HomeMy WebLinkAbout801 Form - Parks & Recreation (4th of July & Summer Concerts Sponsorship)Payment to Agency Report A Public Document
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 Email
408-777-3225 LaurenS(a.cupertino.gov
Agency Contact (name and title)
Lauren Sapudar, City Clerk
2. Donor Name and Address
PAYMENT TO AGENCY REPORT
R 1VED
For Official Use Only
AUG06 6 2026 I
CITY
❑ Amendment (explain in comment section)
Date of Original Filing:
(month, day, year)
❑
❑ Individual Other Various Vendors
Last Name First Name 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.
� o 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
❑ Rail
Transportation Provider
$ $
Lodging Expenses Meal Expenses
3.1 (b) Payment(s) not related to travel:
Location of Travel
Dates (month, day, year)
❑ Air ❑ Bus ❑ Auto ❑ Other
Check Applicable Boxes Name of Lodging Facility
$ $ $
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.
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
Comment
(month, day, year)
(Use this space or an attachment for any additional information)
FPPC Form 801 (Jan/18)
advice@fppc.ca.gov
Form 801- 2026 Parks & Recreation Itemized List (4th of July and Summer Concert Sponsorships)
Donated By
Item
Estimated
Value
Kalos Health
Monetary Donation
$750
1875 S Bascom Ave, Campbell, CA
(4th of July Sponsorship)
95008
Jennifer Walle
Jennifer@livekalos.com
(415) 715-1285
AT&T
Monetary Donation
$1200
1670 Las Plumas Ave Suite H,
(4th of July & Summer Concerts Sponsorship)
San Jose, CA 95133
Chanmonyka San
cs697c@att.com
(408) 643-4359