803 Behested Payment Report (Orrin Mahoney) 01-21-14 Behested Payment Report A Public Document Behested Payment Report
1. Elected Officer or CPUC Member(Last name,First name) (, tri - •
Orrin Mahoney •
Agency Name fficial Use Only
City of Cupertino
JAN 2 2014
Agency Street Address
10300 Torre Ave. Cupertino, CA 95014 C PERTIN
Designated Contact Person(Name and title,if different)
❑ Amendment(See Part 5)
Area Code/Phone Number E-mail (Optional) Date of Original Filing:
(month,day,year)
408-725-1767 omahoney @cupertino.org
2. Payor Information (For additional payors,include an attachment with the names and addresses.)
Pacific Gas and Electric
Name
Address City State Zip Code
3. Payee Information (For additional payees,include an attachment with the names and addresses.)
Cupertino Rotary Endowmwnt Foundation
Name
Address City State Zip Code
4. Payment Information (Complete all information.)
Date of Payment: Dec 19, 2013 Amount of Payment: (In-KindFMV) $ 10,000
(month,day,year) (Round to whole dollars.)
Payment Type: ® Monetary Donation or ❑ In-Kind Goods or Services(Provide description below.)
Brief Description of In-Kind Payment:
Purpose:(Check one and provide description below.) ❑Legislative ❑Governmental 0 Charitable
Describe the legislative, governmental, charitable purpose, or event, This donation was a sponsorship for the
Rotary Club of Cupertino Fall Festival, a community wide event highlighting environmental, health, and safety issues.
S. Amendment Description or Comments
6. Verification
I certify, under penalty of perjury under the laws of the State of California,that to the best of my knowledge,the information contained
herein is true and complete.
l 2-0
Executed on By
DATE SIGNATURE OF ELECTED FICER OR CPUC MEMBER
FPPC Form 803(December/09)
FPPC Toll-Free Helpline: 866/ASK-FPPC(866/275-3772)