RECEIVED
City of MAY 2, 4 2022
Santa Clara City wierk's Office
The Center of V ossible City of Santa Clara
CITY COUNCIL WRITTEN PETITION
Please provide the information requested below. When complete, please submit to the City Clerk's Office, 1500 Warburton Avenue, Santa Clara, CA 95050.
Date: May 24, 2022
1, Brian Doyle _ am hereby requesting to be placed on the Santa Clara City Council Agenda for the following purpose:
An explanation by Councilmember Kevin Park of the apparent inconsistent statements in official filings regarding his employment and sources of income. The details of the inconsistent statements and copies of public records demonstrating the inconsistencies are attached.
I understand that it is important that I attend the meeting in the event there are any questions the Council wishes to ask me.
Signed:
NAME: Brian Doyle
ADDRESS: Council District 5
Street
Santa Clara 95050
City Zip Code
TELEPHONE:*
Optional
DATE: May 24, 2022
*NOTE: This is a public document. If your telephone number is unlisted or if you do not want it to be public, please provide an alternate number where you can be reached.
S:ICityClerk|FORMS AND INFORMATION FOR STAFF USElWritten Petition Form - 2016.doc
WRITTEN PETITION REGARDING KEVIN PARK
There are some serious inconsistencies in official filings by Councilmember Kevin Park that indicate at best an unacceptable level of deceit and at worst perjury.
On August 4, 2020 Kevin Park filed a Statement of Economic Interest (Form 700) in conjunction with his candidacy on which he declared that he had no reportable interests of any kind. (Attachment 1) He signed his name under the statement: "I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct."
The following is a screenshot of the signature portion of Mr. Park's August 4, 2020 Statement:
-or- D None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document) I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained herein and in any attached schedules is true and complete. I acknowledge this is a public document.
I certity under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date Signed 4 August 2020 Signature
(month. day, year) (File the originaly signed paper stafement with your fling official.
The instructions for Form 700 contain the following requirement:
- . . .
Candidate Statement:
If you are filing a statement in connection with your
candidacy for state or local office, investments, interests in real property, and business positions held on the date of filing your declaration of candidacy must be reported.
In addition, income (including loans, gifts, and travel payments) received during the 12 months prior to the date of filing your declaration of candidacy is reportable. Do not change the preprinted dates on Schedules A-1, A-2, and B.
On August 6, 2020, Mr. Park signed and filed an Official Filing Form entitled Ballot Designation Worksheet (Attachment 2) in which he stated his justification for his ballot designation as "Manager" to be his job title for his employer "TCS" and that he held the job from February 2017 through "present" (i.e. August 6, 2020).
The following is a screenshot of the relevant portion of Mr.Park's Worksheet:
Justication for use of 34 pVo: ob Titte
SaVEN Does: Feb 2017 - presont
Current or most recent job title: Manager
Employer Name or Business: TCS
Person who can verify this information:
Phone Number(s) Emal:
Noma Greapina Lopez
Before signing below, answer/initial the following questions. Does your proposed ballot designation:
OYes No Initial_
Use only a portion of the title of your current elecled office? Initial K 2) Non-judicial candidales: Use only the word incumbent" for an elective office to which you were appointed? •Yes ENo Use more than three total words for your principal professions, vocations, or occupations? ONes No Initial f 3) Initial_[
4) Suggest an evaluation of you, such as outstanding, leading, expert, virtuous, or eminent? Initial
5) Refer to a status (Veteran, Activist, Founder, Scholar), rather than a profession, vocation, or occupations? Initial_S
6) Abbreviate the word "retired? Initial S
7) Place the word 'retired" after the words it modifies? Example: Accountant, rehired Yes ENo 8) Use an word or prefix (except 'retired") such as "former" or "ex-" to refer to a former profession, vocation, or occupation? Use the word "retired' along with a current profession, vocation, or occupation? Example: Retired Firefighter/Teacher Yes ENo 9) DYes ENo 11111
10) Use the name of a political parly or political body? Refer to a racial, religious, or ethnic group? Yes I Nc 11) DYes ENC
12) Refer to any activity prohitited by law?
If the answer to any of these questions is "yes," your proposed ballot designation is likely to be rejected. 8 1 61 2028
Date Signed: Month Day Year
Candidate's Signature
For your reference, attached are Elections Code sections 13107, 13107.3, and 13107.5, and California Code of Regulations (CCR), title 2, section 20711. Yu also may wish to consult CCR, title 2, sections, 20712-20719 (found at wwww.sos.ca.gov) Rev 09/2019
The August 6, 2020 filing clearly states that Mr. Park was employed by "TCS" from February 2017 through at least the date of filing. Yet Mr. Park never declared any income from TCS on his August 6 Statement of Financial Interest as he was required to do.
On December 22, 2020 Mr. Park filed his "Assuming Office" Statement of Financial Interest (Form 700). (Attachment 3) He again declared that he had no reportable interests of any kind. He signed his name under that statement: "I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct." The following is a screenshot of the signature portion of Mr. Park's December 22, 2020 Statement:
-or- 1 None - No reportable interess on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the informalion contained herein and in any altached schedules is true and complete. I acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that. damni made Date Signed Decenber 22, 2020 Signa
nonin, day. year)
The instructions for Form 700 contain the following requirement:
Assuming Office Statement:
If you are a newly appointed official or are newly employed in a position designated, or that will be designated, in a state or local agency's conflict of interest code, your assuming office date is the date you were sworn in or
otherwise authorized to serve in the position. If you are a newly elected official, your assuming office date is the date you were sworn in.
• Report: Investments, interests in real property, and
business positions held on the date you assumed the
office or position must be reported. In addition, income (including loans, gifts, and travel payments) received
during the 12 months prior to the date you assumed the
office or position.
Mr. Park was sworn in as a Santa Clara City Councilmember on December 8, 2020.
Thus, he was required to report his income from the prior 12 month period beginning December 7, 2020, including any income received from TS. Instead, he stated under penalty of perjury that he had no reportable financial interests.
In Mr. Park's latest Form 700 filed on April 1, 2022 (Attachment 4) he states under penalty of perjury that he received over $100,000 in income from Tata America for the period of January 1, 2021 through December 31, 2021:
• 1. INCOME RECEIVED
NAME OF SOURCE OF INCOME
Tata America
ADDRESS (Business Address Acceptable)
Edison, NU 08837.
BUSINESS ACTIVITY. IF ANY. OF SOURCE
Technical Consultancy and Engineering
YOUR BUSINESS POSITION
Senior Manager
GROSS INCOME RECEIVED • No Income - Business Position Only $500 - $1,000 $1.001 - $10,000
[$10,001 - $100,000 X] OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED
[X] Salary Spouse's or registered domestic partner's income For self-employed use Schedule A-2.)
• Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2 )
• Sale of
(Real property car. boat. ate )
• Loan repayment
• Commission or • Rental Income, ist each sounce of $ 10,000 ce more (Doscroo)
• Other
(Descibo)
The foregoing public records raise the following questions:
• Councilmember Park was required to have declared his sources of income from the twelve month periods beginning in August 5, 2019 and December 7, 2019, yet he states under penalty of perjury on two separate occasions that he has none.
• At the same time, he states in his Official Filing Form entitled Ballot Designation Worksheet that he worked at TCS from February 2017 at least through August 6, 2020. TCS stands for Tata Consulting Services.
• Then in his April 1, 2022 Form 700 he states that he earned more than $100,000 from Tata America during calendar year 2021.
• Did Mr. Park really stop earning any income from TCS after August 5, 2019 and then start earning income from Tata America sometime in 2021? • If so, how could he afford to live in Santa Clara?
• Did Mr. Park falsely state on his Official Filing Form that he was still employed as a Manager by TCS on August 4, 2020?
• Or did Mr. Park really have income in the period from August 2019 through December 2020, and he committed perjury when he filed his two Form 700's in 2020?
I hereby request the City Council to place an item on a future agenda to allow Mr. Park to answer these questions. Please do not vote to cover up Mr. Park's apparent dishonesty about his sources of income.
CALIFORNIA FORM 700 STATEMENT OF ECONOMIC INTERESTS Date ning oral ug Received
RECEMED COVER PAGE
FAIR POLITICAL PRACTICES COMMISSION
FAIR POLICAL A PUBLIC DOCUMENT GO SANTA CLARA
TACTICES COMMISSION OFF • T CITY CLERK
Please type or print in ink.
