17 225 S Civic Dr. Suite 213 Palm Springs, CA 92262 Date of 10/9/17 I ThlsFiftng Report No. •Amendment to Report No. (explain belOw) 1 No. of Pages CANDIDATE ANO OFFICE OR MEASURE ANO JURISDICTION 1~nns,r no1s1ege Palm Springs City Council Reason for Amendment:--------------------------------- .. , AMOUNT OF DATE OF ELECTION CONTRIBUTION (IF APPLICABLE) $2000 11ll/2017 FPPC Form 497 (Jul/2016) FPPC Advice: advlce@lfppc.ca.gov (866/275-3772) -.fppc.ca.gav Recipient Committee Campaign Statement Cover Page Statement covers period from July 1, 2017 SEE INSTRUCTIONS ON REVERSE August 31, 2017 through 1. Type 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 0 Controlled (Nso Complelfl Pad 5) 0 Sponsored (Nso Comjlletel'alf6) ~ General Purpose Committee Q Sponsored D Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Mo Q)mplere PMI 7) Committee Information 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) 44719 Johnston Dr CITY Temecula STATE ZIP CODE CA 92592 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 7608611230 AREA CODE/PHONE ---------. --- Date Stamp )~"'·~•~, CALIFORNIA 460 ,,i:c!.7\YED FORM r,L L.. cpf-:,'1.!::~. nf pi I }-1;) 1'·,H« .. 1 5 ,,_I JI. h Page of Date of election if applicable: M'1 9: 42 (Month, Day, Year) 2111 SEP 21 al Use Only 2. Type of Statement: ~ Preelection Statement D Quarterly Statement D Semi-annual Statement D Termination Statement (Also file a Form 410 Termination) D Amendment (Explain below) Treasurer(s) NAME OF TREASURER Damien Myers MAILING ADDRESS 44719 Johnston Dr CITY Temecula NAME OF ASSISTANT TREASURER, IF ANY Brian Davis MAILING ADDRESS 35970 Bordeaux Pl CITY Winchester OPTIONAL: FAX/ E-MAIL ADDRESS D Special Odd-Year Report STATE ZIP CODE CA 92592 STATE ZIP CODE CA 92591 AREA CODE/PHONE 7608611230 AREA CODE/PHONE 9098555003 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. 9/14/2017 ~ ~ Executed on By Date 7' Si~surer or Assistant Treasurer Executed on Date Executed on Date Executed on Date BY--=----,-.----=---,-----,------=------------,,----,----Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Ollioer of Sponsor By Signaltxe of Controlling Olficellolder. Candidate, State Measure Proponent By Signaltxe of Controlling Olficellolder. Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) 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, Line 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................................................................ Schedule E, Line 4 $ 7. Loans Made....................................................................... Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS.......................................... Add unes B + 7 $ 9. Accrued Expenses (Unpaid Bills) .............. . Schedule F, Line 3 10. Nonmonetary Adjustment... ...................................................... Schedule c. Line 3 11. TOTAL EXPENDITURES MADE. ....................................... Add Lines s + 9 + 10 $ Current Cash Statement 12. Beginning Cash Balance Previous Summary Page, Line 16 $ 13. Cash Receipts Column A, Line 3 abov& 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, th&n subtract Line 15 $ ff this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED Schedule B, Part 2 $ Amounts may be rounded to whole dollars. Column A TOTAL THIS F'ERIOD (FROM ATTACHED SCHEDULES) 0 0 0 5.00 0 5.00 5.00 15,171.55 0.44 5.00 15,166.99 SUMMARY PAGE Statement covers period July 1, 2017 ~om ________ _ CALIFORNIA 460 FORM 2 5 August 31, 2017 through _______ _ Page ___ of __ _ Column B CALENDAR YEAR TOTAL TO DATE 10,000 $ 10,000 $ $ 10,000 $ 55.00 $ 55.00 $ 55.00 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 I.D. NUMBER 881536 I Calendar Year Summary for Candidates Running In Both the State Primary and General Elections I '" lh-.,. 7/1 to Date 20. Contributions Received $ $ I 21. Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made• (If Subject to Voluntary Expenditure Limit) Date of Election (mm/dd/yy) Total to Date $ ___ _ $ ___ _ •Amounts in this section may be different from amounts reported in Column B. filed for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts I from Lines 2 , 7, and 9 (if any). 18. Cash Equivalents................................................ See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 + Line 9 in Column B above $ FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275•3772) www.fppc.ca.gov Schedule A SCHEDULE A Monetary Contributions Received Amounts may be rounded to whole dollars. Statement covers period July 1, 2017 rrom ________ _ CALIFORNIA 460 FORM August 31, 2017 through _______ _ 3 5 Page ___ of __ _ SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Safety Association PAC DATE RECEIVED FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR I CONTRIBUTOR (IF COMMITTEE, ALSO ENTER l,D, NUMBER) CODE * Schedule A Summary •IND •COM DOTH •PTY •sec •IND •COM DOTH •PTY •sec DINO •COM DOTH •PTY •sec DINO •COM DOTH 0PTY •sec DINO •COM DOTH •PTY •sec IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) SUBTOTAL$ AMOUNT RECEIVED THIS PERIOD 1. Amount received this period -itemized monetary contributions. 