County ofsanta Clara Office ofthe Clerk of the Board of Superv isors County Government Center, East Wing 70 West Hedding Street San Jose, California 95110-1770 (408) 299-5001 FAX 938-4525 fpy/^ Megan Doyle Clerk ofthe Board Page 1 of 9 LOBBYIST DISCLOSURE REPORT Plfipse mark the type of report being filed: Initial Registration ^ Annual Registration and Quarterly Lobbyist Disclosure Report for Oct. 1-Dec. 31 (Due Jan. 15) 2 Quarterly Lobbyist Disclosure Report for Jan. 1 - Mar. 31 (Due Apr. 15th) Quarterly Lobbyist Disclosure Report for Apr. 1 - Jun. 30 (Due Jul. 15th ) Quarterly Lobbyist Disclosure Report for Jul. 1 - Sept. 30 (Due Oct. 15th) Amendment to Disclosure Filed: Termination of Lobbying Activity (A lobbyist termination sheet must also be completed) Report each category of lobbyist: (Check all that apply) ^. Contract Lobbyist In-House Lobbyist Expenditure Lobbyist Lobbyist Information: Name: pjl Telephone: Fax: Email: e lo Business Address Street: yzs'o S>As^Wv\\ ^ \!( City: SfVO State: CLA Zip Code: (a 'i i n Mailing Address : Street: I City: State: Zip Code:
COUNTY OF SANTA CLARA LOBBYIST DISCLOSURE REPORT Page3 of 9 Describe the organization ofthe Lobbyist (i.e. sole proprietorship, partnership, corporation, etc.): Kc 0 ^ 0/\ Ifthe Lobbyist is a sole proprietorship or partnership offewer than five people, list the names ofall owners. 1. 2. \14. 5. ; Ifthe Lobbyist is a corporation, list the names ofthe officers and agent for services ofprocess. 1. ^ 4. 5. 6. 7. 8. 9. 10. 11. Agent: The remainder ofthe Lobbyist Disclosure Report is divided into 4 sections. j ContractLobbyists must complete Sections la, IB, and IC. In-House Lobbyists must complete Section 11. Expenditure Lobbyists must complete Section III. All Lobbyists must complete Section IV. Fees and Verification. Ik..
SECTION la. CONTRACT LOBBYIST INFORMATION Page 4 of9 : Contract Lobbyists must complete the followins forms: la: Contract Lobbyist Information (This Form) IB: Current and Former Client List IC: Current Client Disclosures THE NATURE OF THE BUSINESS, ORGANIZATION OR ASSOCIATION Describe the purpose ofthe Contract Lobbyist's business. EMPLOYEES ENGAGED IN LOBBY ACTIVITY g ilf the Contract Lobbyist is an entity, name ofeach person working for the Contract Lobbyist who contacts icounty Officials on behalfofthe lobbyist, and list his or her clients. Lobbyist Client(s) 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.
SECTION IB. CONTRACT LOBBYIST INFORMATION Page 5 of9 LIST ALL CURRENT CLIENTS CURRENT AND FORMER CLIENT LIST Client Name Effective Date LIST ALL CLIENTS TERMINATED DURING THE PREVIOUS QUARTER Client Name Termination Date We (o fc Ot,f (v>/\ Cfcc 3\. ^DlM j This page may be duplicated. Check the box if this page is duplicated.
SECTION IC. CONTRACT LOBBYIST INFORMATION Page 6 of9 CLIENT INFORMATION ContractLobbyists must complete this form for all current clients. Current Client Information: Name: Aero Telephone: \'XO<^'2,3W>\2>SO Fax: Email: (^Wero^cflj r C 0 Business Address jstreet: ^5*073 P^a3r>0L 0< c^s...v- -2-^0 icity: State: C.-A> Zip Code: ) Describe tlie nature and purpose ofthe Client's business. «OlC,AJC ; LEGISLATIVE ORADMINISTRATIVE ACTION(S) LOBBYIST SEEKS TO INFLUENCE \ Describe in detail the legislative or administrative action(s) the Contract Lobbyist was retained to influence and the outcome sought. 1.. V)fc\virv^ "4t> a()'0/p-\ ^ cs> ffovjlc^ 2.! 3. 4. COMPENSATION The total compensation promised or received from the Client for lobbyist services: 0.00-500 ]501-1,000 II11,001-10,000 [^10.001-100.000 100,001-200,000 200,001-300,000 _ 300,001-400,000 11 This page may be duplicated. Check the box if this page is duplicated. "updated 3/2014 " Over 400,001
SECTION IV. FEES AND VERIFICATION Page 9 of9 FEES DUE Initial Registration Fee - 180 (filed between January 1 - June 29 for period ending December 31) Reduced Registration Fee - 90 (filed between June 30 - December 31 for period ending December 31) Annual Registration Fee - 60 (due by January 15th) Penalty for Delinquent Filing of Registration - 60 per calendar day Penalty for Delinquent Filing ofquarterly Disclosure Report - 10 Total Payment Due with Report CD ^0 VERI^ATION (Check all verifications) I acknowledge that each Lobbyist is required to file an Annual Registration Report and pay annual fees due on the 15th ofjanuary. a I acknowledge that each Lobbyist is required to file a Quarterly Lobbyist Disclosure Report due on the 15th ofeach month following the calendar quarter. I acknowledge that a late fee will be assessed for late annual and quarterly reports. I certify that I have been authorized by the Lobbyist(s) identified above to make this verification. I have reviewed the requirements ofthe provisions ofthe County ofsanta Clara Ordinance Code Division A3, Chapter VII, relating to Lobbying. I certify under penalty ofperjury under the laws ofthe State ofcalifor nia that I have reviewed this Lobbyist Report and to the best ofmy knowledge the information contained herein is true, correct, and complete. Print Name Title Signature Date 20,f