San Francisco Ethics Commission For SFEC use 25 Van Ness Avenue, Suite 220 San Francisco, CA 94102 E-Filed 06/21/2018 Phone: (415) 252-3100 17:34:06 Fax: (415) 252-3112 Email: [email protected] Filing ID: 172220378 Web: www.sfethics.org MATCHING REQUEST: APPLICATION FOR ADDITIONAL PUBLIC FUNDS BY CANDIDATES FOR MAYOR AND THE BOARD OF SUPERVISORS (S.F. Campaign and Governmental Conduct Code § - 1.144(c) and 1.144(d)) Note: This form is to be used by candidates who have been certified to receive public funds and who wish to apply for additional public funds based on matching contributions. To apply for additional public funds, please write legibly and fill out this form completely; failure to do so may delay your request for funds. CANDIDATES FOR BOARD OF SUPERVISORS A candidate who is certified as eligible to receive public funds must complete this form whenever he/she seeks additional public funds. The Ethics Commission may disburse public funds to eligible candidates up to $155,000 to non-incumbent candidates and $152,500 to incumbent candidates provided that the disbursement will not cause the candidate to exceed his or her Trust Account Limit. CANDIDATES FOR MAYOR A candidate who is certified as eligible to receive public funds must complete this form whenever he/she seeks additional public funds. The Ethics Commission may disburse public funds to eligible candidates up to $975,000 to non-incumbent candidates and $962,500 to incumbent candidates, provided that the disbursement will not cause the candidate to exceed his or her Trust Account Limit. PART I. FILER INFORMATION Name of Candidate Office (District No.) Date of Election Theo Ellington BOS District 10 11/06/2018 Name of Campaign Committee FPPC ID No. Candidate Email [email protected] Theo Ellington for Supervisor 2018 1398949 Candidate Mailing Address Candidate Telephone (510) 423-4300 San Francisco CA 94114 Name of Treasurer Treasurer Email [email protected] Stacy Owens Treasurer Mailing Address Treasurer Telephone (510) 423-4300 San Francisco CA 94114 Edited: 6/2016 Page 1 of 16 Forms Covered: 144(c)-1, 144(d)-1 PART II. THE PURPOSE OF THIS SECTION IS TO DETERMINE WHETHER AN ELIGIBLE CANDIDATE HAS REACHED HIS/HER TRUST ACCOUNT LIMIT Trust Account Limit = Individual Expenditure Ceiling – Amount Spent Your Trust Account Limit (TAL) is the amount of funds that you may have in your Campaign Contribution Trust Account (CCTA) such that the expenditure of these funds would cause you to reach, but not exceed your Individual Expenditure Ceiling (IEC). Complete the following: Line 1: Amount of Individual Expenditure Ceiling1 $ _______________250,000.00 Line 2: Amount Spent (include outstanding checks) $ _______________48,702.91 $ _______________0.00 Line 3: In-kind contributions received2 Line 4: Subtotal: Line 2 plus Line 3 $ _______________48,702.91 Line 5: Trust Account Limit (Line 1 minus Line 4) $ _______________201,297.09 Line 6: Amount of unpaid bills $_________________0.00___ This line cannot exceed line 5 CAUTION: Your unpaid bills may never exceed your TAL. In addition, all unpaid bills must be paid in full within 180 days of incurring them. State the amount of funds you have in the following accounts and the amount of total contributions you received as of the date you are completing this form. When reporting cummulative contribuitons below, you must count monetary contributions, public funds, and loans received, including items received but not yet deposited. Campaign Contribution Trust Account (CCTA) $____________________97,002.06 Campaign Contingency Account (CCA) $__________________________0.00 Cumulative contributions (monetary, in-kind and loans) and public funds received $ ____________________125,704.97 PART III. CANDIDATE’S VERIFICATION I hereby declare that: . The Ethics Commission has certified that I am eligible to receive public funds for the election to be held on ____________(11/06/2018 election date and year). 3 . I am requesting $________54,127.26 in matching contributions of the total $________59,545.26 contributions that I have received from private contributors be matched with public funds. I am providing information about these contributions on the Matching Contributions List included in. this document. I declare under penalty of perjury that I have read and understand the requirements of the public financing program as set out in the Campaign Finance Reform Ordinance. I also declare under penalty of perjury that to the best of my knowledge, information and belief, the information I provide in this form and all supporting documentation is true and correct. _______Theo Ellington_______________________________________ ___________________________06/21/2018 Candidate’s Signature Date 1 Because you cannot make or incur expenses greater than your IEC, the total amount of your paid bills, unpaid bills, and in-kind contributions may not exceed your IEC. 2 Candidates for Board of Supervisor and Mayor: Qualified campaign expenditures include in-kind contributions; thus, you must include the amount of in-kind contributions you receive when determining your TAL. 3 A matching contribution is a monetary contribution of up to $500, other than a loan or a qualifying contribution that is made by an individual, other than the candidate or the candidate's immediate family, who is a resident of San Francisco and that complies with all requirements of the Campaign Finance Reform Ordinance. Matching contributions do not include contributions that are received more than 18 months before the date of the election. S.F. Campaign and Governmental Conduct Code § 1.104(k). Page 2 of 16 Edited: 6/2016 Forms Covered: 144(c)-1, 144(d)-1 Disbursement of Public Funds for Board of Supervisor Candidates Private Funds Raised Matching Public Private Funds Raised Matching Public Funds by Non-Incumbents Funds by Incumbents Initial $10,000 $20,000 $15,000 $20,000 1:2 $50,000 $100,000 $50,000 $100,000 1:1 $35,000 $35,000 $32,500 $32,500 Total $95,000 $155,000 $97,500 $152,500 Total Public and $250,000 $250,000 Private Funds Disbursement of Public Funds for Mayoral Candidates Private Funds Raised Matching Public Private Funds Raised Matching Public Funds by Non-Incumbents Funds by Incumbents Initial $50,000 $100,000 $75,000 $100,000 1:2 $425,000 $850,000 $425,000 $850,000 1:1 $25,000 $25,000 $12,500 $12,500 Total $500,000 $975,000 $512,500 $962,500 Total Public and $1,475,000 $1,475,000 Private Funds Page 3 of 16 Edited: 6/2016 Forms Covered: 144(c)-1, 144(d)-1 MATCHING CONTRIBUTIONS - SUPPORTING DOCUMENTATION Each candidate must submit the following documentation in order to be considered for public funds: . Matching Contributions List (see below). Evidence of each contribution received, such as electronic copies of contributor checks, contributor cards and credit card authorizations. (These documents must be arranged in batches according to deposit batch number. The committee’s record-keeper should assign a batch number to each deposit.) . Electronic copies of itemized deposit slips, deposit receipts and evidence of S.F. residency. Any claim form that is not accompanied by these documents will not be considered for payment. Last First Building #, Zip Code, Occupation Employer Payment Date Date Deposit Amount of Amount Name Name Street, City Method Received Deposited Batch # Contribution Requested Apt. to be Matched 1.Tirtandai Adrian 94107 Chief Executive Officer Open Door Legal Electronic 12/15/2017 01/04/2018 50.00 50.00 San Francisco 2.Armstrong Lionel 94131 Computer Programmer University Of California, Check 12/30/2017 01/04/2018 010418U 250.00 150.00 San Francisco San Francisco 3.Drake Jay 94104 Attorney Reuben, Junius & Rose Cash 12/15/2017 01/04/2018 010418U 100.00 100.00 San Francisco 4.Gipson Edwin 94124 General Laborer City And County Of San Check 12/15/2017 01/04/2018 010418U 500.00 400.00 Francisco, CA. San Francisco 5.Lee Carolyn 94109 Retired N/A Check 12/20/2017 01/04/2018 010418U 500.00 400.00 San Francisco 6.Lee Sandy 94107 Insurnace Agent Self Employed Check 12/12/2017 01/04/2018 010418U 500.00 400.00 San Francisco 7.Loy Sandra 94134 Not Employed N/A Check 12/24/2017 01/04/2018 010418U 50.00 50.00 San Francisco 8.Silvestri Russell 94117 Investment Manager Skiritai Capital LLC Check 12/15/2017 01/04/2018 010418U 500.00 400.00 San Francisco 9.Sun Bangchun 94122 Retired N/A Check 12/19/2017 01/04/2018 010418U 300.00 300.00 San Francisco 10.Zanze Anthony 94129 Chief Operating Officer Hamilton Zanze & Cash 12/15/2017 01/04/2018 010418U 500.00 500.00 Company San Francisco 11.Ford Chris 94121 Architect BRW Architects Check 12/31/2017 01/09/2018 011618 500.00 500.00 San Francisco 12.Rosenlund Ford April 94121 Trustee Rosenlund Family Check 12/31/2017 01/16/2018 011618 500.00 500.00 Foundation San Francisco 13.Burton John 94107 Retired N/A Check 01/12/2018 01/24/2018 012418U 500.00 400.00 San Francisco 14.Ma Fiona 94116 Board Member California State Board of Check 01/15/2018 01/24/2018 012418U 250.00 150.00 Equalization San Francisco 15.Phillips Garth 94107 General Manager McCarthy Cook & Co. Check 03/14/2018 03/27/2018 032718 100.00 100.00 San Francisco Subtotals 5,100.00 4,400.00 Edited: 6/2016 Forms Covered: 144(c)-1, 144(d)-1 Page 4 of 16 Matching Contributions List (Continuation) Last First Building #, Zip Code, Occupation Employer Payment Date Date Deposit Amount of Amount Name Name Street, City Method Received Deposited Batch # Contribution Requested Apt. to be Matched 16.Recchiuti Michael 94107 Founder Recchiuti Confections Check 03/14/2018 03/27/2018 032718 200.00 200.00 San Francisco 17.Rothschild Matthew Joseph 94133 Lawyer City and County Of San Check 03/14/2018 03/27/2018 032718 118.00 118.00 Francisco, CA San Francisco 18.Sullivan Alison 94107 Pastry Chef Self Employed Check 03/14/2018 03/27/2018 032718 150.00 150.00 San Francisco 19.Clay Michael 94158 Architect Golden State Warriors Check 09/27/2017 09/27/2017 092717 100.00 100.00 San Francisco 20.Nabhan Antoun 94131 Vice President of Raptor Pharmaceuticals, Check 10/18/2017 10/24/2017 102417 500.00 400.00 Corporate Development Inc.