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2012/07/01 - 2012/12/31 - AFSCME - Form 460Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200 - 84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period from 07/01/12 through 12/31/12 1. Type of Recipient Committee: All Committees – Complete Parts 1, 2, 3, and 4. ❑ Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure Q State Candidate Election Committee Committee Q Recall Q Controlled (Also Complete Part 5) Q Sponsored (Also complete Part 6) ® General Purpose Committee ® Sponsored Q Small Contributor Committee Q Political Party /Central Committee 3. Committee Information NAME (OR CANDIDATE'S NAME IF NO AFSCME LOCAL 101 AFL -CIO PAC ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) I.D. NUMBER STREET ADDRESS (NO P.O. BOX) 1150 N. 1ST ST CITY STATE ZIP CODE AREA CODE /PHONE SAN JOSE CA 95112 408 - 998 -2070 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE /PHONE Date Stamp Date of election if applicable: f1 + (Month, Day, Year) L�l� 11103/12 2. Type of Statement: ❑ Preelection Statement ® Semi - annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) COVER PAGE Page --I— of For Official Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report ❑ Supplemental Preelection Statement - Attach Form 495 Treasurer(s) NAME OF TREASURER CAROL GARCIA MAILING ADDRESS MAILING ADDRESS CITY STATE ZIP CODE AREA CODE /PHONE OPTIONAL: FAX / E -MAIL ADDRESS OPTIONAL: FAX / E -MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my Assistant Treasurer Executed on Date BY Signature of Controlling Officeholder, Candidate, State Measure Proponent or Responsible Officer of Sponsor Executed on Data BY Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on Date BY Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866/ASK -FPPC (86612753772) State of Callfomla Campaign Disclosure Statement Summary Page CCC 1KICT01 11'T1f)MQ nW RFVFRSF NAME OF FILER AFSCME LOCAL 101 AFL -CIO PAC Contributions Received 1. Monetary Contributions .......................... 2. Loans Received ...... ............................... 3. SUBTOTAL CASH CONTRIBUTIONS .... 4. Nonmonetary Contributions ................... 5. TOTAL CONTRIBUTIONS RECEIVED ••, Type or print in ink. Amounts may be rounded to whole dollars. Expenditures Made 6. Payments Made Schedule E, Line 4 $ 14,250.00 7. Loans Made .............................. ............................... Schedule H, Line 3 0 B. SUBTOTALCASH PAYMENTS ..... ............................... Add Lines 6 + 7 $ 14,250.00 9. Accrued Expenses (Unpaid Bills .... Schedule F Line 3 0 10. Nonmonetary Adjustment ........... ............................... Schedule C, Line 0 11. TOTAL EXPENDITURES MADE ................................ AddLines8 +s +10 $ 14,250.00 Statement covers period 07/01/12 from through Column B CALENDARYEAR TOTALTO DATE $ 70,000.00 0 70,000.00 0 $ 70,000.00 $ 69,250.00 0 $ 69,250.00 0 0 $ 69,250.00 Current Cash Statement Column A TOTALTHIS PERIOD 2,909.28 (FROMATTACHED SCHEDULES) ............... Schedule A, Line 3 $ 15,000.00 ................ Schedule A Line 3 0 .................... Add Lines 1 + 2 $ 15,000.00 ................ Schedule C, Line 3 0 ....................... Add Lines 3 + 4 $ 15,000.00 Expenditures Made 6. Payments Made Schedule E, Line 4 $ 14,250.00 7. Loans Made .............................. ............................... Schedule H, Line 3 0 B. SUBTOTALCASH PAYMENTS ..... ............................... Add Lines 6 + 7 $ 14,250.00 9. Accrued Expenses (Unpaid Bills .... Schedule F Line 3 0 10. Nonmonetary Adjustment ........... ............................... Schedule C, Line 0 11. TOTAL EXPENDITURES MADE ................................ AddLines8 +s +10 $ 14,250.00 Statement covers period 07/01/12 from through Column B CALENDARYEAR TOTALTO DATE $ 70,000.00 0 70,000.00 0 $ 70,000.00 $ 69,250.00 0 $ 69,250.00 0 0 $ 69,250.00 Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 2,909.28 To calculate Column B, add 13. Cash Receipts Column A, Line 3 above 15,000.00 amounts in Column A to the corresponding amounts 14. Miscellaneous Increases to Cash ........................... Schedule 1, Line 4 0 from Column B of your last 14,250.00 report. Some amounts in 15. Cash Payments .................. ............................... Column A, Line 8 above Column A may be negative 16. ENDING CASH BALANCE. Add Lines 12 + 13 + 14, then subtract Line 15 $ 3,259.28 figures that should be subtracted from previous If this is a termination statement, Line 16 must be zero. period amounts. If this is the first report being filed for this calendar year, only 0 17. LOAN GUARANTEES RECEIVED ........................... Schedules, Part 2 $ carry over the amounts from Lines 2, 7, and 9 (if Cash Equivalents and Outstanding Debts any). 18. Cash Equivalents ......... ............................... See instructions on reverse $ 0 19. Outstanding Debts ......................... Add Line 2 + Line 9 in Column B above $ 0 SUMMARY PAGE 12/31/12 Page 2 of- I.D. NUMBER 821697 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 $ 0 0 $ 21. Expenditures Made $ 0 $ 0 Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (K Subject to Voluntary Expenditure Llmlt) Date of Election Total to Date (mm /dd /yy) $ 0 $ 0 *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule A Type or print in Ink. SCHEDULE A Amounts may as rounaea Monetary Contributions Received Statement covers period iI to whole dollars. CALIFORNIA • 07/01/12 from FORM through 12131/12 3 SEE INSTRUCTIONS ON REVERSE Page of NAME OF FILER I.D. NUMBER AFSCME LOCAL 101 AFL -CIO PAC 821697 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE, ALSO ENTERI.D,NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF SELF - EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ❑IND AFSCME LOCAL 101 ❑COM 8/26/12 1150 N. 1ST STREET ®OTH 15,000.00 70,000.00 SAN JOSE, CA 95112 ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL $ Schedule A Summary 1. Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.) ......................................................................... ............................... $ 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 $ 15,000.00 0 15,000.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866/ASK-FPPC (8661275 -3772) *Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC — Small Contributor Committee Schedule D RC:HFni 11 F n Summary of Expenditures Type or print in ink. Statement covers period - , Supporting/Opposing Other Amounts may be rounded to whole dollars. 07/01/12 • - U1111111 i Candidates, Measures and Committees from 12/31/12 page �' of SEE INSTRUCTIONS ON REVERSE through NAME OF FILER I.D. NUMBER AFSCME LOCAL 101 AFL -CIO PAC 821697 DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR TYPE OF PAYMENT DESCRIPTION AMOUNT THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE MEASURE NUMBER OR LETTER AND JURISDICTION, (IF REQUIRED) PERIOD (JAN.1 -DEC. 31) (IF REQUIRED) OR COMMITTEE VOTE JIMMY NGUYEN FOR CITY Monetary CHECK #1510 8/16/12 COUNCIL 2012 Contribution PAC CONTRIBUTION 500.00 500.00 500.00 4848 SAN FELIPE #150 ❑ Nonmonetary SAN JOSE, CA 95135 FPPC# 1344095 Contribution ❑ Independent m Support ❑ Oppose Expenditure 9/20/12 COMMITTE TO SUPPORT LOCAL 0 Monetary Contribution CHECK # 1511 5,000.00 SCHOOLS YES ON MEASURE H PAC CONTRIBUTION 5,000.00 5,0000.00 1346 THE ALAMEDA SUITE 7125 ❑Nonmonetary SAN JOSE, CA 95126 FPPC# 1351261 Contribution ❑ Independent 0 Support ❑ Oppose Expenditure SAFE, CLEAN WATER FOR OUR FUTURE, m Monetary CHECK # 1212 9/28/12 YES ON MEASURE B Contribution PAC CONTRIBUTION 5,000.00 5,000.00 5,000.00 2125 CANOAS GARDEN AVE SUITE 120 ❑ Nonmonetary SAN JOSE, CA 95125 FPPC# 1350538 Contribution ❑ Independent ® Support ❑ Oppose Expenditure SUBTOTAL $ 10,500.00 Schedule D Summary 1. Itemized contributions and independent expenditures made this period. Include all Schedule D subtotals. $ 14,250.00 2. Unitemized contributions and independent expenditures made this period of under $100 0 3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enter on the Summa ry Pa e. ) ............ TOTAL $ 14,250.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 1A3K -FPPC (8861275 -3772) Schedule D (Continuation Sheet) Type or print in Ink. SCHEDULE D (CONT.) Amounts may be rounded Summary of Expenditures to whole dollars. Supporting /Opposing Other Candidates, Measures and Committees Statement covers period from 07/01112 CALIF •' • 460 • - page of AL through 12/31/12 NAME OF FILER I.D. NUMBER AFSCME LOCAL 101 AFL -CIO PAC 821697 DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR MEASURE NUMBER OR LETTER AND JURISDICTION, OR COMMITTEE TYPE OF PAYMENT DESCRIPTION (IF REQUIRED) AMOUNT THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. t -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 10/03/12 ELECT DAVID GINSBORG FOR WATER DISTRICT 2012 ® Monetary Contribution CHECK #1513 PAC CONTRIBUTION 500.00 500.00 500.00 C/O 911 FRUITDALE PLACE ❑ Nonmonetary SAN JOSE, CA 95126 FPPC# 1342512 Contribution ❑ Independent ® Support ❑ Oppose Expenditure 10/18/12 ARMENDARIZ FOR CITY COUNCIL 2012 490 LAS ANIMAS GILROY, CA 95020 FPPC# ® Monetary Contribution ❑ Nonmonetary Contribution CHECK # 1514 PAC CONTRIBUTION 250.00 250.00 250.00 ❑ Independent Support ❑ Oppose Expenditure 10/18/12 TERESA CASTELLANOS FOR SJUSD 2012 789 N. 3RD ST Monetary Contribution CHECK #1515 PAC CONTRIBUTION 250.00 250.00 250.00 SAN JOSE, CA 95112 FPPC #1343111 ❑ Nonmonetary Contribution ❑ Independent Support ❑ Oppose Expenditure 10/18/12 CAT TUCKER FOR CITY COUNCIL 9440 EAGLE VIEW WAY Monetary Contribution CHECK #1516 PAC CONTRIBUTION 250.00 250.00 250.00 GILROY, CA 95020 FPPC# 1298566 ❑ Nonmonetary Contribution ❑ Independent �j Support ❑ Oppose Expenditure SUBTOTAL $ 1,250.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661278.3772) Schedule D (Continuation Sheet) Type or print in Ink. SCHEDULE D (CONT.) Amounts may be rounded Summary of Expenditures to whole dollars. Supporting /Opposing Other Candidates, Measures and Committees Statement covers period from 07/01/12 • ' 460 • - Page of through 12/31/12 NAME OF FILER I.D. NUMBER AFSCME LOCAL 101 AFL -CIO PAC 821697 DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR MEASURE NUMBER OR LETTER AND JURISDICTION, OR COMMITTEE TYPE OF PAYMENT DESCRIPTION (IF REQUIRED) AMOUNT THIS PERIOD CUMULATIVE TO DATE CALENDAR YEAR (JAN. -DEC. 31) PER ELECTION TO DATE (IF REQUIRED) 10/18/12 FRIENDS OF JIM BEALL PO BOX 72007 SAN JOSE, CA 95172 FPPC# 1304649 ® Monetary Contribution ❑ Nonmonetary Contribution CHECK #1517 2,500.00 3,500.00 3,500.00 ❑ Independent ® Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure ❑ Monetary Contribution ❑ Nonmonetary Contribution ❑ Independent ❑ Support ❑ Oppose Expenditure SUBTOTAL $ 2,500.00 FPPC Form 460 (January/05) FPPC Toil -Free Helpline: 866/ASK-FPPC (8661275.3772) Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER AFSCME LOCAL 101 AFL -CIO PAC Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 07/01/12 through 12/31/12 