0 (Include all Schedule A subtotals.) ......................................................................................................... $ ______ _ 2. Amount received this period-unitemized monetary contributions of less than $100 ........................... $ ______ _ 3. Total monetary contributions received this period. 0 (Add Lines f and 2. Enter here and on the Summary Page, Column A, Line 1.) ...................... TOTAL $ _____ _ 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) 0TH -Other (e.g., business entity) PTY -Political Party sec -Small Contributor Committee ~i] FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULE E Schedule E Payments Made Amounts may be rounded to whole dollars. Statement covers period July 1, 2017 from ________ _ CALIFORNIA 460 FORM August 31, 2017 4 5 SEE INSTRUCTIONS ON REVERSE 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. I.D. 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 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) NAMEANDADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Secretary of State Political Reform Division PMB 1467 Sacramento, CA 95 Government Code Section 84101.5 Statement of Org 812-1467 nization Payment 50.00 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ Schedule E Summary 0 1. Itemized payments made this period. (Include all Schedule E subtotals.) ............................................................................................................. $ _____ _ 5.00 E--- 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).) ............................................................................. $ _____ _ 5.00 4. Total payments made this period. {Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ........................... TOTAL $ _____ _ FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov .. 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 I.D. NUMBER) Attach additional information on appropriately labeled continuation sheets. Schedule I Summary 1. Itemized increases to cash this period ................................... . Amounts may be rounded to whole dollars. Statement covers period July 1, 2017 from _______ _ August 31, 2017 through ______ _ DESCRIPTION OF RECEIPT SUBTOTAL$ . ............................................................... $ ____ _ 2. Unitemized increases to cash of under $100 this period ................................................................................................. $ 0.44 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 0 44 Summary Page, Line 14.) ............................................................................................................................. TOTAL $ · SCHEDULE I CALIFORNIA 460 FORM 5 Page __ 1.0. NUMBER 881536 of 5 -- AMOUNT OF INCREASE TO CASH FPPC Form 460 (Jan/2016) FPPC Advice: advice(!j)fppc.ca.gov (866/275-3772) www.fnnc.ca.1Pnv a. ~ -... Statement of Organization Recipient Committee Statement Type D Initial REr,EIVED AND FILED in the ffice of lhe Secretary of State of i,ie 8ra,e «Caibrii, CALIFORi'IIA 4•1 0 F0RM 1 0 Not yet qualilled or 0 Date qualified as committee NAME OF COMMITTEf Palm Springs Fire Safety Association PAC STREET ADDRESS (NO P.O. BOX) 44719 Johnston Dr i2I Amendment 08 06 1988 ---4/__J _ Date quafilied as committee (If amending ID pnwkla Illa dllle) . See Part6 D Tonnlnot,on-JUL 10 2011 __ _,f--J __ Dale of termination NAME OF TR_EASUR[R Damien Myers STREET ADDRESS (NO P.O. BOIi) 44719 Johnston Dr CITY Temecula CITY Temecula STATE ZIP CODE AREACODE]iiHON[ NAME OF ASSISTANT TREASUREII, IF ANT CA 92592 (760)861-1230 M.-IUNG ADDIIESS [IF DIFFERENT) E·MAll ADDRESS IREQUIREDj / FAXfbPTIONAl) COUNTY OF DOMICILE JURISDICTION WHEl\E COMMITTEE 15 AC!'IVE Attach odditfonol information on appropriately labeled continuation sheets. STREET ADDRESS (NO P.O. BOlll CITY NAME OF PRINCIPAL Of'flCERIS) Brian Davis UREET ADDRESS (NO P.O. BOXJ 35970 Bordeaux Pl CITY Winchester STATE ZIP CODE CA 92592 STATE ZIPCOOE STATE ZIP CODE CA 92596 ., . ~·. ~,. -.. Pl1 /2: 06 R[Gl8TRAR DF vonnf cowar OF fl/V[RS!D AREA COOE/PIIONE (760)861-1230 AIIEA CODE/PHONE AREA COOE/PIIONE (909)855-5003 I have used all reasonable diligence in preparing this-st"atemerit and tothe best of my knowledge tile information contained herein Is frue and complete. Ice penalty of perjury under the laws of the State of California that the foregoing is true and correct. C-c: ... : Executed on Oa/OS/20 17 DATl' Executed on DATE Executed on PAH Executed on DATE By <<--~ < _;.. ::..a-NATURE Of TREASI/RlR OR AS9§TANT TREASURER By ________________________________________ _ SIGNATURE OF CONTROLUNB OfflCEHOLOER, CANDIDATE, OR STATE MEASURE PROPONENT By ------------:S"'lti"'N"'A"r"'uR"'E"'o""F"'oo=N"'t"'A-O"'w"'N"'G,-:O-:f-:,Fl=CEH"'D"'L"'D"'E"'R,""CA=N-:D"'1D"'A"'T"'E.""o""R"s"r"'Ar"'r"M=EA"'s"'u"A"'E"'P"'Ro"'P"'o""N°'E"'N"T,....---------- Bv ________ ___,,,,,,,,,---_,, ___ _,,,,,.,,.,,,.,.,...,.,.,.,..~-----,.--------,,,,.,.,,.,,.,,..,..,.,,.,..,.--------- s1GNATURE Of CONT RO LUNG OHICEHOlDER, CANDIDAH, OR STATE MEASURE PROPONENT C) --q ___ , ~. ·r· 1 e·: l.' ' N .r:- :x- ::J:: CD c:·, ... C:x, "Tl r rn -u (") >rr, r-- :t:< Vll"l"l -oO A' r.. CJ1 . .., !·_, ~ c.n ;-:~ FPPC Form 410 (May/2017)-· FPPC Advice: advlce@fppc.i:a.gov (866/275-3772t www.fppc.ca .gov --... Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Palm Springs Fire Safety Association PAC CALIFORNIA 41 Q FORM 1.0. "UMBER 881536 • All committees must 11st the flnandal Institution where the campaign bank account Is located. NAME OF FINANCIAL INSTIJUTIDN AREA CODE/PHONE BANK ACCOUNT NUMBER Sun Community Federal Credit Union (760)337-4200 0050109520 ADORES$ an STIIJ[ ZIP CODE 425 N Civic Dr Palm Springs CA 92262 .,....-,--~-=--,-.,------"""7--'---·~~~=~=================;..,;;.;,;-----------i'c1 !: , I 11 Co11tro//ed Co111m1ttee • 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 PARTY D Nonpartisan D Nonpartisan Pr/manly Formed Committee Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATEIS)NAME OR MEASURE(S) FULL TITLE !INCLUDE BALLOT NO, OR LETTER) CANDIDATEfS) OFFICE SOUGHT OR HELD OR MEASURE(S} JURISDICTION (INCLUDE DISTRICT NO, CITY OR COUNTY, AS APPLICABLE) CHECK ONE FPPC Form 410 (May/2017) FPPC Advice: advlce@)fppc.ca.gov (866/275-3772) www.fppc.ca.gov . . ... Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE CALIFORNIA 41 Q FORM Paae General Ptirpo,P Cornmlttee Not formed to support or oppose specific candidates or measures in a single election. Check only one box: l2J CITY Committee O COUNTY Committee O STATE Committee PROVIDE BRIEF DESCAIPTIOH Of ACTIVITY Support Candidates and Measures within the City during a single election. Spo11sorcd Committee Llst additional sponsors on an attachment. NAME OF SPONSOR INDUSTRYGROUPORAfflLIAflON OF SPONSOR Palm Springs Fire Safety Association PAC Palm Springs Fire Safety Unit STREET ADDRESS NO. ANO STREET OTY SlATE ZIP CODE AREA CODE/PIIONE 44719 Johnston Dr Temecula CA 92592 (760)861-1230 Smoll Contrib11tor Committee D---1---1-D•"'"'"'"'"" jli,' 1 • 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 CMay/2017) FPPC Advice: advlce@fppc.ca.gov (866/275-3772) www.fppc.ca,BOv ~ Statement of Organization Recipient Committee Statement Type D lnltlal Date Sta mp \J RECEIVED .,;iTY OF Pf,LH SP CALIFORNIA 41 0 FORM i2I Amendment D Tennination -See Part 5 Far Official Use Only 0 Not yet qualified or 0 Date qualified as committee --1-1-- NAME OF COMMITTEE Palm Springs Fire Safety Association PAC STIIEET ADDRESS (NO P.O. BOX> 44719 Johnston Dr CITY STATE 08 06 1988 --1-1-- Date qualified as committee (If amending 10 provide this dale) ZIP CODE AREA CODE/PHONE 2117 JUL -6 AH IO~ 17 I I Date of termination OfFiCE LF "fli:: tl"rY ai._FlL NAME OF TR.EASURER Damien Myers STREET ADDRESS (NO P.O. BOXf 44719 Johnston Dr CITY ST,0.T£ ZIP CODE Temecula CA 92592 NAME OF ASSISTANT TREASURER, If ANV Temecula CA 92592 (760)861-1230 MAILING ADDRESS (IF DIFFERENT) STREET ADDRESS (NO P.O. BOX) E-MAIL ADDRESS [REC(UIRED] / FAX (OPTIONAll CITY STATE ZIP CODE COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTI\/E NAME Of PRINCIPALOFFICEfllSI Brian Davis STIIEET ADDRESS (NO P.O. BOX) 35970 Bordeaux Pl CITY STATE ZIP CODE Attach additional information on appropriately labeled continuation sheets. Winchester CA 92596 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. penalty of perjury under the laws of the State of California that the foregoing is true and correct. Exea.ited on 06/05/2017 uATE By --------::::,,L,&.:::::.::::;;:;;:~~~~~=:~==----------- · Executed on By DATE ------------s, .. G-N-AT_,U_R __ E_O_F_CO __ N __ T __ R_O_LL_IN_G __ O_FF"'1-c"'EH_O_L_D_E_ll,_CA...,.N'"a-,o-A_T_E,-O-R_S_"_"T_E_M-EA_S_U_R_E_P_R_O_PO_N_E_N_T __________ _ Executed on By DATE ------------S-IG_N_A_J_U_RE_O_F_CO_N_T_R_O_U._I_N_G_O_F_FIC-EH_O_L_II_E_lt_CA_N_D_I_DA_J_E-,0-R-Sli_A_T_E_M_E_A_SU_R_E_P_R_O_P_O_N_EN_T ___________ _ Executed on By DATE -----------"'s"'1G""N"'A"',"'u"'R"'E"'o"'F"'c"'o"N=TR"'o"'u=1N"'G'"o"'F"F"'1c"E"'H"'o""w"'E"'11,~CA=N"'o"'1"'0""AT"'E,..,"'o"'R"'s=TA"'T"'E""M"'E"A"'s"u"'RE"'P"'R"o"P"o"'N"E"'N"'T __________ _ AREA CODE/PHONE (760)861-1230 AREA COPE/PHONE AREA CODE/PHONE (909)855-5003 I certify under FPPC Form 410 (May/2017) FPPC Advice: advice@lfppc.ca.gov (866/275-3772) www.fppc.ca.gov ~ Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE O>MMITTEE NAME Palm Springs Fire Safety Association PAC • All committees must 11st the financial institution where the campaign bank account Is located. NAME OF FINANCIAL IN~TITUTION AREA CODE/PHONE Sun Community Federal Credit Union (760)337-4200 ADDRESS CITV 425 N Civic Dr Palm Springs Controlled Committee BANK ACCOUNT NUMBER ·•0050109520 STATE CA ZIP CODE 92262 CALIFORNIA 410 FORM 1.0. NUMBER 881536 • 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 (INCWDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO~ CITY OR COUNTY, AS APPLIC:ABLEI PARTY D Nonpartisan D Nonpartisan CHECK ONE °[] FPPC Form 410 (May/2017) FPPC Advice: advlce@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME CALIFORNIA 41 0 FORM General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box: i2J CITY Committee O COUNTY Committee O STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY Support Candidates and Measures within the City during a single election. Sponsored Comm;ttee 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. AND STREET CITY STA'E ZIP CODE AREA COOE/PHONE 44719 Johnston Dr Temecula CA 92592 (760)861-1230 Small Contributor Committee D-1--1- D.ate qualified • 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 (May/2017) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period January 1, 2017 from ________ _ June 30, 2017 through ________ _ 1. Type of Recipient Committee: All committees -complete Parts 1, 2, 3, and 4. D Officeholder, Candidate Controlled Committee 0 Stale Candidate Election Committee D Primarily Formed Ballot Measure Committee 0 Recall (Also Comp/ele PBII 5/ ~ General Purpose Committee ~ Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee 3. Committee Information 0 Controlled 0 Sponsored (Nso C(Jllll)lele Part OJ D Primarily Formed Candidate/ Officeholder Committee (Also Comp/tie I'll! 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) 44719 Johnston Dr CITY Temecula STATE ZIP CODE CA 92592 MAILING ADDR-ESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE OPTIONAL: FAX/ E-MAILADDRESS 4. Verification AREA CODE/PHONE 7608611230 AREA CODE/PHONE Date Stamp COVER PAGE ,--- CALIFORNIA 460 FORM . . R EC EI V ED l Page · of I Date of election 1f applicable. I"' I T y O r p t. L H S P R it Ci ~. For Official Use Only (Month, Day, Year) ·' 2111 JUL -6 AH IQ: 16 2. Type of Statement: D Preelection Statement l;;;J Semi-annual Statement D Termination Statement (Also file a Form 41 O Termination) D Amendment (Explain below) Treasurer(s) NAME OF TREASURl:R Damien Myers MAILING ADDRESS 44719 Johnston Dr CITY Temecula NAME OF ASSISTANT TREASURER, IF ANY Brian Davis MAILING ADDRESS 35970 Bordeaux Pl CITY Winchester OPTIONAL: FAX I E-MAIL ADDRESS D Quarterly Statement D Special Odd-Year Report STATE ZIP CODE CA 92592 STATE ZIP CODE CA 92591 AREA CODE/PHONE 7608611230 AREA CODE/PHONE 9098555003 I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information oontained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of Callfornla that the foregoing is true and correct. 7/5/17 Executed on By Date Executed on Date By Executed on By Date Executed on Date By ~----·~· 7" Slgna!Ur~ant TreaSU'er Signature-of Controlling Olficeholder, Candidate, Stele Measure Proponent or Responsible Officer of Sponsor Signature of Controlling Officeholder, Can<i<:late, State Measure Proponenl Signature of Controlling Ollicellolder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) . 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, 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....................................................................... Sclledute H, Line 3 8. SUBTOTAL CASH PAYMENTS .................................... Add Lines 6 + 7 9. Accrued Expenses (Unpaid Bills) Schecfule F, Line 3 10. Nonmonetary Adjustment.................................................. .. Schedule c, Line 3 11. TOTAL EXPENDITURES MADE ....................................... Add Lines a+ 9 + 10 Current Cash Statement 12. Beginning Cash Balance 13. Cash Receipts 14. Miscellaneous Increases to Cash Previous Summary Page, Line 16 Column A, Line 3 above Schedule I, Line 4 15. Cash Payments......................................................... Column A, Line B above 16. ENDING CASH BALANCE .................. Acfd Lines 12 + 13 + 14, then subtract Line 1s If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED Schedule B, Part 2 Cash Equivalents and Outstanding Debts $ $ $ $ $ $ $ $ 18. Cash Equivalents See instructions on reverse $ 19. Outstanding Debts. Add Line 2 + Line 9 in Column B above $ Amounts may b& rounded to whole dollars. Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) 10,000 10,000 10,000 50.00 50.00 50.00 5220.28 10,000 1.27 50.00 15,171.55 SUMMARY PAGE ~tatement covers period January 1, 2017 from _________ _ CALIFORNIA 460 FORM June 30, 2017 2 5 through ________ _ Page ___ of __ _ $ $ $ $ $ $ Column B CALENDAR YEAR TOTAL TO DATE 10,000 W,000 10,000 50.00 50.00 50.00 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 111 lhrough 6/30 711 to Date 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 (mm/dd/yy) --~'___) __ _ __ __,'___) __ _ Total to Date $ ___ _ $ ___ _ *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan/2O16) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schech.I le A Monetary Contributions Received SEE INSTRUCTIONS ON REVERSE NAME 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 ~F COMMITTEE. ALSO ENTER 1.0. NUMeER) CODE * IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF•EMPLOYED. ENTER NAME OF euSINESS) 2/8/17 Palm Springs Fire Safety Unit 180 N Luring Dr. Palm Springs, CA 92262 Schedule A Summary •IND •COM ~OTH •PTY •sec DINO •COM DOTH 0PTY •sec DINO •COM DOTH •PTY •sec •IND •COM DOTH •PTY •sec DINO •COM DOTH •PTY •sec SUBTOTAL$ Statement covers period January 1, 2017 from ________ _ June 30, 2017 through _______ _ SCHEDULE A CALIFORNIA 460 FORM 3 5 Page ___ of __ _ I.D. NUMBER 881536 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) $10,000 $10,000 1. Amount received this period -itemized monetary contributions. (Include all Schedule A subtotals.) ...................................................................... . .. .............. $ 10,000 '"Contributor Codes IND -Individual COM -Recipient Committee (other than PTY or SCC) 0TH -Other (e.g., business entity) PTY -Political Party 2. Amount received this period -unitemized monetary contributions of less than $100 ........................... $ _____ _ 3. Total monetary contributions received this period. 10 000 (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ...................... TOTAL $ ' sec -Small Conbibutor Committee FPPC Form 460 (Jan/2016) FPPC Advice: advlce@fppc.ca.gov (866/275-3n2) www.fppc.ca.gov SCHEDULE E Schedule E Payments Made Amounts may be rounded to whole dollars. Statement covers period January 1, 2017 from ________ _ CALIFORNIA 460 FORM through June 30, 2017 4 5 SEE INSTRUCTIONS ON REVERSE 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. I.D. 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 suNey 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 flF COMMITTEE, ALSO ENTER 1.0. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Secretary of State Political Reform Division PMB 1467 Sacramento, CA 95 Government Code Section 84101. 5 Statement of Org 812-1467 nization Payment 50.00 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) ..................................... ., ..................................................................... $ o 50.00 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).) ............................................................................ $ _____ _ 50.00 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) .......................... TOTAL $ _____ _ FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov {866/275-3772} www.fppc.ca.gov Schedule I Miscellaneous Increases to Cash SEE INSTRUCTION_S_QNRt;YERSI;_ NAME OF FILER Palm Springs Fire Safety Association PAC DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Attach additional information on appropriately labeled continuation sheets. Schedule I Summary Amounts may be rounded to whole dollars. Statement covers period January 1, 2017 from ________ _ June 30, 2017 through ______ _ DESCRIPTION OF RECEIPT SUBTOTAL$ 1. Itemized increases to cash this period ............................................................................................................................ $ _____ _ 2. Unitemized increases to cash of under $100 this period ................................................................................................. $ 1 ·27 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 1 27 Summary Page, Line 14.) ............................................................................................................................. TOTAL $ · SCHEDULE I CALIFORNIA 460 FORM 5 5 Page ___ of __ I.D. NUMBER 881536 AMOUNT OF INCREASE TO CASH FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) --------------------------··-···--··-···-··· --·----------------------------------------~~.fDoc.ca.111ov A i.L • •• , Recipient Committee Campaign Statement Cover Page Type or print in ink. CALIFORNIA 460 2001/02 (Government Code Sections 84200-B4216.5) Statement covers period from January 1, 2017 SEE INSTRUCTIONS ON REVERSE through March 8, 2017 1. Type of Recipient Committee: All Committee& -Complete Parts 1, 2, 3, and 4. D Officeholder, Candidate Controlled Committee D Ballot Measure com'miltee O State Candidate Election Committee O Primarily Formed 0 Recall O Controlled (Also Complete Pan 5J O Sponsored (Also Comp/el<> Part 6) 1K] General Purpose Committee ig) Sponsored O Small Contributor Committee O Political Party/Central Committee 3. Committee Information • Primarily Farmed Candidate/ Officeholder Committee (Afs,i Complete Part 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) 30115 Via Monterey CITY Temecula STATE CA ZIP CODE 92591 MAILING ADDRESS (IF DIFFERENT) NO. ANO 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 FORM Page 1 of 5 Date of election if applicable: (Month, Day, 'efflCE F fri[ CITY CLERH For Official Use Only 2. Type of Statement: D Preetection Statement Iii Semi-annual Statement D Termination Statement D Amendment (Explain below) Treasurer(s) NAME OF TREASURER Damien Myers MAILING ADDRESS 30115 Via Monterey CITY Temecula NAME OF ASSISTANliREASURER, IF ANY Brian Davis MAILING ADDRESS 35970 Bordeaux Pl CITY Winchester 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 92591 ZIP CODE 92591 AREA CODE/PHONE 760 861 1230 AREA CODE/PHONE 909 855 5003 I have used all reasonable dUigence 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 penaHy of perjury under the laws of the State of California that the foregoing is true and correct. Executed on March 8, 2017 By Date Execuled on By Date Execuled on By Date Executed on By Date ~~ *~~atureofTreas ~ssistantfreasl.l"ef Sigmllure ofConlroling Offioeholcler. C8ntidate, Slate MeasL.Fe Proponent or Rospoosible Officer of Sponsor Signature of Controll,ng Olliceholder, Garidiclata, State MeesLZe Proponent Signalure of Controlling Officehokier, Carididate, State Measure Proponent FPPC Fann 460 (June/011 FPPC Toll.fnt11 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 460 FORM SEE INSTRUCTIONS ON REVERSE NAME OF FILER Palm Springs Fire Safety Association PAC Contributions Received 1. Monetary Contributions ......................................... .. 2. Loans Received ..................................................... . Schedule A. Une 3 Schedule B, Une 3 $ 3. SUBTOTAL CASH CONTRIBUTIONS AddUnes 1 +2 $ 4. Nonmonetary Contributions Sc;hedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED Add Unes 3 +4 $ Expenditures Made 6. Payments Made .. .. .. . .. . . .. .............. ... . .. . . .............. .. .. . . Schedule E. Line 4 $ 7. Loans Made . . . . . . ... . . . . . . .. .. . . ..................... ................... Schsdulfl H, Line 3 8, SUBTOTAL CASH PAYMENTS ....... ............ ................. Add Lines 6 + 7 $ 9. Accrued Expenses {Unpaid Bills) 10. Nonmonetary Adjustment Sr:hedule F. Line 3 Schedule C. Line 3 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 + 9 + 10 $ Current Cash Statement 12. Beginning Cash Balance ............... ... ... .. Previous Summary Page, Line 16 $ 13. Cash Receipts . . . . . .. .. . . . ................... ....... ... .......... Column A. Line 3 atwve 14. Miscellaneous Increases to Cash 15. Cash Payments Schedule I, Line 4 Column A. Line B above 16. ENDING CASH BALANCE .......... AddLinss 12 + 13+ 14, thensublracWne 15 $ If this is a termination statement. Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ............... ............ Sr:hedute B. Parl 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 lHS PERIOD (FROM ATTACl-£0 SCHEDUL.ES) 10,000 10,000 10,000 50.00 50.00 50.00 5220.28 10,000 0.41 50.00 15,170.69 from January 1, 2017 ---------- through March 8, 2017 Page 2 of 5 $ $ ColumnB CALENDAR YEAR TOTAL TODA.lE /0,ooc:, 1v,OCO s ____J_Q+O...i.2f2. __ _ $ 50.00 $ 50.00 $ 50.00 1.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 MMe $ _____ _ $ ___ _ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* [If Subjei:tk> Voluntary Expanditun, Llmtt) Date of Election Total to Date (mm/dd/yy) __J__J __ $ __J__J __ $ __j__J __ $ ___J__J __ $ __J__J __ $ __J__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 thal should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only cany over the amounts I •since January 1, 2001. Amounts in this section may be from Lines 2, 7. and 9 (if different from amounts reported in Column B. any). FPPC Fonn 460 IJune/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. Amount& 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. NJMSERJ CODE * IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SEl..f·EMPLOYED, ENTER NAME OF BUSINESS) 2/8/17 Palm Springs Fire Safety Unit 180 N Luring Dr. Palm Springs, CA 92262 Schedule A Summary •IND •COM K]OTH •PTY •sec •IND •COM 00TH OPTY •sec •IND •COM DOTH OPTY •sec •IND •COM DOTH •PTY •sec •IND •COM DOTH •PTY •sec SUBTOTAL$ Statement covers period from January 1, 2017 through March 8, 2017 SCHEDULE A CALIFORNIA 46 0 FORM Page 3 of 5 I.D. NUMBER 881536 AMOUNT RECEIVED THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 • DEC. 31) PER ELECTION TO DATE (IF REQUIRED) $10,000 $10,000 •contributor Codes IND-Individual 1. Amount received this period -contributions of $1 DO or more. (Include alt Schedule A subtotals.) ........................................................................................................ $ 10,000 COM -Recipient Committee (other than PTY or SCC) OTH-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 $ 1 O,DOO PTY -Political Party sec-Small Contributor Committee FPPC Form 460 (June/01) FPPC Toll-Free Helpline: 866/ASK·FPPC SCHEOU..EE ScheduleE Payments Made Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from