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HomeMy WebLinkAboutAmy Chan - 4th Quarter_Annual Renewal - 03.08.2022lJ l5 B y/ Le 11 Reporting U City y &CuLatL�Aol ftegislr itpertino Page 1 & 9 VAR 2:22 Total Number of Pages including additional pages IN0 CITY CLERK CITY OF CUPERTINO LOBBYIST REGISTRATION& REPORTING FORM CUPERTINO (CMC CH. 2.100) TYPE OF REPORT (check all that apply) ❑ Initial Registration I.Annual Renewal (filed annually by January 15) Termination, effective date: ❑ Amendment, filedondate: Amendment explanation: (� Quarterly Report (CIVIC 2.100.100) (check one below) V 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 (Bled by October 15) 4th Quarter- October 1 to December 31(fiiled by January 15) LOBBYIST INFORMATION Are u a: Contract Lobbyist usiness or Organization Lobbyist Expenditure Lobbyist Note: Contract Lobbyist, Business or Organisation Lobbyist, and Expenditure Lobbyist are defined In CMC 2.100.030(o). Name of Lobbyist Telephone Number Business Address (Number and Street) City State Zip Code Cupertino Business 30 b9 License Number City of Cupertino Lobbyist Regetmion a Reponing Page 2 of a DBA 11Lfl CQN Federal Employer Identification II\\ I— Number (FEIN) 1t 6 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 person;.tyith an ownership interest in the 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 REPORT FOR EACH CATEGORY OF It CONTRACT LOBBYIST (CIVIC 2 100.090(all LINT INFORMATION 1 Client Name, (,_, L� Address, and Telephone Number Effective Date of Representation City of Cupertino Lobbyist Registration & Reporting 'age 3 of 8 Specify the nature and purpose of the client's business — C��le 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). ,PC Name of�eatch person Working or the Contra -- Laiaby�istath t is engaged in lobbying activity on behal of the client: A , - QA� .r ADDITIONAL CLIENTS -- K) if the contract lobbyist represents more than one client, attach a separate page providing all of the above information for each additional client. ❑ BUSINESS DR ORGANIZATION LOBBYIST (CIVIC 2.100.090b 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 action(s) the business or organization lobbyfst seeks to influence (Attach additional pages if necessary.) ❑ EXPENDITURE LOBBYIST (CMC 2.100. MOW) 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 action(s) the expenditure lobbyist seeks to influence Amount of Payment(s) or Expenditure(s): $ CMC 2.100. 090 d Name of Payer T (e.g. City agency, City Official or City Official- elect, ballot measure committee) Name of Recipient Lobbyist Amount of Payments(s) Dates) of Payment(s) CAMPAIGN CONTRIBUTIONS (CMC_2.100.090 fit - Name of Lobbyist Making or Delivering Contribution Name of Contribution Recipient (Officeholder, Candidate, or Candidate - Controlled Committee) Date of Contribution Amount of Contribution City of Cupertino LoWst RegistraWn S Reporting Page 5 of 8 (Attach a separate page providing all of the above information for additional contributions as needed.) INDEPENDENT EXPENDITURES (CMC 2.100. 09 ft) 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 ACTIVITY (CMC 2.100.090(h)) ~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 Amounts) 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 MNOIDATE CIVIC 2.10D.YMiH Recipient of Donation (for profit or nonprofit Organization) Amount(s) of Donation(s) Date(s) of Donation(s) City of Cupertino Lobbyist Registration & Reporting Page 6 of 8 Note, only donations totaling more than $1000 in the aggregate per calendar year must be disclosed. CONTACTS WITH CITY OFFICIALS OR CITY OFFICIALS -ELECT (CMC 2.100.0901111 Name(s) of City Official(s) or City Officials} -Elect 1 contacted Date(s) of Contact Methods(s) of Contact Act r rJ - Approximate Number of Contacts during calendar year: ❑ one Contact ❑ Two to Five Contacts ❑ Six to Ten Contacts Eleven or More Contacts ACTIV" EXPENSES (CMC 2.100.090 k Beneficiary or recipienttsj 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) Date(s) of Activity Fxpense(s) Note: Activity Expenses include Gifts, honoraria, consulting fees, salaries and other forms of Compensation, but do not include campaign contributions. TERMINATION 2.100.060 1 certify that I have been author' ed by the Lobbyist identified above to make this verification. 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 the Notice of Termination and to the best of my knowledge the information contained herein is true and complete. Termination Effective: c*dc"wwgng LODby %Reglaeallon a Repwgng Pege 7 of e Print Name Title Signature Executed on: (month, day, year) ATTACHMENTS I k 1 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 we 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 ClerKs Office 10300 Torre Avenue Cupertino, CA 95014 NOTE: Lotejees Hill apply to any lobbying acditnw reported afterthe 15days of Qualifying as a lobbyist *Initial registrationhe Is due within 15 days a/terqualiifying as a lobbyist VERIFICATION 1 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 Cupertim Municipal Code (Chapter 2.100).1 certify under Penalty of perjury under the taws of the State of Caigomla that 1 have reviewed this Lobbyist geport and to the best of my knowledge the Informa0on contained herein is true and complete. (CMC 2.100.09011)1 0T1M, z.. IF m QiV!1/f.5f?T Title r I?tQTAl7� t4� Telephone Number City of Cuperb" Wbbyi& Registretbn 8 Repm ng Page 8 of 8 Signature Z�2Z Executed on: (month, day, year) APPENDIX A: Cupertino Municipal Code Ch. 2.100.