Amy_Chan_CUP_QUARTERLY_2022_04_15City of Cupemno
Lobbyist Regishation & Reporting
Page t of a
Total Number of Pages
including additional pages
�R�� 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 25)
❑ Termination, effective date:
❑ Amendment, filed on date:
�[ Amendment explanation:
fA
rly Report (CMC 2.100.100)(check one below)
st quarter - January 1 to March 31(filed by April 15)
nd Quarter - April 1 to June 30 (filed by July 15)
rd Quarter- July 1 to September 30 (filed by October 15)
❑ 4th Quarter- October 1 to December 31(filed byJanuary 15)
APR 1 5 2022
CUPERTINO CITY CLERK
LOBBYIST INFORMATION
Are u 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)
City
State
Zip Code
Cupertino Business �Q 1
License Number
CM of Cupenino
Lobbyist Registatlon & Reponing
Page 2 of 8
DBA
Federal Employer
Identification
Number (FEIN) "C'4.! IDh cin 9
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 persons.With an ownership interest in the
If the Lobbyist is a corporation (for -profit or non-profit), state the barrels) of corporate Officers
and the Agent for Service of Process and their respective contact information (if different from
above):
REPORT FOR EACH CATEGORY OF LOBBYIST
CONTRACT LOBBYIST (CMC 2.100.090(a)l
LIENT INFORMATION `� L1 n
Client Name, (� ` 1^�iZ C
Address, and
Telephone`
Number ` Z
Effective Date of
Representation Jn�i+ / r ZyZ
City of Cupodino
Lobbyist Registration & Reporting
Page 3 of 8
nature and purpose of the client's business
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
PO
��1��Name of each person workmaor the Contract obbpst th t is engaged in lobbying activity
on behalt of the client: _
• r i
ADDITIONAL CLIENTS
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 ac fon(s) the business or organization lobbyist seeks to
influence
(Attach additional pages if necessary.)
EXPENDITURE LOBBYIST (CMC 2.100.090(c))
City of Cupertino
Lobbyist Registration 8 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): $
Section 3
(CMC2.100.090(d)) /v/P
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)
MC 2.100.090) Ofor
Name of Lobbyist Making or
Delivering Contribution
Name of Contribution
Recipient (Officeholder,
Candidate, or Candidate -
Controlled Committee)
Date of Contribution
Amount of Contribution
CRY of CupeNno
Labbylst Registration S Repw"
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 (CMC 2.100.090
Name(s) of city Official(s) or
City Officials) -Elect �y
contacted
Date(s) of Contact ,L-A 1 ZZ lT
Methods(s) of Contact
Approximate Number of Contacts during calendar year:
❑ One Contact
YyCI Two to Five Contacts
777❑��� Six to Ten Contacts
❑ Eleven or More Contacts
ACTIVITY EXPENSES ICMC 2.100.090(kl) qpr
Beneficiary or recipients) 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
Expense(s)
Note: Activity Expenses include Gifts, honoraria, consulting fees, salaries and other forms
Compensation, but do not include campaign contributions.
TERMINATION (2.100.060)
I certify that I have been authonz)d y 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 1 have
reviewed the Notice of Termination and to the best of my knowledge the information
contained herein is true and complete.
Termination Effective:
Coy or Cupenino
Lo yist Regstration & RepMng
Page 8 cf 8
Signature -
Executed on: T
(month, day, year)
APPENDIX A:
Cupertino Municipal Code Ch. 2.100.