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460 Recipient Committee Campaign Statement 10-17-2009
ecipient Committee Campaign Statement Cover Page Government Code Sections 84200-84216.5) iEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period Date of election if appli o~/01/2009 (Month, Day, Year) from through l0/1~/2009 I . Type of Recipient Committee: All Committees -Complete Parts 1, 2, 3, and 4. ^ Officeholder, Candidate Controlled Committee ^ Primarily Formed Ballot Measure Q State Candidate Election Committee Committee Q Recall Q Controlled (Also Complete Part S) Q Sponsored (Also Complete Part 6) ~ General Purpose Committee ® Sponsored Q Small Contributor Committee Q Political Party/Central Committee ^ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 3. Committee Information I I.D. NUMBER 12996 COMMITTEE NAME (OR CANDIDATE'S NAME IF NO COMMITTEE) Cupertino Chamber PAC (Sponsored by Cupertino Chamber of Commerce) STREET ADDRESS (NO P.O. BOX) 20455 Silverado Avenue CITY STATE ZIP CODE AREA CODEIPHONE Cupertino, CA 95014 408-252-7054 MAILING ADDRESS (IF DIFFERENT) NO. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX I E-MAIL ADDRESS 408-252-0638 Date Stamp Q U'~ i ~ ~ Luv~~ COVER PAGE 1 of ? it Official Use Only 11/03/2009 UpE~Tii~O CITE CL RK 2. Type of Statement: ® Preelection Statement ^ (luarterly Statement ^ Semi-annual Statement ^ Special Odd-Year Report ^ Termination Statement ^ Supplemental Preelection (Also file a Form 410 Termination) Statement -Attach Form 495 ^ Amendment (Explain below) Treasurer(s) NAME OF TREASURER Bob Adams MAILING ADDRESS 20455 Silverdo Avenue CITY STATE ZIP CODE AREA CODE/PHONE Cupertino, CA 95014 408-252-7054 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL: FAX / E-MAIL ADDRESS G. Verification I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. fI /^ n Executed on ~ Z' / '~ "^ t ~' (f1 gy Date r' t Executed on / ~ %- ~ ~ y gy ' ~ Date Executed on Date Executed on gy Date Signature of Controlling Officeholder, Candidate, State Measure Proponent FPPC Form 460 (January/05) FPPC Toll-Free He1pllne: 666/ASK-FPPC (8661275-3772) State of California By Signature of Controlling Officeholder, Candidate, State Measure Proponent Recipient Committee Campaign Statement Cover Page -Part 2 Type or print in ink. COVER PAGE -PART 2 Page 2 of ~ ~. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) RESIDENTIAL/BUSINESS ADDRESS (NO. AND STREET) CITY STATE ZIP Related Committees Not Included in this Statement: List any committees not included in this statement that are controlled by you or are primarily formed to receive contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ^ YES ^ NO COMMITTEEADDRESS STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D. NUMBER 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOTNO.ORLETTER JURISDICTION ^ SUPPORT ^ OPPOSE Identity the controlling officeholder, candidate, or state measure proponent, if any. NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT OFFICE SOUGHT OR HELD DISTRICT NO. IF ANY 7. Primarily Formed Candidate/Officeholder Committee List names of officeholder(s) or candidate(s) for which this committee is primarily formed. NAME OF TREASURER I CONTROLLED COMMITTEE? ^ YES ^ NO COMMITTEEADDRESS STREETADDRESS (NO P.O. BOX) NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ^ SUPPORT ^ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ^ SUPPORT ^ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ^ SUPPORT ^ OPPOSE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ^ SUPPORT ^ OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) State of California :ampaign Disclosure Statement Type or print in ink. Amounts may be rounded Summary Page to whole dollars. Column B CALENDAR YEAR TOTALTO DATE SUMMARY PAGE .EE INSTRUCTIONS ON REVERSE through 10/17/2009 Page 3 of 7 TAME OF FILER I.D. NUMBER :upertino Chamber PAC (Sponsored by Cupertino Chamber of Commerce) 1299673 Column A contributions Received TOTALTHISPERIOD (FROM ATTACHEDSCHEDULES) Monetary Contributions ........................................... schedule A, Line 3 $ z , o0 0.00 :. Loans Received ...................................................... schedule s, Line 3 0.00 .. SUBTOTAL CASH CONTRIBUTIONS ......................... Add Lines 1 +z $ 2, 000.00 •. Nonmonetary Contributions .................................... schedule c, Line 3 0.00 ~. TOTAL CONTRIBUTIONS RECEIVED ..• ........................ Add Lines 3 +q $ 2, 000.00 $ z,ooo.oo o.oo $ 2,000.00 o.oo $ 2,000.00 xpenditures Made ~. Payments Made ....................................................... schedule E, Line q $ 51.00 '. Loans Made ............................................................. Schedule H, Line 3 0.00 ~. JUCS I V tHL I:HJFi F'HYNItN I J .................................... Add Lines 6 + 7 $ 51.00 I. Accrued Expenses (Unpaid Bills) ............................... schedule F Line 3 a, 425.35 0. Nonmonetary Adjustment .......................................... schedule c, Line 3 0.0 0 1. TOTAL EXPENDITURES MADE ................................Add Lines t3 + g + 10 $ 8 , 476.3 5 $ 153.00 0.00 $ 153.00 8.425.35 o.oo $ 8,578.35 current Cash Statement 2. Beginning Cash 681ance ....................... Previous Summary Page, Line 16 $ 246.23 3. Cash Receipts ................................................... column A, Line 3 above z , o0 0 . o 0 4. Miscellaneous Increases to Cash ........................... scheduie 1, Line q o . 00 5. Cash Payments .................................................. column A, Line 8 above s 1.0 0 6. ENDINGCASH BALANCE .......... Add lines 12 + 13 + 14, then subtract Line 15 $ 2, 195.23 If this is a termination statement, Line 16 must be zero. 7. LOAN GUARANTEES RECEIVED ........................... Schedule e, Part 2 $ o.oo :ash Equivalents and Outstanding Debts 8. Cash Equivalents ........................................ See instructions on reverse $ o . 00 9. OUtstanding Debts ......................... Add Line 2 + Line 9 in Column B above $ 8 , 425.3 5 To calculate Column B, add amounts in Column A to the corresponding amounts from Column B of your last report. Some amounts in Column A may be negative figures that should be subtracted from previous period amounts. If this is the first report being filed for this calendar year, only carry over the amounts from Lines 2, 7, and 9 (if any). Calendar Year Summary for Candidates Running in Both the State Primary and General Elections 1/1 through 6/30 7/1 to Date 20. Contributions Received $ $ 21. Expenditures Made $ $ I Expenditure Limit Summary for State Candidates 22. Cumulative FYflenf~11111'P! M~rlo* (It Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) ~ -~-~ $ -~~ ~ Amounts in this section may be different from amounts reported in Column B. FPPC Form 460 (Januaryt05) FPPC Toll-Free Helpline: 8661ASK-FPPC (866/275-3772) Statement covers period from o7/o1/zoo9 chedule A Type or print in ink. SCHEDULE A Amounts may be rounded 1onetary Contributions Received t h l d ll Statement covers period o w o e ars. o .1 from o7/oi/zoos • .E INSTRUCTIONS ON REVERSE through 10/17/2009 Page 4 of 7 MME OF FILER I.D. NUMBER 'upertino Chamber PAC (Sponsored by Cupertino Chamber of Commerce) 1299673 DATE FULL NAME, STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE, ALSO ENTERI.D.NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IF SELF-EMPLOYED, ENTER NAME PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OF BUSINESS) 0/10/2009 Robert Adams ®IND Finance Planner 1,000.00 1,000.00 ^ COM 11669 Olive Springs Court ^ OTH Armstrong Retirement Cupertino, CA 95014 ^ PTY Planning, Inc ^SCC 0/15/2009 ilia Serra ^IND 1,000.00 1,000.00 ^ COM 1900 S. Norfolk Street, Suite 150 ^x OTH ^ PTY San Mateo, CA 94403 ^SCC ^IND ^ COM ^ vTl; ^ PTY ^SCC ^IND ^ COM ^ OTH ^ PTY ^SCC ^IND ^ COM ^ OTH ^ PTY ^SCC SUBTOTAL$ z,ooo.oo chedule A Summary Amount received this period -itemized monetary contributions. (Include all Schedule A subtotals.) .......................................................................... Amount received this period - unitemized monetary contributions of less than $100 Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ...... $ z,ooo.oo o.oo ..... TOTAL $ z,ooo.oo 'Contributor Codes IND-Individual COM -Recipient Committee (other than PTY or SCC) OTH -Other (e.g., business entity) PTY -Political Party SCC -Small Contributor Committee FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) Schedule D cr.Hrnl a 1= n lUR1lTlary OT CXP@nQliUreS type or pant In InK. Statement covers period Amounts may be rounded Supporting/Opposing Other ~ • ' • , to whole dollars. ;andidates, Measures and Committees 07/01/2009 from e - EE INSTRUCTIONS ON REVERSE through 10/17/2009 page 5 of 7 TAME OF FILER I.D. NUMBER Cupertino Chamber PAC (Sponsored by Cupertino Chamber of Commerce) 1299673 DATE NAME OF CANDIDATE, OFFICE, AND DISTRICT, OR TYPE OF PAYMENT DESCRIPTION AMOUNT THIS CUMULATIVE TO DATE CALENDAR YEAR PER ELECTION TO DATE MEASURE NUMBER OR LETTER AND JURISDICTION, (IF REpUIRED) PERIOD (JAN. 1 -DEC. 31) (IF REQUIRED) OR COMMITTEE 10/09/2009 Darcy Pau Mailer 2,808.45 2,808.45 ^ Monetary City Council Member Contribution city of Cupertino ^ Nonmonetary Contribution ® Independent ^x Support ^ Oppose Expenditure 10/09/2009 Mahesh Nihalani ^ Monetary Mailer 2,808.45 2,808.45 Contribution City Council Member city of Cupertino ^ Nonmonetary f:nntrihiitinn ^x Independent © Support ^ Oppose Expenditure 10/09/2009 Orrin Mahoney Mailer 2,808.45 2,808.45 ^ Monetary City Council Member Contribution city of Cupertino ^Nonmonetary Contribution ~ Independent © Support ^ Oppose Expenditure SUBTOTAL $ e, 425.35 Schedule D Summary I. Itemized contributions and inde endent ex enditures made this eriod. Include all Schedule D subtotals. e, 425.35 P P p ( ) ......................................................... $ '. Unitemized contributions and independent expenditures made this period of under $100 ..................................................................................... $ o . 00 S. Total contributions and inde endent ex enditures made this eriod. Add Lines 1 and 2. Do not enter on the Summa Pa e. TOTAL $ s, 425.35 p P p ( rY 9 ) ............ FPPC Form 460 (January/05) FPPC Toll-Free Helpline: 868/ASK-FPPC (886/275-3772) schedule E Type or print in ink. Statement covers period ~a menu Made Amounts may be rounded • ' ~ ~ ' y to whole dollars. 07/o1/zoo9 ~ from .E INSTRUCTIONS ON REVERSE through 10/17/2009 page 6 of 7 aME OF FILER I.D. NUMBER :upertino Chamber PAC (Sponsored by Cupertino Chamber of Commerce) 1299673 ODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. dP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs VS campaign consultants MTG meetings and appearances RFD returned contributions 1B contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries JC civic donations PET petition circulating TEL t.v. or cable airtime and production costs L candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals JD fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals D independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor .G legal defense PRO professional services (legal, accounting) VOT voter registration T campaign literature and mailings PRT print ads WEB information technology costs (internet, a-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE, ALSO ENTER I.D. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Payments that are contributions or independent expenditures must also be summarized on Schedule D. schedule E Summary Itemized payments made this period. (Include all Schedule E subtotals.) . Unitemized payments made this period of under $100 ..................................................................................................... Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).) .......................................... Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ..... SUBTOTAL$ o.oo ........... $ o . o 0 51.00 o.oo TOTAL $ s1.00 FPPC Form 460 (Januaryl05) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772) chedule F Type or print in ink. Statement covers eriod Amounts may be rounded p -ccrued Expenses (Unpaid Bills) to whole dollars. from o7/ol/zoo9 SCHEDULEF .E INSTRUCTIONS ON REVERSE through 10/17/2009 page 7 of 7 4ME OF FILER I.D. NUMBER Cupertino Chamber PAC (Sponsored by Cupertino Chamber of Commerce) 1299673 ;.ODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. NP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs NS campaign consultants iVITG meetings and appearances RFD returned contributions TB contribution (explain nonmonetary)* OFC office expenses SAL campaign workers' salaries VC civic donations PET petition circulating TEL t.v. or cable airtime and production costs IL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging, and meals ND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals iD independent expenditure supporting/opposing others (explain)* POS postage, delivery and messenger services TSF transfer between committees of the same candidate/sponsor EG legal defense PRO professional services (legal, accounting) VOT voter registration R campaign literature and mailings PRT print ads WEB information technology costs (internet, a-mail) (a) (b) (cl (d) NAME AND ADDRESS OF CREDITOR CODE OR OUTSTANDING AMOUNT INCURRED AMOUNT PAID OUTSTANDING (IF COMMITTEE, ALSO ENTER I.D. NUMBER) DESCRIPTION OF PAYMENT BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCE AT CLOSE OF THIS PERIOD (ALSO REPORT ON E) OF THIS PERIOD ~binson Communications Inc. IND Mailer to support 0.00 8,425.35 0.00 8,425.35 Nihalani, Mahoney and X679 Farallone Drive Paul for Cupertino City Council (See Sch D) ipertino, CA 95014 .,uu~ ulu nut waive paymenca co subvendore curing cne reporting perioa. Payments that are contributions or independent expenditures must also be SUBTOTALS $ o . oo $ 8 , 425.35 $ 0.00 $ 8, 425.35 ~mmarized on Schedule D. schedule F Summary . Total accrued expenses incurred this period. (Include all Schedule F, Column (b) subtotals for accrued expenses of $100 or more, plus total unitemized accrued expenses under $100.) ........................... Total accrued expenses paid this period. (Include all Schedule F, Column (c) subtotals for payments on accrued expenses of $100 or more, plus total unitemized payments on accrued expenses under $100.) ......... Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.) ........................................................................................................ INCURRED TOTALS $ 8.425.35 PAID TOTALS $ o.oo NET$ s, 425.35 May be a negative number FPPC Form 480 (January/05) FPPC Toll-Free Helpline: 866/ASK-FPPC (866/275-3772)