Apple_Inc__CUP_REGISTRATION_2021_10_13CITY OF CUPERTINO
LOBBYIST REGISTRATION & REPORTING FORM
(CMC CH. 2.100)
Total Number of Pages
including additional pages
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:
________________________________________________
Quarterly Report (CMC 2.100.100) (check one below)
1st quarter - January 1 to March 31 (filed 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 1 to December 31 (filed by January 15)
Section 1
LOBBYIST INFORMATION
Are you 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
Email
Business Address
City
State
Zip Code
Cupertino Business License Number
City of Cupertino
Lobbyist Registration & Reporting
Page 1 of 8
DBA
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 persons with an ownership interest in the
business:______________________________________________________________________
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
above):________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
Section 2
REPORT FOR EACH CATEGORY OF LOBBYIST
CONTRACT LOBBYIST (CMC 2.100.090(a))
CLIENT INFORMATION
Client Name,
Address, and
Telephone
Number
Effective Date of
Representation
City of Cupertino
Lobbyist Registration & Reporting
Page 2 of 8
Specify the 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
necessary).
Name of each person working for the Contract Lobbyist that is engaged in lobbying activity
on behalf of the client:
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 (CMC 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 action(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 & Reporting
Page 3 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
PAYMENT FOR CONSULTANT OR OTHER SERVICES RENDERED TO CITY, CITY OFFICIALS, ETC.
(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)
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
Lobbyist Registration & Reporting
Page 4 of 8
(Attach a separate page providing all of the above information for additional contributions
as needed.)
INDEPENDENT EXPENDITURES (CMC 2.100. 090(g))
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
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 CMC 2.100.090(i))
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 5 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 2.100.090(j))
Name(s) of City Official(s) or
City Official(s)-Elect
contacted
Date(s) of Contact
Methods(s) of Contact
Approximate Number of Contacts during calendar year:
One Contact
Two to Five Contacts
Six to Ten Contacts
Eleven or More Contacts
ACTIVITY EXPENSES (CMC 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)
Date(s) of Activity
Expense(s)
Note: Activity Expenses include Gifts, honoraria, consulting fees, salaries and other forms of
Compensation, but do not include campaign contributions.
Section 4
TERMINATION (2.100.060)
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 & Reporting
Page 6 of 8
Print Name
Title
Signature
Executed on:
(month, day, year)
ATTACHMENTS
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: Late fees will apply to any lobbying activity not reported after the 15 days of qualifying as a lobbyist
*Initial registration fee is due within 15 days after qualifying 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). I 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 knowledge
the information contained herein is true and complete. (CMC 2.100.090(1))
Print Name
Title
Telephone Number
City of Cupertino
Lobbyist Registration & Reporting
Page 7 of 8
Signature
Executed on:
(month, day, year)
APPENDIX A:
Cupertino Municipal Code Ch. 2.100.
City of Cupertino
Lobbyist Registration & Reporting
Page 8 of 8
E-Filed
10/13/2021
09:58:04
Filing ID:
201202771