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HomeMy WebLinkAboutAmy Chan - 3rd Quarter - 10.12.2021City of Cupedino Lobbyist Registration & Repuding Page 1 of 8 Total Number of Pages including additional pages 1A CITY OF CUPERTINO LOBBYIST REGISTRATION & REPORTING FORM CUPERTINO (CMC CH. 2.100) TYPE OF REPORT (check all that apply) ❑ initial Registration ❑ Annual Renewal (filed annually by January 15) ❑ Termination, effective date: ❑ Amendment, filed on date: Amendment explanation: sl I Quarterly Report (CMC 2.100.100) (check one below) i 1st quarter - January 1 to March 31(fiiled by April 15) 2nd Quarter - April 1 to June 30 (filed by July 15) 3rd Quarter -July 1 to September 30 (filed by October 15) 4th Quarter -October Ito December 31(filed by January 15) LOBBYIST INFORMATION OCT 1 2 2021 CUPERTINO CITY CLERK Are ou a: Contract Lobbyist /❑— Business or Organization Lobbyist ❑ Expenditure Lobbyist Note: Contract Lobbyist, Business or Organization Lobbyist, and Expenditure Lobbyist are defined in CMC 2.100.030(o). Name of Lobbyist Telephone Number Business Address (Number and Street) t4kom City Zip Code Cupertino Business �, 01 License Number Cm' of Cupeaino Lobbyist Registration 8 Roitorting Page 2 of 8 Federal Employer Identification Number (FEIN) Specify how the Contract Lobbyist, Business or Organization Lobbyist, or the Expenditure Lobbyist entity is organized: Sole Proprietorship Partnership ❑ Non -Profit Corporation ❑ For -Profit Corporation ❑ Other: If the Lobbyist is a sole proprietor or partnership of fewer than ten (10) persons, state the name(s) of the sole proprietor or personrstyith an ownership interest in t)te If the Lobbyist is a corporation (for -profit or non-profit), state the name(s) of corporate officers and the Agent for Service of Process and their respective contact information (if different from F;UOTAifr7;Ti_Ta:[9_if cish s'2Ira]'7'.l7FiI CCONTRACT LOBBYIST ICMC 2.100.090(a)1 LIENT INFORMATION 1 Client Name, Address, and Telephone .�. Number Effective Date of Representation 'S 61Jtr r z4iz Specify the nature and purpose of the client's business City of Cupertino Lobbyist Registration & Reporting Page 3 of 8 cu; r-KQ-- F-- r A,)�, CJ76q I Describe the legislative or administrative action(s) the Contract Lobbyist was retained to influence on behalf of the client, and the outcome sought {attach additional pages if necessary). Name of each person working for the Contract Lobbyist th t is engaged in lobbying activity on behalf of the client: Ally - C)Ah� ADDITIONAL CLIENTS K)'P�— if the contract lobbyist represents more than one client, attach a separate page providing all of the above information for each additional client. ❑ BUSINESS OR ORGANIZATION LOBBYIST(CIVIC 2.100.090 b Name of Business Name of owners, officers or employees conducting Lobbying activities on behalf of Business or Organization: Describe the nature and purpose of the business, organization, or association. The legislative of administrative actions] the business or organization lobbyist seeks to influence (Attach additional pages if necessary.) 0 EXPENDITURE LOBBYIST (CMC 2.100. 090(c)) City of Cupertino Lobbyist Registration & Reporting Page 4 of 8 Name of Expenditure Lobbyist Name of each person working for the Expenditure Lobbyist that is engaged in lobbying activity (if applicable): The legislative of administrative actions) the expenditure lobbyist seeks to influence Amount of Payment(s) or Expenditure(s): $ PAYMENT FOR CONSULTAN OR CMC 2.100.090 d Name of Payer ] (e.g. City agency, City Official or City Official- elect, ballot measure committee) Name of Recipient Lobbyist Amount of Payments(s) Date(s) of Payment(s) CAMPAIGN CONTRIBUTIONS (CMC 2.100.090)1r ] Name of Lobbyist Making or Delivering Contribution Name of Contribution Recipient (Off icehoIder, Candidate, or Candidate - Controlled Committee) Date of Contribution Amount of Contribution city orcWatfim Lobbyist Regisireaon a Repmliitg Page 5 of a (Attach a separate page providing all of the above information for additional contributions as