Press Alt + R to read the document text or Alt + P to download or print.
This document contains no pages.
801 Payment to Agency Report (Alan Enterprise) 11-14-24Payment to Agency Ri
1. Agency Name
City of Cupertino
Division, Department, or Reg
City Manager's Office
Street Address
10300 Torre Avenue
Area Code/Phone Number
408-777-3200
Agency Contact (name and title)
Kirsten Squarcia, City Clerk
rt
(if applicable)
A Public Docu
kirstens@cupertino.gov
2. Donor Name and Address
❑ Individual
Last Name First Name
San Francisco
Address Citv
[E0WI
Date Stamp
Nov 1 4 ,924
ERTINO CITY CLERK
TO AGENCY REPORT
Official Use Only
❑ Amendment (explain in comment section)
Date of Original Filing:
(month, day, year)
© Other Alan Enterprise, LLC
Name
CA 94108
State Zip Code
general contracting agency providing building/construction and design services
If "Other" is marked, describe the entity's business activity (if business) or its nature and interests.
- 0 If applicable, identify the name of each source and the amount(s) received by the donor for this payment:
$ 100.00
Name Amount Name Amount
3. Payment Information (Complete Sections 3.1 (a or b), 3.2, 3.3)
3.1 (a) Travel Payment
Location of Travel Dates (month, day, year)
❑ Rail ❑ Air ❑ Bus ❑ Auto ❑ Other
Transportation Provider Check Applicable Boxes Name of Lodging Facility
Lodging Expenses Meal Expenses
3.1 (b) Payments) not related to travel:
Transportation Expenses Other Expenses Total Expenses
Dates (month, day, year)
Total Expenses
3.2. Payment Description. Provide a specific description of the payment and its agency purpose and use.
provided to City a floral arrangement in appreciation for the work of the City.
3.3. Identify the officials who used the payment in Section 3.1 (See instructions)
Last Name
First Name
Position/Title
Department/Division
Last Name First Name Position/Title Department/Division
4. Verification
I autho0z,e t accept-f the rip ed pay TI NrA ment(s) as in compliance with FPPC regulations.
Do�PPamela Wu City Manager
Signature Print Name Title (month, day, year)
Comment:
(Use this space or an attachment for any additional information)
FPPC Form 801 (Jan/18)
advice@fppc.ca.gov
