801 Payment to Agency Report (Angela Chen) 11-21-17Payment to Agency Report A Public Docu
1. Agency Name D
City of Cupertino
Division, Department, or Region (if applicable)
Street Address
10300 Torre Ave Cu
Area Code/Phone Number Email
408-777-3200 manager@cupertino.org
Agency Contact (name and title)
David Brandt, City Manager
2. Donor Name and Address
TO AGENCY REPORT
Official Use Only
NOV 2 1 ''17
RTINO CITY CLARK
❑ Amendment (explain in comment section)
Date of Original Filing:
(month, day, year)
❑ Individual I ❑✓ Other City of Tongxiang, China
Last Name First Name Name
China
Address City State Zip Code
Municipal Government
If "Other" is marked, describe the entity's business activity (if business) or its nature and interests
0 If applicable, identify the name of each source and the amount(s) received by the donor for this payment:
Name Amount Name Amount
3. Payment Information (Complete Sections 3.1 (a or b), 3.2, 3.3)
3.1 (a) Travel Payment Tongxiang, China September 22-25, 2017
Location of Travel Dates (month day year)
United Airlines
Transportation Provider
❑ Rail
$ 453.00 $ 151.00
Lodging Expenses Meal Expenses
3.1 (b) Payment(s) not related to travel:
r❑ Air ❑ Bus ❑ Auto ❑ Other Inspirock Hotel
Check Applicable Boxes Name of Lodging Facility
$ 5,972.00 $ $ 6,576.00
Transportation Expenses Other Expenses Total Expenses
$
Dates (month, day, year)
Total Expenses
3.2. Payment Description. Provide a specific description of the payment and its agency purpose and use.
Travel expenses associated with signing of Friendship City agreement with City of Cupertino and
speech at unveiling of memorial sculpture at Phoenix Lake Park commemorating Friendship City
agreement.
3.3. Identify the officials who used the payment in Section 3.1 (See instructions)
Chen Angela Commissioner Sustainability
Last Name
Last Name
4. Verification
First Name
First Name
Position/Title
Position/Title
Department/Division
Department/Division
I at thaized the acceptance of the reported p ment(�) as in com DJance with FPPC regulations.
..v �! 6� r� /� J l l m _0
/
Signature Print Name Title (month, day, ye
Comment:
(Use this space or an attachment for any additional information) FPPC Form 801 (Jan/14)
advice@fppc.ca.gov