NAME OF FILER (LAST) 22 AUG 3 kalini 4$35
Park
1. Office, Agency, or Court
gency Name (Do not use acronyms
ity of Santa Clar
Division, Board, Department, District, if applicable Your Position District 4 Member, City Council
• If filing for multiple positions, list below or on an attachment. (Do not use acronyms) Agency: Position:
2. Jurisdiction of Office (Check at least one box)
• State •Judge, Retired Judge, Pro Tem Judge, or Court Commissioner (Statewide Jurisdiction)
• Multi-County • County of
• City of Santa Clara •Other
3. Type of Statement (Check at least one box)
• Annual: The period covered is January 1, 2019, through Leaving Office: Date Left December 31, 2019. (Check one circle.)
-OT- O The period covered is January 1, 2019, through the date of The period covered is. - through
December 31, 2019. leaving office.
-Or-
Assuming Office: Date assumed O The period covered is — - through the date of leaving office.
1/ Candidate: Date of Election 3 November 2020 and office sought, if different than Part 1:
4. Schedule Summary (must complete) • Total number of pages including this cover page:
Schedules attached
• Schedule A-1 - Investments - schedule attached • Schedule C - Income, Loans, & Business Positions - schedule attached • Schedule A-2 - Investments - schedule attached • Schedule D - Income - Gifts - schedule attached • Schedule B - Real Property - schedule attached • Schedule E - Income - Giffs - Travel Payments - schedule attached -or- D None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document) I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained herein and in any attached schedules is true and complete. I acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date Signed 4 August 2020 Signature
(month, day, year) (file the originally signed paper statement with your fling official.) Page -5
ATTACHMENT I
Official Filing Form
BALLOT DESIGNATION WORKSHEET
(Elections Code §S 13107, 13107.3, 13107.5; California Code of Regulations § 20711) This entire form must be completed, or it will not be accepted and you will not be entitled to a balt designation. DO NOT LEAVE ANY RESPONSE SPACES BLANK. If information requested is not applicable, please write "N/A" in the space provided, otherwise the information MUST be provided. UPON FILING, THIS WORKSHEET WILL BE A PUBLIC RECORD.
Kevin Nara Park Gener optional, rate sent Sace fom Drop Down i Candidate Name:
Ofice: Cily of Santa Clara, Member, Cily Council, Dist /Emal: [email protected] Candidate Home Address: SANTA CLARA, CA 95051
1 Information
Mailing Address: Same
Business Address: same
Phone Number(s) N/A NA
Home/Mobile: Fax:
Business:
N/A
Attorney Name (or other person authorized to act on your behalf):
Attomey 2
Information Address: N/A
Phone Numbers) N/A N/t
N/A Mobile: Fax:
Business:
You may select as your ballot designation one of the following designations:
Your current principal profession(s), vocation(s), or occupations) [maximum total of three words, separated by a slash (7)) The full title of the public office you currently occupy and to which you were elected. "Appointed (full title of public office]" if you currently serve by appointment in an elective public office and are seeking election to the same office or to some other office.
"Incumbent" if you were elected (or, if you are a Superior Court Judge, you are a candidate for the same office that you hold) to your current public office and seek election to the same office.
"Appointed Incumbent" if you were appointed to your current elective public office and seek election to the same office.
Proposed Ballot Designation(s): Scientist / Engineer/ Manager Proposed
Ballot 3
Alternate Ballot Designations) 1: Engineer / Manager
Designation(s)
Alternate Ballot Designation(s) 2:
In the spaces provided on the next page(s):
(a) Describe why you believe you are entitled to use the proposed ballot designation. (b) if your proposed ballot designation contains one or more slashes ("") separating words in your ballot designation for separate principal profession(s), vocation(s), or occupalion(s) (colleclively known as "PVOs"), complete a justification section for each separate PVO. (c) Attach any documents or exhibits that you believe support your proposed ballot designation. (d) If using the title of an elective office, attach a copy of your certificate of election or appointment. (e) Any supporting documents will not be returned to you. Do not submit originals.
It is your responsibility to justify your proposed ballot designation and to provide all requested details.
If your proposed ballot designation includes the word "volunteer," indicate the tille of your volunteer position and the name of the entity for which you volunteer along with a brief description of the lype of volunteer work you do and the approximate amount of time involved. You may only use the ballot designation "community volunteer" if you volunteer for a 501(c)(3) charilable, educational, or religious organization, a governmental agency or an educational institution.
You may not use "community volunteer" together with another designation.
Rev 09/2019
ATTACIHMENT 2 - Pegal
Official Filing Form
California Secretary of State
BALLOT DESIGNATION WORKSHEET
If your proposed ballot designation contains one or more slashes ("/) separating multiple principal profession(s), vocation(s), or occupation(s) (collectively known as "PVOs"), complete a justification section for each separate PVO Justification for use of 14 PVO: Degree and work dest
Bachelor of Saence StartEnd Dales: /une 1989 - June 1993 Current or most recent job title:
Employer Name or Business: Caltech
Person who can verify this information:
Name: Nate Levis c/o Cattech Phone NumberS): mail:
Justification
for use of Justification for use of 2m pro. egree and work done.
Proposed
Ballot
Designation(s)
If you are
proposing 4 Current or most recent job tile: MS in Mechanical Engineerin StartEnd Dales: June 1993 - June 1995 alternate ballot
designations, Employer Name or Business: Stanford
please provide
Person who can verify this information:
justification for
use of those on Stanford Alumni Associatino Number 6e)) Email:
Name: <
Justification for use of 3 PVO: Job Tittle
StarEnd Dates: Feb 2017 - present
Current or most recent job title: Manager
Employer Name or Business:
Person who can verify this information:
Phone Number(s) Email:
Name Georgina Lopez
Before signing below, answer/initial the following questions. Does your proposed ballot designation: •Yes L No Initial i 1) Use only a portion of the title of your current elected office? Initial_K Non-judicial candidales: Use only the word "Incumbent" for an elective office to which you were appointed? •Yes ENo 2) Yes ENo Initial Z
3) Use more than three total words for your principal professions, vocations, or occupations? Yes / No Initial_B
4) Suggest an evaluation of you, such as outstanding, leading, expert, virtuous, or eminent? Initial E Refer to a status (Veteran, Activist, Founder, Scholar), rather than a profession, vocalion, or occupatics? Yes ENo Initial_ Place the word retired" after the words it modifies? Example: Accountant, retired DIYes ENo Initial_E 7) OYes ENo Initial_
8) Use an word or prefix (except "retired") such as "former" or "ex." to refer to a former profession, vocation, or occupation? Use the word "retired" along with a current profession, vocation, or occupation? Example: Retired Firefighter/Teacher Initial_ 9) Initial_f
10) Use the name of a political party or political body? Initial_ 11) Refer to a racial, religious, or elhnic group? YosE No Initial_ 12) Refer to any aclivity prohibited by law?
If the answer to any of these questions is "yes," your proposed ballot designation is likely to be rejected. 8 2020
Date Signed: Month Day Year
Candidate's Signature
For your reference, attached are Elections Code sections 13107, 13107.3, and 13107.5, and California Code of Regulations (CCR), title 2, section 20711. You also may wish to consult CCR, title 2, sections, 20712-20719 (found at www.sos.ca.gov).
Rev 09/2019
ATTACIMEN 2 - Pagel
California Secretary of State Official Filing Form
BALLOT DESIGNATION WORKSHEET
COMPLETE THIS PAGE ONLY IF one or more Alternate Ballot Designation(s) are provided. If this page is not applicable, please initial:
Justification for use of 1* PVO:
Current or most recent job title: StartEnd Dates:
Employer Name or Business:
Person who can verify this information:
Name: Phone Numbers): Email:
Justification for use of 2nd PVO:
Justification for Start/End Dates:
Alternate Ballot A Current or most recent job title:
Designation(s) 1 Employer Name or Business:
Person who can verify this information:
Name: Phone Number(s): Email:
Justification for use of 3d PVO:
Current or most recent job title: Start/End Dates:
Employer Name or Business:
Person who can verify this information:
Name: Phone Numbers): Email:
Justification for use of 1* PVO:
Current or most recent job title: Start/End Dates:
Employer Name or Business:
Person who can verify this information:
Name: Phone Number(s): Email:
Justification for use of 2nd PVO:
Justification for Start/End Dates:
Alternate Ballot Current or most recent job title:
Designation(s) 2 Employer Name or Business:
Person who can verify this information:
Name: Phone Number(s): Email:
Justification for use of 3d PVO:
Current or most recent job tille: Start/End Dates:
Employer Name or Business:
Person who can verify this information:
Name: Phone Number(s): Email:
Rev 09/2019
ATTACHMENI 2 - Page 3
CALIFORNIA FORM 700 STATEMENT OF ECONOMIC INTERESTS
COVER PAGE
FAIR POLITICAL PRACTICES COMMISSION
A PUBLIC DOCUMEN!
Please type or print in ink. 2020 DEC 22 PM 3: 59
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Kevin ' N
PArk
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of Santa Clara
Division, Board, Department, District, if applicable Your Position City Council District 4 Councilmember 2021 NOV - 8 PM 3: PRACTICES COMMISSI FAIR HOLMICA RECENED • If filing for multiple positions, list below or on an attachment. (Do not use acronyms) Stadium Authority Board Member
Position: -
Agency Bee Attached
2. Jurisdiction of Office (Check at least one box)
• State • Judge, Retired Judge, Pro Tem Judge, or Court Commissioner (Statewide Jurisdiction)
• Multi-County • County of
I City of Santa Clara • Other
3. Type of Statement (Check at least one box)
• Annual: The period covered is January 1, 2019, through • Leaving Office: Date Left.
December 31, 2019. (Check one circle.)
-or- O The period covered is January 1, 2019, through the date o The period covered is , through
leaving office
December 31, 2019. -Or-
12 / 08 / 2020 O The period covered is - -, through
Assuming Office: Date assumed
the date of leaving office.
Candidate: Date of Election and office sought, if different than Part 1:
4. Schedule Summary (must complete) • Total number of pages including this cover page: 1 Schedules attached
• Schedule A-1 - Investments - schedule attached • Schedule C - Income, Loans, & Business Positions - schedule attached • Schedule A-2 - Investments - schedule attached • Schedule D - Income - Gifts - schedule attached • Schedule B - Real Property - schedule attached • Schedule E - Income - Gifts - Travel Payments - schedule altached -or-M None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Anenov Address Recommended - Public Documentl lave used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contain rein and in any attached schedules is true and complete. I acknowledge this is a public docume I certify under penalty of perjury under the laws of the State of California than damn December 22, 2Ø20 Signa
Date Signed
month, day, year)
ATTACHMEUT 3
091600143-NFH-0143
STATEMENT OF ECONOMIC INTERESTS ate Initial Filing Receive CALIFORNIA FORM 700 iling Official Use On
COVER PAGE E-Filed
FAIR POLITICAL PRACTICES COMMISSION
A Public Document 04/01/2022
14:06:51
200020T
Please type or print in ink.
NAME OF FILER (LAST) (FIRST) (MIDDLE)
Park, Kevin
1. Office, Agency, or Court
Agency Name (Do not use acronyms)
City of Santa Clara
Division, Board, Department, District, if applicable Your Position Clara Red valop one genoor Agency to the city of santa Board Member • If filing for multiple positions, list below or on an attachment. (Do not use acronyms) Agency: *SEE ATTACHED FOR ADDITIONAL POSITIONS Position:
2. Jurisdiction of Office (Check at least one box)
Judge, Retired Judge, Pro Tem Judge, or Court Commissione • State (Statewide Jurisdiction
L Multi-County • County of.
[x] City of Santa Clara • Other
3. Type of Statement (Check at least one box)
• Leaving Office: Date Left J.
(x) Annual Thember 31, 202d Is January 1, 2021 through (Check one circle) -or- The period covered is January 1, 2021 through the date o The period covered is _, through eaving office
December 31, 2021.
• Assuming Office: Date assumed The period covered i _, through the date of leaving office
• Candidate:Date of Election. and office sought, if different than Part 1:.
4. Schedule Summary (must complete) 6
• Total number of pages including this cover page:
Schedules attached
• Schedule A-1 - Investments - schedule attached [X] Schedule C - Income, Loans, & Business Positions - schedule attached • Schedule A-2 - Investments - schedule attached [X] Schedule D - Income - Gifts - schedule attached • Schedule B - Real Property - schedule attached [X] Schedule E - Income - Gifts - Travel Payments - schedule attached -Or-
• None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(Business or Agency Address Recommended - Public Document) Santa Clara CA 95050
DAYTIME TELEPHONE NUMBER E-MAIL ADDRESS
have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained herein and in any attached schedules is true and complete. I acknowledge this is a public documen I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date Signed _04/01/2022 Signature Kevin Park (File the originally signed paper stafement with your fling oficial.) (month, day, year)
FPPC Form 700 - Cover Page (2021/2022)
[email protected] • 866-275-3772 • www.fppc.ca.gov
ATTACHMENT Y - Page l
091600143-NFH-0143
STATEMENT OF ECONOMIC INTERESTS CALIFORNIA FORM 700
COVER PAGE FAIR POLITICAL PRACTICES COMMISSION
Expanded Statement Attachment Name
Kevin Park
* This table lists all positions including the primary position listed in the Office, Agency, or Court section of the Cover Page.
