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460 Recipient Committee Campaign Statement – Preelection Statement – 09-25-16 – 10-22-16 Recipient Committee COVER PAGE Campaign Statement DI [ (�. a��f�P� [� � ' . � , ' • 1 Cover Page Statement covers period Date of election if applica�l�� f t of from 9/252016 (Month, Day,Year) �C'T 2 7 2�� `� For Official Use Only � SEE INSTRUCTIONS ON REVERSE th�oUgh 10/22/2016 November 8, 2016 C JPERTINO CITY CLE RK � 1. Type of Recipient Committee: au comm�ttees-comPiete Parts�,z,s,ana a. 2. Type of Statement: 0 Officeholder,Candidate Controlled Committee ❑ Primarily Formed Ballot Measure � Preelection Statement ❑ Quarterly Statement � State Candidate Election Committee Committee ❑ Semi-annual Statement ❑ Special Odd-Year Report � Recall � Controlled ❑ Termination Statement (AlsoComplete Pad 5) � Sponsored (Also file a Form 410 Termination) � �� (Also Complete PaR 6J ❑ General Purpose Committee ❑ Amendment(Explain below) � Sponsored ❑ Primarily Formed Candidate/ 0 Small Contributor Committee Officeholder Committee � Political Party/Central Committee (asoComplefePad7J 3. Committee Information I I.D.NUMBER Treasurer(s) 1386578 COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITi'EE) NAME OF TREASURER Jerry Liu for City Council 2016 Jennifer Fang MAILING ADDRESS STREETADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE - AREA CODE/PHONE NAME OF ASSISTANT TREASURER,IF ANY Cupertino CA 95014 Nan Yu 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-MAILADDRESS 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 nformation 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 an�-corr�ct. October 27, 2016 / ' Executed on By Executed on October 27, 2016 By � Date SignaWre of Controlling Offceholder,Can idate.State Measure Proponent or Responsible Offcer of Sponsor Executed on By Date Signature of Controlling Officeholder,Candidate,State Measure Proponent Executed on By Dale Signature of Controlling Officeholder,Candidate,State Measure Proponent FPPC Form 460(1an/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) COVER PAGE-PART 2 Recipient Committee � _ , Campaign Statement . - ' • � Cover Page — Part 2 Page � of � 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLOER OR CANDIDATE NAME OF BALLOT MEASURE Jerry Liu OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT NO.OR LETTER I JURISDICTION I � SUPPORT Cupertino City Councilmember ❑ oPPosE RESIDENTIAL/BUSINESSADDRESS (NO.ANDSTREET) 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: ��sra�ycommirrees not included in this statement that are contro/led by you or are primarily formed to receive OFFICE SOUGHT OR HELD I DISTRICT NO.IF ANY contributions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D.NUMBER NAME OFTREASURER CONTROLLED COMMITTEE? 7• Primarily Formed Candidate/Officeholder Committee Listnames of officeholder(s)or candidate(s)for which this committee is primarily formed. ❑ YES ❑ NO COMMITTEE ADDRESS STREETADDRESS (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 Summary Page to whole dollars. Statement covers period � . I from 9/252016 • - • � SEE INSTRUCTIONS ON REVERSE through 10/22/2016 page � of � NAME OF FILER I.D.NUMBER Jerry Liu for City Council 2016 1386578 Column A Column B Calendar Year Summary for Candidates Contributions Received TOTALTHISPERIOD CALENDARYEAR (FROMATfACHEDSCHEDULES) TOTALTODATE Running in Both the State Primary and 3924.00 14398.00 General Elections 1. Monetary Contributions................................................... scnedu�ea,�r�e s $ �a 1/1 through 6/30 7/1 to Date 2. Loans Received................................................................ scneduie e,�ine s 0.00 15000.00 3924.00 29398.00 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS.............................. Add�ines�+2 $ $ Received $ $ 4. Nonmonetary Contributions............................................ scnedu�e c,une s � 424.99 21. Expenditures 5. TOTAL CONTRIBUTIONS RECEIVED....................................Add�iness+4 $ 3924.00 � 29822.99 Made $ $ Expenditures Made Expenditure Limit Summary for State 6. Payments Made................................................................ scnedu�e E,une a � 9837.68 � 20558.06 Candidates 7. LOaf1S Made....................................................................... Schedule H,Line 3 0.00 0.00 9837.68 20558.06 22• Cumulative Expenditures Made` 8. SUBTOTAL CASH PAYMENTS.......................................... Add�ines s+� $ $ (If Subject to Voluntary Expenditure Limit) 9. Accrued Ex enses Un aid Bills Schedu/e F,Line 3 0.00 0.00 P � P ) � �� Date of Election Total to Date 10. Nonmonetary Adjustment.........................................................scneduie c,u�e s 0.00 0.00 (mm/dd/yy) 11. TOTAL EXPENDITURES MADE........................................Add�ines s+s+�o $ 9837.68 g 20558.06 �� $ Current Cash Statement �� 12. B2glflfllflg CaSh BalaI1C@............................ Previous Summary Page,Line 16 $ 14975.37 To calculate Column B, 13. Cash ReCelpts........................................................... Column A,Line 3 above 3924.00 add amounts in Column 0.00 A to the corresponding 'Amounts in this section may be different from amounts 14. Miscellaneous Increases to Cash.................................. scned�ie�,une a amounts from Column B reported in Column B. 15. CeSh PaymentS......................................................... Column A,Line 8 above 9837.68 of your last report. Some amounts in Column A may 16. ENDING CASH BALANCE ..................add�ines�2+�3+14,then subtract Line 15 $ 9061.69 be negative figures that should be subtracted from lf this is a termination statement, Line 16 must be zero. previous period amounts. If this is the first report being 17. LOAN GUARANTEES RECEIVED................................ Schedule e,Part 2 $ 0.00 filed for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts from Lines 2,�,and 9(if • 0.00 any). 18. Cash Equlvalents................................................ See instruchons on reverse $ 19. Outstanding Debts.............................. Add Line 2+Line 9 in Column e above $ �500�.�0 FPPC Form 460(1an/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 � _ � 9/252016 • � from • through 10/22/2016 page�of � SEE INSTRUCTIONS ON REVERSE NAME OF FILER I.D.NUMBER Jerry Liu for City Council 2016 1386578 DATE FULL NAME,STREETADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL,ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION (IF COMMITTEE,ALSO ENTER I.D.NUMBER) OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE RECEIVED CODE * �iF sE�F-EMP�oveo,eNreR NnMe PERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) Frank Geefay �IND 10/3/2016 ❑PTY ❑scc ❑IND Min's Unit One LLC ❑Conn 10/1/2016 ❑PTY ❑scc �IND Tina Wu ❑conn Insurance Agent 10/1/2016 ❑PTY ❑scc Plumbers, Steamfitters & Refrigeration Fitters, ❑IND 9/26/2016 �COM 300.00 300.00 300.00 Local 393 Political Action Fund,555 Capitol Mall ❑OTH ❑PTY ❑scc California Apartment Association Political ❑IND 10/11/2016 Action Committee, ❑coM 250.00 250.00 250.00 �OTH ❑PTY ❑scc SUBTOTAL$ 2000.00 I I Schedule A Summary �Contributor Codes 1. Amount received this period -itemized monetary contributions. iN�-�ndividua� (Include all Schedule A subtotals.).........................................................................................................$ 3750.00 COM—Recipient Committee (other than PTY or SCC) 2. Amount received this period -unitemized monetary contributions of less than $100 ...........................$ 174.00 OTH—Other(e.g., business entity) PTY—Political Party 3. Total monetary contributions received this period. scc-smau contr�butor comm�ttee (Add Lines 1 and 2. Enter here and on the Summa Pa e, Column A, Line 1. TOTAL $ 3924.00 � rY 9 )...................... FPPC Form 460(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fnnc.ca.eov i Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULEA (CONT.) Monetary Contributions Received to whole dol�ars. Statement covers period � _ from g�252016 • ' � • 1 through 10/22/2016 page � of � NAME OF FILER I.D.NUMBER Jerry Liu for City Council 2016 1386578 DATE FULL NAME,STREETADDRESSAND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IFAN INDIVIDUAL,ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IF COMMITTEE.ALSO ENTER I.D.NUMBER) CODE * OCCUPATION AND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (iF sE�F-EMP�oveo,eNreR NnMe pERIOD (JAN.1-DEC.31) (IF REQUIRED) OF BUSINESS) Recology Political Action Committee ❑IND 10/11/2016 �COM 500.00 500.00 500.00 FPPC #921099 ❑OTH ❑PTY ❑scc PG&E ❑IND 10/20/2016 ❑PTY ❑scc John Bartas ��ND Software Engineer 10/13/2016 ❑COM 100.00 100.00 100.00 ❑PTY ❑scc Janey Xu G�IND Director 10/7/2016 ❑COM 100.00 100.00 100.00 ❑pTY Arts ❑scc Qin Pan �IND giostatistician 10/4/2016 ❑coM 100.00 100.00 100.00 ❑PTY ❑scc SUBTOTAL$ 1050.00 '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(1an/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 7/1/2016 • ' � . 1 Jerry Liu for City Counci12016 through 9�24/2016 page� of � NAME OF FILER I.D.NUMBER DATE FULL NAME,STREETADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR IF AN INDIVIDUAL,ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED QF COMMITTEE,ALSO ENTER LD.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) John Howe ❑coM engineer 10/5/2016 ❑PTY ❑scc Minh Le �IND Leadership Development 9/30/2016 ❑PTY TWJI ❑scc Building & Construction Trades Council PAC ��ND 10/10/2016 FPPC#743618 ❑PTY ❑scc ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC SUBTOTAL$ 700.00 `Contributor Codes � IND—I�dividual 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 Amounts may be rounded SCHEDULE B-PART 1 Schedule B — Part 1 to whole dollars. Statement covers period . - , � Loans Received 9/252016 • - • from SEE INSTRUCTIONS ON REVERSE through 10/22/2016 page � of � NAME OF FILER I.D.NUMBER Jerry Liu for City Council 2016 1386578 IFAN INDIVIDUAL,ENTER �a� �b) (�) �d)' �e) �t� �g� FULL NAME,STREETADDRESS AND ZIP CODE OUTSTANDING AMOUNT AMOUNT PAID OUTSTANDING INTEREST ORIGINAL CUMULATIVE OF LENDER OCCUPETFOMA�ND�EMPTOYER gALANCE RECEIVED THIS pR FORGIVEN BALANCE AT pA1D THIS AMOUNT OF CONTRIBUTIONS (IF COMMITTEE,ALSO ENTER I.D.NUMBER) NAME OF BUSINE55) BEGINNING THIS pERIOD THIS PERIOD' CLOSE OF THIS pERIOD LOAN TO DATE PERIOD PERIOD Jerry Liu Research Manager ❑ PAID CALENDARYEAR ❑ FORGIVEN RATE pER ELECTION" � 15000 S 0 s 0 12/31/20 5 6/29/16 S 15000 t� IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED � PA�p CALENDAR YEAR g S % S 3 RATE ❑ FORGIVEN PER ELECTION'* S S g S S t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED ❑ PAID CALENDAR YEAR S S % S S RATE ❑ FORGIVEN PER ELECTION�' S S $ S � t❑ IND ❑ COM ❑ OTH ❑ PTY ❑ SCC DATE DUE DATE INCURRED SUBTOTALS $ 0 $ 0 $ 15000 $ (Enter(e)on Schedule B Summary ScheduleE,Line3) 1. Loans received this period....................................................................................................................$ � (Total Column (b) plus unitemized loans of less than $100.) tContributor Codes 2. Loans paid or forgiven this period........ . � � IND—Individual . ............................................................................................... COM—Recipient Committee (Total Column (c) plus loans under$100 paid or forgiven.) (otherthan PTYorSCC) (Include loans paid by a third party that are also itemized on Schedule A.) OTH—Other(e.g.,business entity) PTY—Political Party 3. Net chan e this eriod. Subtract Line 2 from Line 1. NET $ n SCC—Small Contributor Committee 9 p � ) .............................................................. Enter the net here and on the Summary Page, Column A� LII�E 2. (Maybeanegativenumber) Amounts forgiven or paid by another party also must be reported on Schedule A. FPPC Form 460(Jan/2016) "'If required. , FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov i Schedule E Amounts may be rounded SCHEDULE E Statement covers period � _ • , to whole dollars. I Payments Made 9/252016 • ' from SEE INSTRUCTIONS ON REVERSE through 10/22/2016 page � of � NAME OF FILER I.D.NUMBER Jerry Liu for City Council 2016 1386578 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) NAMEANDADDRESS OF PAYEE (IF COMMITTEE,ALSO ENTER I.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID Pacific Printing USPS Cupertino, CA 95014 POS 940.00 *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. 9752.68 p Y P � )............................................................................................................. $ 2. Unitemized payments made this period of under$100..................................................................... 85.00 ..................................................................... $ 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).)............................................................................. $ 0.00 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 $ 9837.68 p Y p � rY 9 )........................... FPPC Form 460(1an/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov