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Home My WebLink About2018-09-14 Form 460 - HarnikRecipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE CI5 OFF TY DESERT. Statement covers period Date of election if applicable: 2010 SEP 2 1 PM 12` from 07/01/2018 (Month, Day, Year) through 09/14/2018 I 06/05/2018 1. Type of Recipient Committee: All Committees —Complete Parts 1, 2, 3, and 4. ❑X Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure Q Stale Candidate Election Committee Committee Q Recall Q Controlled fAj= h Pen 7 Q Sponsored tNwCanddePerre} ❑ General Purpose Committee Q Sponsored 0 Small Contributor Committee Q Political Party/Central Committee ❑ Primarily Formed Candidate/ Officeholder Committee (AlsoC 431W&Pad7) 3. Committee Information I I.D. NUMBER 1395155 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) _ JAN HARNIK FOR SUPERVISOR 201E STREET ADDRESS (NO P.O. BOX) 73-901 SHADOW LAKE DR. CITY STATE ZIP CODE AREA CODEIPHONE PALM DESERT CA 92260 (760)895-2690 MAILING ADDRESS (IF DIFFERENT) NO, AND STREET OR P.O. BOX P.O. BOX 1233 CITY STATE ZIP CODE AREA CODEIPHONE PALM DESERT CA 92261 OPTIONAL: FAX I E-MAIL ADDRESS (916)473-4299 / DAVID@THEAGENCY.US 2. Type of Statement: ❑ Preelection Statement ❑ Semi-annual Statement Q Termination Statement (Also file a Form 410 Termination) ❑ Amendment (Explain below) COVERPAGE — of 8 For Official Use Only ❑ Quarterly Statement ❑ Special Odd -Year Report ❑ Supplemental Preelection Statement -Attach Form 495 Treasurer(s) NAME OF TREASURER DAVID BAUER MAILING ADDRESS 2150 RIVER PLAZA DR., #150 CITY STATE ZIP CODE AREA CODEIPHONE SACRAMENTO CA 95633 (916)473-4298 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL- FAX I E-MAIL ADDRESS 4. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge theinformation under penalty of perjury under the laws of the State of California that the foregoing Is true and correct. Executed on 09/14/2018 Dato Executed on 09/14/2018 Dab Executed on Date Executed on Date www.nefrle.com By By By In the attached schedules is true and complete. I certify By SOuMaeofCa*ongOf iceWderCandidate,StdoMewumPngcnW 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 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE JAN BARNIK OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) County Supervisor: RIVERSIDE COUNTY District 4 RESIDENTIAUBUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP 73--901 SHADOW LAKE DR. PALM DESERT CA 92260 Related Committees Not Included in this Statement: Ustanycommitrees 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 RE-ELECT JAN HARNIK PALM DESERT CITY COUNCIL 1322067 2014 NAME OF TREASURER CONTROLLED COMMITTEE7 ® YES ❑ NO COMMITTEEADDRESS STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE PALM DESERT CA 92260 (760)285-7531 COMMITTEENAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O. BOX) COVER PAGE - PART 2 Page 2 of 8 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO. OR LETTER I 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 —i 1 a1A1c ctr LAjuc ARC^%.Uurvrnunc Attach continuation sheets if necessary www.nefle.com FPPC Form 460 (Janl2016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) www.fppc.r.a.gov Campaign Disclosure Statement Amounts may be rounded Summary Page to whole dollars. SEE INSTRUCTIONS ON REVERSE NAME OF FILER JAN BARNIR FOR SUPERVISOR 2018 Contributions Received 1. Monetary Contributions ........................................... schedule A. Una 3 2. Loans Received...................................................... schedule B, tine 3 3. SUBTOTALCASH 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 if tine 3 6. SUBTOTALCASH PAYMENTS .................................... Add tines 6 + T 9. Accrued Expenses (Unpaid Bills) ............................... schedule F Line 3 10. Nonmonetary Adjustment ......................................... schedule C, Line 3 11. TOTAL EXPENDITURES MADE ............................... Add tines a + s + 10 Current Cash Statement 12. Beginning Cash Balance ....................... Previous Summary Page, tine 16 13. Cash Receipts ................................................... Column A, Line 3above 14. Miscellaneous Increases to Cash ........................... schedule t. Line 4 15. Cash Payments .................................................. Column A, Line a above 16. ENDING CASH BALANCE .......... Add Lines 12 + 13 + 14, then subtract Line 15 !f this is a termination statement, Line 16 must be zero. Statement covers period from 07/01/2018 through 09/14/201B I Page 3 of 8 Column A Column B TOTALTHr5 PER100 C 4LENOMt YEAR ¢ROMATrACHEOSCHEMES) TOTALTO DATE $ 2,450.00 $ 231,264.00 0.00 0.00 $ 2,450.00 0.00 $ 2,450.00 $ 8,492.45 0.00 $ 8,492.45 -35,895.63 0.00 $-27,403.18 $ 5,342.45 2,450.00 700.00 0,492.45 17. LOAN GUARANTEES RECEIVED ........................... schedule B. Part $ Cash Equivalents and Outstanding Debts 18. Cash Equivalents... ............. .. .............. see instructions on reverse 19. Outstanding Debts .......................