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410 Amendment tatement of Organization Recipient Committee Statement Type ^ Initial Not yet qualified ^ or -J~ Date qualified as committee Type or print in ink Amendment List I.D. number: # 12996 10 / 22 12007 Date qualified as committee (If applicable) Stamp STATEMENT OF ORGANIZATION ^ Termination -See Part 5 t ~ t ; ` , .Y For ort~ial use omy List LD. number: ~, ~_J Date of Termination [mac ; - , 1. Committee Information NAME OF COMMITTEE Cupertino Chamber of Commerce (Sponsored by Cupertino Chamber of Commerce) STREET ADDRESS (NO P.O. BOX) 20455 Silverado Avenue CITY STATE ZIP CODE AREA CODE/PHONE Cupertino CA 95014 MAILING ADDRESS (IF DIFFERENT) OPTIONAL: FAX / E-MAIL ADDRESS 408-252-0639 COUNTY OF DOMICILE COUNTY WHERE COMMITTEE IS ACTIVE IF DIFFERENT THAN COUNTY OF DOMICILE Santa Clara County Attach additional information on appropriately labeled continuation sheets 2. Treasurer and Ot her Principal 'Offic~t~" NAME OF TREASURER Cecelia S. Blackman STREET ADDRESS 20455 Silverado Avenue CITY STATE ZIP CODE Cupertino CA 95014 AREA CODE/PHONE 408-252-7054 NAME OF ASSISTANT TREASURER, IF ANY STREET ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE NAME AND POSITION OF OTHER PRINCIPAL OFFICER(S), IF APPLICABLE See Attached List MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE 3. Verification I have used all reasonable diligence in preparing this statement and to the best of my perjury under the laws of the State of California that the foregoing is true and correct. Executed on January 9, 2009 By DATE Executed on DATE Executed on Executed on DATE DATE the information contained herein is true and complete. I certify under penalty of n„ By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By -SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT FPPC Form 410 (January/05) FPPC Toll-Free Helpllne: 886/ASK-FPPC (886!275-3772) 009 CUPERTINO CHAMBER OF COMMERCE BOARD OF DIRECTORS MIKE FOULKES 2009 PRESIDENT SUZI BLACKMAN, CEO CEO Apple Inc. Cupertino Chamber of Commerce 1 Infinite Loop, 81-2CF. 20455 Silverado Avenue Cupertino, CA 95014 Cupertino, CA 95014 Phone:(408) 974-2503 Phone:(408) 252-7054; FAX: (408) 252-0638 Email: FOULKESCa~APPLE.COM Email: suziCa~CUPERTINO-CHAMBER.ORG BOB ADAMS PAST PRESIDENT SHAWNA HOLMES VP LEGISLATIVE ACTION Armstrong Retirement Planning L.L.C Hewlett-Packard 11669 Olive Spring Court 3000 Hanover Street, MS1035 Cupertino, CA 95014 Palo Alto, CA 94304 Phone: (408) 257-4137 FAX: (408) 257-4137 Phone: (650) 857-2523; F: (650) 857-7594 Email: BOBCa~ARMSTRONGPLANNING.COM Email: SHAWNA.HOLMESCa~HP.COM ROXANA BAKER. CCIM Ritchie Commercial Real Estate 34 W. Santa Clara Street San Jose, CA 95113 Phone: 408-282-8505 Email: rbakerCa~ritchiecommercial.com MARK McKENNA VP LOGISTICS Stevens Creek Quarry 12100 Stevens Canyon Road Cupertino, CA 95014 Phone: (408) 253-2512, ext 223; Email: MMCKENNAC~SCQINC.COM RICHARD R. BATEH Keypoint Credit Union 2805 Bowers Avenue Santa Clara, CA 95051 Phone: 408-725-4244; C: 408-595-3630 Email: rbatehla~kevaointcu.com LYNN CHING. CPA VP SPECIAL EVENTS Ramp Partners 10025 Tantau Avenue Cupertino, CA 95014 Phone: C: (408}205-5868 W:(408)910-6410 Email:Ivnn.chinaCa~nliohtvc.com YOGICHUGH.AGENT State Farn Insurance 21710 Stevens Creek Blvd. Ste 225 Cupertino, CA 95014 Phone: 408-996-9999; C: Email: voaiCa)voaichuah.com PAULA DAVIS Flint Center for the Performing Arts P.O. Box 1897 Cupertino, CA 95015 Phone: (408) 864-8870; C: (408) 547-7410 Email: FLINTGM(rDIX.NETCOM.COM STEVE ELICH Coldwell Banker 10105 S. De Anza Blvd. Cupertino, CA 95014 Phone: (65072-1599 Email: STEVE.ELICHCa)CBNORCAL.COM RAM GOPAL VP COMMUNITY OUTREACH Cupertino Bakery 10251 S. De Anza Blvd. Cupertino, CA 95014 Phone Cell: (408) 