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Roloff 460Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE 1. Type of Recipient Committee: All Committees from Statement covers period 01/01/2016 through 06/30/2016 Complete Parts 1, 2, 3, and 4. IZ Officeholder, Candidate Controlled Committee El O State Candidate Election Committee O Recall (Also Complete Part 5) El General Purpose Committee O Sponsored O Small Contributor Committee O Political Party/Central Committee 3. Committee Information COMMITTEE NAME (OR CANDIDATES NAME IF NO COMMITTEE) Jennifer Roloff City Council 2016 STREET ADDRESS (NO P.O. BOX) CITY Alameda Primarily Formed Ballot Measure Committee O Controlled O Sponsored (Also Complete Pert 6) Primarily Formed Candidate/ Officeholder Committee (Also Complete Pert 7) .D. NUMBER 1385651 STATE ZIP CODE CA 94501 AREA CODE/PHONE 415-999-4395 Date of election if applicable: (Month, Day, Year) Da tamp AUG 0 1 2016 COVER PAGE 460 CALIFORNIA FORM CITY OF ALAMED/ 11/08/2016 CITY CLERK'S OFFICE 2. Type of Statement: O Preelection Statement 21 Semi-annual Statement O Termination Statement (Also file a Form 410 Termination) O Amendment (Explain below) Treasurer(s) NAME OF TREASURER Todd Roloff MAILING ADDRESS GITY Alameda NAME OF ASSISTANT TREASURER, IF ANY 1 of 8 For Official Use Only 0 Quarterly Statement 0 Special Odd-Year Report STATE ZIP CODE CA 94501 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE OPTIONAL: FAX / E-MAIL ADDRESS OPTIONAL: FAX / E-MAIL ADDRESS jennifer@jenniferroloff.com todd@jenniferroloff.com 4. ▪ Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledg 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. 07/29/2016 Date 07/29/2016 Date Signature of Controllir% Proponent or Responsible Officer of Sponsor Signature of Controlling Officeholder, Candidate, State Measure Proponent Signature of Controlling 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 Jennifer Roloff OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Alameda City Council 2016 RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP Alameda CA 94501 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? 0 YES 0 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? 0 YES 0 NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE 0591■11111111111■18- MEM= JJ.19■10= 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER JURISDICTION COVER PAGE - PART 2 CALIFORNIA Agn FORM %PI° Page 2 of 8 O SUPPORT O 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 NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD Attach continuation sheets if necessary O SUPPORT O OPPOSE O SUPPORT O OPPOSE O SUPPORT O OPPOSE O SUPPORT O OPPOSE 1110111.44■110.1■11.12 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Summary Page SEE INSTRUCTIONS ON REVERSE NAME OF FILER Jennifer Roloff City Council 2016 Contributions Received 1. Monetary Contributions Schedule A, Line3 $ 2. Loans Received Schedule B, Line 3 3. SUBTOTAL CASH CONTRIBUTIONS Add Lines 1 + 2 $ 4. Nonmonetary Contributions 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 AddLines6 +7 9. Accrued Expenses (Unpaid Bills) Schedule F, Line 3 10. Nonmonetary Adjustment Schedule C, Line 3 11. TOTAL EXPENDITURES MADE Add Lines 8 +g +10 $ Current Cash Statement 12. Beginning Cash Balance Previous Summary Page, Line 16 13. Cash Receipts Column A, Line 3 above 14. Miscellaneous Increases to Cash Schedule I, Line 4 15. Cash Payments Column A, Line 8 above 16. ENDING CASH BALANCE Add Lines 12 + 13 + 14, then subtract Line 15 If this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED Schedule B, Part 2 $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents See instructions on reverse 19. Outstanding Debts Add Line 2 + Line 9 in Column B above $ Amounts may be rounded to whole dollars. Column A TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) 847.99 2,500.00 3,347.00 0.00 3,347.99 346.50 0.00 346.50 2,500.00 0.00 2.846.50 0.00 3,347.00 0.00 346.50 3,000.50 0.00 0.00 2,500.00 $ Statement covers period 01/01/2016 from through Column B CALENDAR YEAR TOTAL TO DATE 847.99 2,500.00 3,347.00 0.00 3.347.99 346.50 0.00 346.50 2,500.00 0.00 2,846.50 To calculate Column B, add amounts in Column Ato 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). 06/30/2016 SUMMARY PAGE CALIFORNIA FORM Page 3 of 8 I.D. NUMBER 1385651 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6/30 20. Contributions Received $ 21. Expenditures Made $ 7/1 to Date Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (It Subject to Voluntary Expenditure Limit) Date of Election (mm /dd /yy) / / $ $ Total to Date *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Jan /2016) FPPC Advice: advice @fppc.ca.gov (866/275 -3772) www.fppc.ca.gov Schedule A Monetary Contributions Received SEE INSTRUCTIONS ON REVERSE NAME OF FILER Jennifer Roloff City Council 2016 DATE RECEIVED 05/23/2016 Amounts may be rounded to whole dollars. FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE Kevin Krause Oakland, CA. 94611 James Smallman 06/09/2016 Alameda, CA, 06/10/2016 Ken Gonzalez Alameda, CA. 94501 IND ❑ COM 1110TH ❑ PTY ❑ scc VJ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC I2 IND ❑ COM ❑ OTH ❑ PTY ❑ scc ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF - EMPLOYED, ENTER NAME OF BUSINESS) Executive Manager PSEC Retired Retired Technology Executive FireEye, Inc SUBTOTAL $ 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 Tess 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 $ Statement covers period 01/01/2016 from through 06/30/2016 AMOUNT RECEIVED THIS PERIOD 250.00 150.00 100.00 500.00 500.00 347.99 847.99 SCHEDULE A CALIFORNIA FORM 460 Page 4 of I.D. NUMBER 1385651 CUMULATIVE TO DATE CALENDAR YEAR (JAN. 1 - DEC. 31) 250.00 8 PER ELECTION TO DATE (IF REQUIRED) 250.00 150.00 150.00 100.00 100.00 *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 B — Part 1 Loans Received SEE INSTRUCTIONS ON REVERSE NAME OF FILER Jennifer Roloff City Council 2016 Amounts may be rounded to whole dollars. MIMEO���������������������������� FULL NAME STREET ADDRESS AND ZIP CODE OF LENDER (IF COMMITTEE, ALSO ENTER LD. NUMBER) Todd Roloff Alameda, CA. 94501 I IND OCOMOOTH 0 PTY OSCC /O IND 0 COM 0 oTH 0 PTY O ooc O/wo 0 COM 0 OTH OPTY Oscc Schedule B Summary IFAN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, s" NAME OF BUSINESS) Self Employed Todd Roloff Consulting OUTSTANDING BALANCE BEGINNING THIS PERIOD S Statement covers period 01/01/2016 from through *i--------w---' AMOUNT AMOUNT PAID RECEIVED THIS OR FORGIVEN PERIOD THIS PERIOD* s 0.00 0 FORGIVEN O PAID FORGIVEN � 0 PAID $ 0 FORGIVEN 06/30/2016 OUTSTANDING BALANCE AT CLOSE OF THIS PERIOD o 2.500.00 4/26/17 DATE DUE DATE DUE DATE DUE V1— INTEREST PAID THIS PERIOD SCHEDULE B - PART 1 CALIFORNIA 460 FORM 5 8 Page of /o.wumosn 1385651 61- `--T9) —' ORIGINAL CUMULATIVE AMOUNT OF CONTRIBUTIONS LOAN TO DATE CALENDAR YEAR 0 m ,250O.0O s 2.500.00 PER ELECTION** s 2.500.00 RATE 0.00 RATE RATE SUBTOTALS $ 2.500.00 $ 0.00 $ 2.500.00 $ 0.00 (Enter won Schedule E, Line 3) 1. Loans received this period � (Total Column (b) plus unitemized Ioans of Iess than $1 00.) 2. Loans paid or forgiven this period � (Total Column (c) plus loans under $100 paid or forgiven.) (Include Ioans 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. *Amourlts forgiven or paid by another party also must be reported on Schedule A. ** If required. 2,500.00 0 v.so0OO (May be a negative number) 04/26/16 DATE INCURRED DATE INCURRED DATE INCURRED CALENDAR YEAR PER ELECTION** CALENDAR YEAR PER ELECTION** tContributor Codes |wo — |nuwumu COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — P /m Party sco — amanovmmuuxxcvm,mwoo 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 REVERSE NAME OF FILER Jennifer Roloff City Council 2016 Amounts may be rounded to whole dollars. Statement covers period 01/01/2016 from through 06/30/2016 CODES: If one of the following codes accurately describes the pmymerd, you may enter the code. [thenwise, describe the payment. CMP CNS CTB CVC FIL FND IND LEG LIT oampoignparaphomoliaonisc. campaign consultants contribution (explain nonmonetary)* civic donations oandiUmefi|in8moUot fees fundraising events independent expenditure supporting/opposing others (explain)* legal defense campaign literature and mailings NAMEANDADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Alameda Post Office Alameda, CA. 94501 State of California FPCC Filing Campaign Partner www.campaignpartner.com On-Line Web Hosting - Boston MA MBR MTG OFC PET PHO POL poa PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads CODE POS FIL WEB * Payments that are contributions or independent expenditures must also be summarized on Schedule D. RAD RFD SAL TEL TRC TRS TSF VOT WEB SCHEDULE