2019-10-07 Form 460 - PS Fire SafetyRecipient Committee
Campaign Statement
Cover Page
Date Stamp
COVER PAGE
CALIFORNIA 460
FORM
ECEIYED
,-:-S:-t:-a'.'"te_m_e_n:-l-c_o_v-er_s_p_e_r=-io:-dc--.-=o-at'.'"e-o:-f:-e:-le-c""r:-10-n:-i:-f a-p-p€:tic7a"'bre': fJf PA L H SPRINGS Page __ 1~-of __ 4 __
from ____ 7/_1_/1_9 __ _
SEE INSTRUCTIONS ON REVERSE ';· 9/21/19 through ________ _
1. Type of Recipient Coininittee: All Comm;ttees -Complete Paris 1, 2, 3, and 4.
D Officeholder, Candidate Controlled Committee
0 State Candidate Election Committee
0 Recall
(Also Comp/et& Part SJ
~ General Purpose Committee
® Sponsored
0 Small Contributor Committee
0 Political Party/Central Committee
3. Committee Information
D Primarily Formed Ballot Measure
Committee
0 Controlled
0 Sponsored
(Also Comp/eta Part 6J
D Primarily Formed Candidate/
Officeholder Committee
(Also Comp/et& 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)
CITY
Palm Springs
STATE ZIP CODE
CA 92399
MAILING ADDRESS (IF DIFFERENT) NO. ANO STREET OR P.O. BOX
CITY STATE ZIP CODE
OPTIONAL: FAX/E-MAILADDRE~S
4. Verification
AREA CODE/PHONE
AREA CODE/PHONE
(Month, Day, Year~019 Q _
l T :.:7 AM 8: 55
For Official Use Only
1115119 OF~ICE F THE CITY CLER!\
2i Type of Statement:
li2I Preelection Statement
D Semi-annual Statement
D Termination Statement
(Also file a Form 410 Termination)
D Amendment (Explain below)
Treasurer(s)
NAME OF TREASURER
Brandon Wright
MAILING ADDRESS
CITY
Yucaipa
NAME OF ASSISTANT TREASURER, IF ANY
Damien Myers
MAILING ADDRESS
CITY
Temecula
OPTIONAL: FAX/ E-MAILADDRESS
D Quarterly Statement
D Special Odd-Year Report
STATE ZIP CODE
CA 92399
STATE ZIP CODE
CA 92592
AREA CODE/PHONE
AREA CODE/PHONE
I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contai
certify under penalty of perjury under the laws of the State of California that the for'egoing is true and
herein and in the attached schedules is true and complete.
Executed on 10/6/19
Date
Executed on
,Date
Executed on
Date
Executed on
Date
By
By
By
By
Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officer of Sp_onsor
Signature of Conlrolllng Officeholder, Candidate, State Measure Proponent
Signature of Control!ing Officeholder, 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
· Cdntributions Received ~--
t. 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. Paymenls Made................................................................ Schedule E, Line 4 $
7. Loans Made....................................................................... Schedule H, Une 3
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. ....................................... Addlines8+9+10 $
Current Cash Statement
12. Beginning Cash Balance ............................ Previous Summa,Y Page, Line 16 $
13. Cash Receipts ............................................ 0 •••••••••••••• ColumnA,Line3above
14. Miscellaneous Increases to Cash.................................. Schedule 1, Line 4
15. Cash Payments ......................................................... ColumnA,Line8above
16. ENDING CASH BALANCE .................. Add Lines 12 + 13 + 14, then subtractune 15 $
If this is a termination statement, Line 16 must be zero.
17. LOAN GUARANTEES RECEIVED ................................ Schedule B, Parl 2 $
Cash Equivalents and Outstanding Debts
18. Cash Equivalents ................................................ See instructions on reverse $
19. Outstanding, Debts.............................. Add Line 2 + Lina 9 in Column B above $
Amounts may be rounded
to whole dollars.
Column A
TOTAL THIS PERIOD
(FROM ATTACHED SCHEDULES)
4950
4950
4950
1106.54
1106.54
1106.54
16996.26
4950
1106.54
20839.72
SUMMARY PAGE
Statement covers period CALIFORNIA 460
FORM 7/1/19 from _________ _
2 4 9/21/19 through ________ _ Page ___ of __ _
$
$
$
$
$
$
Column B
CALENDAR YEAR
TOTAL TO DATE
14910
14910
14910
2792.13
2792.13
2792.13
To calculate Column B,
add amounts in Column
A to the corresponding
amounts from Column B
of your last report. Some
amounts in Column A may
be negative figures that
should be subtracted from
previous period amounts. If
this is the first report being
filed for this calendar year,
only carry over the amounts
from Lines 2, 7, and 9 (if
any).
I.D.NUMBER
881536
Calendar Year Summary for Candidates
Running in Both the State Primary and
General Elections
1/1 through 6/30 7/1 to Date
20. Contributions
Received $ _____ _ $ ____ _
21. Expenditures
Made $ _____ _ $ ____ _
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made*
(If Subject to Voluntary Expenditure 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/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 CONT°R.JBlJTOR CONTRIBUTOR
(IF COMMITTEE,ALSO ENTER 1.D. NUMBER) . CODE *
IF.AN INDIVIDUAL. ENTER
OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER NAME
OF BUSINESS)
7/15/19
8/15/19
9/15/19
Palm Springs Firefighters Association
180 N Luring Dr.
Palm Springs, CA 92262
ID# 881536
Palm Springs Firefighters Association
180 N Luring Dr.
Palm Springs, CA 92262
ID# 881536
Palm Springs Firefighters Association
180 N Luring Dr.
Palm Springs, CA 92262
ID# 881536
Schedule A Summary
•IND
!!".ICOM
00TH •PTY •sec
•IND
iZJCOM
00TH •PTY •sec
•IND
li2l COM •oTH •PTY •sec
•IND •COM
DOTH •PTY •sec
•IND •COM
00TH •PTY •sec
SU_BTOTAL$
SCHEDULE A
Statement covers period
CALIFORNIA 460
FORM from ____ 7_/_1_/1_9 __ _
through ___ 9_12_1_1_19 __ _ Page __ 3 __ of __ 4 __
AMOUNT
REC-EIVED THIS
PERIOD
$1650
$1650
$1650
I.D. NUMBER
881536
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 • DEC. 31)
$11610
$13260
$14,910
PER ELECTION
TO DATE
(IF REQUIRED)
*Contributor Codes
IND -Individual 1. Amount received this period -itemized monetary contributions.
(Include all Schedule A subtotals.) ......................................................................................................... $ _____ 4_9_5_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.
(Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ...................... TOTAL $ _____ 4_9_5_0
sec -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
Palm Springs Fire Safetf-'Assciciation PAC
!':.
DATE
9/6/19
NAME OF CANDIDATE, OFFICE, AND DlSTRICT, OR
MEASURE NUMBER OR LETTER ANO JURISDICTION,
OR COMMITTEE
Geoff Kors, City Council, District 3
D Support D Oppose·
D Support D Oppose
D Support D Oppose
Schedule D Summary
Amounts may be rounded
to whole dollars.
-:c.....,..
TYPE OF PAYMENT
iZI Monetary
Contribution
• Non monetary
Contribution
• Independent
Expenditure
• Monetary
Contribution
• Nonmonetary
Contribution
• Independent
Expenditure
• Monetary
Contribution
• Nonmonetary
Contribution
• Independent
Expenditure
~
DESCRIPTION
(IF REQUIRED)
SUBTOTAL
Statement covers period
from ----'-7'--'/1"-/1-'-9'---
through, ___ 9"-/"'2-'-1 /'-'1~9 __
SCHEDULED
CALIFORNIA 460
FORM
Page __ 4_ of __ 4_
I.D. NUMBER ,.,
881536'>-.
!':.
AMOUNT THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 -DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
$1000 $1000
$
1. Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.) ....................................................... $ ____ ..c10,,,o,,o,....
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 .. $ _____ 1,.,0,,0"'0'--
FPPC Form 460 (Jan/2016)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov