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Roland Velasco - Form 460 - 2016/10/23 - 2016/11/01Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200 - 84216.5) SEE INSTRUCTIONS ON REVERSE fro Type or print in ink. Statement covers period I Date of election if applicable m 10/23/2016 (Month, Day, Year) through 11/1/2016 I 11/8/2016 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. ❑ Officeholder, Candidate Controlled Cc-nmittee Q State Candidate Election Committee Q Recall (Also Complete Part 5) ❑ General Purpose Committee Q Sponsored Q Small Contributor Committee Q Political Party /Central Committee ❑ Primarily Formed Ballot Measure Committee Q Controlled Q Sponsored (Also Compete Part 6) ® Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 3. Committee Information I -D. NUMBER 1383384 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Roland Velasco for Mayor 2016 STREET ADDRESS (NO P.O. BOX) 9720 Bunting Court CITY STATE ZIP CODE AREA CODE /PHONE Gilroy Ca 95020 408 710 -8508 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY OPTIONAL: FAX / E -MAIL ADDRESS roland @rolandvelasco.co STATE ZIP CODE AREA CODE /PHONE COVER PAGE Stamp H04, '- .,. ge - of 9 ` X016 O For Official Use Only 2. Type of Statement: Preelection Statement ❑ Semi - annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) ❑ Quarterly Statement ❑ Special Odd -Year Report ❑ Supplemental Preelection Statement - Attach Form 495 Treasurer(s) NAME OF TREASURER Joan M. Lewils MAILING ADDRESS 8130 Oak Court CITY Gilroy STATE CA ZIP CODE AREA CODE /PHONE 95020 408 842 -8698 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE /PHONE OPTIONAL: FAX / E -MAIL ADDRESS joaniemlewis @charter. knet 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to By Signature of Controlling Officeholder, Candidate, State Measure Proponent By Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/276 -3772) State of California Recipient Committee Type or print in ink. COVERPAGE -PART2 Campaign Statement CALIFORNIA • 1 Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Roland Velasco OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Mayor RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP 9720 Bunting Court Gilroy, Ca 95020 Related Committees Not Included in this Statement: List any committees not included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION Page ;l' of L ❑ SUPPORT ❑ OPPOSE Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate /Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee is primarily formed. NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT Roland Velasco Mayor ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) State of California Campaign Disclosure Statement Summary Page Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period frnm 10/23/2016 SUMMARY PAGE Expenditures Made 6. Payments Made ........................ ............................... Schedule E, Line 4 $ through 11/1/2016 Page 3L of 9 SEE INSTRUCTIONS ON REVERSE 9. Accrued Expenses (Unpaid Bills) ........ ....................... Schedule F Line 3 10. Nonmonetary Adjustment ........... ............................... Schedule c, Line 3 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 +9 +to $ NAME OF FILER I.D. NUMBER 1383384 Contributions Received olulmn AoD Colu�mn B Calendar Year Summary for Candidates To (FROMATTACHED SCHEDULES) TOTALTODATE Running in Both the State Primary and General Elections 1. Monetary Contributions ............ ............................... Schedule A, Line 3 $ 6250.00 $ 61039.00 2. Loans Received ....................... ............................... schedule e. Line 3 1000.00 1/1 through 6/30 7/1 to Date 3. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 + 2 $ 6250.00 $ 62039.00 20. Contributions Received $ $ 4. Nonmonetary Contributions ..... ............................... schedule C, Line 3 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED •..• ... ....................AddLines3 +4 $ 6250.00 $ 62039.00 Made $ $ Expenditures Made 6. Payments Made ........................ ............................... Schedule E, Line 4 $ 7. Loans Made .............................. ............................... Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS ..... ............................... Add Lines 6 + 7 $ 9. Accrued Expenses (Unpaid Bills) ........ ....................... Schedule F Line 3 10. Nonmonetary Adjustment ........... ............................... Schedule c, Line 3 11. TOTAL EXPENDITURES MADE ................................ Add Lines 8 +9 +to $ Current Cash Statement 12. Beginning Cash Balance.. ..................... Previous summary Page, Line 16 $ 13. Cash Receipts .................... ............................... Column A, Line 3above 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 Lime 15 $ If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ........................... Schedule e, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents ......... ............................... See instructions on reverse $ 19. Outstanding Debts ......................... Add line 2 +Line 9 in Column 8 above $ 10342.64 $ 48412.73 10342.64 $ 48412.73 10342.64 $ 48412.73 17718.41 6250.00 10342.64 13625.77 1000.00 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). Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made' (If Subject to voluntary Expenditure Limit) Date of Election Total to Date (mm /dd /yy) -/� $ I 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 Monetary Contributions Received Amounts may be rounded ry on Statement covers period - to whole dollars. ' from 10/23/2016 - • through 11/1/2016 9 Pa y of 9 Page 9 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Roland Velasco For Mayor 2016 1383384 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED ( IFCOMM(TTEE, ALSO ENTER ID.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) VI IND 10/24/2016 John Filice ❑COM Manager Glen Loma 200.00 500.00 ❑OTH Corp. Gilroy, Ca 95020 E] PTY ❑ SCC MIND 10/24/2016 Rene T Coleman ❑COM Teacher, Santa Clara 750.00 750.00 E] OTH Unified School District Santa Clara, Ca 95050 ❑ PTY ❑ SCC ® IND 10/24/2016 David A Gillmor ❑COM Real Estate, Gillmor 750.00 750.00 E] OTH Associates Santa Clara, Ca 95050 ❑ PTY ❑ SCC ® IND 10/24/2016 David Profitt ❑COM ❑OOH Retired 750.00 750.00 Los Altos, Ca 94024 ❑ PTY ❑ SCC Michelle Profitt ®IND ❑COM Retired 10/24/2016 ❑ OTH 750.00 750.00 Los Altos,Ca 94024 ❑ PTY ❑ SCC SUBTOTAL$ 3200.00 ' Schedule A Summary Amount received this period — itemized monetary contributions. (Include all Schedule A subtotals.) ......................................................................... ............................... $ Za )• 00 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 $ Iaas7o. 06 '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 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period to whole dollars. 10/23/2016 CALIFORNIA • ' - from • 11/1/2016 S through Page of NAME OF FILER I.D. NUMBER Roland Velasco For Mayor 2016 1383384 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 ENTER I.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) OIND Charles T. Muinger, Jr. Experimental physicist, 10/24/2016 ❑OTH Stanford Linear 500.00 500.00 Palo Alto, Ca 94301 ❑ PTY Accelerator ❑ SCC Ron & Wendy Gong W]IND ❑IoM CPA CTC /MYCFO 10/24/2016 ❑ OTH 500.00 500.00 Gilroy, Ca 95020 ❑ PTY ❑ SCC Tim Filice V❑IOM Glen Loma Group 10/27/2016 []OTH Executive 200.00 200.00 Gilroy, California 95020 ❑ PTY ❑ SCC Trece Herder ❑]IND Manager Cal Atlantic 10/27/2016 ❑OTH 500.00 500.00 Fairfield, Ca 94534 ❑ PTY ❑ SCC B. Wayne Hughes, Jr. ®IND ❑COM Board Member of Public 10/28/2016 Storage. Retired g 750.00 750.00 Malibu, Ca 90265 E] PTY ❑ SCC SUBTOTAL$ 2450.00 *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 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661275 -3772) Schedule A (Continuation Sheet) Type or print in ink. SCHEDULE A (CONT) Monetary Contributions Received Amounts may be rounded Statement covers period to whole dollars. 10/23/2016 - i 1 from o 11/1/2016 9 through Page of NAME OF FILER I.D. NUMBER Roland Velasco For Mayor 2016 1383384 DATE EET A FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR ZI DE O CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED COMMITTEE, ALSOND (IF .D.N CODE OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) Ernest Fortino OCOM Owner Fortino Winery 11/1/2016 []OTH Retired 300.00 300.00 Gilroy, Ca 95020 ❑ PTY ❑SCC Al Pastor ®IND Retired 11/1/2016 ❑COM ❑ OTH 300.00 300.00 Gilroy, Ca 95020 ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL $ 600.00 *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 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) SCHEDULER -PART1 Schedule B — Part 1 Amounts may u Amounts may be rounded Statement covers period _ Loans Received to whole dollars. 