„ Add Line 2+Line.9in Column Babove www.net111e.com 0.00 $ 0.00 $ 231,264.00 15,968.06 $ 247,232.06 $ 543,251.12 0.00 $ 543,251.12 0.00 15,968.06 $ 559,219.18 To calculate Column B. add amounts in Column A la 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). I.D. NUMBER 1 1395155 Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 111 through 6130 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made S $ Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made` Pt subject to Voluntary Expenditure Umit) Date of Election Total to Date (mmlddlyy) Amounts in [his section may be different from amounts reported in Column B. FPPC Form 460 (Jant2016) FPPC Advice: advictrtfppc.ca.gov (8661275-37721 www.fppc.ra.gov Schedule A SCHEDULE A Amounts may oe rounaen Monetary Contributions Received Statement covers period p to whole dollars. CALIFORNIA ' from 07/01/2018 FORM SEE INSTRUCTIONS ON REVERSE through 09/14/2018 Page 4 of 8 NAME OF FILER I D. NUMBER JAN HARNIR FOR SUPERVISOR 2018 1395155 �� FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR ADDRESSAND ZIPDE O CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF CT AS .D.N CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE QFSELF-EMPLOYED, ENTER NAME PERIOD (JAN, 1 - DEC 31) (IF REQUIRED) of BUSINESS) 00/01/2018 Mary Kelly QIND Not employed 50.00 175.00 P2018 $725.00 ❑ OTH ❑ PTf ❑SCC OB/01/2018 Chuck/Priscilla Porter QIND Retired 500.00 1,000.00 P2018 $1,000.00 ❑OTH ❑ PTY []SCC 08/22/2018 FREDERICK W. NOBLE X❑IND EXECUTIVE 2,650.00 1,900.00 P2018 $1,900.DO ❑OTH ❑ P-ry ❑ SCC 09/14/2018 FREDERICK W. NOBLE X❑IND EXECUTIVE —750.00 11 900. 00 P2018 $1,900.00 ❑OTH ❑ PTY ❑SCC ❑IND ❑COM ❑OTH ❑ PTY ❑SCC SUBTO€AL$ 2, 450.00 Schedule A Summary 1. Amount received this period — itemized monetary contributions. (Include all Schedule subtotals.) ............. $ . 2,450.00 2. Amount received this period-- unitemized monetary contributions of less than $100 ............................. $ 0.00 3. Total monetary contributions received this period. Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1. g ) ....................... TOTAL_ $ 2,450.00 www.netrile.com '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 (Jan12016) FPPC Advice: advice@fppc.ca.gov {8661275-3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER JAN HARNIK FOR SUPERVISOR 201E Amounts may be rounded to whole dollars. Statement covers period from 07/01/201B through 09/14/201B I Page 5 of B I.D. NUMBER CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment 1395155 CW campaign paraphemalialmisc. NW membercommunications RAD radio airtime and production costs CNS campaign consultants VM meetings and appearances RFD returned contributions CTB contribution (explain nonmonelary)' OFC office expenses SAL campaign workers' salaries CVC civic donations PEr petition circulating TEL t.v, or cable airtime and production costs FL candidate frlingfballol fees PHO phone banks M candidate travel, lodging, and meals FND fundralsing events POL polling and survey research TRS staffispouse travel, lodging, and meals IPD independent expenditure supportinglopposing others (explain)' POS postage, delivery and messenger services TSF transfer between committees of the same candidatelsponsor 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 QFCOMIAME.ALSDENTERI.O.HUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNTPAID Citi Cards Phonebanks, election night gathering 4,659.83 P.O. Sox 78045 Phoenix, AZ 85062 La Bodega FND 1,235.80 3512 Central Ave. RIVERSIDE, CA 92506 Roemer & Harnik LLP PRO See Sch. G for pass -through information 1,882.67 45025 Nanitou Dr. Indian Wells, CA 92210 Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 7,778.30 Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) .................... $ 8,492.45 2. Unitemized payments made this period of under $100.......................................................................................................................................... $ a . oo 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. . TOTAL $ 8,492.45 www.►]efflie.com FPPC Form 464 (Jan/2016) FPPC Toll -Free Helpline: 866/ASK-FPPC (6661275-3772) www.fppc.ca.gov Schedule E SCHEDULEE(CONT. covers period ` (Continuation Sheet) Amounts may be rounded StatementA• - A i to whole dollars. - Payments Made from 07/01/2018 SEE INSTRUCTIONS ON REVERSE NAME OF FILER through 09/14 /2018 Page 6 Of 8 I.D. NUMBER JAN HARNIK FOR SUPERVISOR 2018 1395155 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CW campaign paraphemalialmisc. NIR member communications RAD radio airtime and production costs CNS campaign consultants NITG 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 F1L candidate filing/ballot fees PFIO phone banks TRC candidate travel, lodging, and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals ND independent expenditure supporting/opposing others (explain)' POS postage, delivery and messenger services TSF transfer between committees of the same candidatelsponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration UT campaign literature and mailings PRf print ads WO 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 David Bauer Sacramento, CA 95833 PRO 714.15 * Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL $ 714.15 FPPC Form 460 (Jan12016) FPPC Toll -Free Helpline: 8661ASK-FPPC (8661275-3772) www.netrile.com www.fppc.ca.gov SCHEDULE F Schedule F Accrued Expenses (Unpaid Bills) NAME OF FILER .TAN HARNIK FOR SUPERVISOR 2018 Amounts may be rounded to whole dollars. Statement covers period from 07/01/2018 through 09/14/2018 Page 7.of 0 I.D. NUMBER 1395155 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CUP campaign paraphernalia/misc. NM member communications RAD radio airtime and production costs CNS campaign consultants WM 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 filinglballot fees PHO phone banks TRC candidate travel, lodging, and meals FND fundralsing events POL polling and survey research TRS staff/spouse travel, lodging, and meals W independent expenditure supportinglopposing others (explain)' POS postage, delivery and messenger services TSF transfer between committees of the same candidatelsponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration UT campaign literature and mailings PRT print ads WEB information technology costs (Internet. e-mail) ( { (c) { NAME AND ADDRESS OF CREDITOR CODE OR OUTSTAA NDING AMOUNTIN CURRED AMOUNT PAID OUTSTANDING OF COMMrrrM ALSO ENTER 1.0, NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD Roemer 5 flarnik LLP PRO See Sch. G for 30,000.00 -28,117.33 1,682.67 0.00 45025 Manitou Dr. pass -through Indian Wells, CA 92210 information Citi Cards Phonebanks, election 4,659.83 0.00 4,659.83 0.00 P.O. Sox 78045 night gathering Phoenix, AZ 85062 La Bodega IFND 1,235.00 0.00 1,235.80 0.00 3512 Central Ave. RIVERSIDE, CA 92506 ' Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTALS $ 35, 895.63$ -28, 117.33 $ 7, 778.30$ 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.)............................................ INCURRED TOTALS $-26,117.33 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 $ 7,778.30 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A. Line 9.)..................................................................................................................... .......-----...... NET $ -35, 895.63 May ba a negabve n rnba FPPC Form 460 (JaN2016) FPPC Toll -Free HelpHne: 8661ASK-FPP) WWW.nefile.com www.fppc.ca.gov Schedule I SCHEDULEI Miscellaneous Increases to Cash Amounts may be rounded Statement covers periodFPage 6 to whole dollars. Jfrom 07/01/2018 SEE INSTRUCTIONS ON REVERSE through 09/14/2018 8 of 8 NAME OF FILER I.D NUMBER JAN HARNIK 7nR SUPERVISOR 2018 1395155 DATE FULL NAME AND ADDRESS OF SOURCE AMOUNT OF RECEIVED OF COMMUTES. ALSO ENTER I.D. NUMBER) DESCRIPTION OF RECEIPT INCREASE TO CASH 08/31/2010 Political Data Inc. Refund of duplicate payment 500.00 12501 Imperial Hwy #200 Norwalk, CA 90650 09/14/2018 (City of La Quints 78-495 Calle Tampico LA QUINTA, CA 92253 Attach additional information on appropriately labeled continuation sheets. Refund of deposit SUBTOTAL $ Schedule I Summary 1. Itemized increases to cash this period........................................................................................................................ $ 700.00 2. Unitemized increases to cash of under $100 this period. ..................... $ 0.00 3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).)................................. $ 0.00 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Line 14.)........................................................................... .......... TOTAL $ 700.00 www.nettile.com 200.00 700.00 FPPC Form 460 (Jan12016) FPPC Advice: advice@fppc.ca.gov (8661275-3772) www.fppc.ca.gov