Page • of -f- 821697 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 RFD radio airtime and production costs returned contributions CNS campaign consultants MTG OFC meetings and appearances office expenses SAL campaign workers' salaries CTB contribution (explain nonmonetary)* PET petition circulating TEL t.v. or cable airtime and production costs CVC FIL civic donations candidate filing /ballot fees PHO phone banks TRC TRS candidate travel, lodging, and meals staff /spouse travel, lodging, and meals FND IND fundraising events independent expenditure supporting /opposing others (explain)* POL POS polling and survey research postage, delivery and messenger services TSF transfer between committees of the same candidate /sponsor LEG legal defense PRO professional services (legal, accounting) VOT WEB voter registration information technology costs (internet, e-mail) L.IT campaign literature and mailings PRT print ads NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE, ALSO ENTER I.D. NUMBER) VOTE JIMMY NGUYEN FOR CITY COUNCIL 2012 CHECK # 1510 4848 SAN FELIPE #150 CTB 500.00 SAN JOSE, CA 95135 FPPC# 1344095 COMMITTE TO SUPPORT LOCAL SCHOOLS YES ON MEASURE H CTB CHECK # 1511 5,000.00 1346 THE ALAMEDA SUITE 7125 SAN JOSE, CA 95126 FPPC# 1351261 SAFE, CLEAN WATER FOR OUR FUTURE, YES ON MEASURE B CTB CHECK #1512 5,000.00 2125 CANOAS GARDEN AVE SUITE 120 SAN JOSE, CA 95125 FPPC# 1350538 * Payments that are contributions or Independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 10,500.00 Schedule E Summary 14,250.00 1. Itemized payments made this period. (Include all Schedule E subtotals.) ............................................................................... ............................... $ 0 2. Unitemized payments made this period of under $100 ••••••..••..... ..•.•.•.......•••••.•'•"......• $ .......... 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ..................................... ............................... ......... $ 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ............................. TOTAL $ u 14,250.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661275 -3772) Schedule E (Continuation Sheet) Payments Made Type or print In ink. Amounts may be rounded to whole dollars. Statement covers period from 07/01/12 SCHEDULE E (CONT.) iEE INSTRUCTIONS ON REVERSE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE, ALSO ENTER I.D. NUMBER) through 12/31 /12 Page _$_ of VAME OF FILER CHECK #1513 C/0 911 FRUITDALE PLACE I.D. NUMBER AFSCME LOCAL 101 AFL -CIO PAC 500.00 SAN JOSE, CA 95126 FPPC# 1342512 821697 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. 3VP campaign paraphernalia /misc. MBR member communications RAD radio airtime and production costs CM 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 RL 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 1 IT ramnainn literature and mailinas PRT print ads WEB information technology costs (internet, e-mail) NAME AND ADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE, ALSO ENTER I.D. NUMBER) ELECT DAVID GINSBORG FOR WATER DISTRICT 2012 CHECK #1513 C/0 911 FRUITDALE PLACE CTB 500.00 SAN JOSE, CA 95126 FPPC# 1342512 ARMENDARIZ FOR CITY COUNCIL 2012 CHECK # 1514 250.00 490 LAS AN I MAS CTB GILROY, CA 95020 TERESA CASTELLANOS FOR SJUSD 2012 CHECK # 1515 250.00 789 N. 3RD ST CTB SAN JOSE, CA 95112 FPPC# 1343111 CAT TUCKER FOR CITY COUNCIL CHECK # 1516 250.00 9440 EAGLE VIEW WAY CTB GILROY, CA 95020 FRIENDS OF JIM BEALL CHECK # 1517 2,500.00 P.O. BOX 72007 CTB SAN JOSE, CA 95172 FPPC# 1304649 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 3,750.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661275 -3772)