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Home My WebLink AboutFitzsimmons -Form 460 1st pre-election AMENDMENTRecipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from 1/1/2020 through 9/19/2020 1. Type of Recipient Committee: All Committees - Complete Parts 1, 2, 3, and 4. (1 Officeholder, Candidate Controlled Committee U State Candidate Election Committee O Recall fASo Complete Part 5) ❑gneral Purpose Committee Sponsored Small Contributor Committee Political Party/Central Committee 3. Committee Information (OR CANDIDATE'S Fitzsimmons for Saratoga Council 2020 ❑ Primarily Formed Ballot Measure Committee 8 Controlled Sponsored (Also Compkle Part 6) ❑ Primarily Formed Candidate/ Officeholder Committee fA so Campwe Part 7) I.D. NUMBER STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE Saratoga CA 95070 MAILING ADDRESS (IF DIFFERENT) NO, AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE Saratoga CA 95070 OPTIONAL: FAX lE-MAIL ADDRESS COVER PAGE Date Stamp CALIFORNIA I RECEIVED i • - M EQ Date of election if applicable Pagg I of 7 (Month, Day, Year) a M n „t, For Official Use On i 11/3/2020 CITY OF SARATO f 2. Type of Statement - ❑ Preelection Statement ❑ Quarterly Statement ❑ Semi-annual Statement ❑ Special Odd -Year Report ❑ Termination Statement (Also file a Form 410 Termination) W1 Amendment (Explain below) 1st Pre -Election Amendment: added I.D #, Schedule E -removed $3885.00 filing fees, updated Summary Page, "from" date corrected to 1/1/2020 Treasurer(s) NAME OF TREASURER Kathleen Fitzsimmons MAILING ADDRESS CITY STATE ZIP CODE AREACODE/PHONE Saratoga CA 95070 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREACODE/PHONE 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 knowledge the inf rmation Contained herein and in the attached schedules is true and complete. I certify under penalty ofPp rjury rider the laws of the State of California that the forego of Sponsor Executed on Date By Signature of Controlling Officeholder, Candidate. State Measure Proponent Executed on Date By Signature of Contra ling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Colleen "Koolcie" Fitzsimmons OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Saratoga City Council RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP Saratoga CA 95070 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 STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE COVER PAGE - PART 2 Page 2 of 7 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 or officeholder(s) 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 I ❑ OPPOSE Attach continuation sheets if necessary FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Summary Page Amounts may be rounded to whole dollars. Statement covers period from 1/1/2020 SUMMARY PAGE 9/19/2020 Page 3 of 7 SEE INSTRUCTIONS ON REVERSE through NAME OF FILER I.D. NUMBER Fitzsimmons for Saratoga Council 2020 1432153 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTAL THIS PERIOD CALENDAR YEAR IEROMATTACHED SCHEDULESt TOTAL TO DATE Running in Both the State Primary and General Elections 1. Monetary Contributions................................................... Schedule A. Line 3 $ 605.00 $ 605.00 5100.00 $100.00 1/1 through 6/30 7/1 to Date 2. Loans Received................................................................ Schedule B, Line 3 570500 5705.00 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS .............................. Add Lines 1 +2 $ . $ Received $ $ 4. Nonmonetary Contributions ............................................ Schedule c, Line 3 0 0 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED ................................ Add Lines 3+4 $ 5705.00 $ 5705.00 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made................................................................ Schedule E, Line 4 $ 1675.00 $ 1675.00 Candidates 7. Loans Made....................................................................... Schedule H, Line 3 0 0 1675 1675.00 22. Cumulative Expenditures Made" 8. SUBTOTAL CASH PAYMENTS ....................................... nes 6+7 Add Lines $ $ (If Subject to Voluntary Expenditure Limit) 9. Accrued Expenses (Unpaid Bills) .......................................... Schedule F Line 3 0 0 Date of Election Total to Date 10. Nonmonetary Adjustment.. ............................ .......................... Schedule C, Line 3 0 0 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE....................................Add Lines 8+9+10 $ 1675.00 $ 1675.00 It $ Current Cash Statement --// $ 12. Beginning Cash Balance ............................ Previous Summary Page, Line 16 $ 0 To calculate Column B, 13. Cash Receipts........................................................... Column A, Line 3 above 5705.00 add amounts in Column 0 A to the corresponding *Amounts in this section may be different from amounts 14. Miscellaneous Increases to Cash... ........... ................... schedule 1, Line 4 amounts from Column B reported in Column B. 15. Cash Payments......................................................... Column A. Line 8above 1675.00 of your last report. Some 16. ENDING CASH BALANCE ..................Add Lines 12 + 13 + 14, then subtract Line 15 $ 4030.00 amounts in Column A may be negative figures that should be subtracted from It this is a termination statement, Line 16 must be zero. previous period amounts. If this is the first report being 17. LOAN GUARANTEES RECEIVED Schedule B, Part $ 0 filed for this calendar year, ................................ only carry over the amounts Cash Equivalents and Outstanding Debts g from Lines 2, 7, and 9 (if 0 any). 18. Cash Equivalents ................................................ See instructions on reverse $ 19. Outstanding Debts .............................. Add Line 2 +Line 9 in Column B above $ 5100.00 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 Monetary Contributions Received uwnuleuunal'' Statement covers period e _ I ' from 1/1/2020 e - 0 through 9/19/2020 Page 4 of 7 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Fitzsimmons for Saratoga Council 2020 1432 553 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED CONTRIBUTOR CODE "` OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) m IND 8/26/2020 Steve Schirle El COM Chief Councel 100.00 100.00 100.00 ❑ OTH PG&E San Francisco, CA 94127 ❑ PTY ❑SCC ®IND 8/29/2020 Adrianna Cohen ❑ COM n/a 100.00 100.00 100.00 ❑ OTH New York, NY 10028 ❑ PTY ❑ SCC ® IND 9/8/2020 Cheriel Jensen El COM n/a 200.00 200.00 200.00 ❑ OTH Saratoga, CA 95070 ❑ PTY ❑ SCC ® IND 9/18/2020 Ann Marie Burger ❑ COM n/a 200.00 200.00 200.00 ❑ OTH San Jose, CaA95110 ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTAL $ Schedule A Summary 1. Amount received this period — itemized monetary contributions. 600.00 (Include all Schedule A subtotals.) ................... ................................................................................... _$ 2. Amount received this period — unitemized monetary contributions of less than $100 ...........................$ 5.00 3. Total monetary contributions received this period. Add Lines 1 and 2. Enter here and on the Summary , Column A, Line 1. ( rY Page, 9 ) ......................TOTAL $ 605,00 '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 SCHEDULE 8 - PART 1 Schedule B — Part 1 "'vtG whole dollars. V Statement covers perlod Loans Received from 1/1/2020 9 through 9/19/2020 page 5 of 7 SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D. NUMBER Fitzsimmons for Saratoga Council 2020 1432153 FULL NAME, STREET ADDRESS AND ZIP CODE IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING INTEREST ORIGINAL CUMULATIVE OF LENDER BALANCE RECEIVED THIS OR FORGIVEN BALANCE AT PAID THIS AMOUNT OF CONTRIBUTIONS (IF COMMITTEE.ALSO ENTER I.D. NUMBER) (IF SELF-EMPLOYED. ENTER NAME OF BUSINESS) BEGINNING THIS PERIOD PERIOD THIS PERIOD* CLOPERIOD THIS PERIOD LOAN TO DATE ❑ PAID CALENDAR YEAR Colleen "Koolde" Fitzsimmons Health Science Specialist $ 100.00 100.00 $ 100.00 $ % s ❑ FORGIVEN PER ELECTION Veterans Affairs RATE Saratoga, CA 95070 s 0 s 100.00 $ s 8/26/2020 $ DATE DUE DATE INCURRED t® IND ❑ COM ❑ OTH ❑ PTY ❑ SCC PAID CALENDAR Colleen "Kookie' Fitzsimmons Health Science Specialist $ $ 5000.00 s 5000.00 it 5100.00 ❑ FORGIVEN PER ELECTION Veterans Affairs RATE Saratoga, CA 95070 0 5000.00 y $ 9/19/2020 s t® IND ❑ COM ❑ OTH ❑ PTY ❑ SCC S S DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR $ $ % S $ ❑ FORGIVEN PER ELECTION" RATE S S 5 S $ DATE DUE DATE INCURRED t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC SUBTOTALS $ 5100.00 $ $ 5100.00 $ Schedule B Summary 5100.00 1. Loans received this period....................................................................................................................$ (Total Column (b) plus unitemized loans of less than $100.) 0 2. Loans paid or forgiven this period.........................................................................................................$ (Total Column (c) plus loans under $100 paid or forgiven.) (Include loans paid by a third party that are also itemized on Schedule A.) 5100.00 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. (May be a negarne number) `Amounts forgiven or paid by another party also must be reported on Schedule A. ** If required. (Enter (e) an 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 (Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov SCHEDULE E Schedule E Amounts may be rounded Statement covers period to whole dollars. Payments Made from 1/1/2020 through 9/19/2020 I Page 6 of 7 i ON REVERSE Fitzsirnatons for Saratoga Cotlnci12020 1432153 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 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 (internet, e-mail) NAME ANDADDRESS OF PAYEE (IF COMMITTEE, A150 ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID WIX.com Tel Aviv, Israel Victory Store Davenport, IA 52802 WEB I website development 1 354.00 CMp I yard signs 1 1035.00 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 1389.00 Schedule E Summary 167S_OD 1. Itemized payments made this period. (Include all Schedule E subtotals.)............................................................................................................. $ 2. Unitemized payments made this period of under$100.......................................................................................................................................... $ 0 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column(e).)............................................................................. $ 0 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.)........................... TOTAL $ 1675.00 FPPC Form 460(Jan/2016)) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule E (Continuation Sheet) Payments Made Amounts may be rounded to whole dollars. Statement covers period 1/1/2020 from SCHEDULE E (CONT) SEE INSTRUCTIONS ON REVERSE through 9/19/2020 Page 7 of 7 NAME OF FILER I.D. NUMBER Fitzsimmons for Saratoga Council 2020 1432153 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/mist. 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 Lv. 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 Registrar of Voters voter data file 129.00 San Jose, CA 95112 Vistaprint LIT advertising cards 39.00 Waltham, MA 02451 Office Depot LIT flyers 59.00 , Los Gatos, CA 95032 Saratoga Post Office campaign PO Box 59.00 Saratoga, CA 95070 Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 286.00 FPPC Form 460 (Jan 2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov