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460 Recipient Committee Campaign Statement – Preelection Statement – 09-22-16 – 10-25-16 COVER PAGE Recipient Committee D: �;�,�_..:r � . Campaign Statement � ' � � Cover Page �i �t OCT 2 � 2016 a��e. 1 of �� 1 Statement covers period Date of election if applical le: 9 9-25-16 (Month,Day,Year) F�Official Use Only from C JPERTINO CITY C ERK SEE INSTRUCTIONS ON REVERSE through 10-22-16 11/08/2016 � i ' � 1. Type Of ReCiple►lt Committee: A���ommittees-�omp�ete Parts�,z,s,a�a a. 2. Type of Statement: � Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure � Preelection Statement ❑ Quarterly Statement � State Candidate Election Committee Committee ❑ Semi-annual Statement ❑ Special Odd-Year Report Q Recall � Controlled ❑ Termination Statement (AlsoComplefePart5J � Sponsored (Also file a Form 410 Termination) (Also Complefe PaR 6J ❑ General Purpose Committee ❑ Amendment(Explain below) � Sponsored ❑ Primarily Formed Candidate/ � Small Contributor Committee Officeholder Committee � Political Party/Central Committee (�soComplefePart7J 3. Committee Information I.D.NUMBER Treasurer(s) 1386483 COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OF TREASURER Bharwad for City Council 2016 Jakshi Bharwad MAILING ADDRESS STREETADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREACODE/PHONE CITY STATE ZIPCODE AREACODElPHONE NAMEOFASSISTANTTREASURER,IFANY Cupertino Ca 95014 MAILING ADDRESS(IF DIFFERENT)NO.AND STREET OR P.O.BOX MAILING ADDRESS CITY STATE ZIP CODE AREA CODE/PHONE � CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/E-MAIL ADDRESS OPTIONAL: FAX/E-MAIL ADDRESS 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 co e t Executed on �0/26/2016 BY Date of Sponsor Executed on BY Date SignaWre of Controlling Offceholder,Candidate,State Measure Proponent Executed on By Date Signature of Controlling Offceholder,Candidate,State Measure Proponent FPPC Form 460(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov COVER PAGE-PART 2 Recipient Committee . - . Campaign Statement . - � • � Cover Page — Part 2 Page 2 of �� 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALLOT MEASURE Parth Bharwad OFFICE SOUGHT OR HELD QNCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER I JURISDICTION I � SUPPORT Cupertino City Council ❑ oPPosE RESIDENTIAL/BUSINESSADDRESS (NO.AND STREET) CITY STATE ZIP Identify the controlling officeholder,candidate,or state measure proponent,if any. Cupertino CA 95014 NAME OF OFFICEHOLDER,CANDIDATE,OR PROPONENT Related Committees Not Included in this Statement: �rsra�ycommrrtees not included in this statement that are controlled by you or are primarily formed to receive OFFICE SOUGHT OR HELD I DISTRICT N0.IF ANY contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D.NUMBER NAME OF TREASURER CONTROLLED COMMITTEE7 �• Primarily Formed Candidate/Officeholder Committee Listnames of officeholder(s)or candidate(s)for which this committee is primarily formed. ❑ YES ❑ NO COMMITTEE ADDRESS STREET ADDRESS (NO P.O.BOX) NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE COMMITTEE NAME I.D.NUMBER NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF TREASURER CONTROLLED COMMITTEE? NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ YES ❑ NO ❑ SUPPORT ❑ OPPOSE COMMITTEEADDRESS STREETADDRESS (NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE Attach continuation sheets if necessary FPPC Form 460(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Amounts may be rounded SUMMARY PAGE Summa Pa @ to whole dollars. Statement covers period � - , � g from 09-25-16 � - � ' throu h 10-22-16 page J of � SEE INSTRUCTIONS ON REVERSE 9 NAME OF FILER I.D.NUMBER Parth Bharwad ��$� � �� Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHISPERIOD CALENDARYEAR (FROMATTACHEDSCHEDULES) TOTALTODATE Running in Both the State Primary and 2502 21343.54 General Elections 1. Monetary Contributions................................................... scnedu�ea,u�e s $ $ 1/1 through 6/30 7/1 to Date 2. Loans Received................................................................ soned�ie e,une s 0 0 2502 21343.54 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS.............................. Add�ines 1+2 $ $ Received $ 19,031.54 $ 4133.61 1631.61 1821.61 4. Nonmonetary Contributions............................................ soned�re c,une 3 21. Expenditures 4133.61 23165.15 Made g 6,965.28 $ 7164.14 5. TOTALCONTRIBUTIONSRECEIVED....................................Add�ines3+4 $ $ Expenditures Made Expenditure Limit Summary for State 6. P8yfT1@f1tS MBCI@................................................................ Schedule E,Line 4 $ 7164.14 g 14129.42 Candidates 7. L0811S MaCI@....................................................................... Schedule H.Line 3 0 � 7164.14 14129.42 22• Cumulative Expenditures Made' 8. SUBTOTAL CASH PAYMENTS.......................................... Add�ines 6+7 $ $ (If Subject to Voluntary Expenditure Limit) 9. Accrued Ex enses Un aid Bills Schedule F,Line 3 � 0 P ( p ) Date of Election Total to Date 10. Nonmonetary Adjustment.........................................................scned�ie c,u�e s 0 0 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE........................................Add�ines 8+g+1p $ 7164.14 g 14129.42 �� $ Current Cash Statement �� $ 12. Be91ll�1f19 CeSh B818f1Ce............................ Previous SummaryPage,Line 16 $ 1 1,876.26 To calculate Column B, 13.Cash Receipts........................................................... co��mn a,u�e 3 abo�e 2502 add amounts in Column � A to the corresponding tAmounts in this section may be different from amounts 14. Miscellaneous Increases to Cash.................................. scnedu�e l,�ine a amounts from Column B reported in Column B. 15. CBSh P8y1712C1tS......................................................... Column A,Line 8 above 7164.14 of your last report. Some amounts in Column A may 16.ENDING CASH BALANCE ..................Add�ines 12+13+14,then subt�act Line 15 $ 7214.12 be negative figures that should be subtracted from If this is a termination statement,Line 16 must be zero. previous period amounts. If this is the first report being 17. LOAN GUARANTEES RECEIVED................................ Schedu�e e.Part 2 $ filed for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts from Lines 2,�,and 9(if 18. CBSh EqUIV812ntS................................................ See instructions on reverse $ 0 a�y� 19. OUtst2fldiflg Debts.............................. Add Line 2+Line 9 in Column B a6ove $ � FPPC Form 460(lan�2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov Schedule A Amounts may be rounded SCHEDULE A Monetary Contributions Received to whole dollars. Statement covers period � . from 09-25-16 � - � • 1 through 10-22-16 page � of � SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Parth Bharwad 1386483 DATE FUIL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL,ENTER RECEIVOED THIS CUCAL NTDAR O ARTE PERO D TEION (IF COMMITTEE,ALSO ENTER I.D.NUMBER) * OCCUPATION AND EMPLOYER RECEIVED CODE �iF se�F-eMP�oveo,eNTeR NnMe PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) Dinu J. Amin �IND 09-28-2016 ❑coM Retired $151 $151 ❑PTY ❑scc m IND 09-25-2016 Anay P. Patel ❑coM ��e��'n� $151 $151 ❑PTY ❑scc D IND 09-28-2016 The Howard Family Revocable Trust ❑conn Retired $100 $100 ❑PTY ❑scc AADIJ Investments Inc. ❑�N� 09-29-2016 ❑COM $500 $500 �OTH ❑PTY ❑SCC Gill Trucking ❑IND 10-02-2016 ���M $100 $100 �OTH ❑PTY ❑SCC SUBTOTAL$ 1002 I Schedule A Summary `Contributor Codes 1. Amount received this period-itemized monetary contributions. iNo-individuai (Include all Schedule A subtotals.) $ 2502 COM—Recipient Committee ......................................................................................................... (other than PTY or SCC) 2. Amount received this period-unitemized monetary contributions of less than$100 ...........................$ � OTH—Other(e.g.,business entity) PTY—Political Party 3. Total monetary contributions received this period. scc-smaii contributor commitcee Add Lines 1 and 2. Enter here and on the Summa Pa e, Column A, Line 1. TOTAL $ 2502 � ry g ) FPPC Form 460(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULEA (CONT.) Monetary Contributions Received to whole dollars. Statement covers period � . from 09-25-16 • ' � • 1 through 10-22-16 page � of � NAME OF FILER I.D.NUMBER Parth Bharwad 1386483 CONTRIBUTOR IF AN INDIVIDUAL,ENTER I AMOUNT CUMULATIVE TO DATE PER ELECTION DATE FULL NAME,STREETADDRESS AND ZIP CODE OF CONTRIBUTOR * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED QF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE (IF SELF-EMPLOYED,ENTER NAME ' � OFBUSINESS) PERIOD (JAN.1-DEC.31) (IF REQUIRED) Ashok K Bhatt ❑coM Self Employed, 10-16-2016 ❑PTY ❑scc Richard Lowenthal ��ND Retired 10-13-2016 ❑PTY ❑scc ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC SUBTOTAL$ 1500 I I *Contributor Codes IND—Individual COM—Recipient Committee (other than PTY or SCC) OTH—Other(e.g.,business entity) PTY—Political Party FPPC Form 460(Jan/2016) SCC—Small Contributor Committee , FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov Schedule C Amounts may be rounded SCHEDULE C Nonmonetary Contributions Received to whole dollars. . _ � Statement covers period from 09-25-16 � ' � ' through 10-22-16 page � of 1 SEEINSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Parth Bharwad 1386483 IF AN INDIVIDUAL,ENTER AMOUNT/ CUMULATIVE TO � pER ELECTION DATE FULL NAME,STREETADDRESS AND CONTRIBUTOR DESCRIPTION OF DATE RECEIVED ZIP CODE OF CONTRIBUTOR CODE* OCCUPATION AND EMPLOYER GOODS OR SERVICES FAIR MARKET TO DATE (IF COMMITTEE,AlSO ENTER I.D.NUMBER) (IF SELF-EMPLOYED,ENTER VALUE CALENDAR YEAR ��F REQUIRED) NAME OF BUS�NESS) (JAN 1-DEC 31) �IND 10/12/201 Viraj Bharwad ❑COM Montecito PreSchool Letter sent to $1631.61 $1631.61 �pN ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC Attach additional information on appropriately labeled continuation sheets. SUBTOTAL$ I Schedule C Summary 'Contributor Codes 1. Amount received this period-itemized nonmonetary contributions. iN�-individuai (Include all Schedule C subtotals.)......................................................................................................................$ $1631.61 COM—Recipient Committee (other than PTY or SCC) 2. Amount received this period -unitemized nonmonetary contributions of less than $100 ..................................$ 0 OTH—Other(e.g.,business entity) PTY—Political Party 3. Total nonmonetary contributions received this period. scc-smau concributor committee Add Lines 1 and 2. Enter here and on the Summa Pa e, Column A, Lines 4 and 10. TOTAL $ $1631.61 � ( rY 9 )..................... FPPC Form 460(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov SCHEDULEE Schedule E Amounts may be rounded Statement covers period � . to whole dollars. � � ' Payments Made 09-25-16 • ' from through 10-22-16 page � of � SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Parth Bharwad 1386483 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution(explain nonmonetary)` OFC office expenses SAL campaign workers'salaries CVC civic donations PET petition circulating TEL t.v.or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel,lodging,and meals FND fundraising events POL polling and survey research TRS staff/spouse travel,lodging,and meals IND independent expenditure supporting/opposing others(explain)` POS postage,delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services(legal,accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs(internet,e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE,ALSO ENTER LD.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Poli Application to assist with canvassing/voter data In &Out Printing Printing and mailing for campaign literature *Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ Schedule E Summary 1. Itemized a ments made this eriod. Include all Schedule E subtotals. $ 7130.28 P Y P � )............................................................................................................. 2. Unitemized payments made this period of under$100..........................................................................................................................................$ $33.86 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).).............................................................................$ � 4. Total a ments made this eriod. Add Lines 1, 2, and 3. Enter here and on the Summa Pa e, Column A, Line 6. TOTAL $ �164.14 P Y p � rY 9 )........................... FPPC Form 460(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov