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Home My WebLink AboutTom Fischer - Form 460 - 2014/10/01 - 2014/10/18Recipient Committee Campaign Statement Cover Page (Government Code Sections 84200 - 84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period from 10/01/14 through 10/18/14 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. ® Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure 0 State Candidate Election Committee Committee 0 Recall 0 Controlled (Also Complete Part 5) 0 Sponsored ❑ General Purpose Committee (Also Complete Part 6) 0 Sponsored ❑ Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee 0 Political Party/Central Committee (Also Complete Part 7) 3. Committee Information I.D. NUMBER 1366034 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) 4. Tom Fischer for City Council 2014 STREET ADDRESS (NO P.O. BOX) 745 Dawn Way CITY STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 408 - 847 -4716 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE /PHONE OPTIONAL: FAX / E -MAIL ADDRESS Date of election if applicable: (Month, Day, Year) 11/04/14 Date Stamp OCT 2014 CITY CLERKS 01-FICE GILROY, CA I 2. Type of Statement: ® Preelection Statement ❑ Semi - annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Marie P Blankley COVER PAGE Page 1 of 6 For Official Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report ❑ Supplemental Preelection Statement - Attach Form 495 MAILING ADDRESS 2290 Coral Bell Ct. CITY STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 408 - 842 -4544 NAME OF ASSISTANT TREASURER. IF ANY Tom Fischer MAILING ADDRESS 745 Dawn Way CITY STATE ZIP CODE AREA CODE /PHONE Gilroy CA 95020 408 - 847 -4716 OPTIONAL: FAX / E -MAIL ADDRESS 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 v By / It of rAssis nt urer Executed on Z� y By✓ Date Sionalure of o!i r Canalilike. State Medglire Pr000nent of Resoonsible Officer of Soonsru Executed on Date Executed on By Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/06) FPPC Toll -Free Helpline: 866 /ASK -FPPC (866/276 -3772) State of California Recipient Committee Type or print in ink. COVERPAGE -PART2 Campaign Statement F CALIFORNIA • it Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Tom Fischer OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) City Council Member, City of Gilroy RESIDENTIAIJBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP 745 Dawn Way Gilroy, CA 95020 Related Committees Not Included in this Statement: Listany 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 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER I CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Page 2 of 6 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER I JURISDICTION I El 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 officeholders) or candidate(s) for which this committee is primarily formed. 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 NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE Attach continuation sheets ff necessary FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661276 -5772) State of California Campaign Disclosure Statement Summary Page Type or print In ink. Amounts may be rounded to whole dollars. Statement covers period from 10/01/14 SUMMARY PAGE SEE INSTRUCTIONS ON REVERSE $ 6. Payments Made ........................ ............................... schedule E, Line 4 $ through 10/18/14 page 3 of 6 NAME OF FILER 10. Nonmonetary Adjustment ........... ............................... Schedule C, Linea 11. TOTAL EXPENDITURES MADE . ............................... Add Lines 8 + g + 10 $ I:D. NUMBER Tom Fischer for City Council 2014 figures that should be subtracted from previous 1366034 Contributions Received the first report being filed Column A Column B Calendar Year Summary for Candidates carry over the amounts TOTALTHISPERIOD (FROMATTACHED SCHEDULES) CALENDAR YEAR TOTALTODATE Running in Both the State Primary and FPPC Form 460 (January/05) General Elections 1. Monetary Contributions ............ ............................... Line 3 Schedule A, li 1600.00 $ $ 9749.00 2. Loans Received ....................... ............................... Schedule B, Line 3 7500.00 _ _ 1/1 through 6/30 7/1 to Date 3. SUBTOTAL CASH CONTRIBUTIONS ......................... nes 1 +2 Add Lines 1600.00 $ $ 17249.00 20. Contributions Received $ $ 4. Nonmonetary Contributions ..... ............................... schedule C, Line 3 50.05 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED •..•..• .• ..................AddLines3 +4 $ 1600.00 $ 17299.05 Made $ $ Expenditures Made $ 6. Payments Made ........................ ............................... schedule E, Line 4 $ 7. Loans Made .............................. ............................... schedule H, Line 3 8. SUBTOTALCASH PAYMENTS ..... ............................... Add Lines 6 +7 $ 9. Accrued Expenses (Unpaid Bills) ............................... schedule F Line 3 10. Nonmonetary Adjustment ........... ............................... Schedule C, Linea 11. TOTAL EXPENDITURES MADE . ............................... Add Lines 8 + g + 10 $ 122.94 $ 122.94 $ 122.94 $ Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, Line 16 $ 4212.89 13. Cash Receipts .................... ............................... Column A, Line 3 above 1600.00 14. Miscellaneous Increases to Cash ........................... Schedule /, Line 4 15. Cash Payments ................... ............................... Column A, Line 8 above 122.94 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 $ 5689.95 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ........................... schedule B, Part 2 $ I Cash Equivalents and Outstanding Debts 18. Cash Equivalents ......... ............................... see instructions on reverse $ 19. Outstanding Debts ......................... Add Line 2 +Line 9 in Column B above $ 11559.05 11559.05 50.05 11609.10 Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* IN Subject to Voluntary Expenditure Limit) Date of Election Total'to Date (mmldd /yy) $ To calculate Column B, add amounts in Column A to the corresponding amounts *Amounts in this section may be different from amounts from Column B of your last reported in Column B. 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) FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661275 -3772) Schedule A Type or print In ink. SCHEDULE A Monetary ontributions Received wmounts may be rounaea ry dollars. Statement covers period CALIFORNIA to whole 460 from 10/01/14 . 10/18/14 4 6 SEE INSTRUCTIONS ON REVERSE through Page Of NAME OF FILER I.D. NUMBER Tom Fischer for City Council 2014 1366034 DATE EET A ZIP FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR ADDRESS DE O CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVETO DATE PER ELECTION RECEIVED IT SAND (IF .D.N CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IFSELF- EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) WJIND 10/6/14 Craig Filice ❑coM self- employed investor 200.00 200.00 7888 Wren Ave, Ste D143 ❑OTH Glen Loma Corp Gilroy, CA 95020 ❑ PTY ❑SCC South County Democratic Club pcoM 10/6/14 15231 Perry Lane MOTH 250:00 250:00 Morgan Hill, CA 95037 ❑ PTY ❑ SCC ®IND 10/6/14 Carolyn Dodd y ❑coM Associate CFO 250.00 250.00 9761 Zuni Lane ❑OTH Next Pharmaceutical Gilroy, CA 95020 El PTY []SCC ❑IND Associated Engineering Surveying Services, Inc pcoM 10/6/14 7651 Eigleberry Street ®OTH 250.00 250.00 Gilroy, CA 95020 ❑ PTY ❑ SCC Arcadia Development Co. ❑IND ❑coM 10/13/14 P.O. Box 5368 ®OTH 250.00 250.00 San Jose, CA 95150 -5368 ❑ PTY ❑ SCC SUBTOTAL$ 1200.00 -" Schedule A Summary 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 $ 1600.00 1600.00 '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/06) FPPC Toll -Free Helpline: 866 /ASK -FPPC (8661276 -3772) Schedule A (Continuation Sheet) Type or print IninL SCHEDULEA (CONT.) Monetary Contributions Received Amounts may be rounded Statement covers period to whole dollars. CALIFORNIA 10/01/14 from ', ORM through 10/18/14 Page 5 of 6 NAME OF FILER I.D.NUMBER Tom Fischer for City Council 2014 1366034 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR ZIP DE O CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED OFCOMMrDRE,ALSAND .D.N CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE OF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) _ OF BUSINESS) ®IND Julia J. Gimenez ❑COM retired 10/16/14 8405 Watsonville Rd. ❑OTH 150.00 150.00 Gilroy, CA 95020 ❑ PTY ❑SCC Arcadia Homes, Inc. ❑IN° 10/17/14 P.O. Box 5368 ❑COM W] OTH 250.00 250.00 San Jose; CA 95150 -5368 ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑COM ❑ OTH ❑ PTY [-]SCC SUBTOTALS 400.00 '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 E Payments Made Type or print in Ink. Amounts may be rounded to whole dollars. Statement covers period from 10/01114 SEE; INSTRUCTIONS ON REVERSE through 10/18/14 page 6 of 6 NAME OF FILER I.D. NUMBER Tom Fischer for City Council 2014 1366034 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP 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 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 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 AMOUNTPAID Staples 8840 San Ysidro Ave Gilroy, CA 95020 Toner, postage stamps 122.94 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 122.94 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) $ 122.94 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 Summa ry Page, e, Column A, Line 6. 122.94 ) ............................. TOTAL $ FPPC Form 460 (January/05) FPPC Toll -Free Helpline: 866 1ASK -FPPC (8661275 -3772)