10/23/2016 ' • from • 11/1/2016 7 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER I.D. NUMBER Roland Velasco For Mayor 2016 1383384 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER a OUTSTANDING BALANCE (b) AMOUNT (c) AMOUNT PAID (d) OUTSTANDING (e) INTEREST t) ORIGINAL (g) CUMULATIVE OF LENDER (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF - EMPLOYED, ENTER BEGINNING THIS RECEIVED THIS PERIOD OR FORGIVEN BALANCEAT CLOSE C THIS PAID THIS PERIOD AMOUNTOF CONTRIBUTIONS NAMEOFBUSINESS) PERIOD THIS PERIOD* PERIOD LOAN TO DATE Roland Velasco District Aide Supervisor ❑ PAID CALENDAR YEAR 9720 Bunting Court Mike Wasserman $ $ 1000.00 , $ 1000.00 $ 1000.00 ❑ FORGIVEN PER ELECTION** Gilroy, Ca 95020 RATE $ 1000.00 $ $ $ 2/16/201 $ t9 IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATEDUE DATE INCURRED ❑ PAID CALENDAR YEAR ❑ FORGIVEN PER ELECTION*" RATE s $ a a $ DATE DUE DATE INCURRED to IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ PAID CALENDAR YEAR ❑ FORGIVEN PER ELECTION*" RATE to IND ❑ COM ❑ OTH ❑ PTY ❑ SCC $ $ $ $ $ DATEDUE DATE INCURRED SUBTOTALS $ $ $ $ Schedule B Summary 1. Loans received this period ..................................................................................... ............................... $ (Total Column (b) plus unitemized loans of less than $100.) 2. Loans paid or forgiven this period .......................................................................... ............................... $ (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 3. Net change this period. (Subtract Line 2 from Line 1.) ................................ ............................... NET $ Enter the net here and on the Summary Page, Column A, Line 2. *Amounts forgiven or paid by another party also must be reported on Schedule A. ** If required. 1000.00 (May be a negative number) (Enter (e) on Schedule E, Line 3) tContributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party SCC —Small Contributor Committee FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) Schedule E Type or print in ink. Payments Made Amounts may be rounded y to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER Roland Velasco For Mayor 2016 Statement covers period from 10/23/2016 through 1111/2016 Page - of I.D. NUMBER 1383384 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment SCHEDLILEE CNP campaign paraphernalia /misc. MBR member communications RAID 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 (intemet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Legacy Print, Inc. Mailer number 4 -R1 -4 3310 Woodward Avenue LIT Invoice 9714 2489.29 Santa Clara Ca 95054 Legacy Print, Inc Postage for #4 -R1-4 3310 Woodward Avenue POS Invoice 9714 -1 2828.15 Santa Clara Ca 95054 Legacy Print Inc Tri -fold brochure 3310 Woodward Avenue LIT Invoice 9836 431.74 Santa Clara, Ca 95054 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 5,749.18 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) ......................................... ............................... 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.) .... $4�a`f ....... ............................... $ ....... TOTAL $ 1a1 3 4 a,. FPPC Form 460 (January /05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule E CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID E fundraising 2131 Capital Avenue Sacramento, Ca 95816 WEB Transaction Fees SCHEDULE E (CONT.) (Continuation Sheet) Type or print in ink. Amounts may be rounded Postcard ROL- 10,000 Print and Mailing Invoice 9720 Statement covers period CALIFORNIA 460 Payments Made to whole dollars. from 10/23/2016 • 11/1/2016 h through � Page ` % of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Roland Velasco For Mayor 2016 1383384 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CW 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 (intemet, e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID E fundraising 2131 Capital Avenue Sacramento, Ca 95816 WEB Transaction Fees 23.00 Legacy Print, Inc 3310 Woodward Avenue Santa Clara, Ca 95054 LIT Postcard ROL- 10,000 Print and Mailing Invoice 9720 4570.46 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 4593.46 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772)