801 Payment to Agency Report (Earth Day & Live Well Age Well Health Expo)Payment to Agency Report A Public Document
1. Agency Name
City of Cupertino
Division, Department, or Region (if applicable)
City Manager
Street Address
10300 Torre Ave., Cupertino CA 95014
krea Code/Phone Number Email
408-777-3225 kirstens@cupertino.gov
Agency Uontact (name and title)
Kirsten Squarcia, City Clerk
2. Donor Name and Address
❑ Individual
Last Name
First Name
City
RdWED
JUL 10 2025
%RTINO CITY CI
PAYMENT TO AGENCY REPORT
For Official Use Only
❑ Amendment (explain in comment section)
Date of Original Filing:
(month, day, year)
Various Vendors
• Other
Solar Stage for event and monetary donations.
If "Other" is marked, describe the entity's business activity (if business) or its nature and interests.
State
ame
If applicable, identify the name of each source and the amount(s) received by the donor for this payment:
(See attached itemized list) $ $
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.
Solar Stage for event and monetary donations for Parks and Recreation 2025 Earth & Arbor Day
Festival and the 2025 Live Well Age Well Health Expo.
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
4. Verification
First Name
Positionrfltle
Department/Division
I authorize a tance of -the reported payment(s) as in compliance with FPPC regulations. _ ._
Tina Kapoor Interim City Manager �/� v/
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
Form 801- 2025 Parks & Recreation Itemized List (Earth & Arbor Day & Live Well Age Well Health
Expo)
Donated By
Item
Estimated
Value
Star One Credit Union
Monetary Donation
$450
1306 Bordeaux Ave, Sunnyvale,
CA 94089
Grace Thompson
(408) 543-5292
an Jose Water
Monetary Donation
$450
110 W. Taylor Street, San Jose,
CA 95110
Liann Walborsky
(408) 918-7247
Let Nature Sing
Monetary Donation
$450
6244 Gunter Way, San Jose, CA
95123
Eun Mi Shin
(408) 396-2114
Bye Bye Mattress
Monetary Donation
$450
580 N. Fourth Street, Ste. 230,
Columbus, OH 43215
lexa Acosta
(773) 318-6657
ecology Cupertino
Monetary Donation
$450
1675 Rogers Avenue, San Jose,
CA 95112
Marcus Mirt
(415) 725-0227
Silicon Valley Clean Energy
Solar Stage for Earth Day Event
$3000
333 W El Camino Real #330,
Sunnyvale, CA 94087
Juliette Pascual
(661) 348-3813
Form 801- 2025 Parks & Recreation Itemized List (Earth & Arbor Day & Live Well Age Well Health
Expo)
Bay Area Air Quality
Monetary Donation
$450
Management District
375 Beale Street, Ste 600, San
Francisco, CA 94105
Matthias Shiber
(415) 749-5000
eafFilter Gutter Protection
Monetary Donation
$450
1595 Georgetown Rd, Hudson,
OH 44236
ustin Lowry
(800) 726-7703
Star One Credit Union
Monetary Donation
$750
1306 Bordeaux Ave, Sunnyvale,
CA 94089
Grace Thompson
(408) 543-5292
ClearCaptions
Monetary Donation
$500
3001 Lava Ridge Court #100,
oseville, CA 95661
lli Tehrani
(408) 510-1941
Los Gatos Audiology
Monetary Donation
$750
15899 Los Gatos Almaden Rd
Ste 8, Los Gatos, CA 95032
Shawn Brady
(408) 354-1312
Saratoga Retirement Company
Monetary Donation
$750
14500 Fruitvale Ave, Saratoga,
CA 95070
azmina Lopez
(408) 550-5201
Form 801- 2025 Parks & Recreation Itemized List (Earth & Arbor Day & Live Well Age Well Health
Expo)
Geriatric Care Solution
Monetary Donation
$500
(925) 209-0901
1630 Contra Costa Blvd Unit
#216, Pleasant Hill, CA 94523
Griswold Home Care for
Monetary Donation
$750
Cupertino
1061 Monroe St, Santa Clara,
CA 95050
Wilfred Mabanta
(408) 869-0022