410 Statement of Organization Recipient Committee – Amendment 7-2-18Statement of Organization
Recipient Committee
Statement Type ❑ Initial ❑ Amendment
0 Not yet qualified
or
0 Date quailfted as committee
Date qualified as committee
ID
Date Stamp
JUL 2 - 2018
❑ Termination — See Pd. rt 5
Date of termination
CUP, RTINO CITY CLERK
1. Committee Information I.D. Number 2. Treasurer and Other Principal Officers
(if applicable) 1299673
NAME OF COMMITTEE
CUPERTINO CHAMBER OF COMMERCE PAC
STREET ADDRESS (NO P.O. BOX(
CITY STATE TIP CODE AREA CODE/PHONE
MAILING ADDRESS (IF DIFFERENT)
E-MAIL ADDRESS (REQUIRED) / FAX (OPTIONAL)
COUNTY OF DOMICILE]URISDiCTiON WHERE COMMITTEE 15 ACTIVE
SANTA CLARA CITY OF CUPERTINO
ANDREW WALTERS
STREET ADDRESS (NO P.O. BOX)
For Official Use Only
CITY
STATE
Zip CODE
AREACODE/PHONE
NAM E OF ASSISTANT TREASU RER, IF ANY
SAMUEL HARVEY
STREET ADDRESS NO P.O. BOX)
CYTY
STATE
ZIP CODE
AREA CODE/PHONE
NAME OF PRINCIPAL OFFICEMSI
RICHARD ABIDALAH
STREET ADDRESS (NO P.O. BOX)
CITY STATE ZIPCODE ARFACODVPHONE
Attach additional information on appropriately labeled continuation sheets.
3. Verification
1 have used all reasonable diligence in preparing this statement and to the best of my knowledge the information contained herein is true and complete. I certify under
penalty of perjury Vider the laws of the State of California that
Executed an I By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
Executed on By
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, ORSTATE MEASUREPRO PONENT
Executed on
DATE
By
SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT
FPPC Form 410 (February/207.$)
FPPC Advice: advice@fppC-ca.gaV (866/275-3772)
www.fppc.ca.gov
Statement of OrganizationCALIFORNIA
Recipient Committee FORM
INSTRUCTIONS ON REVERSE
Paget Page 2 0f 3
COMMITTEE NAME I.D. NUM6ER
CUP13RTINO CHAMBER OF COMMERCE PAC 1299673
• All committees must list the financial institution where the campaign bank account is located.
NAME OF FINANCIAL IN5TITUTXN AREACODE/PHONE aANKACCOUNTNUMBER
BANK OF THE WEST (
ADDRESS CITY STATE ZIP CODE
4. Type of Committee Complete the applicable sections.
• List the name of each controlling officeholder, candidate, or state measure proponent.. If candidate or officeholder controlled, also list the elective office sought or held, and
district number, if any, and the year of the election.
• List the political party with which each officeholder or candidate is affiliated or check "nonpartisan." Stating "No party preference" is acceptable.
• If this committee acts jointly with another controlled committee, list the name and identification number of the other controlled committee.
ELECTfVEOFFICE SOUGHT ORHELD YEAR OF PARTY
NAME OF CAN DIDATE/OFFI CEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IF APPLICABLE) ELECTION CHECK ONE
Primarily formed to support or oppose specific candidates or measures in a single election. List below:
CAN DIDATE(S) NAME OR MEASURE(S) FULL TITLE (INCLUDE BALLOT N0. 0R LETTER)
IFARECALL,STATE -RECALL IN FRO NT OF THE 0FF[CEHOLDER'SNAM E_
CANDIDATF(S) 0FACESOUGHT OR HELD OR MEASURE(S) JURISWCTION
(INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE)
CHECK ONE
T OPPOSE
OPPOSE
FPPC Form 410 (February/2018)
FP PC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppc.ca.gov
Statement of Organization
Recipient Committee
INSTRUCTIONS ON REVERSE
Page 3 page 3 of 3
COMM
CUPERTINO CHAMBER OF COMMERCE PAC 1299673
4. Type of Committee (Continued)
Not formed to support or oppose specific candidates or measures in a single election. Check only one box:
0 CITY Committee ❑ COUNTY Committee ❑ STATE Committee ❑ Political Party/Central Committee
PROVIDE BRIEF DESCRIPTION OF ACTIVITY
TO SUPPORT LOCAL AND STATEWIDE CANDIDATES AND BALLOT MEASURES
List additional sponsors on an attachment.
NAME OF SPONSOR JINDUSTRY GROUP OR AFFILIATION OF SPONSOR
CUPERTINO CriAMBER OF COMMERCE
STREET ADDRESS NO. AND STREET
Date qualified
CITY STATE ZIP CODE AREA
S. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, ofilceholder, or proponontoertify that all of the follmOngoonditions have been met:
• This committee has ceased to receive contributions and make expenditures;
• This committee does not anticipate receiving contributions or making expenditures in the future;
• This committee has eliminated or has no intention or ability to discharge all debts, loans received, and other obligations;
• This committee has no surplus funds; and
• This committee has filed all campaign statements required by the Political Reform Act disclosing a[[ reportable transactions.
— There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Referto Government
Code Section 89519.
-- Leftover funds of ballot measure committees maybe used for political, legislative or governmental purposes under Government Code Sections 89511 - 89518, and are
subject to Elections Code Section 1.8580 and FPPC Regulation 18521..5.
FPPC Form 410 (February/2018)
FPPC Advice: advice@fppc.ca.gov (866/275-3772)
www.fppr-ca.gov