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460 Recipient Committee Campaign Statement - Semi Annual 10-23-16 to 12-31-16 Recipient Committee COVER PAGE tlate3alnp I ' ;:' 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 Q 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 Part 6) ❑ Primarily Formed Candidate/ Officeholder Committee (Also Complete Part 7) 3. Committee Information I I.D.NUMBER COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) 138357< David Fung for City Council 2016 STREETADDRESS(NO P.O.BOX) ❑ Preelection Statement 7539 Barnhart Place ❑ Termination Statement CITY STATE ZIP CODE AREA CODE/PHONE CA 95014 (408)821-6359 MAILING ADDRESS(IF DIFFERENT)NO.AND STREET OR P.O.BOX P.O. Box 281 CITY STATE ZIP CODE AREA CODE/PHONE CA 95015 (408) 821-6359 OPTIONAL: FAX/E-MAILADDRESS David @Fung4Cupertino.com Date of election if applicable: (Month, Day,Year) C 11/08/2016 1 JAN 6 - 2017 PERTINO CITY 2. Type of Statement: ❑ Preelection Statement Semi-annual Statement ❑ Termination Statement (Also file a Form 410 Termination) ❑ Amendment(Explain below) Page 1 of 7 For Official Use Only ..y ❑ Quarterly Statement ❑ Special Odd-Year Report Treasurer(s) NAME OF TREASURER Kathy Jacques MAILING ADDRESS CITY STATE ZIP CODE AREACODE/PHONE ( NAME OF ASSISTANT TREASURER,IF ANY MAILINGADDRESS CITY STATE ZIP CODE AREA CODE/PHONE OPTIONAL: FAX/E-MAIL ADDRESS VW I II/bdLlV 11 I have used all reasonable diligence in preparing and reviewing this statement and 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 David Fung OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) Member, Cupertino City Council RESIDENTIAL/BUSINESSADDRESS (NO.ANDSTREET) 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. i Ufvllvn i 1 CC NHIVIC 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 NAMt UF- I REASURER COMMITTEE ADDRESS STREET I.D.NUMBER ❑ YES P.O.BOX) ❑ NO CITY STATE ZIP CODE AREA CODE/PHONE COVER PAGE-PART 2 Page 2 of 7 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 to whole dollars. from Statement covers period 10/23/2016 SUMMARY PAGE SEE INSTRUCTIONS ON REVERSE 6. Payments Made................................................................ through 12/31/2016 Page 3 of 7 NAME OF FILER 0 8. SUBTOTAL CASH PAYMENTS.......................................... Add Lines 6+7 $ 0 9. Accrued Expenses (Unpaid Bills).......................................... schedule F Line 3 David Fung for City Council 2016 10. Nonmonetary Adjustment.,...................................................... schedule C,Line 3 0 11. TOTAL EXPENDITURES MADE........................................ I.D.NUMBER 5,545 1383579 Contributions Received Column A TOTAL Column B Calendar Year Summary for Candidates THIS PERIOD (FROM ATTACHED SCHEDULES) CALENDAR YEAR TOTAL TO DATE Running in Both the State Primary and 1. Monetary Contributions................................................... Schedule A,Line 3 1,450 $ $ 16,097 General Elections 2. Loans Received................................................................ schedule B,Line 3 0 5,000 1/1 through 6/30 711 to Date 3. SUBTOTAL CASH CONTRIBUTIONS.............................. Add Lines 1+2 1,450 $ $ 21,097 20. Contributions Received $ $ 4. Nonmonetary Contributions............................................ Schedule C,Line 3 0 0 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED....................................Add Lines 3+4 $ 1,450 $ 21,097 Made $ $ Expenditures Made 6. Payments Made................................................................ schedule E,Line 4 $ 5.545 7. Loans Made....................................................................... Schedule H,Line 3 0 8. SUBTOTAL CASH PAYMENTS.......................................... Add Lines 6+7 $ 0 9. Accrued Expenses (Unpaid Bills).......................................... schedule F Line 3 0 10. Nonmonetary Adjustment.,...................................................... schedule C,Line 3 0 11. TOTAL EXPENDITURES MADE........................................ Add Lines s+9+10 $ 5,545 Current Cash Statement 12.Beginning Cash Balance............................ Previous summary Page,Line 16 $ 7,917 13.Cash Receipts........................................................... Column A,Line 3 above 1,450 14. Miscellaneous Increases to Cash.................................. Schedule 1,Line 4 296 15.Cash Payments......................................................... Column A,Line 8 above 5,545 16.ENDING CASH BALANCE Add Lines 12+13+14,then subtract Line 15 $ 4,118 If this is a termination statement,Line 16 must be zero. 17.LOAN GUARANTEES RECEIVED................................ Schedule B,Part 2 $ 0 Cash Equivalents and Outstanding Debts 18. Cash Equivalents................................................ See instructions on reverse $ 19. Outstanding Debts.............................. Add Line 2+Line 9 in Column B above $ C I $ 17,575 0 $ 0 0 0 $ 17,575 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). Expenditure Limit Summary for State Candidates 22. Cumulative Expenditures Made* (if Subject to Voluntary Expenditure Limit) Date of Election Total to Date (mm/dd/yy) E.3 *Amounts in this section may be different from amounts reported in Column B. FPPC Form 460(Jan/2016) FPPC Advice:advice @fppc.ca.gov(866/275-3772) www.fppc.ca.gov Schedule A Amounts may be rounded SCHEDl1LF A �_,_ IYIVI WWI y t,pfltflouilons KecelVea Statement covers period 10/23/2016 _ • from _ SEE INSTRUCTIONS ON REVERSE through 12/31/2016 Page 4 of 7 NAME OF FILER I.D.NUMB NUMB ER David Fung for City Council 2016 13 DATE RECEIVED FULL NAME,STREET ADDRESS AND ZIP CODE OF CONTRIBUTOR (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CONTRIBUTOR IF AN INDIVIDUAL,ENTER OCCUPATION AND EMPLOYER AMOUNT RECEIVED THIS CUMULATIVE TO DATE PER ELECTION CODE* (IF SELF-EMPLOYED.ENTER NAME PERIOD CALENDAR YEAR (JAN.1-DEC.31) TO DATE (IF REQUIRED) OF BUSINESS) Kevin Jacques IND 10/23/16 1110 Hunterston Place El CoM El OTH Vice President, Intuit 100 100 100 Cupertino, CA 95014 ❑PTY ❑SCC Ravi Shankar ®IND 10/25/16 1474 Rose Garden Lane F-1 coM E]OTH Senior Director, Oracle 200 200 200 Cupertino, CA 95014 ❑PTY ❑SCC CREPAC-CAR#890106 for Silicon Valley AoR � S.Virgil Avenue, Los Angeles CA 90020 COM (GOTH 1,000 1,000 1,000 ❑PTY ❑SCC Simy Taneja �IND 2016 11553 Country Spring Court ❑COM Instructor, Self-Employed 100 100 100 ❑OTH Cupertino, CA 95014 ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC SUBTOTAL$ 1,400 0t;i1euule H aummary 1. Amount received this period—itemized monetary contributions. (Include all Schedule A subtotals.).................................................................................... 2. Amount received this period—unitemized monetary contributions of less than $100 ...... 3. Total monetary contributions received this period. (Add Lines 1 and 2. Enter here and on the Summary Page, Column A, Line 1.).............. $ 1,400 $ 50 TOTAL $ 1,450 '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(Jan/2016) FPPC Advice:advice @fppc.ca.gov(866/275-3772) www.fppc.ca.gov Schedule E Payments Made SEE INSTRUCTIONS ON REVFRSF David Fung 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 5 of 7 I.D.NUMBER 1383579 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 RAD 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 SAL campaign workers'salaries FIL candidate filing/ballot fees PHO petition circulating 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 All Things Printed Mailer Printing USPS Mailer Postage Cicero's Pizza Campaign event *Payments that are contributions or independent expenditures must also be summarized on Schedule D. Schedule E Summary 1. Itemized payments made this period. (Include all Schedule E subtotals.)................................................................................... 2. Unitemized payments made this period of under$100...................................................... .......................................................... 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).)................................................... 4. Total payments made this period. (Add Lines 1, 2, and 3. Enter here and on the Summary Page, Column A, Line 6.).............. AMOUNT PAID 1,392 1,450 129 SUBTOTAL$ 2,971 $ 5.377 $ 168 .................... $ 0 ....... TOTAL $ 5,545 FPPC Form 460(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov Schedule E (Continuation Sheet) Payments Made SEE INSTRUCTIONS ON REVERSE NAME OF FILER David Fung for City Council 2016 Amounts may be rounded to whole dollars. SCHEDULE E(CONT.) Statement covers period CALIFORNIA from 10/23/2016 FORM through 12/31/2016 6 7 Page of I.D.NUMBER 1383579 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 RAD radio airtime and production costs CTB campaign consultants contribution(explain nonmonetary)* MTG OFC meetings and appearances office expenses RFD returned contributions CVC FIL civic donations PET petition circulating SAL TEL campaign workers'salaries t.v,or cable airtime and production costs FND candidate filing/ballot fees fundraising events PHO phone banks TRC candidate travel,lodging,and meals IND independent expenditure supporting/opposing others(explain)* POL POS polling and survey research postage,delivery and messenger services TRS TSF staff/spouse travel,lodging,and meals transfer between committees of the same candidate/sponsor LEG LIT legal defense PRO professional services(legal,accounting) VOT voter registration campaign literature and mailings PRT print ads WEB information technoloov costs fintPrnat a-main NAME AND ADDRESS OF PAYEE (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID David A. Fung Reimbursement for Candidate Statement Fee paid to 7539 Barnhart Place CMP City of Cupertino 1,920 Cupertino, CA 95014 David A. Fung Reimbursement for Postal Permit Registration ($215), 7539 Barnhart Place CMP office expenses ($125), cash tip to Cicero's for 365 Cupertino, CA 95014 campaign event($25) David A. Fung Reimbursement for Facebook Ad Fees 7539 Barnhart Place CMP 121 Cupertino, CA 95014 Nayments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 2.4n6 FPPC Form 460()an/2016) FPPC Advice:advice @fppc.ca.gov(866/275-3772) www.fppc.ca.gov Schedule I Amounts may be rounded CzrNFnI II G I Iviisceiianeous increases to Gash to whole dollars. Statement covers period • . from 10/23/2016 • ' SEE INSTRUCTIONS ON REVERSE through 12/31/2016 Page 7 of 7 NAME OF FILER I.D.NUMBER David Fung for City Council 2016 1383579 DATE RECEIVED FULL NAME AND ADDRESS OF SOURCE (IF COMMITTEE,ALSO ENTER I.D.NUMBER) DESCRIPTION OF RECEIPT AMOUNT OF INCREASE TO CASH City of Cupertino Candidate Statement refund 12/23/16 10300 Torre Avenue Cupertino, CA 95014 296 nudcn dUUfuund+,rnuwrnauon on appropnareiy moeiea continuation sheets. Schedule I Summary 1. Itemized increases to cash this period. ...........................................................................................................................$ 2. Unitemized increases to cash of under$100 this period. ................................................................................................$ 3. Total of all interest received this period on loans made to others. (Schedule H, Column (e).) .......................................$ 4. Total miscellaneous increases to cash this period. (Add Lines 1, 2, and 3. Enter here and on the SummaryPage, Line 14.) ............................................................................................................................. TOTAL $ SUBTOTAL$ 296 0 0 296 296 FPPC Form 460(Jan/2016) FPPC Advice:advice @fppc.ca.gov(8661275-3772) www.fppc.ca.gov