801 Payment to Agency Report (Mayor Chai and Chat (April-June)Payment to Agency Report A Public Document PAYMENT TO AGENCY REPORT
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 kirstens@cupertino.gov
Agency Contact (name and title)
Kirsten Squarcia, City Clerk
2. Donor Name and Address
❑ Individual
Last Name
First Name
1.J
JUL 10 2025 For Official Use Only
'ERTINO CITY CLER
❑ Amendment (explain in comment section)
Date of Original Filing:
(month, day, year)
Various Restaurants
M Other
Name
Address City State Zip Code
Restaurant businesses that prepare and serve food and drinks onsite and takeout.
If "Other" is marked, describe the entity's business activity (if business) or its nature and interests.
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.
Food donation for all attendees at the 2025 Chai and Chat With the Mayor (April -June).
3.3. Identify the officials who used the payment in Section 3.1 (See instructions)
Last Name
Last Name
First Name
First Name
Position/Title
Position/Title
Department/Division
Department/Division
4. Verification
I authoriz a eptance of the reported payment(s) as in compliance with FPPC regulations.
Tina Kapoor Interim City Manager 7//u
ignature 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 Mayor Chai Chats Itemized List
Donated By
Item
Estimated
Value
Kishore Muvva
Chai Tea and snacks
$125
vachi Biryani House
ddress: 10251 S De Anza Blvd,
Cupertino, CA 95014
Phone: (408) 982-5220
Lee's Sandwiches
Chai Tea and snacks
$300
20363 Stevens Creek Blvd,
Cupertino, CA 95014
08-446-5030
ade Tea Garden
Chai Tea and snacks
$175
10911 N Wolfe Rd
Cupertino, CA 95014
da Tai
669-888-1188
hai Bangkok
Chai Tea and snacks
$178.74
21670 Stevens Creek Blvd,
Cupertino, CA 95014
669-342-7300