needed.) INDEPENDENT EXPENDITURES( CMC 2.100.090(g)) JA- Name of Lobbyist Making Independent Expenditure Name of City Official or candidate for City office that is intended beneficiary of Independent Expenditure Date of Expenditure Amount of Expenditure (Attach a separate page providing all of the above information for additional expenditures as needed.) FUNDRAISING ACFIVITY (CIVIC 2.100.090(hl) Name(s) of beneficiary of Fundraising Activity (City Official, candidate, committee, or party) Name of City Official requesting Fundraising Activity (if applicable) Date of Fundraising Activity Name(s) of contributors who made contributions in connection with Fundraising Activity Amount(s) of contributions raised in connection with Fundraising Activity (Attach a separate page providing all of the above information for additional expenditures as needed.) DONATIONS TO ORGANIZATIONS MADE AT BEHEST OF CITY OFFICIAL OR(CANDIDATE CIVIC 2.100.090(il) Yv/'rl Recipient of Donation (for profit or nonprofit Organization) Amount(ss) of Donation(s) Date(s) of Donation(s) City of Cupertino Lobbyist Registration a RepoNn Page a of a Note: only donations totaling more than $1000 in the aggregate per calendar year must be disclosed. CONTACTS WITH CITY OFFICIALS OR CITY OFFICIALS -ELECT ICMC 2.100.09D(ill Name(s) of City Official(s) or City Official(s)-Elect contacted +N L) S �E\ ,� J b 1 z)\ � . tRC� %OL. (WA 1)-Lk. Date(s) of Contact Pw''feu� C{\ Methods(s) of Contact CI&L S LP \ViOn1 (�t� vYt�Z Approximate Number of Contacts unng ca ender year: ❑ One Contact Two to Five Contacts ❑ 5ixto Ten Contacts ❑ Eleven or More Contacts ACTIVITY EXPENSES (CIVIC 2.100.090(k Beneficiary or recipient(s) of Activity Expense(s) (City Official, City Official- elect or member of his or her immediate family or domestic partner) Amount(s) of Activity Expense(s) kpr Date(s) of Activity Expense(s) Note: Activity Expenses include Gifts, honoraria, consulting fees, salaries and otherforms of Compensation, but do not include campaign contributions. TERMINATION 12.100.060) Or I certify that I have been authorized by the Lobbyist identified above to make this verification. I have reviewed the requirements of the provisions of the Cupertino Municipal Code (Chapter 2.100). I certify under penalty of perjury under the laws of the State of California that I have reviewed the Notice of Termination and to the best of my knowledge the information contained herein is true and complete. Termination Effective: City of Cupertino Lobbyist Registration & Reponag Page T of a Print Name Title Signature Executed on: (month, day, year) ATTACHMENTS � ` t I have reviewed the lobbyist guidelines and I have nothing to report Attached to this Report is/are the following: (If additional space is needed, attach additional pages with responses to each of the above disclosure categories( FEES DUE (CMC 2.100.080 and see Fee Schedule A —General) Lobbyist Registration Fee` (January 1- December 31) $ Delinquent Fee $ Total Payment Due With Report $ Registration Fee Delinquent Fees $178.96 $25 per day with a max of $500 Make checks payable to: City of Cupertino Send Forms and Payment to: City of Cupertino City Clerk's Office 10300 Torre Avenue Cupertino, CA 95014 NOTE: Lore fees will apply to any lobbying activity net reported after the 15 days of qualyjying as a lobbyist *Initial registration fee is due within 15 days after saulifymg as a lobbyist VERIFICATION I certify that I have been authorized by the Lobbyist identified above to make this verification. I have reviewed the requirements of the provisions of the Cupertino Municipal Code (Chapter 2.100).1 certify under penalty of perjury under the laws of the State of California that I have reviewed this Lobbyist Report and to the best of my knovdedge the information contained herein is true and complete. (CIVIC 2.100.090(1)) �' r"..177!'!�SFIS�C.SV/lLRLT� Title cs n-rtl7ca%L� Telephone Number CitydCupenino Lobbyist Regisbeeon a Re Ang Page a of B Signature Executed on: )month, day, year) APPENDIX A: Cupertino Municipal Code Ch. 2.100.