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460 recipient Committee Campaign Statement-Amend 10-17-2009 ecipient Committee Campaign Statement Cover Page (Government Code Sections 84200-84216.5) SEE INSTRUCTIONS ON REVERSE Type or print in ink. Statement covers period from 07/01/2009 through to/17/zoo9 1, Type of Recipient Committee: All Committees-Complete Parts 1, 2, 3, ena a. ^ Officeholder, Candidate Controlled Committee ^ Primarily Formed Ballot Measure Q State Candidate Election Committee Committee Q Recall Q Controlled (AlsoComplefeVaA51 Q Sponsored (Also CamplefeVart6) x^ General Purpose Committee ® Sponsored ^ Primarily Formed Candidate) QSmaIlContributorCommittee Officeholder Committee QPoliticalPartylCentralCommittee (Also Complete Pert 7) 3, Committee Information I.D. NUMBER NAME (0R 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 95019 908-252-7054 MAILING ADDRESS (IF DIFFERENT) N0. AND STREET OR P.O. BOX CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL: FAX I E-MAIL ADDRESS ~~~~~ ~~ Date of election if ap (Month, Day, Ye ~ EEB - 1 2(}i0 2009 ~RTINO CITY CLER 2. Type of Statement: ® Preelection Statement ^ Semi-annual Statement ^ Termination Statement (Also file a Form 410 Termination) ® Amendment (Explain below) COVER PAGE of 9 For O~cial Use Only ^ Quartedy Statement ^ Special Odd-Year Report ^ Supplemental Preelection Statement -Attach Form 495 Amendment to reflect corrected amounts on Summary Page, Sch D, Treasurerls) NAME OF TREASURER Bob Adams MAILING ADDRESS 20455 Silverdo Avenue CITY STATE ZIP CODE AREA CODEIPHONE Cupertino, CA 95019 408-252-7059 NAME OF ASSISTANT TREASURER, IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREA CODEIPHONE OPTIONAL: FAX I E-MAIL ADDRESS 408-252-0638 4. 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. .~ Executed on ~ ~ I ~y gy Executed on ~~ ~ 1 ~ gy Dale Executed on Date Executed on g Dale y SgnatureofConharirgOficelrolder,Cendkate,StateNleasurePropanent FPPC Form46olJenuary105) FPPC Toll•Free Helpline: BBBIASK-FPPC (866127li-3772) State of California By Sgnature of Caitrdlirg Oficeholtluv, Cand idate, Slate Measure Proponent Recipient Committee Campaign Statement Cover Page -Part 2 Type or print in Ink, 6. Primarily Formed Ballot Measure Committee NAMEOFBALLOTMEASURE Page 2 of 9 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD (INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) RESIDENTIALIBUSINESSRDDRESS (N0. AND STREET) CITY STATE ZIP Related Committees Not Included in this Statement: List any committees not included in this statement that are conGolled by you or are primarily formed fo receive contrihutions or make expenditures on hehalf of your candidacy. COMMITTEENAME I.D. NUMBER NAME OF TREASURER CONTROLLEDCOMMITTEE? ^ YES ^ NO COMMITTEEADDRESS STREETADDRESS (NOP.O.BOX) CITY STATE ZIP CODE AREA CODEIPHONE COMMITTEE NAME I.D. NUMBER NAME OF TREASURER CONTROLLEDCOMMITTEE? ^ YES ^ NO COMMITTEEADDRESS STREETADDRESS (NO P.O.BOX) CITY STATE ZIP CODE AREA CODEIPHONE BALLOTNO.ORLETTER (JURISDICTION ^ SUPPORT ^ OPPOSE C0VERPAGE•PART2 Identity the controlling oNiceholder, candidate, or state measure proponent, if any, NAME OF OFFICEHOLDER, CANDIDATE, OR PROPONENT UFFIGE SOUGHT OR HELD DISTRICT N0. IF ANY 7. Primarily Formed CandidatelOfficeholderGommittee Ust names of officeholder(s) or candidate(s) for which this committee is primarily formed. 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 Attach continuation sheets if necessary FPPC Form 460 (January106) FPPC Toll•Free Helpline: 6661ASK•FPPC (6661276.772) State of California Campaign Disclosure Statement Summary Page Type or print In ink. Amounts may be rounded to whole dollars. Column 6 CALENDARYEAR TOTALTDDATE Calendar Year Summary for Candidates Running in Both the State Primary and General Elections SEEINSTRUCTIDNS ON REVERSE through 10/17/2009 Page 3 Of 9 NAME OF FILER I.D. NUMBER Cupertino Chamber PAC (Sponsored by Cupertino Chamber of Commerce) 1299673 Contributions Received Column A TOTALTHISPERIOD (FROMATTACHEDSCHEDULES) 1. Monetary Contributions .............................. ............. scneduleA,Llne3 $ 2,000. 00 Z. Loan$ RBCBIVed ......................................... ............. Schedule B, Line 3 0. 00 3. SUBTOTAL CASH CONTRIBUTIONS ........ ................. AddLlnesi+2 $ 2,000. 00 4. Nonmonetary Contributions ....................... ............. schedule c, Line 3 0. 00 5. TOTAL CONTRIBUTIONS RECEIVED •.•• ... ....................Addunes3+4 $ 2,000. 00 $ 2,000.00 0.00 g z,ooo.oo o.oo $ 2, 000.00 Expenditures Made 6. Payments Made ........................................ ............... scbedule e, Llne q $ 51. 00 7. Loan$ Made .............................................. ............... Schedule H, Line 3 0. 00 8. SUBTOTALCASHPAYMENTS ................. ................... Addunessi~ $ 51. 00 g. ACCfUed EXpenSeS (Unpaid BIIIS) ............ ...................ScheduleF,Line3 6,496. 66 10. Nonmonetary Adjustment ........................ .................. scbedule c, Line 3 0. 00 11. TOTALEXPENDITURESMADE ................ ................AddLlnesa+9+TO $ 6,999. 66 Current Cash Statement 12. Beginning Cash Balance ....................... PrehoussummaryPa9e,unet6 $ 246.23 13. CashReC2lpts ................................................... Column A,Llne3above z,ooo.oo 14. Miscellaneous Increases to Cash ........................... schedule I Line 4 0.00 15. Cash Payments .................................................. column A,Lineaabove 51.00 16. ENDING CASH BALANCE..........Addlf'nes12+t3+iq,thensubfractll'ne15 $ 2,195.23 H this is a termination statement, Line 16 must be zero. 17. LOAN GUARANTEES RECEIVED ........................... Schedule B, Part 2 $ a. 00 Cash Equivalents and Outstanding Debts 18. Cash Equivalents ........................................ See instmcfions on reverse $ o . 00 19. OUfStanding DebtS ......................... Add Line2+Line9inColumn8above $ 6,446.66 $ 153.Oo Statement covers period from o7/0l/2009 0.00 $ 153.00 6.448.66 o.oo $ 6,601.66 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 aver the amounts ~ from Lines 2, 7, and 9 (if any). SUMMARY PAGE 111 through 6130 711 to Date 20. Contributions Received $ $ 21, Expenditures Made $ $ Expenditure Limit Summary for State Candidates 22, ui7iuiatiVc t:xpeiidituiv5 mau'y' (ttsuhledtoVoluMary Expendtture Llmttl Date of Election Total to Date (mm/ddlyy) -J~- S 'Amounts in this section may be different from amounts reported in Column B. FPPC Form 480 (January105) FPPC Toll•Free Helpline: 8681ASK•FPPC (8881275.3172) cheduleA Type or print In Ink ^^____~___.. ... .. _ nm,.,,•~. _.,. ~_ ._.._~_~ SCHEDULER mUfleiary VUfliflDUtI011S KeCelVed ~~~~~•"~~' "'°' •° '""""°" to whole dollars Statement covers period • . ~ ~ , ' from o7/ol/zoo9 ~ SEEINSTRUCTIONS ONREVERSE through 10/17/2009 PagB 4 Of 9 NAME OF FILER Cupertino Chamber PAC (Sponsored by Cupertino Chamber of Commerce) LD.NUMBER 1299673 DATE FULL NAME, STREETADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL, ENTER AMOUNT CUMULATNETODATE PER ELECTION RECEIVED QF COMMrnEE. ALSOENTER ro.NUMeER) CODE OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE QFSELF•EMPLOYEU,ENTERNAME OFBUSINESS) PERIOD (JAN.t-DEC. 31) (F REQUIRED) 10/10/2009 Robert Adams ®IND Finance Planner 1,000.DO 1,000.00 ~ COM 11669 Olive Springs Court D()TH PTY Armstrong Retirement Pl i Cupertino, CA 95014 ann ng, IRC ^SCC 10/15/2009 ilia Serra BIND l ooo oo l ooo oo ~COM , . , . 1900 S. Norfolk Street, Suite 150 x~OTH San Mateo, CA 94403 ~ PTY SCC BIND OCOM I 1JOTH I ~ PTY ~ SCC BIND ~ COM Q OTH Q PTY ^SCC BIND OCOM BOTH ~ PTY ~ SCC SUBTOTALS z,ooo.oo ~ ~ . Schedule A Summary 1. Amount received this period- itemized monetary contributions. (InclutleallScheduleAsubtotals.) ........................................................................................................$ z,ooo.oo 2. Amount received this period - unitemizetl monetary contributions of less than $100 ............................. $ o. 00 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.) ....................... TOTAL $ z, ooo. 00 "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 (January105) FPPC Toll•Free Helpllne; 8851ASK•FPPC (8881275.3772) Schedule D c11~,M,~.,, ..s c,,.,...,.r;a,,..,,. SCHEDULED n nM1, VI rAF/~i11M1{NI ~i~7 IyR@ VI PIIIII I11 mR. Statement covers period Supportingl0pposingother Amounts may be rounded ~ - ~ 4 I to whole dollars. , S' Candidates, Measures and Committees 07/01/2009 from SEEINSTRUCTIONS ON REVERSE through 10/17/2009 page 5 of 9 NAME 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 AMOUNTTHIS CUMULATIVETO DATE PER ELECTION MEASURE NUMBER OR LETTER AND JURISDICTION, (IFREDUIRED) CALENDAR YEAR TO DATE ORCOMMITTEE PERIOD (JAN.1-DEC.31 I (IF REl]UIRED) 10/09/2009 Darcy Pau Mailer 2,149.56 2,149.56 Monetary City Council Member Contribution City of Cupertino ~ Nonmonetary Contribution ® Independent ~x Support ~ Oppose Expenditure 10/09/2009 Mahesh Nihalani Monetary Mailer 2,149.55 2,149.55 City Council Member Contribution city of Cupertino 0 Nonmonetary CDrddbu~ion Independent ® Support ~ Oppose Expenditure 10/09/2009 Orrin Mahoney Mailer 2 199.55 2 149 55 Monetary , , . City Council Member Contribution City of Cupertino Q Nonmonetary Contribution ~ Independent xQ Support ~ Oppose Expenditure SUBTOTAL $ 6,448.66 . Schedule D Summary 1. Itemized contributions and independent expenditures made this period. (Include all Schedule D subtotals.) ......................................................... $ 6, 448.66 2. Unitemizetl contributions and independent expenditures made this period of under $100 ..................................................................................... $ o. Do 3. Total contributions and independent expenditures made this period. (Add Lines 1 and 2. Do not enter on the Summary Page.) ............ TOTAL $ 6, 448.66 FPPC Form 480 (January105t FPPC Toll•Free Helpllne: 8881ASK•FPPC (8881275.3772) Schedule E Payments Made Type or print in Ink. Amounts may be rounded to whole dollars. Statement covers period from o7/0l/2009 SEE INSTRUCTIONS ONREVERSE through 10/17/2009 page 6 of 9 NAME OF FILER Cupertino Chamber PAC (Sponsored by Cupertino Chamber of Commerce) I.D. NUMBER 1299673 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CHP CNS campaign paraphernalialmisc. campaign consultants hiBR membercommunications RAD radio airtime and production costs CTB contribution (explain nonmonetary)' MTG OFC meetings and appearances office expenses RFD returned contributions ' CVC FlL civic donations PEf petition circulating SAL TEL campaign workers salaries t.v. or cable airtime and production costs F1~ candidate Tilinglballot fees fundraising events PFIO phone banks TRC candidate travel, lodging, and meals ~A independent expenditure supportinglopposing others (explain)' POL POS polling and survey research postage delivery and messenger services TRS TSF stafflspouse travel, lodging, and meals t f LEG legal defense PRO , professional services (legal, accounting) VOT rans er between committees of the same candidatelsponsor voter registration LIT campaign literature and mailings PRT print ads VuEB information technology costs (intemet, a-mail) Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.) ..................................................................................... $ o. 00 2. Unitemized payments made this period of under $100 .............................................................. $ sl. 00 ..................................................................... 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1,Column (e).) ............................................................................... $ o. 00 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.) ............................. TOTALS 51.00 FPPC Form 460 (January105) FPPC Toll•Free Helpline: 85WASK•FPPC (8681275•x772) " Payments that are contributions or independent expenditures must also be summarized on Schedule D, SUBTOTALS o.ao chedule F rypeorprintlnink. Accrued Expenses (Unpaid Bills) Amounts may be rounded towhole dollars. SEE INSTRUCTIONS ON REVERSE NAMt OF FILER Cupertino Chamber PAC (Sponsored by Cupertino Chamber of Commerce) Statement covers period from 07/ol/zoo9 SCHEDULEF through to/I7/zoo9 I page 7 of 9 I.D. NUMBER 1299673 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CNP CNS campaign paraphemalialmisc. i NCR member communications RAD radio airtime and production costs CTB campa gn consultants contribution (explain nonmonetary)' MTG OFC meetings and appearances office expenses RFD S returned contributions ' CVC civic donations Ftr petition circulating AL TEL campaign workers salaries t.v. or cable airtime and production costs FIL candidate flinglballot fees PFIO phone banks 1RC candidate travel, lodging and meals FhA r,D fundraising events i POL polling and survey research TRS , stafilspouse travel, lodging, and meals ndependent expenditure supportinglopposing others (explain)' POS postage, delivery and messenger services TSF transfer behveen committees of the same cantlidatelsponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LfT campaign literature and mailings PRT print ads VvE6 information technology costs (intemet, a-mail) NAME AND ADDRESS OF CREDITOR pFCOMMITTEE,ALSOENTERLD.NUMBER) CODE OR DESCRIPTION OF PAYMENT (s) OUTSTANDING (h) AMOUNTINCURRED (c) AMOUNTPAID )d) OUTSTANDING BALANCE BEGINNING THIS PERIOD THIS PERIOD BALANCEATCLOSE OF THIS PERIOD (Also REPOer oN E( OF THIS PERIOD Robinson Communications Inc. IND Mailer to support Nihalani, Mahoney and 0.00 6,448.66 0.00 6,448.66 10679 Farallone Drive Paul for Cupertino City Cupertino, CA 95014 Council (See Sch D) - raymente roar are contributions or independent expendhures must also tre SUBTOTALS S summarized on Schedule D. 0.00 S 6,448.66 a O.OOS 6,448.66 Schedule F Summary 1. 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.) ............................................ INCURRED TOTALS $ 6, 948.66 2. 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.) ................................. PAID TOTALS $ o. 00 3. Net change this period. (Subtract Line 2 from Line 1. Enter the difference here and on the Summary Page, Column A, Line 9.) ................................................................................................................................................ NET $ 6, 448.66 ey a negative num r FPPC Form 460 (January105) FPPC Toll•Free Helpline: 8561ASK•FPPC (8661175.3772) chedule G Payments Made by an Agent or Independent Amounts may be rounded Statement covers period SCHEDULE G Contractor~onBehalfofThisCommittee) towholedollare. _ ~ ~ ~ I ~ I fro m D7,Dl,2oo9 ,. SEEINSTRUCTIONSONREVERSE through 10/17/2009 page B of 9 NAME OF FILER Cupertino Chamber PAC (Sponsored by Cupertino Chamber of Commerce) LD.NUMBER 1299673 NAMEOFAGENTORINDEPENDENTCONTRACTOR Pacific Printing CODES: If one of the following codes accurately describes the payment, you may enter the code . Otherwise, describe the payment. ChP campaign paraphemalialmisc. MBR CNS campaign consultants membercommuninations RAD radio airtime and production costs MiG CTB contribution (explain nonmonetary)" OFC meetings and appearances office expenses RFD returned contributions ' CVC civic donations PET FIL candidate filinglballot fees petition circulating SAL TEL campaign workers salaries l.v, or cable airtime and production costs Poi0 FND fundraising events POL phone banks polling and survey research TRC TRS candidate travel, lodging, and meals PD independent expenditure supportinglopposing others (explain)' POS LEG legal defense postage, delivery and messenger services TSF stafflspouse travel, lodging, and meals transfer between committees of the same candidatelsponsar PRO LIT campaign literature and mailings PRT professional services (legal, accounting) VOT voter registration print ads V~EB information technology costs (intemet, e-mail) "Payments that are contributions or Independent expendhures must also be summarized on Schedule D, NAMEANDADDRESS OF PAYEE OR CREDITOR (IF COMMITTEE, AL50 ENTER LD. NUMBER) United States Postal Service 21701 Stevens Creek Blvd. Cupertino CA 95014 Attach additional information on appropriately labeled continuation sheets. CODE OR DESCRIPTION OF PAYMENT IND Postage for mailer to support iviiiaiaui, iriahoney and Paul ISee Sch D) " Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or independent contractor as reported on Schedule E. TOTAL' S AMOUNT PAID 1,524.24 1,524.24 FPPC Form 460 (January105) FPPC Toll•Free Helpline; 86WASK-FPPC (8661275.3772) chedule G Payments Made by an Agent or Independent Contractor (on Behalf of This Committee) SEE INSTRUCTIONS ON REVERSE NAME OF FILER Type or print in Ink. Amounts may be rounded towholedollars. Statement covers from o7/0l/2009 through to/17/zoo9 I page 9 of 9 I.D. NUMBER Cupertino Chamber PAC (Sponsored by Cupertino Chamber of Commerce) 1299673 NAME OF AGENT OR INDEPENDENT CONTRACTOR Robinson Communications Inc. CODES: If one of the following codes accurately describes the payment, you may enter the code . Otherwise, describe the payment. CruP CNS campaign paraphemalialmisc. i MBR member communications RAD radio airtime and production costs CTB campa gn consultants contribution (explain nonmonefary)" MiG OFC meetings and appearances office ezpenses RFD S returned contributions ' CVC civic donations PET petition circulating AL TFl campaign workers salaries t.v. or cable airtime and production costs FIL FPD candidate filingroallot fees fundraising events PFIO phone banks TRC candidate travel, lodging, and meals PD independent expenditure supportinglopposing others (explain)' POI, POS polling and survey research postage, delivery and messenger services TRS TSF stafflspouse travel, lodging, and meals transfer between commidees of the same candidatelsponsor LEG legal defense PRO professional services (legal, accounting) VOT voter registration LfT campaign literature and mailings PRT pant ads VyE6 information technology costs (intemet, a-mail) 'Payments that are contributions or independent expendRures must also be summarized on Schedule D. NAMEANDADDRESSOFPAYEEORCREDITOR (IF COMMITTEE, ALSO ENTER LD. NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Pacific Printing IND Mailing services for mailer to 1,187.70 226C Monterey Road support ivihaiani, riahoney and Paul (See SCh D) San Jose CA 95112 Pacific Printing IND Posts e for mailer to su ort g PP 1,524.24 2260 Monterey Road Nihalani, Mahoney and Paul (See SCh D) San Jose CA 95112 Pacific Printing IND Printin for mailer to su ort g PP 1,865.66 2260 Monterey Road Nihalani, Mahoney and Paul (See SCh D) San Jose CA 95112 Attach additional information on appropriately labeled continuation sheets. TOTAL* E 4, s77. so Do not transfer to any other schedule or to the Summary Page. This total may not equal the amount paid to the agent or independent contractor as reported on Schedule E. FPPC Form 460 (January105) FPPC Toll-Free Helpline: 86WASK•FPPC (8661275.3771)