801 Payment to Agency Report (Wafu School of Ikebana) 03-11-24Payment to Agency Report A Public Docu
1. Agency Name
City of Cupertino
Division, Department, or Region (if applicable)
City Manager
Street Address
10300 Torre Ave., Cupertino CA 95014
Area Code/Phone Number Email
408-777-3225 1 kirstens@cupertino.org
Agency k;ontact (name and title)
Kirsten Squarcia, City Clerk
2. Donor Name and Address
❑ Individual
Last Name
Address
School for Japanese art of floral arranging
First Name
Cupertino
city
AGENCY REPORT
MAR 11 20241 I I UJIfficial Use Only
0I1IPERTINO CITY CLERK
❑ Amendment (explain in comment section)
Date of Original Filing:
(month, day, year)
® Other
Wafu School of Ikebana, California Chapter
Name
CA 95014
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:
Fusako Hoyrup $ 200.00 $
Name Amount Name Amount
3. Payment Information (Complete Sections 3.1 (a or b), 3.2, 3.3)
3.1 (a) Travel Payment
Location of Travel Dates (month, day, year)
❑ Rail ❑ Air ❑ Bus ❑ Auto ❑ Other
Transportation Provider Check Applicable Boxes Name of Lodging Facility
$ Lodging Expenses $ Meal Expenses Transportation Expenses $ Other Expenses $ Total Expenses
3.1 (b) Payment(s) not related to travel: $
Dates (month, day, year) Total Expenses
3.2. Payment Description. Provide a specific description of the payment and its agency purpose and use.
Flower arrangement donation for display at City of Cupertino State of the City event on 2/15/24
3.3. Identify the officials who used the payment in Section 3.1 (See instructions)
Last Name First Name Position/Title Department/Division
Last Name First Name Position/Title Department/Division
4. Verification
I auth ized the acceptance of the reported payment(s) as in compliance with FPPC regulations.
Pamela Wu City Manager 03/11/24
Signature Print Name Title (month, day, year)
Comment:
(Use this space or an attachment for any additional information)
FPPC Form 801 (Jan/18)
advice@fppc.ca.gov