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460 Recipient Committee Campaign Statement – Preelection Statement – 09-22-16 – 10-22-16 Recipient Committee �p�t�p� � � �- � GOVER PAGE Campaign Statement D ' � ' � ' � • 1 Cover Page � Statement covers period Date of election if applic e. O CT 2 � 2O�U tg � of 7 09/25/2016 (Month, Day,Year) For Official Use Only from -- 10/22/2016 11/08/2�16 ��RT(NO CITY CLE 3i� SEE WSTRUCTIONS ON REVERSE through � 1. Type Of ReClp1811t COIflCYiItteB: All committees—Complete Parts 1,s,s,and 4. 2. Type of Statement: [� Officeholder, Candidate Controlled Committee ❑ Primarily Formed Ballot Measure � Preelection Statement ❑ Quarteriy Statement 0 State Candidate Election Committee Committee ❑ Semi-annual Statement ❑ Special Odd-Year Report � Recall 0 Controlled ❑ Termination Statement (AlsoCompt�tePeR5) � Sponsored (Also file a Form 410 Termination) (Nso Ccmpkte Part 6) ❑ General Purpose Committee ❑ Amendment(Explain below) � Sponsored ❑ Primarily Formed Candidate/ � Small Contributor Committee Officeholder Committee � Political Party/Central Committee (/usoCompletePert7J 3. Committee Information I i.o."'u"'BER Treasurer(s) 1383579 COMMITTEE NAME(OR CANDIDATE'S NAME IF NO COMMITTEE) NAME OFTREASURER David Fung for City Council 2016 Kathy Jacques MAILING ADDRESS STREETADDRESS(NO P.O.BOX) CITY STATE ZIP CODE AREA CODE/PHONE CITY STATE 7JPCODE AREACODE/PHONE NAMEOFASSISTANTTREASURER,IFANY Cupertino CA 95014 ( MAILING ADDRESS(IF DIFFEREN�NO.AND STREET OR P.O.BOX MAILING ADDRESS CITY STATE ZIPCODE AREACODE/PHONE CITY STATE ZIPCODE AREACODE/PHONE Cupertino CA 95015 ( OPTIONAL FAX/E-MAILADDRESS OPTIONAL: FAX/E-MAILADDRESS David@Fung4Cupertino.com treasurer4fungcampaign@gmail.com 4. Verification � I have used all reasonable diligence in preparing and reviewing this statement and to the best of my knowledge the information contained herein and in the attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and corr Executed on 10l27/2016 8y �/ Date ' � / � Officer oi Sponsor Executed on B Date ' Y Signature of Confrolling Officeholder,Candidate,State Measure Proponent Executed on g Date � Y Signature of Controlling Officeholder,Candidate.State Measure Proponent FPPC Form 460(1an/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov COVER PAGE-PART 2 Recipient Committee , � . , Campaign Statement � . � • � Cover Page — Part 2 Page 2 of � 5. Officeholder or Candidate Controlled Committee 6. Primarily Formed Ballot Measure Committee NAME OF OFFICEHOLDER OR CANDIDATE NAME OF BALL�T MEASURE David Fung OFFICE SOUGHT OR HELD(INCLUDE LOCATION AND DISTRICT NUMBER IF APPLICABLE) BALLOT N0.OR LETTER JURISDICTION � SUPPORT Member, Cupertino City Council I I❑ oPPosE RESIDENTIAUBUSINESS ADDRESS (NO.AND STREET) CITY STATE ZIP Identify the controlling officeholder,candidate,or state measure proponent,if any. Cupertino, CA 95014 NAME OF OFFICEHOLDER,CANDIDATE,OR PROPONENT Related Committees Not Included in this Statement: �isranycomminees not included in this statement that are controiled by you or are primarily formed to receive OFFICE SOUGHT OR HELD I DISTRICT NO.IF ANY contri6utions or make expenditures on behalf of your candidacy. COMMITTEE NAME I.D.NUMBER NAME OF TREASURER CONTROLLED COMMITTEE? 7• Primarily Formed Candidate/Officeholder Committee List names of officeholder(s)or candidate(s)for which this committee is primarily formed. ❑ YES ❑ NO COMMITTEEADDRESS STREETADDRESS (NO P,O.BOk) NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE CITY STATE ZIP CODE AREA CODE/PHONE NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE COMMITTEE NAME I.D.NUMBER NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ SUPPORT ❑ OPPOSE NAME OF TREASURER CONTROLLED COMMITTEE? NAME OF OFFICEHOLDER OR CANDIDATE OFFICE SOUGHT OR HELD ❑ YES ❑ NO ❑ SUPPORT ❑ OPPOSE COMMITTEEADDRESS STREETADDRESS (NO P.O.BOX) CITY STATE ZIP CODE AREA CODEIPHONE Attach continuation sheets if necessary FPPC Form 460(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov Campaign Disclosure Statement Amounts may be rounded SUMMARY PAGE Summary Page to whole dollars. Statement covers period � . , from 09/25/2016 , • - / • � SEE INSTRUCTIONS ON REVERSE through 10/22/2016 page 3 of � NAME OF FILER I.D.NUMBER David Fung for City Council 2016 1383579 Column A Column B Galendar Year Summary for Candidates Contribu�ions Received TOTALTHISPERIOD CALENDARYEAR (FROMATTACHEDSCHEDULES) TOTALTODATE Running in Both the State Primary and 2,500.00 14,647.00 �eneral Elections 1. Monetary Contributions................................................... sohedu�ea,Line 3 $ $ 1J1 through 6l30 �i� co Date 2. Loans Received................................................................ s�ned�ie e,�ine s 0 5,0OO.OQ 2,500.00 19,647.00 20. Contributions 3. SUBTOTAL CASH CONTRIBUTIONS.............................. Add�ines 1+2 $ $ Received $ $ 4. Nonmonetary Contributions............................................ s�nedu�e c,�rne s � � 21. Expenditures 5. TOTALGONTRIBUTIONS RECEIVED....................................AddLines3+4 $ 2,500.00 $ 19,647.00 Made $ $ Expenditures Made 7 9 Expenditure Limit Summary for State 6. Payments Made................................................................ soneauie E,une a $ Q5.90 $ 12;03020 Candidates 7. Loans Made....................................................................... s�ned��e H,Line 3 0 0 7,905.90 12.030.20 22• Cumulative Expenditures Made• 8. SUBTOTAL CASH PAYMENTS.......................................... Add Lines 6+7 $ $ (If Subject to Voluntary Expenditure Limit) 9. Accrued Ex enses Un aid Bilis Schedule F,Line 3 � � Date of Election Total to Date P � P ).......................................... 10. Nonmonetary Adjustment.........................................................s�hedu�e c,Line 3 0 0 (mmldd/yy) 11. TOTAL EXPENDITURES MADE........................................Add�ines8+g+io $ 7.9Q5.90 $ 12,030.20 _�_J $ Current Cash Statement �_� � 12. Beginning Cash Balance............................ Pre,�o��s�mmaryPaye,Line 16 $ 13,322.70 To calculate Column B, 13. CBSh ReCelPts........................................................... Column A,Line 3 above 2,500.00 add amounts in Column � A to the corresponding *Amounts in this section may be different from amounts 14. Miscellaneous Increases to Cash.................................. sonedUie i,Line 4 amounts from Column B reported in Column B. 15. CBsh Payme�ts......................................................... Column A,Line 8 above 7905.90 of your last report. Some amounts in Column A may 16.ENDING CASH BALANCE ..................Add�ines i2+13+�4,then subtract(.ine 15 $ 7,916.80 be negative figures that should be subtracted from If fhis is a termrnation statement, Line ?6 must be zero. previous period amounts. If this is the first report being 17. LOAN GUARANTEES RECEIVED................................ schedule B,Pan z $ 0 filed for this calendar year, only carry over the amounts Cash Equivalents and Outstanding Debts from��neS 2, 7,and 9(if 18. Cash EqUlV8leflt5................................................ See inshuctions on reverse $ O any). 19. OulSt811d1t1g DEb1S.............................. Add Line 2+Line 9 in Column B above $ � FPPC Form 460(1an/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov Schedule A Amounts may be rounded SCHEDULE A to whole dollars. Statement covers eriod Monetary Contributions Received P . . - , � � 09/25/2016 � from • � SEE INSTRUCTIONS ON REVERSE through �0/22/2016 page 4 of 7 NAME OF FILER I.D.NUMBER Davici Fung for City Co,uncil 2016 1383579 FULL NAME,STREETADDRESS AND ZIP CODE OF CONTRIBUTOR IFAN INDIVIDUAL,ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION DATE CONTRIBUTOR (IFCOMMITTEE,ALSOENTERI.D.NUMBER) OCCUPATIONANDEMPLOYER RECEIVEDTHIS CALENDARYEAR TODATE RECEIVED CODE * (IFSELF-EMPLOYED,ENTERNAME PERIOD oFBuslNEss) (JAN.1-DEC.31) (IF REQUIRED) Claire Amspacher ��N� 9/27/2016 ❑PTY ❑scc California League of Conservation Voters ❑�coM 9/27/2016 Santa Clara County Chapter �orH 250 250 ❑PTY ❑scc ❑IND PG&E ❑coM 250 250 10/10/2016 ❑PTY ❑scc Frank S. Geefay �iNo 10/9/2p16 ❑PTY ❑scc Recology Inc. - Political Action Comm#921099 ❑IND 10/11/2016 ❑PTY ❑scc SIJBTOTAL$ 2,100 I Schedule A Summary ' �Contributor Codes � 1. Amount received this period-itemized monetary contributions. iN�-individuai (Include ail Schedule A subtotals.) � 2,500 COPJI—Recipient Committee ................................................................................................. (other than PTY or SCC) 2. Amount received this period-unitemized monetary contributions of less than $100...........................$ O OTH—Other(e.g., business entity) PTY—Political Party 3. Total monetary contributions received this period. scc-sma��contributor committee Add Lines 1 and 2. Enter here and on the Summa Pa e, Column A, Line 1. 2,500 - � rY 5 )......................TOTAL $ FPPC Form 46Q(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov Schedule A (Continuation Sheet) Amounts may be rounded SCHEDULkA (CONT.) Monetary Contributions Receiv�d towholedollars. statementcovers period � . . . , • 1 from 09/25/2016 • ' through 10/22/2016 page 5 of 7 NAME OF FILER I.D.NUMBER David Fung for City Council 2016 1383579 DATE FULL NAME,STREETADDRESS AND ZIP CODE OF CONTRIBUTOR CONTRIBUTOR �FAN INDIVIDUAL,ENTER AMOUNT CUMULATIVE TO DATE PER ELECTION RECEIVED (IFGOMMITTEE,ALSOENTER I.D.NUMBER) CODE * OCCUPATIONAND EMPLOYER RECEIVED THIS CALENDAR YEAR TO DATE (IFSELF-EMPLGYED,ENTERNAME p�RIOD (JAN.1-DEC.31) (IFREQUIRED) OF HUSINESS) Gale Edward Bloom ��oM President, People 10/12/2016 ❑Pn ❑scc Minh Le �IND president, The Wilfred 10/14/2016 p P-� ❑scc Joe Simitian �IND County Supervisor, 1Q/16/2016 ❑P-� Santa Clara ❑scc ❑IND ❑COM ❑OTH ❑PTY ❑SCC ❑IND ❑COM ❑OTH ❑PTY ❑SCC 5UBTOTAL$ 400 l "Contributor Codes IND—Individual COM—Recipient Committee (other than PTY or SCC) OTH—Other(e.g., business e�tity) PTY—Political Party FPPC Form 460 1an 2016 SCC—Small Contributor Committee � � � . FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.tppc.ca.gov Amounts may be rounded SCHEDULE E Schedule E Statementcovers period , � to whole dollars. • � � � , Payments Made 09/25/2016 • � from SEE INSTRUCTIONS ON REVERSE through 10/22/2016 page 6 of � NAME OF FILER I.D.NUMBER David Fun,g for City Council 2016 1383579 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, describe the payment. CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution(explain nonmonetary)'' OFC office expenses SAL campaign workers'salaries CVC civic donations PET petition circulating TEL t.v.or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging,and meals FND fundraising events POL polling and survey research TRS staff/spouse travel,lodging, and meals IND independent expenditure supporting/opposing others(explain)* POS postage,delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services(legal,accounting) VOT voter registration LIT campaign literature and mailings PRT print ads WEB information technology costs(internet, e-maii) NAME AND ADDRESS OF PAYEE f.IFCOMIAITTEE,ALSO ENTER I.D.NUMBER) CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID All Things Pr�nted Mailer Printing All Things Printed Mailer Printing USPS Mailer postage " Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 5,958.29 Schedule E Summary 1. itemized p.ayments made this period. (Inciude all Schedule E subtotals.)............................................................................................................. $ 7;673.29 2. Unitemized payments made this period of under$100.......................................................................................................................................... $ 232.61 3. Total interest paid this period on loans. (Enter amount from Schedule B, Part 1, Column (e).)............................................................................. $ � 4. Total a ments made this eriod. Add Lines 1, 2, and 3. Enter here and on the Summar Pa e, Column A Line 6.) TOTAL $ 7,905.90 P Y p ( Y 9 � ........................... FPPC Form 460(Jan/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fippc.ca.gov Schedule E Amounts may be rounded SCHEDULE E(CONT.) (Continuation Sheet) towholedollars. Statementcovers period , � . � / ' Payments Made from 09/25/2016 • - ' throu h 10/22/2016 SEE INSTRUCTIONS ON REVERSE g Page 7 of 7 NAME OF FILER , ____.-______-- I.D.NUMBER David Fung for City Council 2016 1383579 CODES: If one of the following codes accurately describes the payment, you may enter the code. Otherwise, desc�ibe the payment. CMP campaign paraphernalia/misc. MBR member communications RAD radio airtime and production costs CNS campaign consultants MTG meetings and appearances RFD returned contributions CTB contribution(explain nonmonetary)' OFC office expenses SAL campaign workers'salaries CVC civic donations PET petition circulating TEL t.v.or cable airtime and production costs FIL candidate filing/ballot fees PHO phone banks TRC candidate travel, lodging,and meals FND fundraising events POL polling and survey research TRS staff/spouse travel, lodging, and meals IND independent expenditure supporting/opposing others(explain)* POS postage,delivery and messenger services TSF transfer between committees of the same candidate/sponsor LEG legal defense PRO professional services(legal, accounting) VOT voter registration LIT campaign literature and mailinc�s PRT print ads WEB information technology costs(internet,e-mail) NAMEANDADDRESS OF PAYEE CODE OR DESCRIPTION OF PAYMENT AMOUNT PAID (IF COMMITTEE,ALSO ENTER I.D.NUMBERJ USPS Annual Fee All Things Printed Mailer printing *Payments that are contributions or independent expenditures must also be summarized on Schedule D. SUBTOTAL$ 1,715.00 . FPPC Form 460(1an/2016) FPPC Advice:advice@fppc.ca.gov(866/275-3772) www.fppc.ca.gov