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460 Recipient Committee Campaign Statement –Semi Annual – 10-23-16 – 12-31-16 Recipient Committee Campaign Statement Cover Page SEE INSTRUCTIONS ON REVERSE Statement covers period from 10/23/2016 through 12/31/2016 1. Type of Recipient Committee: All Committees—Complete Parts 1,2,3,and 4. Officeholder,Candidate Controlled Committee 0 State Candidate Election Committee 0 Recall (Also Complete Part 5) ❑ General Purpose Committee 0 Sponsored 0 Small Contributor Committee 0 Political Party/Central Committee ❑ Primarily Formed Ballot Measure Committee 0 Controlled 0 Sponsored (Also Complete Parl 6) ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 3. Committee Information ' I.D.NUMBER 138648' COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) Bharwad for City Council 2016 STREET ADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREACODE/PHONE MAILING ADDRESS(IF DIFFERENT)NO.AND STREET OR P.O.BOX CITY STATE ZIP CODE AREA CODE/PHONE IMIMMAMMINI Sir M I Lim ;MZM t-AL.IFORNIA A GA Date of election if applic ble: JAN 3 1 2017 1 of Li (Month,Day,Year) i For Official Use Only 11/08/2016 CL PERTINO CITY CL RK 2. Type of Statement: I-I�P,,reelection Statement ❑ Quarterly Statement Semi-annual Statement ❑ Special Odd-Year Report ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment(Explain below) Treasurer(s) NAME OF TREASURER Jakshi Bharwad MAILING ADDRESS CITY STATE ZIP CODE AREACODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY MAILING ADDRESS CITY STATE ZIP CODE AREACODE/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 certify under penalty of perjury under the laws of the State of California that the foregoinq is true and correct. Executed on 01/30/2017 Date Executed on 01/30/2017 Date Executed on Date Executed on Date By By By Signature of Controlling Officeholder,Candidate,State Measure Proponent By Signature of Controlling Officeholder,Candidate,State Measure Proponent FPPC Form 460(Jan/2016) FPPC Advice:advice @fppc.ca.gov(866/275-3772) www.fppc.ca.gov Recipient Committee Campaign Statement Cover Page — Part 2 5. Officeholder or Candidate Controlled Committee NAME OF OFFICEHOLDER OR CANDIDATE Parth Bharwad OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Cupertino City Council 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. liv vilv11 I I CC INHIvIC I.D.NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE COMMITTEE NAME I.D.NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE COVER PAGE-PART 2 A Page 2 of 11 6. Primarily Formed Ballot Measure Committee NAME OF BALLOT MEASURE BALLOT NO.OR LETTER JURISDICTION ❑ SUPPORT ❑ OPPOSE Identify 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 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(Jan/2016) FPPC Advice:advice @fppc.ca.gov(866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Amounts may be rounded SUMMARY PAGE Summary Page to whole dollars. Statement covers period CALIFORNIA 10/23/2016 � - � 6 from 12/31/2016 3 SEE INSTRUCTIONS ON REVERSE through page of-1 NAME OF FILER I.D.NUMBER Bharwad for City Council 2016 1386483 Contributions Received Column A Column B Calendar Year Summary for Candidates TOTAL THIS PERIOD (FROM ATTACHED SCHEDULES) CALENDAR YEAR TOTAL TO DATE Running in Both the State Primary and General Elections 1. Monetary COntrlbUtlOr1S................................................... Schedule A,Line 3 0 $ $ 21343.54 2. Loans Received................................................................ Schedule 8,Line 3 0 1/1 through 6/30 7/1 to Date 3. SUBTOTAL CASH CONTRIBUTIONS.............................. Add Lines 1+2 $ $ 21343.61 20. Contributions Received $ 19031.54 $ 4133.61 4. Nonmonetary Contributions............................................ schedule C,Line 3 0 1821.61 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED.................................... Add Lines 3+4 $ 0 $ 23165.15 Made $ 6965.28 $ 10596.89 Expenditures Made Expenditure Limit Summary for State 6. Payments Made................................................................ schedule E,Line 4 $ 3432.75 $ 17562.17 Candidates 7. Loans Made....................................................................... Schedule H,Line 3 0 8. SUBTOTAL CASH PAYMENTS.......................................... Add Lines 6+7 $ 3432.75 $ 17562.17 22• Cumulative Expenditures Made* (If Subject to Voluntary Expenditure Limit) 9. Accrued Expenses(Unpaid Bills).......................................... schedule F Line 3 0 Date of Election Total to Date 10. Nonmonetary Adjustment......................................................... schedule c,Line 3 0 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE........................................ Add Lines 8+9+10 $ 3432.75 $ 17562.17 J � $ Current Cash Statement J � $ 12. Beginning Cash Balance............................ Previous summary Page,Line 16 $ 7214.12 To calculate Column B, 13. Cash Receipts........................................................... Column A,Line 3 above 0 add amounts in Column 14. Miscellaneous Increases to Cash.................................. schedule 1,Line 4 0 A to the corresponding *Amounts in this section may be different from amounts amounts from Column B reported in Column B. 15. Cash Payments......................................................... Column A,Line 8 above 3432.75 of your last report. Some 16. ENDING CASH BALANCE ..................Add Lines 12+13+ 14,then subtract Line 15 $ 3781.73 amounts in Column A may be negative figures that If this is a termination statement,Line 16 must be zero. should be subtracted from previous period amounts. If this is the first report being 17. LOAN GUARANTEES RECEIVED................................ schedule e,Part 2 $ 0 filed for this calendar year, only carry over the amounts from Lines 2,7,and 9(if Cash Equivalents and Outstanding Debts 18. Cash Equivalents................................................ See instructions on reverse $ 0 any). 19. Outstanding Debts.............................. Add Line 2+Line 9 in Column 8 above $ 0 FPPC Form 460(Jan/2016) FPPC Advice:advice @fppc.ca.gov(866/275-3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVERSE Bharwad for City Council 2016 Amounts may be rounded to whole dollars. Statement covers period from 10/23/2016 through 12/31/2016 SCHEDULE E Page 11114 of 1386483 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP CNS campaign paraphernalia/misc. MBR member communications RAID radio airtime and production costs CTB campaign consultants contribution(explain nonmonetary)* MTG meetings and appearances RFD returned contributions CVC civic donations OFC PET office expenses petition circulating SAL campaign workers'salaries FIL candidate filing/ballot fees PHO phone banks TEL t.v.or cable airtime and production costs FND fundraising events POL polling and survey research TRC TRS candidate travel,lodging,and meals staff/spouse travel,lodging,and meals IND LEG independent expenditure supporting/opposing others(explain)* legal defense POS postage,delivery and messenger services TSF transfer between committees of the same candidate/sponsor LIT campaign literature and mailings PRO PRT professional services(legal,accounting) VOT voter registration print ads WEB information technology costs(internet,e-mail) NAME AND ADDRESS OF PAYEE (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID In &Out Printing 14682 Wicks Blvd. CMP San Leandro, CA 94577 $3152.23 "Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.).......................................................................... 2. Unitemized payments made this period of under$100....................................................................................................... 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).).......................................... 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.)..... $ 3152.23 $ 286.52 ...................................$ 0 ......................TOTAL $ 3438.75 FPPC Form 460(Jan/2016) FPPC Advice:advice @fppc.ca.gov(866/275-3772) www.fppc.ca.gov