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801 Payment to Agency Report (Alan Enterprise) 11-14-24Payment to Agency Ri 1. Agency Name City of Cupertino Division, Department, or Reg City Manager's Office Street Address 10300 Torre Avenue Area Code/Phone Number 408-777-3200 Agency Contact (name and title) Kirsten Squarcia, City Clerk rt (if applicable) A Public Docu kirstens@cupertino.gov 2. Donor Name and Address ❑ Individual Last Name First Name San Francisco Address Citv [E0WI Date Stamp Nov 1 4 ,924 ERTINO CITY CLERK TO AGENCY REPORT Official Use Only ❑ Amendment (explain in comment section) Date of Original Filing: (month, day, year) © Other Alan Enterprise, LLC Name CA 94108 State Zip Code general contracting agency providing building/construction and design services 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: $ 100.00 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 3.1 (b) Payments) not related to travel: 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. provided to City a floral arrangement in appreciation for the work of the City. 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 autho0z,e t accept-f the rip ed pay TI NrA ment(s) as in compliance with FPPC regulations. Do�PPamela Wu City Manager 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