HomeMy WebLinkAbout801 Form Parks & Rec - Parks & Recreation (4th of July & Summer Concerts Sponsorship)Payment to Agency Report A Public Document PAYMENT TO AGENCY REPORT
City of Cupertino
Date Stamp California 801 Form
For Official Use Only Division, Department, or Region
Parks and Recreation
Street Address
10300 Torre Ave., Cupertino CA 95014
Area Code/Phone Number
408-777-3225
Email
LaurenS@cupertino.gov Amendment (explain in comment section)
Date of Original Filing:
(month, day, year) Agency Contact
Lauren Sapudar, City Clerk
2. Donor Name and Address
Individual
Last Name First Name Other Various Vendors
Name
Address City State Zip Code
Monetary donations.
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)
Transportation Provider
Rail Air Bus
Check Applicable Boxes
Auto Other
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.
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 authorized the acceptance of the reported payment(s) as in compliance with FPPC regulations.
Tina Kapoor 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
Clear Page Print Form
Tina Kapoor (Aug 6, 2026 09:55:33 PDT)08/06/2026
Form 801- 2026 Parks & Recreation Itemized List (4th
Donated By Item Estimated
Value
1875 S Bascom Ave, Campbell, CA
95008
Jennifer Walle
(4th of July Sponsorship)
AT&T
cs697c@att.com
(408) 643-4359
Monetary Donation
(4th of July & Summer Concerts Sponsorship)
CA Form 801
Final Audit Report 2026-08-06
Created:2026-08-04
By:Melissa Robertson (melissar@cupertino.gov)
Status:Signed
Transaction ID:CBJCHBCAABAAxwZ1jG9c_KdpSkeMoCg3P8xARArmIAsX
"CA Form 801" History
Document created by Melissa Robertson (melissar@cupertino.gov)
2026-08-04 - 3:36:04 PM GMT
Document emailed to Tina Kapoor (TinaK@cupertino.gov) for signature
2026-08-04 - 3:36:08 PM GMT
Email viewed by Tina Kapoor (TinaK@cupertino.gov)
2026-08-04 - 3:36:45 PM GMT
Email viewed by Tina Kapoor (TinaK@cupertino.gov)
2026-08-05 - 4:03:39 PM GMT
Email viewed by Tina Kapoor (TinaK@cupertino.gov)
2026-08-06 - 4:20:11 PM GMT
Document e-signed by Tina Kapoor (TinaK@cupertino.gov)
Signature Date: 2026-08-06 - 4:55:33 PM GMT - Time Source: server - Signature Appearance Selected: DRAW
Agreement completed.
2026-08-06 - 4:55:33 PM GMT