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Roloff 460Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE from a��m�ocovo, p,nnu 10/23/2016 through 12/31/2016 Date of election if applicable (Month, Day, Year) 11/08/2016 1. Type of Recipient Committee: All Committee — Complete Parts 1.2,x. and 4. 2. Type of Statement: gji Officeholder, Candidate Controlled Committee O State Candidate Election Committee [} Recall (Also Complete Pad 5) O General Purpose Committee O Sponsored O Small Contributor Committee O Political Party/Central Committee 3. Committee Information '-----' lJU�U�l 0 Primarily Formed Ballot Measure Committee O Controlled O Sponsored (Also Complete Part 6) [�P��y��dCa��� Cffi�h��,Cmnm�� I uzwumosn 1385G5' oumwnTsswAmcmnoAwmo^Tsawxme/pwocoMMn�ss Jennifer Roloff City Council 2016 BOX) �� A|amnds STATE CA ZIP CODE AREA CODE/PHONE 94501 415-999'4385 mmuwaaooeem(/Fo�rsnsm) wo.xwosTnssronmzuox CITY STATE ZIP CODE xmsAnoos/P*uws OPTIONAL: FAX / E-MAIL ADDRESS ]ennifer@jonnifenn|off.nnm 4. Verification 1 have used all reasonable diligence in preparing and review(ng this statement and to the best Signature m Controlling officehnld7r, Candidate, State Measure Proponent Signature of Controlling Ot6coholder, Candidate, State Measure Proponent FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772 Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE 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 BALLOT NO. OR LETTER JURISDICTION COVER PAGE - PART 2 CALIFORNIA 41 460 FORM Page 2 of 10 O SUPPORT • OPPOSE Alameda CA 94501 Identify the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT 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? EI YES 0 NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE J■112■1•1. re_ 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 0 SUPPORT LI OPPOSE O SUPPORT 111 OPPOSE O SUPPORT O OPPOSE El SUPPORT O OPPOSE 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, Line 3 $ 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 Add Lines 6 +7 $ 9. Accrued Expenses (Unpaid Bills) Schedule F, Line 3 10. Nonmonetary Adjustment Schedule C, Line 3 11. TOTAL EXPENDITURES MADE Add Lines 8+ 9 + 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 1, 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) 3,859.00 0.00 3,859.00 0.00 3,859.00 4.262.17 0.00 4,262.17 4,800.00 0.00 9,062.17 3,205.66 3,859.00 0.00 4,262.17 2,802.49 0.00 4,800.00 $ $ Statement covers period 10/23/2016 from through Column B CALENDAR YEAR TOTAL TO DATE 14,678.99 2,500.00 17,178.99 2,025.75 19,204.74 14,399.25 0.00 $ 14,399.25 4,800.00 2,025.75 $ 21,225.00 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 9 (if any). 12/31/2016 SUMMARY PAGE CALIFORNIA FORM Page 3 I.D. NUMBER 1385651 of 10 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* (If 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 Amounts may be rounded to whole dollars. Statement covers period 10/23/2016 from SCHEDULE A CALIFORNIA 460 FORM 12/31/2016 4 10 SEE INSTRUCTIONS ON REVERSE through Page of NAME OF FILER |.o.wuMasn Jennifer Roloff City Council 2016 1385651 DATE RECEIVED "n� '"'24/2"'n,n " Alameda CA. 94501 FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF COMMITTEE, ALSO ENTER I.O.NUMBER) ' CODE * Diane Steed James Hager 10/28/2016 Alameda CA. 94502 10/31/2016 11/01/2016 Genet Garamendi Alameda CA. 94501 Kyle and Elgina Connor Alameda, CA. 94501 Stewart Chen 11/01/2818 Alameda CA. 94501 IFAN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED. ENTER NAME OF BUSINESS) IZ IND Ocom Retired UOTH Retired U PTY LJGCS V]|wo ▪ oom Retired []oTH Retired OPTY []GCc V|ND O COm SVP �]OTH Terra Via OPTY []aco ▪ |wo []Com Self Employed []oTH Theater Owner OPTv []aoC ▪ |wo []COm Chiropractor []oTH Self Employed (Stewart []PTY Chen) []soc ~- AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED THIS CALENDAR YEAR TO DATE PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 100.00 100.00 500.00 1.500.00 250.00 250.00 750.00 750.00 200.00 200.00 SUBTOTAL $ 1.800.00 Schedule A Summary 1. Amount received this period — itemized monetary contributions. (lnclude alt Schedule A subtotals.) 3,650.00 2. Amount received this period — unitemized monetary contributions of less than $100 209.00 3. Total monetary contributions received this period. 385B� O0 (Add Lines 1 and 2. Enter here and on the Summary Pago, Column A, Line 1.) TOTAL $ ' *Contributor Codes |mo — muwmva| COM — Recipient Committe (other than PTY or SCC) OTH — Other (e.g., business entity) PTY — Political Party GCC — GmoUCnnthbumrCommimen FPPC Form 460 (Jan/2016 pppc Advice: advice@fppc.ca.Kov(Sss/a7s'szxa) www.fppc.ca.gov Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER Jennifer Roloff City Council 2016 DATE RECEIVED Amounts may be rounded to whole dollars. FULL NAME, STREETADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR (IF C0MMITrEE, ALSO ENTER ID. NIJMBER) CODE * De Long Liu 1101/2010 Walnut Creek, CA. 94597 Kathleen Shumacher 11/09/2016 Alameda CA. 94501 Maureen Connor 11/09/2016 Alameda CA. 84502 Jeanette Betties 10/10/2018 Alameda CA. 94501 Travis Wilson 11/15/2016 Alameda CA. 94501 I2]|wo OCOM UOTH UPTY LJaco g|wo OCOm []oTH El PTY []GCC VI|mo OCOM OOTH []PTY []scn V|wo OCOm []OTH El PTY []000 []|ND []COm oTH []PTY []aoo IFAN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOY D, ENTER NAME OF BUSINESS) Self Employed Owner - Circle K Retired Retired Real Estate Investment La Maison Properties Finance Manager Kaiser Foundation Health Plan Computer Programmer Self Employed (Consultant) Statement covers period from 10/23/2016 through 12/31/2016 SCHEDULE A (CONT.) CALIFORNIA 460 FORM Page Page 5 /.uwuwasR 1385651 of 10 AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED THIS CALENDAR YEAR TO DATE PERIOD (JAN. 1 - DEC. 31) (IF REQUIRED) 1.000.00 1.000.00 100.00 100.00 500.00 500.00 100.00 100.00 50.00 150.00 SUBTOTAL$ 1.750.00 "Contributor Codes IND — Individual COM — Recipient Committee (other than PTY or SCC) OTH — Other (e.g., business entity) pTY — Pu|idcm|Puny 000 — smvnCont,iuuto,Cvmmiwae rppc Form 4au(Jan/auzs) . ' FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Schedule A (Continuation Sheet) Monetary Contributions Received NAME OF FILER Jennifer Roloff City Council 2016 DATE RECEIVED 11/02/16 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 * Beth Plavan PArk City, UT. 84098 *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 LZ IND 1=1 COM 1=1 OTH PTY SCC IND COM LI OTH Li PTY scc 0 IND 111 COM 1=1 OTH PTY SCC IND El COM Eli OTH LI PTY LI scc 0 IND El COM El OTH El PTY El SCC IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Retired Retired Statement covers period from 10/23/2016 through -111 If MIN I (Siff MK 12/31/2016 SCHEDULE A (CONT.) CALIFORNIA Agn FORM —111. 16oF Page 6 of 10 I.D. NUMBER 1385651 AMOUNT CUMULATIVE TO DATE RECEIVED THIS CALENDAR YEAR PERIOD (JAN. 1 - DEC. 31) 100.00 100.00 SUBTOTAL $ 100.00 PER ELECTION TO DATE (IF REQUIRED) 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 FULL NAME, STREET ADDRESS AND ZIP CODE OF LENDER (IF COMMITTEE, ALSO ENTER I.D. NUMBER) Todd Roloff Alameda, CA. 94501 V IND 0 COM 0 OTH 0 PTY 0 SCC I IND 0 COM 0 OTH 0 PTY 0 SCC IND 0 COM 0 OTH 0 PTY 0 SCC Schedule B Summary Amounts may be rounded to whole dollars. IF AN INDIVIDUAL, ENTER OCCUPATION AND EMPLOYER (IF SELF-EMPLOYED, ENTER NAME OF BUSINESS) Self Employed Todd Roloff Consulting Statement covers period 10/23/2016 from through ) (c) OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING INTEREST BALANCE RECEIVED THIS OR FORGIVEN BALANCE AT BEGINNING THIS CLOSE OF THIS PAID THIS PERIOD PERIOD THIS PERIOD* PERIOD PERIOD 12/31/2016 SCHEDULE B - PART 1 CALIFORNIA 460 FORM 7 Page I.D. NUMBER 1385651 .■••■ 2500.00 SUBTOTALS $ 0 PAID 0.00 0 FORGIVEN 0.00 0.00 0 PAID 0 FORGIVEN 0 PAID 0 FORGIVEN 2.500.00 4/26/17 DATE DUE DATE DUE DATE DUE 0 % RATE 0.00 RATE RATE 0.00 $ 0.00 $ 2,500.00 $ 0.00 (Enter (e) on Schedule E, Line 3) 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.) 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. NET $ (Loa_ (May be a negative number) ORIGINAL AMOUNT OF LOAN $ 2500.00 04/26/16 DATE INCURRED DATE INCURRED DATE INCURRED 1 of 10 (9) CUMULATIVE CONTRIBUTIONS TO DATE CALENDAR YEAR $ 2.500.00 PER ELECTION** s 2.500.00 CALENDAR YEAR PER ELECTION** $ CALENDAR YEAR PER ELECTION** 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 Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER Jennifer Roloff City Council 2016 Amounts may be rounded to whole dollars. Statement covers period 10/23/2016 from through JIMVIE(8/7/1111MM 12/31/2016 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 campaign consultants contribution (explain nonmonetary)* civic donations candidate fi|ing/baUvtfees fundraising events independent expenditure supportinglopposing others (explain)* legal defense campaign literature and mailings NAMEANDADDRESS OF PAYEE (IF COMMIUEE,ALSO ENTER ID. NUMBER) Alameda Sun Alameda CA. 94501 Alameda Journal Alameda CA. 94501 Campaign Part er www.campaignpartner.com On-Line Web Hosting - Boston MA Mon MTG OFC PET PHO POL roe 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 mm RFD SAL TEL TRC TRS TSF VOT WEB SCHEDULE E CAl..IFORNIA 460 FORM 8 10 Page of /o.wowosn 1385651 radio airtime and production costs returned contributions campaign workers' salaries tv. or cable airtime and production costs candidate travel, |odging, and meals staff/spouse travel, |odging, and meals transfer betw en committees of the same candidate/sponsor voter registration information technology costs (internet, e-mail) OR DESCRIPTION OF PAYMENT Newspaper Ads Newspaper Ads PRT (ytd $1,825.23) Web hosting WEB (ytd $232) * Payments that are contributions or independent expenditures must atso be summarized on Schedule D. AMOUNT PAID $1,751.10 $387.48 $58.00 SUBTOTAL $ 2.196.58 Schedule E Summary 1. ltemized payments made this period. (lnclude 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 $ 4,244.69 17.48 0.00 4,262.17 FPPC Form 460 (Jan/2016) FPPC Advice: advice@f pc.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 doltars. Statement covers period 10/23/2016 12/31/2016 from through CODES: If one of the foliowing codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP CNS CTB CVC FIL FND IND LEG LIT campaign campaign consultants contribution (explain nonmonetary)* civic donations candidate fihing/bailot fees fundraising events independent expenditure supporting/opposing others (explain)* legal defense campaign Uterature and mailings NAMEANDADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER m.NUMBER) Stripe San Francisco CA. 94107 Sing Tao Daily South San Francisco, CA, 94080 Face Book Palo Alto, CA. 94304 Pacific Fine Foods Alameda, CA. 94501 MBR member communications MTG meetings and appearances OFo office ex o PET petition circulating PHO phone banks POL polling and survey research POS postage, dehivery and messenger services PRO professional services (legal, accounting) PRT print ads CODE OR RAD RFD SAL TEL TRC TRS TSF VOT WEB SCHEDULE E (CONT.) CALIFORNIA 460 FORM Q 10 Page of I.uwmwBER 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, |ngg|ng, and meals transfer between cmmmittaeaofthesamesandidute/sponao, voter registration information technology costs (internet, e-mail) DESCRIPTION OF PAYMENT Transfer Fees for Contributions PRO (ytd $230.07) PRT WEB CMP * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Newspaper Ad Internet Ads/Postings Appreciation event - Catering services for the volunteers and supporters of the campaign. AMOUNT PAID $76.22 $345.60 $394.41 SUBTOTAL$ $2,048.11 FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772) 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 campaign consultants contribution (explain nonmonetary)* civic donations candidate fi|ing/hoUotfaes fundraising events independent expenditure supporting/opposing others (explain)* legal defense campaign literature and mailings NAMEANDADDRESS OF CREDITOR (IF COMMITTEE, ALSO ENTER la NUMBER) Todd Roloff Alameda, CA. 94501 City of Alameda Alameda, CA. 94501 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. Amounts may be rounded to whole dollars. Statement covers period 10/23/2016 from through the payment, you may enter the code. Otherwise, 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 OR DESCRIPTION OF PAYMENT CTB (Loan to begin Campaign) FIL (balance of filing fees) SUBTOTALS $ (a) OUTSTANDING BALANCE BEGINNING OF THIS PERIOD 2,500.00 2,300.00 4,800.00 $ RAD RFD SAL TEL TRC TRS Tap VOT WEB 12/31/2016 SCHEDULE F CALIFORNIA 460 FORM 10 10 Page of I.uwomBER 1385651 describe the payment. 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 betw en committees of the same candidate/sponsor voter registration information technology costs (internet, e-mail) (b) AMOUNT INCURRED THIS PERIOD 2,500.00 2,300.00 (c) AMOUNT PAID THIS PERIOD (ALSO REPORT ON E) (d) OUTSTANDING BALANCE xrCLOSE OF THIS PERIOD 0.00 2.500.00 0.00 2.300.00 4,800.00 $ 0.00 $ 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.) 2. Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus tota unitemized payments on accrued expenses under $100.) 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and onthe Summary Page, Column A, Line 0l ..... ..... ..... .............. ...... --...... ........................................... ......... ............. ......... ............ ............................ ....... NET $ INCURRED TOTALS $ PAID TOTALS $ 4,800.00 4,800.00 0.00 4,800.00 May be a negative number FPPC Form 460 (Jan/2016) FPPC Advice: advice@fppc.ca.gov (866/275-3772)