E CALIFORNIA 460 FORM 6 8 Page of /.uwumosn 1385651 radio airtime and production costs returned contributions campaign workers' salaries tv. or cable airtime and production costs candidate travel, lodging, and meals staff/spouse travel, lodging, and meals transfer betweeri committees of the same candidate/sponsor voter registration information technology costs (internet, e-mail) WWI OR DESCRIPTION OF PAYMENT AMOUNT PAID 106.00 50 58 SUBTOTAL $ 214.00 Schedule E Summary 1. ltemized payments made this period. (Include alt 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.) TOTAL $ 346.50 0.00 0.00 346.50 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) Schedule E (Continuation Sheet) Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Jennifer Roloff City Council 2016 Amounts may be rounded to whole dollars. Statement covers period 01/01/2016 06/30/2016 from through CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP CNS CTB CVC FIL FND IND LEG LIT campaign paraphernalia/misc. campaign consultants contribution (explain nonmonetary)* civic donations candidate filing/ballot fees fundraising events independent expenditure supporting/opposing others (explain)* legal defense campaign literature and mailings NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Speed Pro Graphics Alameda, CA. 94501 MBR MTG OFC PET PHO POL POS PRO PRT member communications meetings and appearances office expenses petition circulating phone banks polling and survey research postage, delivery and messenger services professional services (legal, accounting) print ads CODE OR LIT * Payments that are contributions or independent expenditures must also be summarized on Schedule D. RAD RFD SAL TEL TRC TRS TSF VOT WEB SCHEDULE E (CONT.) CALIFORNIA A6(1 FORM Page 7 of NUMBER 1385651 8 radio airtime and production costs returned contributions campaign workers' salaries t.v. or cable airtime and production costs candidate travel, lodging, and meals staff/spouse travel, lodging, and meals transfer between committees of the same candidate/sponsor voter registration information technology costs (Internet, e-mail) DESCRIPTION OF PAYMENT AMOUNT PAID 132.50 SUBTOTAL $ 132.50 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule F Accrued Expenses (Unpaid Bills) SEE INSTRUCTIONS ON REVERSE NAME OF FILER Jennifer Roloff City Council 2016 CODES: If one of the following codes accurately describes CMP CNS CTB CVC FIL FND IND LEG LIT campaign paraphernalia/misc. campaign consultants contribution (explain nonmonetary)* civic donations nondidamfi|ing/oaUnt fees fundraising events independent expenditure supporting/opposing others (explain)* legal defense campaign literature and mailings NAME AND ADDRESS OF CREDITOR (IF COMMITTEE, ALSO ENTER LD. NUMBER) Todd Roloff Alameda, CA. 04501 * Payments that are contributions or independent expenditures must eisa be summarized on Schedule D. Amounts may be rounded to whole dollars. Statement covers perio 01/01/2016 from through the poyment, you may enter the code. Othenwise, MBR member communications em MTG meetings and appearances RFD OFC office expenses SAL PET petition circulating TEL PHO phone banks TRC POL polling and survey research TRS Poo postage, delivery and messenger services TSF PRO professional services (legal, accounting) VOT PRT print ads WEB CODE OR DESCRIPTION OF PAYMENT Loan to begin Campaign (a) OUTSTANDING BALANCE BEGINNING OF THIS PER1OD 0.00 SUBTOTALS $ 0.00 $ 06/30/2016 SCHEDULE F CALIFORNIA A6n FORM 8 8 Page of /.D.wumosn 1385651 describe the payment. radio airtime and production costs returned contributions campaign workers salaries t.v. or cable airtime and production costs candidate travel, lodging, and meals staff/spouse travel, lodging, and meals transfer between committees ofthe same candidate/sponsor voter registration information technology costs (internet, e-mail) ~'�����`�������'�— (b) (c) (d) AMOUNT INCURRED AMOUNT PAID OUTSTANDING rx/spsmoo THIS PERIOD BALANCE AT CLOSE (ALSO REPORT ON 5) OF THIS PERIOD 2,500.00 2,500.00 $ 0.00 2.500.00 0.00 $ 2,500.00 Schedule F Summary 1. Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) INCURRED TOTALS $ 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) PAID TOTALS $ 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.) 2,500.00 0.00 25U000 May be a negative number NET� ' � FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov