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410 Statement of Organization Recipient Committee – Amendment Stamped by SOSStatement of Organization Recipient Committee Statement Type ❑ initialx❑ Amendment O Not yet qualified Or Q Date qualified as committee / Date qualified as committee 1. Committee Information I.D. Number (if applicable) 2299673 NAME OF COMMITTEE CUPERTINO CHAMBER OF COMMERCE PAC EN -FED IFIL in the office of the Secretary of Siate ❑ Termination —See Part b Qi -the St* Of ^valifi mie JUL02 Date of termination STREET ADDRESS (NO P.O. BOX) CITY STATE ZIP CODE AREA CODE/PHONE MAILING ADDRESS (IF DIFFERENT) E-MAILADDRE55 (REQUIRED)/ FAX(OPTIONAL1 COUNTY OF DOMICILE JURISDICTION WHERE COMMITTEE 15 ACTIVE SANTA CLARA CITY OF CUPERTINO Attach additional information on appropriately labeled continuation sheets. CU 2. Treasurer and Other Principal Officers NAME OF TREASURER ANDREW WALTERS For Official Use Only JUL l 2 2018 STREETADDRESS (NO P.O. BOX) CITY STATE ZIP CODE ARLACODE/PHONE NAME OF ASSISTANTTREASU REA, IF ANY SAMUEL HARVEY STREET AO DRESS (NO P.O. BOX) CITY STATE ZIP CODE AREACODE/PHONE NAME OF PRINCIPAL OFFICER(5) RICHARD ABDALAH STREETADDRESS (NO P.O. BOX( CITY STATE ZIPCODE AREA CDDE/PHONE 3. Verification I have used all reasonable diligence in preparing this statement Executed on DATE Executed on DATE Executed on DATE By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE, OR STATE MEASURE PROPONENT By SIGNATURE OF CONTROLLING OFFICEHOLDER, CANDIDATE. OR STATE MEASURE PROPONENT FPPC Form 410(February/2028) FPPC Advice= advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization Recipient Committee INSTRUCT{ONS ON REVERSE Page 2 Page 2 of 3 COMMITTEE NAME I.D. NUMBER CUPERTINO CHAMBER OF COMMERCE PAC 3.299673 - All committees must list the financial institution where the campaign bank account is located. NAME OF FI NANCIAL IN5TITUTION AREACODE/PHONE BANK ACCOUNT NUMBER 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. ELECTIVE OFFICE SOUGHT OR HELD YEAR OF PARTY NAME OF CAN DIDATE/O FFI CEHOLDERJSTATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER 1FAPPLICABLE) ELECTION CHECK ONE Primarily formed to support or oppose specific candidates or measures in a single election. List below: CANDIDATEiS) NAME OR MEASURE(5) FULL TITLE (INCLUDE BALLOT NO. OR LETTER) CANDIDATE(S) OFFICE SOUGHT OR HELD OR MEASURE(S)JURISDICTION IF A RECALL, STATE "RECALL" IN FRONT OF THE OFFICEHOLDER'S NAME_ (INCLUDE DISTRICT NO., CITY OR COUNTY, AS APPLICABLE) CHECK ONE SUPPORT I OPPOSE OPPOSE FPPC Form 410 (February/2018) FPPC Advice: advice@fppcca.gov (866/275-3772) www.fppc.ca.gov Statement of Organization ORNJA' Recipient Committee • - INSTRUCTIONS ON REVERSE P19e3 Page 3 of 3 COMMITTEE NAME I.D. NUMBER CUPERTINO CHAMBER OF COMMERCE PAC 1299673 4. Type of Committee (Continued) General PurPOse COMMitt-e 11 Not formed to support or oppose specific candidates or measures in a single election. Check only one box: © CITY Committee ❑ COU NTY Committee ❑ STATE Committee ❑ Political Parry/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 INDUSTRY GROUP OR AFFILIATION OFSPONSOR CUPERTINO CHAMBER OF COMMERCE STREET ADDRESS NO_ANDSTREET CITY STATE ZIP CODE AREA COD E/PHONE Dace qualified 5. Termination Requirements By signing the verification, the treasurer, assistant treasurer and/or candidate, officeholder, or proponent certify that all oithe foHovAng condidons 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 all reportable transactions. -- There are restrictions on the disposition of surplus campaign funds held by elected officers who are leaving office and by defeated candidates. Refer to 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 18680 and FPPC Regulation 18521.5. FPPC Form 410(February/2018) FPPC Advice: advice@fppc.ca.gov (866/275-3772) www.fppc.ca.gov