Tam 460Recipient Committee
Campaign Statement
Cover Page
(Government Code Sections 84200-84216.5)
1099283
SEE INSTRUCTIONS ON REVERSE
COVER PAGE
Statement covers period
from 09/25/2016
through 10/22/2016
Date of election if applicable:
(Month, Day, Year)
OT
7 Mg'
CITY
• CLERV,'S
For Official Use Only
1. Type of Recipient Committee: All Committees - Complete Parts 1, 2,3, and 4.
Officeholder, Candidate Controlled Committee
0 State Candidate Election Committee
(I) Recall
(Also Complete Part 5)
0 General Purpose Committee
(1) Sponsored
0 Small Contributor Committee
0 Political Party/Central Committee
0 Primarily Formed Ballot Measure
Committee
O Controlled
O Sponsored
(Also Complete Part 6)
• Primarily Formed Candidate/
Officeholder Committee
(Also Complete Part 7)
2. Type of Statement:
El
Preelection Statement
Semi-annual Statement
0 Termination Statement
(Also file a Form 410 Termination)
E] Amendment (Explain below)
O Quarterly Statement
O Special Odd-Year Report
O Supplemental Preelection
Statement - Attach Form 495
I.D. NUMBER
3. Committee Information
1387962
COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE)
Tam for Council 2016
STREET ADDRESS (NO P.O. BOX)
CITY
Alameda
STATE ZIP CODE
CA 94501
AREA CODE/PHONE
(510)590-4536
MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX
CITY STATE ZIP CODE
AREA CODE/PHONE
OPTIONAL: FAX / E-MAIL ADDRESS
Treasurer(s)
NAME OF TREASURER
Susan Reyes
MAILING ADDRESS
CITY
Alameda
STATE ZIP CODE
CA 94501
AREA CODE/PHONE
(510)882-4536
NAME OF ASSISTANT TREASURER, IF ANY
MAILING ADDRESS
CITY
STATE ZIP CODE
a Tam
AREA CODE/PHONE
OPTIONAL: FAX / E-MAIL ADDRESS
ssj reyes@comcast net
4. Verification
1 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
Executed on
Executed on
Date
Executed on
Date
10/24/2016
Dale
10/24/2016
Date
By
Susan Reyes
Responsible Officer of Sponsor
By Len
By
Signature of Controlling Officeholder, Candidate, State Measure Proponent
By
Signature of Controlling Officeholder, 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
NAME OF OFFICEHOLDER OR CANDIDATE
Lena Tam
OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE)
City Council Member
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?
❑ 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 AREA CODE /PHONE
COVER PAGE - PART 2
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 of
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
❑ OPPOSE
Attach continuation sheets if necessary
FPPC Form 460 (Jan /2016)
FPPC Advice: advice @fppc.ca.gov (866/275 -3772)
Campaign Disclosure Statement
Summary Page
SEE INSTRUCTIONS ON REVERSE
NAME OF FILER
Tam for Council 2016
Amounts may be rounded
to whole dollars.
Statement covers period
09/25/2016
mm
through
10/22/2016
SUMMARY PAGE
Page 3 of
8
I.uwuwoEn
1387962
Contributions Received
t
2.
3.
4.
5. TOTAL CONTRIBUTIONS RECEIVED
Monetary Contributions
Loans Received
SUBTOTAL CASH CONTRIBUTIONS
Nonmonetary Contributions
Schedule A, Line 3
Schedule 8, Line 3
Add Lines 1 + 2
Schedule C, Line 3
Add Lines 3 + 4
�
�
Column A
TOTALTHIS PERIOD
(FROM ATTACHED SCHEDULES)
3,103.00
o'nn
3,103.00
0.00
3,103.00
Column B
CALENDAR YEAR
TOTALTO DATE
23,615.27
867.00
24,482.27
670.00
25,152.27
Calendar ¥ear Summary for Candidates
Running in Both the State Primary and
General Elections
20. Contributions
Received �
21. Expenditures
Made �
1/1 through 6/30
�
7/1 to Date
Expenditures Made
6. Payments Made
7. Loans Made
8. SUBTOTAL CASH PAYMENTS
9. Accrued Expenses (Unpaid Bills)
10. Nonmonetary Adjustment
11. TOTAL EXPENDITURES MADE
Schedule E, Line 4
Schedule H, Line 3
_-,~Add Lines s~r
Schedule F, Line 3
Schedule C, Line 3
.... ~'. ........ 'Auu Lines a+o~m
3,515.01
0.00
3,515.01 $
0.00
0.00
3,515.01 $
16,925.41
0.00
16,925.41
0.00
670.00
17,595.41
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 Line 12 + 13 + 14, then subtract Line 15
If this is a termination statement, Line 16 must be zero.
17. LOAN GUARANTEES RECEIVED
Schedule 8, Part 2
0.00
Cash Equivalents and Outstanding Debts
18. Cash Equivalents
19. Outstanding Debts
See instructions on reverse
Add Line 2 + Line 9 in Column 8 above
�
�
867.00
To calculate Column B, add
amounts in Column A to the
corresponding amounts
from Column Buf 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).
Expenditure Limit Summary for State
Candidates
22. Cumulative Expenditures Made*
(If Subject to Voluntary Expenditure Limit)
Date of Election
/ / �
� / �
Total to Date
*Amounts in this section may be different from amo mn
reported in Column B.
pppc Form w60(Jamz16)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
Schedule A
Monetary Contributions Received
SEE INSTRUCTIONS ON REVERSE
Amounts may be rounded
to whole dollars.
Statement covers period
from
09/25/2016
through 10/e2/2016
SCHEDULE A
CALIFORNIA
FORM
0�
Page
4
of
8
NAME OF FILER
Tam for Council 2016
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CONTRIBUTOR
CODE *
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF-EMPLOYED, ENTER NAME
OF BUSINESS)
AMOUNT
RECEIVED THIS
PERIOD
I.D. NUMBER
1387962
CUMULATwmDATE
CALENDAR YEAR
PER ELECTION
TO DATE
(IF REQUIRED)
10/05/2016
Calvin Fong
Richmond, CA 94803
IND
UC0N
OTH
PTY
LJGcc
Chief of Staff
City of Berkeley
100.00
100.00
o2016 $100.00
10/05/2016
Bill Smith
Alameda, CA 94502
Engineer
LLML
100.00
200.00
o2014 $80.00
c2016 $200.00
10/05/2016
Macy Tong
San Ramon, CA 94582
IND
OCOM
UOTH
PTY
LJaCC
Geotechnical Engineer
Engeo
250.00
250.00
n2016 $250.00
10/05/2016
Bill Withrow
Alameda, CA 94502
IND
COM
UOTH
PTY
[]GCC
Business Executive
Pear Track Security
Systems, Inc
100.00
100.00
o2016 $100.00
10/16/2016
Hal & Rose Gin
San Lozeouo, CA 94555
wm
Ucom
UOTH
LJPTY
[]SCC
City Planner
Alameda County
250.00
250.00
o2014 $250.00
G2016 $250.00
SUBTOTAL $
800.00
Schedule A Summary
1. Amount received this period — itemized monetary contributions.
(Include all Schedule A subtotals.) �
2. Amount received this period — unitennized 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 $ 3'103.00
900.00
2,203.00
*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)
Schedule A (Continuation Sheet)
Monetary Contributions Received
Amounts may be rounded
to whole dollars.
Statement covers period
from 09/25/2016
through 10/22/2016
SCHEDULE A (CONT.)
CALIFORNIA
Page
5
of
NAME OF FILER
Tam for Council 2016
I.D. NUMBER
1387962
DATE
RECEIVED
FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CONTRIBUTOR
CODE *
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF - EMPLOYED, ENTER NAME
OF BUSINESS)
AMOUNT
RECEIVED THIS
PERIOD
CUMULATIVE TO DATE
CALENDAR YEAR
(JAN. 1 - DEC. 31)
PER ELECTION
TO DATE
(IF REQUIRED)
10/20/2016
Annie Lam
Elk Grove, CA 95624
IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
Executive Director
Women's Caucus
00.00
00.00
G2016 $100.00
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑ IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
❑IND
❑ COM
❑ OTH
❑ PTY
❑ SCC
SUBTOTAL$ 100.0o
*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)
Schedule B — Part 1
Loans Received
SEE INSTRUCTIONS ON REVERSE
Amounts may be rounded
to whole dollars.
SCHEDULE B - PART 1
Statement covers period
from 09/25/2016
through
10/22/2016
Page 6
of 8
NAME OF FILER
Tam for Council 2016
FULL NAME, STREET ADDRESS AND ZIP CODE
OF LENDER
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
IF AN INDIVIDUAL, ENTER
OCCUPATION AND EMPLOYER
(IF SELF - EMPLOYED, ENTER
NAME OF BUSINESS)
(a)
OUTSTANDING
BALANCE
BEGINNING THIS
PERIOD
(b)
AMOUNT
RECEIVED THIS
PERIOD
(c)
AMOUNT PAID
OR FORGIVEN
THIS PERIOD*
)
OUTSTANDING
BALANCEAT
CLOSE OF THIS
PERIOD
(e)
INTEREST
PAID THIS
PERIOD
I.D. NUMBER
1387962
(f)
ORIGINAL
AMOUNT OF
LOAN
(9)
CUMULATIVE
CONTRIBUTIONS
TO DATE
Lena Tam
Alameda, CA 94501
t® IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
Manager
EBMUD
867.00
0.00
❑ PAID
0.00
® FORGIVEN
0.00
867.00
12/31/2018
DATE DUE
0
RATE
0,00
867.00
08/08/2016
DATE INCURRED
CALENDAR YEAR
$ 867.00
PER ELECTION **
$ 02016 867..00
t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
❑ PAID
❑ FORGIVEN
DATE DUE
RATE
DATE INCURRED
CALENDAR YEAR
PER ELECTION **
t ❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC
❑ PAID
❑ FORGIVEN
DATE DUE
RATE
SUBTOTALS $
0.00$
0.00$
867.00$
0.00
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 $ 0.00
(Total Column (c) plus loans under$100 paid or forgiven.)
(Include loans paid by a third party that are also itemized on Schedule A.)
0.00
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 $ 0.00
(May be a negative number)
(Enter (e) on
Schedule E, Line 3)
CALENDAR YEAR
PER ELECTION **
DATE INCURRED
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)
Schedule
Payments Made
SEE INSTRUCTIONS ON REVERSE
Amounts may be rounded
to whole dollars.
Statement covers period
from 09/25/2016
through 10/22/2016
SCHEDULE E
NAME OF FILER
Tam for Council 2016
CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment.
radio airtime and production costs
returned contributions
campaign workers' salaries
t.x or cable airtime and production costs
candidate travel, lodging, and meals
staff/spouse tmve|, lodging, and meals
transfer between committees of the same candidate/sponsor
voter registration
information technology costs (internet, e-mail)
CIVP
CNS
CTB
CVC
FIL
FND
IND
LEG
LET
campaign
campaign consultants
contribution (explain nonmonetary)*
civic donations
candidate fi|ine/Uq||ntfenv
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)
MBR member communications
MTG meetings and appearances
OFC office expenses
FET petition circulating
PHo phone banks
POL polling and survey research
POS postage, delivery and messenger services
PRO professional services (legal, accounting)
PRr print ads
RAD
RFD
SAL
TEL
TRC
TRS
TSF
VOT
WEB
Page 7 of 8
/z\wmmasn
1387962
CODE OR DESCRIPTION OF PAYMENT
AMOUNT PAID
Alameda Sun
PRT
1,525.50
Asian Health Services
CVC
160.00
Cedric Cheng Design
Concord, CA 94520
PRT
600.00
* Payments that are contributions or independent expenditures must also be summarized on Schedule D.
SUBTOTAL $
2,285.50
Schedule E Summary
1. Itemized payments made this period. (Include all Schedule E subtotals.)
2. Unitemized payments made this period of under $100
3. Total interespaid 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.)
3,450.50
64.51
0.00
TOTAL $
3,515.01
rppc Form ^enp^n/201q
Schedule E
(Continuation Sh
Payments Made
SEE INSTRUCTIONS ON REVERSE
Amounts may be rounded
to whole dollars.
SCHEDULE E (CONT.)
m
S atement cover period
09/25/2016
through 10/22/2016
NAME OF FILER
Tam for Council 2016
Page 8 of 8
I.uwmwBER
1387962
CODES: If one ofthe following codes aocurah*lydescrbeotho
MP compaignparapwpmaoa/m/xc Man
CNS campaign consultants MTG
CTB contribution (explain n9nmnnatory)^ OFC
CVC civic donations ! PET
FIL candidate fi|ing/uo||utfees PHO
FND fundraising events POL
IND independent expenditure supporting/opposing others (explain)* POS
LEG legal defense PRO
LIT campaign literature and mailings PRT
payment, you may enter the code. Othenwne, describe the payment.
member communications
meetings and appearances
office expenses
petition circulating
phone banks
polling and survey research
pmstnge, delivery and messenger services
professional services (|ogo[, accounting)
print ads
RAD
RFD
SAL
TEL
TRC
TRS
Tap
VOT
WEB
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)
NAME AND ADDRESS OF PAYEE
(IF COMMITTEE, ALSO ENTER I.D. NUMBER)
CODE
OR DESCRIPTION OF PAYMENT
AMOUNT PAID
Robouiaz
Falls Church, VA 22046
PHO
82.50
v= Interactive
Boston, MA 02118
WEB
1'000.00
oobodiaz.oze
Falls Church, VA 220*6
PHO
82.50
* Payments tha are contributions or independent expenditures must also be summarized on Schedule D.
SUBTOTAL $
1,165.00
FPPC Form 460 (Jan/2016)