823-7185) Email: RGOPAL 01Ca~YAHOO.COM CHARLES (CHUCK) MOLLETT. CPA Charles E Mollett, CPA 1101 S. Winchester Blvd. Ste 0-276 San Jose, CA 95128 Phone: (408265-9691 Email: CHUCKMOLLETT(c~hotmail.com MAHESH NIHALANI Jewels in Style 505 S. Pastoria Avenue, Ste 211 Sunnyvale, CA 94086 Phone: (408) 616-0011 Email: NIHALANISCa~COMCAST.NET PHIL QUON Cupertino Union School District 10301 Vista Drive Cupertino, CA 95014 Phone: (408) 252-3000 Email: QUON PHILCa7CUPERTINO.KI2.CA.US JAMES (JIM- RODRIGUEZ. Attorney James Rodriguez, Valley Law Center 10455 Torre Avenue Cupertino, CA 95014 Phone: (408) 252-5211 Email: JJRODRIGUEZCc~JUNO.COM MARIA STREEBY PRES-ELECT/TREASURER The Cypress Hotel 10050 S. De Anza Blvd. Cupertino, CA 95014 Phone: (408) 342-4805; Email: MARIA.STREEBY<tilTHECYPRESSHOTEL.COM JOHN ZIRELLI Los Altos Garbage 850 Martin Avenue Santa Clara, CA 95050 Phone: (408) 588-7224 Email: JZIRELLICa~LOSALTOSGARBAGE.COM Last update - 1/12/2009 Statement of Organization Recipient Committee INSTRUCTIONS ON REVERSE Cupertino Chamber PAC (Sponsored by Cupertino Chamber of Commerce) 4. Type of Committee Complete the applicable sections. NT OF ORGANIZATION Page 2 1299673 • List the name of each controlling officeholder, candidate, or state measure proponent. If candidate or officeholder controlled, also list the elective office sought or held, and district number, if any, and the year of the election. • List the political party with which each officeholder or candidate is affiliated or check "non-partisan." • If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee. • List the financial institution where the campaign bank account is located (controlled "candidate election" committees only) NAME OF FINANCIAL INSTITUTION ADDRESS AREA CODE/PHONE CITY BANK ACCOUNT NUMBER STATE ZIP CODE -. . Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S) JURISDICTION (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE SUPPORT OPPOSE OPPOSE FPPC Form 410 (January/OS) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275772) ELECTIVE OFFICE SOUGHT OR HELD NAME OF CANDIDATElOFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) YEAR OF ELECTION PARTY tatement of Organization STATEMENT OF ORGANIZATION Recipient Committee , . ; INSTRUCTIONS ON REVERSE Page 3 COMMITTEE NAME I.D. NUMBER Cupertino Chamber PAC (Sponsored by Cupertino Chamber of Commerce) 1299673 4. Type of Committee (Continued) Not formed to support or oppose specific candidates or measures in a single election. Check only one box: ^ CITY Committee ^ COUNTY Committee ®STATE Committee PROVIDE BRIEF DESCRIPTION OF ACTIVITY To support Local and Statewide candidates • • • ' • • List additional sponsors on an attachment. NAME OF SPONSOR INDUSTRY GROUP OR AFFILIATION OF SPONSOR Cupertino Chamber of Commerce Chamber of Commerce STREET ADDRESS NO. AND STREET CITY STATE ZIP CODE 20455 Silverado Avenue t^i inchinn n n ncn• • • • • ^ -J_J Check box and provide the date this committee qualified as a small contributor committee. If the committee qualified as a Date qualified small contributor committee on January 1, 2001, enter 1/1/01. 5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that all of the following condkions have been met • This committee has ceased to receive contributions and make expenditures; • This committee does not anticipate receiving contributions or making expenditures in the future; • This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations; • This committee has no surplus funds; and • This committee has filed all campaign statements required by the Political Reform Act disclosing all reportable transactions. -- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to Government Code Section 89519. FPPC Forth 410 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)