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Roland Velasco - Form 460 - 2016/11/02 - 2016/12/31Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200 - 84216.5) fro Type or print in ink. Statement covers period I Date of election if applicable: 11/02/2016 (Month, Day, Year) m SEE INSTRUCTIONS ON REVERSE I through 12/31/2016 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 O Recall Q Controlled (Also Complete Part 5) O Sponsored (Also Complete Part s) ❑ General Purpose Committee Q Sponsored Q Small Contributor Committee Q Political Party /Central Committee W] 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 STATE ZIP CODE AREA CODE /PHONE COVER PAGE Date Stamp CALIFORNIA FORM 460 e of 9 For Official Use Only 11/8/2016 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 STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 408 842 -8698 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE /PHONE OPTIONAL: FAX / E -MAIL ADDRESS OPTIONAL: FAX / E -MAIL ADDRESS roland @rolandvelasco.co joaniemiewis @charter.knet 4. Verification 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. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on Date Executed on i& Data Executed on Data By By By Signature of Controlling Officeholder, Candidate, State Measure Proponent Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Forth 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275.3772) State of California Type or print in ink. COVERPAGE -PART2 Recipient Committee RNIA Campaign Statement O CALIFORM 4 • 0 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 RESIDENTIAL/BUSINESS 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 Page 2' of 9 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION ❑ 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. COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary 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 FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661276 -3772) State of California Campaign Disclosure Statement Summary Page Type or print in ink. Amounts may be rounded to whole dollars. Statement covers period from 11/02/2016 SUMMARY PAGE FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) through 12/31/2016 Page 4 of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Roland Velasco for Mayor 2016 1383384 Contributions Received Column Column B Calendar Year Summary for Candidates TOTALTHISPERIOD (FROM ATTACHED SCHEDULES) CALENDAR YEAR TOTALTODATE Running in Both the State Primary and General Elections 1. Monetary Contributions ............ ............................... schedule A, Line 3 $ 63.50 $ 61102.50 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 $ 63.50 $ 62102.50 20. Contributions Received $ $ 4. Nonmonetary Contributions ..... ............................... Schedule C, Line 3 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ........................... Add Lines 3 +4 $ 63.50 $ 62102.50 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made ........................ ............................... Schedule E, Line 4 $ 5075.76 $ 53488.49 Candidates 7. Loans Made .............................. ............................... Schedule H, Line 3 8. SUBTOTAL CASH PAYMENTS ..... ............................... Add Lines 6 + 7 $ 5075.76 $ 53488.49 22• Cumulative Expenditures Made* (if Subject to voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) ........ ....................... Schedule F Line 3 Date of Election Total to Date 10. Nonmonetary Adjustment ............. ............................. Schedule C, Line 3 (mm /dd /yy) 11. TOTAL EXPENDITURES MADE . ............................... Add Lines s + 9 + 10 $ 5075.76 $ 53488.49 $ $ Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 13625. 77 To calculate Column B, add 13. Cash Receipts .................... ............................... Column A, Line 3 above 63.50 amounts in Column A to the 14. Miscellaneous Increases to Cash ........................... schedule /, Line 4 corresponding amounts from Column B of your last *Amounts in this section may be different from amounts reported in Column B. 15. Cash Payments ................... ............................... Column A, Line s above 5075. 76 report. Some amounts in Column A may be negative 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 8613.51 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 17. LOAN GUARANTEES RECEIVED ........................... Schedule e, Part 2 $ for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if Cash E Equivalents and Outstanding Debts q 9 any). 18. Cash Equivalents ......... ............................... See instructions on reverse $ 19. Outstanding Debts ......................... Add Line 2 +Line s in Column a above $ 1000.00 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule A Type or print in ink. SCHEDULE A ramounts may De rounaea Monetary Contributions Received Statement covers period p to whole dollars. C CALIFORNIA , 1 from \6�\ �•bt �. • • - through 1�►� 3' Page Aj of SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Roland Velasco for Mayor 2016 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIB UTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITEE,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) ❑IND 12/09/2016 Roland Velasco EICOM Refund from City of 63.50 63.50 9720 Bunting Court W1 OTH Gilroy from 2016 Gilroy, Ca 95020 ❑ PTY Campaign ❑SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL$ 63.50 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.) ...... ............. $ .................... $ 63.50 ........... TOTAL $ 63.50 *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 B - PART 1 Schedule B — Part 1 'ry -m, ry""b' ," "u... Amounts may be rounded Statement covers period P Loans Received to whole dollars. 11/02/2016 CALIFORNIA • from FORM 12/31/2016 Page SEE INSTRUCTIONS ON REVERSE through of NAME OF FILER I.D. NUMBER _ 20 1 1383384 l �l � 6 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTE OCCUPATION AND EMPLOYER a OUTSTANDING BALANCE (b) AMOUNT (�) AMOUNT PAID (d) OUTSTANDING BALANCEAT (e) INTEREST ( ORIGINAL (g) CUMULATIVE OF LENDER (IFCOMMITTEE, ALSO ENTER I.D. NUMBER) (IFSELF- EMPLOYED, ENTER BEGINNING THIS RECEIVED THIS PERIOD OR FORGIVEN CLOSE OF THIS PAID THIS PERIOD AMOUNT OF CONTRIBUTIONS TO DATE NAMEOF BUSINESS) E IOD THIS PERI00* ERI LOAN Roland Velasco District Aide Supervisor ❑ PAID CALENDAR YEAR 9720 Bunting Court Mike Wasserman $ $ 1000.00 % s 1000.00 $ 1000.00 ❑FORGIVEN PER ELECTION** Gilroy, Ca 95020 RATE $ 1000.00 $ $ $ 2/16/201 $ tv IND El COM [:3 OTH [_1 PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR ❑ FORGIVEN PER ELECTION ** RATE S S S S S DATEDUE DATE INCURRED t ❑ IND El COM El OTH ❑PTY El SCC ❑ PAID CALENDAR YEAR ❑ FORGIVEN PER ELECTION ** RATE f IND ❑ COM ❑ OTH ❑ PTY ❑ SCC s s s S a DATE DUE 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. A SCHEDULEE Amounts may Statement covers period Payments Made to whole be rounded dollars. from 11/02/2016 • • ' SEE INSTRUCTIONS ON REVERSE through 12/31/2016 page_ of NAME OF FILER 1 I.D. NUMBER 1383384 v CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CtirP campaign paraphernalialmisc. 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 filingiballot 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 LrT 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 AMOUNTPAID Moxxy Marketing Revision to campaign Brochure 380 Main Street LIT Invoice 4497 40.00 Salinas, Ca 93901 Moxxy Marketing Design postcards 380 Main Street LIT Invoice 4498 975.00 Salinas, Ca 93901 Old City Hall Old City Hall Restaurant 7400 Monterey Street CMP Banquet/Election Night 500.00 Gilroy, Ca 95020 " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 1515.00 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) ............................................................................... ............................... $ Z475-7- Zr 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 $ 4rZI16 -v/ FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 1ASK -FPPC (866/275 -3772) Schedule E CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Susan Mister SCHEDULE E (CONT.) (Continuation Sheet) or print in ink. Amounts may be rounded Statement covers p period • ' ' , Payments Made to whole dollars. from 11/02/2016 • • ' Susan Mister through 12/31/2016 h Page of AL_ SEE INSTRUCTIONS ON REVERSE CMP 91.83 —I-- NAME OF FILER l Roland Velasco I.D. NUMBER Hall of Fame Lunch 9720 Bunting Court MTG 1383384 CODES: If one of the following codes accurately Ascribes the payment, you may enter the code. Otherwise, describe the payment. CW campaign paraphemalia /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 W 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 Susan Mister Printing Walk Flyers 9265 Braquet Lane LIT 71.35 Gilroy, CA 95020 Susan Mister Election Night Costs -Cake, Balloons, And Gift Card 9265 Braquet Lane CMP 91.83 Gilroy Ca 95020 Roland Velasco Hall of Fame Lunch 9720 Bunting Court MTG 45.00 Gilroy Ca 95020 Roland Velasco Gilroy Downtown Association Beer Crawl 9720 Bunting Court CVC 40.00 Gilroy, Ca 95020 Roland Velasco Printing Walk List 9720 Bunting Court LIT 187.50 Gilroy, Ca 95020 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 435.68 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/275 -3772) Schedule E SCHEDULE E (CONT.) Type or print in ink. d i covers period (Continuation Sheet) Amounts may be rounded Statement • ' 4 . 1 Payments Made to whole dollars. from 11/02/2016 pa a SEE INSTRUCTIONS ON REVERSE through 12/31/2016 of g 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. Clue 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 PEr 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 FIND 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 1.0. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Roland Velasco Lumber for repair of signs 9720 Bunting Court CMP 28.38 Gilroy, Ca 95020 Roland Velasco Gilroy Recreation -Youth Scholarship Funraiser 9720 Bunting Court CVC 90.27 Gilroy, Ca 95020 Roland Velasco Name tags for election night 9720 Bunting Court CMP 6.51 Gilroy, Ca 95020 Joan Lewis Facebook and Google Campaign Activity 8130 Oak court WEB 2742.30 Gilroy, Ca 95020 Joan Lewis Ink for Printer 8130 Oak Court OFC 63.06 Gilroy Ca 95020 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 2930.52 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661275 -3772) Schedule E CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID David Ferry Photography SCHEDULE E (CONT.) (Continuation Sheet) Type or print in ink. Amounts may be rounded Statement covers period • _ J ' Payments Made Gilroy, Ca 95020 to whole dollars . from 11/02/2016 � FPag, Ink for Printer 9720 Bunting Court through 12/31 /2016 of SEE INSTRUCTIONS ON REVERSE Gilroy, Ca 95020 Political Reform Division NAME OF FILER Annual Fee 1500 11th Street -Room 495 FIL I.D. NUMBER Roland Velasco for Mayor 2016 Sacramento, Ca 95814 ID #1383384 1383384 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CW campaign paraphemalia /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 M 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 I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID David Ferry Photography Photography of Ceremony Coverage PRO Invoice #121916001 125.00 Gilroy, Ca 95020 Roland Velasco Ink for Printer 9720 Bunting Court OFC 19.56 Gilroy, Ca 95020 Political Reform Division Annual Fee 1500 11th Street -Room 495 FIL Local Campaign 50.00 Sacramento, Ca 95814 ID #1383384 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 194.56 FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 8661ASK -FPPC (8661275 -3772)