HomeMy WebLinkAbout801 Form Parks & Rec - Senior Center Live Well Age Well ExpoPayment to Agency Report
1. Agency Name
City of Cupertino
Division, Department, or Region (if applicable)
Parks and Recreation
Street Address
10300 Torre Ave., Cupertino CA 95014
Area Code/Phone Number Emal
408-777-1312 _..____,._..
Agency Contact (name and title)
Lauren Sapudar, City Clerk
2. Donor Name and Address
A Public Document
❑ Individual ❑ Other
Last Name First Name
PAYMENT TO AGENCY REPORT
Date Stamp
RECEIVED
For Official Use Only
MAY 2 1 2026
CITY
❑ Amendment (explain in comment section)
Date of Original Filing:
Various Vendors
(month, day, year)
Name
Address City State Zip Code
Senior Center Live Well Age Well Health Expo Sponsorships.
If "Other" is marked, describe the entity's business activity (if business) or its nature and interests.
�.� If applicable, identify the name of each source and the amount(s) received by the donor for this payment:
(See attached itemized list) $ $
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)
O Rail ❑ Air ❑ Bus ❑ Auto ❑ Other
Transportation Provider Check Applicable Boxes
Name of Lodging Facility
$ $ $ $
$
Lodging Expenses Meal Expenses Transportation Expenses Other Expenses
Total Expenses
3.1 (b) Payment(s) not related to travel: $
Dates (month, day, year)
Total Expenses
3.2. Payment Description. Provide a specific description of the payment and its agency purpose and use.
Senior Center Live Well Age Well Health Expo Sponsorships.
3.3. Identify the officials who used the payment in Section 3.1 (See instructions)
Last Name First Name Positionrritle
Department/Division
Last Name First Name Position/Title
Department/Division
4. Verification
I authorized)e e acceptance of the reported payment(s) as in compliance with FPPC regulations.
�� I I
Tina Kapoor City Manager
ure Print Name Title
(month, day, year)
Comment:
(Use this space or an attachment for any additional information)
Clear Page •Print Form
FPPC Form 801 (Jan/18)
advice@fppc.ca.gov
Form 801- 2026 Parks & Recreation Itemized List (Senior Center Live Well Age Well Health
Expo Sponsorships)
Donated By
Item
Estimated
Value
Star One Credit Union
Monetary Donation
$1000
1306 Bordeaux Ave, Sunnyvale, CA 94089
Grace Thompson
(408) 543-5292
Saratoga Retirement Community
Monetary Donation
$1000
14500 Fruitvale Ave (Bldg 2000),
Saratoga, CA 95070
Sponsor Email:
ilopersaratogaretirementcommunitV.
pjg
Sponsor Phone Number: (408) 550-5201
The Forum at Rancho San Antonio
Monetary Donation
$1000
23500 Cristo Rey Drive, Cupertino, CA
95014
Sponsor Email:
AntoniaAvelar@theforumrsa.com
Sponsor Phone Number: (408) 621-5279
Seniors Helping Seniors
Monetary Donation
$1000
San Jose, CA 95124 / Headquarters 203
Ulrich Lane, Leesport, PA 19533
Sponsor Email: laura@sanioseshs.com
Sponsor Phone Number: (925) 330-7161
Family Companion Agency
Monetary Donation
$450
100 S Murphy Ave STE 200 #4063,
Sunnyvale, CA 94086
Sponsor Email:
familycompanionagency@gmail.com
Sponsor Phone Number: (650) 405-3841
Form 801- 2026 Parks & Recreation Itemized List (Senior Center Live Well Age Well Health
Expo Sponsorships)
FirstLight Home Care Silicon Valley
Monetary Donation
$1000
1475 South Bascom Ave Suite 203,
Campbell, CA 95008
Sponsor Email:
miohnson@firstlighthomecare.com
Sponsor Phone Number: (925) 286-9509
Alignment Health
Monetary Donation
$1000
1100 W. Town & Country Rd #1600,
Orange, CA 92868
Sponsor Email: mlok@ahcusa.com
Sponsor Phone Number: (415) 605-3320
ClearCaptions
Monetary Donation
$1000
3001 Lava Ridge Court #100, Roseville, CA
95661
Sponsor Email:
elli.tehrani@clearcaptions.com
Sponsor Phone Number: (408) 510-1941