January 1, 2017 CALIFORNIA 460 FORM SEE INSTRUCTIONS ON REVERSE th h March 8, 2017 roug 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. t.D. NUMBER 881536 OJP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions ClB contribution (explain nonmonelary)" OFC office expenses SAL campaign workers' salaries eve civic donations PEr petition circulating lEL t.v. or cable airtime and production costs FIL candidate filing/ballot fees PK) phone banks TRC candidate travel, lodging, and meals R-0 fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals NJ independent expenditure supporting/opposing others (explain)" POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense FR'.) professional services (legal, accounting) VOT voter registration UT campaign literature and mailings PRT print ads \11.£8 information technology costs (internet. e-mail) NAME AND ADDRESS OF PAYEE ilF GOlolMITTEE. ALSO ENTER LD. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Secretary of State Government Code Section 84101.5 Political Reform Division Statement of Organization Payment $50.00 PMB 1467 Sacramento, CA 95812-1467 a • Payments that are contributions or Independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 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 .......................................................................................................................................... $ 50.00 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 S 5o.oo FPPC Fonn 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 AND ADDRESS OF SOURCE (IF COMMITTEE, ALSO ENTER 1.D. NUMBER) Attach additional information on appropriately labeled continuation sheets. Schedule I Summary Type or print In Ink. Amounts may ba rounded to whole dollars. Statement covers period from January 1, 2017 through March 8, 2017 DESCRIPTION OF RECEIPT SUBTOTAL$ 1. Increases to cash of $100 or more this period ........................ : .................................................................................. $ _____ _ 2. Unitemized increases to cash under $100 this period ............................................................................................... $ 0.41 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.41 SCHEDULE I CALIFORNIA 460 FORM Page_5_ of _5_ LO.NUMBER 881536 AMOUNT OF INCREASE TO CASH FPPC Form 4B0 (June/01) FPPC Toll-Free Helpline: 866/ASK-FPPC -,., ei ~ ,, Staten1ent of Organization Recipient Committee Date Stamp RE¢EIVED AND FILED) . CALIFORNIA 41 Q FORM · Statement Type •Initial Not yet qualified D or 121 Amendment List '-D. number: D Termination -See Part S List I .D. number: in th~ ofli.::e oi the Secreta;y ol Statf of the Stct:l of ca:itomia For CJfflcial L!IBJnly -I Fi --< rr, <-0 C) :x:a-..,:o __ _,/ __ _,, __ _ Dale qualified as committee # 881536 2.!!_,06 , 1988 Date qualified as committee (If applicable) # _______ _ ---11---1--- Date of Termination JAN 11 20i7 ""Yl :z: ,,, ¥_, N '""'o :::i CJ1 :::-~ rn r- e, -0 ::t< =-, :::x t.J"l ~ --oO ~!'l~fflmJ~,~PMt~~-~ry;:t,,:1'-iii~~~1iji~fef7,,;1:,,.~1Ji~*~•-.t•i•" •:,;; 2~HtJl"E!asurer;iilJ~iC>therJ>ri11c:ipal Officf:!rs ::-+0 1 NAME OF COMMITTEE NAME or TREASURfR Palm Springs Fire Safety Association PAC Damien Mlers STREET ADD ff EIS (NO P.O. BOX) 30115 Via Monterey STREET ADDRESS {NO P.O. BOXI CITY STATE ZIP CODE AREA CODE/PHONE 30115 Via Monterey Temecula CA 92591 (760}861-1230 CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Temecula CA 92591 (760)861-1230 MAILING ADDRESS (IF DIFFERENT) STREET ADDRESS (NO P.O. BOX} FAX/ E-MAIL ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE COUNTV OF •OMICllE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PR NCIPAL OFFICER(S) Brian Davis STREET ADDRESS (NO PO. eox, 35970 Bordeaux Pl CITY STATE ZIP CODE AREA CODE/PHONE Attach additional information on appropriately labeled continuation sheets. Winchester CA 92596 I have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and comple!E Ea!rti und':iJ penalty of perjury under the laws of the State of California that the foregoing is true and correct. -~ e, rr, -< ;::o - Executed on 01/09/2016 DATE Executed on DATE Executed on DATE Executed on DATE => -<) :.., :::o -' m By ~ ~ ? ~~-----·-··------·-···----·- -·~ c::> - By------------------------------------------==-~ J:11" < ~< =-: rn :::o~ = 0 SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASUffE PROPONcNT By----------------------------------------------~,...., ~- <,;;::J ::0 ~nu:, \D SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STAH MEASURE PROPONENT By--------------------------------------SIGNATURE OF CONTROLLING OFFICEHOLDER, CA~DIDATE, OR STATE MEAS~RE PROPONENT FPPC Form 410 (Jan/20161 FPPC Advice: advice@fppc.ca.gov (866/275-37721 www.fppc.ca.gov v· Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Palm Springs Fire Safety Association PAC CALIFORNIA 41 Q FORM I.D. NUMBER a 1881536 • All committees must list the financial institution where the campaign bank account is located. NIIME Of FINANCIAL INSTITUTION A'lEA CODE/PHONE-. BA~K ACCOUNT NUMBER Palm Springs Federal Credit Union (760)327-7474 10952 ADDRESS CITY 5TAH !IP CODE 425 N. Civic Drive Palm Springs CA 92262 ~~TftJ,t~f(C::Pffl'rtlltteett;:dmplete'.theappllpable seaions.·:;)(;::t · .i~.;.,t.dtt!:al:~,w:, .. :r;J;_;~,s,~;,:,,._,:,, . .,¼ . ..,,;i;;,.,0~':4:,:,.;.-.... ..,, _ •s,,J.,c;.:: •. i.,,;•; .. •,_ ·-_ . ' ·.:;c_ --~ ., ,.,,,; ·.,_:,_· .. , ' ,i_i,·,.:, .. ,;:;,: ·:,;: :-·:,; ,· r),X ;-0:-.:, •• • ,' • ,; y:,;o:·,;:,; ~ Contra/led 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: CANDIO/\TEISJ NAME OR MEASUREIS] FULL TITLE (INCLUDE BALLOT NO. OR LHTERJ CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEA5URE(S) JUHISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) PARTY 0 Nonpartisan 0 Nonpartisan CHECK ONE SUPPORT OPPOSf • • SULJT a• FPPC Form 410 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov ), Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Palm SprinQs Fire Safety Association PAC ~~T9pe1"1:;t9rn~ltteeff:V~ CALIFORNIA 41 Q FORM I.D. NUMBER General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box: 121 CITY Committee O CO U NTV Committee D STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY Support Candiates 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 STREH ADDRESS NO. AND STREET CITY STATE ZIP CODE 30115 Via Monterey Temecula CA 92591 Small Contributor Committee D _ _,. __ , __ Date qualified $~~-lml!'--lijf_t!,m~~iii.,~bi~~~it~~~~~~:~#~~J~~-~~fa~[l/~;9llliid~te1-~~6l~e,t;·~•~~~~<~mrx;M"~#g.~~;~~l!,_~~!'5~~:~.~~~Jtil:~j~;~'. • 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 (Jan/2O16) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov ..# -\_-; ·staten1ent of Organization Recipient Committee Statement Type 0 Initial Not yet qualified D or --1--1--•ate qualified as committee 11'._Jiielli;o1m1lli~ti~l:~1:ma NAME OF COMMITTEE 12) Amendment List I.D. number: # 881536 08 ,06 ,1988 .: .. Date qualified as committee (If applic.ahle) D Termination -See Part 5 List I.D. number: "-------- / __ _ Date of Termin~tion NAME O' TREASURER Date Stamp RECEIVED Y OF Pf,LH SPRING::. 17 JAN-9 AH II: 26 JhMES THOHPSOr. CITY CLERK ' CALIFORNIA 41 0 FORM For Official Use Only Palm Springs Fire Safety Association PAC Damien Myers STREET ADDRESS (NO P.O. BOX) 30115 Via Monterey_ STREET ADDRESS (NO P.O. BOX) CITV 30115 Via Monterey Temecula CITY STATE ZIP CODE AREA CODE/PHONE NAME OF ASSISTANT TREASURER, IF ANY Temecula CA 92591 (760)861-1230 MAILING ADDRESS (IF DIFFERENT) STREET AD~RESS INO P.O. BOX) FAX/ E-MAIL ADDRESS CITY CDUIJTY CJF DOMICILE JURISDICTION WHERE COMMITTEE IS ACTIVE NAME OF PRINCIPAL OFFICER(SI Brian Davis STREET ADO RESS IND P.O. BOX) 35970 Bordeaux Pl CITV Attach additional information on appropriately labeled continuation sheets. Winchester Executed on 01/09/2016 By DATE ~:2 2' .;?!!%:(IGNATURE OF TREASURE, OR ASSISTANT TREASURER Executed on By DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDII.TE, 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, ~ANO:DATE, DR STATE MEASURE PROPONENT STATE ZIP CODE A,£A CODE/PHONE CA 92591 (7_§9J861-1230 STATE 21P CODE AREACO •E/PHONE STATE ZIP CODE AREA CODE/~HDNE CA 92596 (909)855-5003 FPPC Form 410 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov \/ ..,; ~tatement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Palm Springs Fire Safety Association PAC D CALIFORNIA 41 Q FORM I.D. NUMBER 881536 • All committees must list the financial institution where the campaign bank account is located. NAME OF FINANCIAL INSTITUTION AREA CODE/PHONE BANK ACCOUNT NUMBER Palm Springs Federal Credit Union (760)327-7 4 7 4 10952 ADDRESS CITY STATE ZIP CODE 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 CAND!DATE/OFFICEf-lOLDER/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(SI NAME OR MEASURE($) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE[S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY DR COUNTY, AS APPLICABLE) PARTY D Nonpartisan D Nonpartisan :HECK O~E ;UPP ORT OPPOSE • • suLJ oLJ FPPC Form 410 IJan/20161 FPPC Advice: advice@fppc.ca.gov (866/275-37721 www.fppc.ca.gov --~tatement of Organization Recipient Committee INSTRUCTIONS ON REVERSE COMMITTEE NAME Palm Springs Fire Safety Association PAC CALIFORNIA 41 0 FORM General Purpose Committee Not formed to support or oppose specific candidates or measures in a single election. Check only one box: Ii'.! CITY Committee D COUNTY Committee D STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY Support Candiates 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 CITV STATE ZIP CODE 30115 Via Monterey Temecula CA 92591 Smull Contributor Committee o __ .., ___ , __ _ Date qualified • 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 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov