801 Payment to Agency Report (Women's Networking Luncheon)Payment to Agency Report A Public Document
1. Agency Name
City of Cupertino
Division, Department, or Region (if applicable)
City Manager
Street Address cut
10300 Torre Avenue 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 R Other
Last Name First Name
PAYMENT TO AGENCY REPORT
REC!WTh
For Official Use Only
UL 10 2025
CITY CLERK
❑ Amendment (explain in comment section)
Date of Original Filing:
(month, day, year)
Various Restaurants
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 Women's Networking Luncheon held on 6/26/25.
3.3. Identify the officials who used the payment in Section 3.1 (See instructions)
Last Name First Name
Last Name
First Name
Position/Title
Position/Title
Department/Division
Department/Division
4. Verification
I authorize cce nce of the reported payment(s) as in compliance with FPPC regulations.
Kapoor Interim City Manager 7 11012 ---
Tina �
gneture 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 Women's Networking Luncheon 6-26-2025: Itemized List
Donated By
Item
Estimated
Value
KeyPoint Credit Union
1 Solopreneur Membership to the Cupertino
$180.00
10815 N. Wolfe Rd., Suite 100
Chamber of Commerce
Cupertino, CA 95014
Stephanie Smith
1-888-255-3637
KeyPoint Credit Union
4 Amazon Gift Cards
$100.00
10815 N. Wolfe Rd., Suite 100
$25.00 each
Cupertino, CA 95014
Stephanie Smith
1-888-255-3637
Cupertino Chamber of
1 bottle of Vidovich Wine
$95.00
Commerce
20455 Silverado Ave,
Cupertino, CA 95014
Deborah L. Feng
08-252-7054
KeyPoint Credit Union
Whole Foods
139.55
10815 N. Wolfe Rd., Suite 100
Cupertino, CA 95014
Stephanie Smith / Doron
1-888-255-3637
KeyPoint Credit Union
Pineapple Thai
958.02
10815 N. Wolfe Rd., Suite 100
Cupertino, CA 95014
Stephanie Smith
1-888-255-3637