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Home My WebLink AboutTom Fischer - Form 460 - 2016/09/25 - 2016/10/22ent Committee Recipient COVER PAGE Campaign Statement Date Stamp • 1 Cover Page OCT 2 12016 ge 1 of 7 Statement covers period Date of election if applicable. from 9/25/16 (Month, Day, Year) a �� • For Official Use Only SEE INSTRUCTIONS ON REVERSE through 10/22/16 11/8/201 10 016 1. Type of Recipient Committee: All Committees — Complete Parts 1, 2, 3, and 4. 2. Type of Statement: ® Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure ® Preelection Statement ❑ Quarterly Statement 0 State Candidate Election Committee Committee ❑ Semi - annual Statement ❑ Special Odd -Year Report 0 Recall 0 Controlled ❑ Termination Statement (Alaoconplds Part 5) 0 Sponsored (Also file a Form 410 Termination) El General Purpose Committee (Also CompNfe Pad 6) ❑ Amendment (Explain below) O Sponsored ❑ Primarily Formed Candidate/ O Small Contributor Committee Officeholder Committee O Political Party /Central Committee (AiaoComplete Pal 7) 3. Committee Information I.D. NUMBER 1366034 Tom Fischer for City Council 2016 STREET ADDRESS (NO P.O. BOX) 745 Dawn Way CITY STATE ZIP CODE AREA CODEMHONE Gilroy CA 95020 408 - 847 -4716 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA ODE/PHO E OPTIONAL: FAX/ E- IL ADDRESS Treasurer(s) NAME OF TREASURER Tom Fischer MAILINGADDRESS 745 Dawn Way 77— STATE ZIP CODE AREA CODE(PHO E Gilroy CA 95020 408 - 847 -4716 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODE /PHONE OPTIONAL: FAX/ E -MAIL ADDRESS 4. Verification I have used all reasonable diligence In preparing and reviewing this statement and Executed on Date Executed on Date Executed on By or By Signature of ontro ing Ofteholder. Candidate. State Measure Proponent By Signature of Contraillng Officeho r, andidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (8661275 -3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page — Part 2 6. 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 RESIDENTIAUBUSINESS ADDRESS (N0. A D STREET) CITY STATE 7jP 745 Dawn Way Gilroy, CA 95020 Related Committees Not Included in this Statement: Llsranycommhtees not Included In IhIs statement that are controlled by you or are primarily formed to rece/ve contributions or make expenditures on behalf of your candidacy. CITY STATE ZIP CODE AREA COOEfPHONE COMMITTEE NAME I I.D. NUMBER NAME OF TREASURER ❑ YES ❑ NO CITY STATE ZIP CODE AREA CODE/PHONE COVER PAGE - PART 2 Page 2 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT SURE of 7 BALLOT NO. OR LETTER JURISDICTION ❑ SUPPORT ❑ OPPOSE Identify the controlling of"ceholder, candidate, or state measure proponent, If any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT NO, IF ANY 7. Primarily Formed Candidate /Officeholder Committee List nerves of officeholder(s) or candideWs). for which this committee /a 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 If necessary FPPC Form 460 {Jan /2016) FPPC Advice: advicedPfppc.ce.gov (866/275 -3772) www.fppc.ca.gov Campaign Disclosure Statement Amounts may be rounded SUMMARY'PAGE Summary Page to whole dollars. Statement covers period • e d from 9125/16 • •' 0 SEENSTRUCTIONS ON REVERSE through 10/22/16 Page 3 of 7 I NAME OF FILER I.D. NUMBER Tom Fischer 1366034 Contributions Received 1. Monetary Contributions .................... ............................... schedule A Line 3 2. Loans Received ................................. ............................... schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 +2 4. Nonmonstary Contributions ................................... I........ schedule C, Line 3 5. TOTAL CONTRIBUTIONS RECEIVED ....... ............................Add Lines 3 +4 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. Nonmonetery Adjustment .......................... ............................... sareaule C, Line 3 11'. TOTAL EXPENDITURES MADE ......... ............................... Add Lines s + 9 + 10 Current Cash Statement 12. Beginning Cash Balance ............................ Previous summary Page, Line to 13. Cash Receipts ............................ ............................... Column A, Line 3 above 14. Miscellaneous Increases to Cash ... ............................... schedule 1, Line 4 15. Cash Payments . ......... ........ ............................... Column A, Line s above 16. ENDING CASKSALANCE ..................Add Linea 12 + 13 + 14, themsubtrect Line 15 If this is a termination statement, Line 16 must be zero. Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) $ 800.00 $ $ $ Column B CALENDAR YEAR TOTAL TO DATE 8,055:00 800.00 $ 8,055.00 144:92 800.00 $ 8,199:92 $ 7,210.72 $ 8,545.89 $ 7,210.72 $ 8,545.89 $ 7,210.72 $ 8,545.89 $ 7,455.78 800:00 7,210.72 $ 1,045.06 17. LOAN GUARANTEESRECEIVED . ............................... schedule s, Pert 2 $ Cash Equivalents and' Outstanding Debts 18. Cash Equivalents ....................... :........................ See Instructions on reverse $ 19. Outstanding Debts .............................. Add Line ,2 + Line 9 In ColumrrB above $ 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 a (if any). Calendar Year Summary for Candidates Running In Both the State Primary and General Elections 111 through 6130 711 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 Total,to Date (mm/dd /yy) I $ 'Amounts In this section may be different from amounts reported in Column S. FPPC Form 460 (Jan /2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Schedule A Amounts may be rounded SCHEDULE A to whore dollars. Monetary Contributions Received Statement covers: period e 9/25/16 from through 10/22/18 page 4 of_ 7 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I,D. NUMBER Tom Fischer 1366034 E DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CONTRIBUTOR IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE ED CODE • (IF SELF- EMPLOYED, ENTER NAME PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) OF BUSINESS) ® IND 9/28/16 Bruno Bo Fliice Brun ❑ COM ❑'OTH Retired 200.00 200.00 200.00 Gilroy, CA 95020 ❑ PTY ❑ SCC m IND 9/29/16 Pete and Julia Gimenez ❑ Retired 300.00 300.00 300.00 00TH Gilroy, CA 95020 ❑1PTY ❑ SCC DIND South County Democratic Club ❑ COM 9/30/16 m OTH 250.00 250.00 250.00 San Martin, CA 95046 ❑ PTY ❑ SCC Sam and Judy Bozzo ® IND 0 COM Retired 10/3/16 []OTH 25.00 25.00 25.00 Gilroy, CA 95020 ❑PTY El-SCC Brad Bannister ®1IND ❑ CoM Realtor 10/4/16 Coldwell Banker 25.00 25.00 25.00 Gilroy, CA 95020 O Pn ❑ SCC SUBTOTAL $ 800.00 Schedule A Summary 1. Amount receivedithis period — itemized monetary contributions. 800.00 (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 $ 0.00 800.00 "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 (Jan /2016) FPPC Advice: advice@fppc.ca.gov )866/275 -3772) www.fppc.ca.gov Amounts may ha mundad SCHEDULE B - PART 1 Schedule B — Part 9 _____ ars..___ to whole dollars. stateme�t,covere period Pe • Loans Received 9/25/16 �' • �1 from • SEE INSTRUCTIONS ON REVERSE through 10/22/16 Page 5 of 7 NAME OF FILER I.D. NUMBER Tom Fischer 1366034 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING INTEREST ORIGINAL CUMULATIVE OF LENDER (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER NAME BALANCE BEGINNING THIS RECEIVED THIS PERIOD OR FORGIVEN BALANCE AT CLOSE OF THIS PAID THIS PERIOD AMOUNT OF CONTRIBUTIONS TO DATE OF BUSINESS) PERIOD THIS PERIOD PERIOD LOAN Tom Fischer Candidate ❑ PAID CALENDARYEAR 745 Dawn Way a $ 1.000.00 % 87500.00 a PER ELECTION" Gilroy, CA 95020 ❑ FORGIVEN RATE s 1,000.00 8128/14 t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC $ $ s s DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR PER ELECTION" ❑ FORGIVEN RATE t❑ IND ❑ COM ❑ OTH [I PTY ❑ SCC a a a a a DATE DUE DATE INCURRED ❑ ,PAID CALENDAR YEAR PER ELECTION" ❑ FORGIVEN RATE t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC a = a DATE INCURRED a DATE DUE 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. (May be a newt" number) (Enter (e) on Schedule E, Line 3) ?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 (Jan /2016) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www,fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON Tom Fischer Amounts may be rounded to whole dollars. Statement covers period from 9/25/16 through 10/22/18 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. Page 6 of 1366034 CMP campaign parephemalie /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 alrtime and production costs FIL candidate filing /ballot fees PHO phone banks TRC candidate travel, lodging, and meals FIND fundralaing 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 COMMrrTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Medius Corp. Printing and mail service 1800 Dobbin Dr. 3,276.00 San Jose, CA 95113 U.S. Postmaster Postage for voter postcard 3,177.97 Articulate Solutions Design Services 65 Fifth St. 276.75 Gilroy, CA 95020 * Payments that are contributions or Independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 6,730.72 Schedule E Summary 1. Itemized payments made this period: (Include all Schedule E subtotals.) ............................... ............................... ......................... $ 7,210.72 2. Unitemized payments made this period r of under $100 ..................... $ 0,00 3. Total'interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) ................ ...... .. .................. ' ................... $ 0.00 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ............ 7,210.72 ............... TOTAL $ FPPC Form 460 ()an /2016) FPPC Advice: advice@fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Schedule E CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID SCHEDULE :E (CONT.) (Continuation Sheet) Amounts may be rounded to whole dollars. Statement covers period 460, Payments Made from 9/25/16 • SEE INSTRUCTIONS ON REVERSE through 10/22/16 - Page 7 of 7 NAME OF FILER I.D. NUMBER Tom Fischer 1366034 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalialmisc. MBR member communications RAID redlo airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' saledes 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 AMOUNT PAID Political Data Inc. PO Box 59570 Norwalk, CA 90652 Voter Lists 480.00 * Payments that are contributions or Independent, expenditures must also be summarized on Schedule D. SUBTOTAL $ 480.00 FPPC Form 460'(1an/2016) FPPC Advice. advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov