803 Behested Payment Report (Orrin Mahoney) 08-22-14 Behe$ted Payment Report A Public Docum aymentReport
1. Elected Officer or CPUC Member(Last name, First name) u a to Orrin Mahoney Agency Name City of Cupertino A�� fr)Agency Street Address
10300 Torre Ave Cupertino, CA 95014 CUPERTINO CITY CLE!17
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 lomahoney@cupertino.org
2. Payor Information (Foradditional 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: 7/24/14 Amount of Payment: (in-KindFnnv) $ 5000
(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 ®Charitable
Describe the legislative,governmental, charitable purpose, or event: This donation was a sponsorship for the
Rotary Club of Cupertino Fall Festival, a community event highlighting environmental, health, and safety issues.
5. Amendment Description or Comments
6. Verification
I certify, under penalty of perjury under the laws of the State of Californiazo/that to the best of my knowledge,the information contained
herein is true and complete.
Executed on By
DATE SIGNATURE OF ELE ED OFFICER OR CPUC MEMBER
FPPC Form 803(December/09)
FPPC Tall-Free Helpline: 866/ASK-FPPC(866/275-3772)