2024-03-27 801 •
Payment to Agency Report A Public Documen I •'YM: d, GENCY REPORT
1.Agency Name f a Stamp al for'ilia
g y Date Stamp R
1
City of Alameda MAR 2 7 2024 f''Ir.n v O
Division, Department,or Region(if applicable) For Official Use Only
CITY OF ALAM:DA
Street Address CITY CLERK'S O'FICE
Alameda CA 94501
Area Code/Phone Number Email
❑ Amendment(explain in comment section)
5107474700 jowens@alamedaca.gov
Agency Contact(name and title) Date of Original Filing:
(month,day,year)
Jodi Owens, Executive Assistant
2. Donor Name and Address
M Individual Wang Yao ❑Other
Last Name First Name Name
Alameda CA 94501
Address City State Zip Code
If"Other"is marked,describe the entity's business activity(if business)or its nature and interests.
If applicable, identify the name of each source and the amount(s)received by the donor for this payment:
Yao Wang $100.00 $
Name Amount Name Amount
3. Payment Information (Complete Sections 3.1 (a or b), 3.2, 3.3)
3.1 (a)Travel Payment
Location of Travel • Dates(month,day,year)
❑Rail ❑Air ❑Bus ❑Auto ❑Other
Transportation Provider Check Applicable Boxes Name of Lodging Facility
s$ _Lodging Expenses $ Meal Expenses Transportation Expenses $ Other Expenses Total Expenses
3.1 (b) Payment(s) not related to travel: $
Dates(month,day,year) Total Expenses
3.2. Payment Description. Provide a specific description of the payment and its agency purpose and use.
Yao Wang donated a painting to the City of Alameda on September 19, 2023 and it is currently
hanging in the City Manager's Office.
3.3. Identify the officials who used the payment in Section 3.1 (See instructions)
Last Name First Name Position/Title Department/Division
Last Name First Name Position/Title Department/Division
4. Verification
I authorized the acceptance of the reported payment(s)as in compliance with FPPC regulations.
Amy Wooldridge Acting City Manager 03/27/24
Signature Print Name Title (month,day,year)
Comment:
(Use this space or an attachment for any additional information) FPPC Form 801(Jan/18)
advice@fppc.ca.gov
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