410 Statement of Organization Recipient Committee - Amendment 10-12-18 � � � � � � �
Sta#ement of Organization oateS�mP � - .
Recipient Committee ��� ! f `,",I?� �
1 �
Statement T 2 X For Officiai Use Only
YP ❑initiai ❑ Amendment ❑ Termination—See Part 5
0 Not yet qualfied
or C� ��fiT��� t!�d I l��� �
�Date qualified as committee � � � �
Date quaified as commiftee Dafe of termination
/ /
1. Cornmittee Inforrnation '-D. Number 1299673 Z. Treasurer and Other Princi�al OfFicers
(ff aPplicable)
NAMEOFCOMMITTEE NAME OF TREASURER -
ANDREW CM1TALTERS
CIIPERTINO CHAMBER OF COMMERC� PAC
,
SAMIIEL HARVEY
MAILING ADDRESS(IE DIFFERENTJ STREEf ADDRE55(NO P.O.BOXJ
COUMY OF DOMICILE lURISDICTiON WHERE COMMITTEE IS ACiIVE NAME OF P.RINQPAL OFFICER(S)
SANTA CI,P12A C22Y OF CIIPERT=NO
RSCI3ARD ABDAI,AFi
STREETADDRE55(NO P.O.BOX}
3. Verification
f have used all reasonable diligence in preparing this statement
�
Executed on gy
DATE SIGNATURE OF CONTROLLWG OFFICEHOLDER,CANDIDATE,OR 57ATE MEASURE PROPONENT �
Executed on gy
DATE SIGNATURE OF CONTROLLING OFFICEHOLDER,CANDIDATE,OR STATE MEASURE PROPONENT
Executed on gy
DATE � SIGNA7UREOFCONTROLLINGOFFICEHOLDER,CANDIDATE,ORSTATEMEASUREPROPONENT
- � � - � - - - �• FPPC form 410(February/2018)
FPPC Advice:advice@fppc.ca.gov{866/275-3772)
� . www.fppc.ca.gov
. S�Eatement of Organization
Recipient Committee ' • ' ` � �
. -
INSTRUCTIOI�tS ON REVERSE �
Page 2 0£ 4
COMMITTEE NAME I.D.NUMBER
1299673
CUPERTINO CHATiBER OF COMMERCE PAC
2a. Additional Officers/Assistant Treasurers
NAME NAME
ANDREW i7ALTERS
NAME NAME
MAILING ADDRESS MAILING ADDRESS
CIIY STATE ZIP CODE AREA CODE/PHONE CITY STATE ZIP CODE AREA CODE/PHONE
NAME NAME
MAILING ADDRESS MAILING ADDRESS
CIIY STATE ZIP CODE AREA CODEIPHONE C[TY STATE ZIP CODE AREA CODE/PHONE
NAME NAME
MAILING ADDRESS MAILING ADDRESS
C��' STATE ZlPCODE AREACODE/PHONE CITY STATE ZIPCODE AREACODElPHONE
FPPC Form 410(February/2018J
www.ne�le.com FPPC Advice:advice@fippc.ca.gov(866/275-3772)
� • , - , . . . . _ ,.-. c,-��r�s���:..Vn.c��•;� �r✓.fp��.ca.gov
Statement of Organization � • - � '
Recipient Committee • - ,
INSTRUCTIONS ON REVERSE
Page 2 Page 3 of 4
. COMMtTTEENAME . I,D.NUMBER
CIIPERTSNO CHAMBER OF CO�RCE PAC 1299673
• AI(cammittees must list the iinancial institution where the campaign bank account is located.
NAME OF FINANCIALINSTITUTION AREACODE/PHONE BANKACCOUN7NUMBER
BANK OF THE WEST ( 042012484
4.Type Of COmmittee Complete the applicable sections.
. .
• List the name of each controlling officeholder,candidate,or state measure proponent. If candidate or officeholder contro(led,also list the elective office sought or held,and
district number,if any,and the year ofthe election_
• List the political party with which each officeholder or candidate is affiliated or check"nonpartisan:' Stating"No party preference"is acceptable.
• Ifithis 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 PAR7Y
NAME OF CANDIDATE/OFFICEHOLDER/STATE MEASURE PROPONENT (INCLUDE DISTRICT NUMBER IFAPPLICABLE) � ELECTION CHECKOnIE
Nonpartisan Partisan (list political party below)
Nonpartisan Parrisan (list political party below)
Primarily formed to support or oppose specific candidates or measures in a single election. List beiow:
CANDIDATE(5�NAME DR MEASURE(S)FULLTITLE(INCLUDE BALLOT NO.OR LE7TER) 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 APPLICABLEJ CHECKONE
• SUPPORT OPPOSE
SUPPORT OPPOSE
•- - FPPC Form 430(February/2018}
EPPC Advice:advice@fppc.ca.gov(866/2753772)
www.fppc.ca.gov
S#atement of Organization � • - � !
Recipient Cornmittee • - ,
[NSiRUCT10NS ON REVERSE
Page3 page 4 of a
COMMITTEE NAME � I.D.NUMBER
CIIPERTINO CHPI�ER 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:
. � CITY Committee ❑ COUNTY Committee 0 STAI'E Commiitee❑ Political PartyJCentral Committee
PROVtDE BRIEF DESCRiPTION OFACTIVI7Y
TO SIIPPORT I,OCAI� AND STATEW2DE CANDSDATES AND BAI,LOT MEASIIRES
- List additional sponsors on an attachment.
NAME OF SPOfVSOR INDUSTRY 6ROUP OR AFFILIATfON OF SPONSOR
CIIPERTSNO CHAMBER OF COMMERCE
STREETADDRE55 NO.ANDSfREET CI7Y SiATE ZIPCODE AREACODE/PHONE
❑ � �
Date qualified '
S.TerminafionRequirements Sysigningtheverification,thetreasurer,assistanttreasurerand/orcandidate,officeholder,orproponentcertifythatallofthefollowingconditionshavebeenmet:
• This tommittee has ceased to receive contributions and make expenditures;
• This commitEee 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 obtigations;
- This committee has no surplus funds;and
� This committee has filed alI campaign statements required by the Political Reform Act disclosing all reporta6le 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 baflot measure committees may be used for pol[tical,legislative or governmental purposes under 6overnment Code Sections 89511-89518,and are
subject to Elections Code Section 18680 and FPPC Regulation 18521.5.
• FPPC Form 410(February/201$)
- FPPC Advice:advice a�fppc.ca.gov(866/275-3772j
www.fippc.ca.gov