Agency Div/Board/Dept/District Position Type of Statement SAN # Board Member Annual 1/1/2021 - 12/31/2021 091600143-NFH-0143 City of Santa Clara
City of Santa Clara ayshore North Project Boardmember Annual 1/1/2021 - 12/31/2021 091600143-NFH-0143 inhancement Authorit
City of Santa Clara Housing Authority Boardmember Annual 1/1/2021 - 12/31/2021 091600143-NFH-0143 City of santa Clara Stadium Authority Boardmember Annual 1/1/2021 - 12/31/2021 091600143-NFH-0143 city of Santa Clara Industrial Development Boardmember Annual 1/1/2021 - 12/31/2021 091600143-NFH-0143 Authority
City of Santa Clara Boardmember Annual 1/1/2021 - 12/31/2021 091600143-NFH-0143 ports and Open Spar
athorit
Mayor and City Council Councilmember Annual 1/1/2021 - 12/31/2021 091600143-NFH-0143 City of Santa Clara
City of Santa Clara Joint Financing Authority Director Annual 1/1/2021 - 12/31/2021 091600143-NFH-0143 City of Santa Clara Public Facilities Financing Director Annual 1/1/2021 - 12/31/2021 091600143-NFH-0143 Authority
FPPC Form 700 - Cover Page Expanded (2021/2022)
[email protected] • 866-275-3772 • www.fppc.ca.gov
ATTACHMENT 4 - Page 2
091600143-NFH-0143
SCHEDULE C CALIFORNIA FORM 700
Income, Loans, & Business FAIR POLITICAL PRACTICES COMMISSION Positions Name
(Other than Gifts and Travel Payments) Park, Kevin
• 1. INCOME RECEIVED • 1. INCOME RECEIVED
NAME OF SOURCE OF INCOME NAME OF SOURCE OF INCOME
start-up company (via Trinet) Bluebird Montessori Child Care Center ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) blin, CA 9456 an Jose, CA 9511'
USINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCI Software Engineering Child Care
YOUR BUSINESS POSITION YOUR BUSINESS POSITION
Engineering Manager Teacher
GROSS INCOME RECEIVED • No Income - Business Position Only GROSS INCOME RECEIVED • No Income - Business Position Only • $500 - $1,000 • $1,001 - $10,000 • $500 - $1,000 [X] $1,001 - $10,000 [X $10,001 - $100,000 • OVER $100,000 • $10,001 - $100,000 • OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED CONSIDERATION FOR WHICH INCOME WAS RECEIVED [ Salary • Spouse's or registered domestic partner's income ] Salary [X] Spouse's or registered domestic partner's incom (For self-employed use Schedule A-2.) For self-employed use Schedule A-2 • Partnership (Less than 10% ownership. For 10% or greater use • Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.)
Sale of • Sale of
(Real property, car, boat, etc.) (Real property, car, boat, etc.) Loan repayment • Loan repayment
• Commission or • Rental Income, list each source of $10,000 or more • Commission or • Rental Income, list each source of $10,000 or more (Describe) (Describe)
• Other - • Other
(Describe) (Describe)
2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD * You are not required to report loans from a commercial lending institution, or any indebtedness created as part of a retail installment or credit card transaction, made in the lender's regular course of business on terms available to members of the public without regard to your official status. Personal loans and loans received not in a lender's regular course of business must be disclosed as follows:
NAME OF LENDER* INTEREST RATE TERM (Months/Years)
_% • None
ADDRESS (Business Address Acceptable)
SECURITY FOR LOAN
BUSINESS ACTIVITY, IF ANY, OF LENDER • None • Personal residence • Real Property
Street address
HIGHEST BALANCE DURING REPORTING PERIOD
• $500 - $1,000 CHty
• $1,001 - $10,000
• Guarantor
• $10,001 - $100,000
•OVER $100,000 •Other
(Describe)
Comments:
FPPC Form 700 Schedule C (2021/2022)
[email protected] • 866-275-3772 • www.fppc.ca.gov
ATTACHMENT 4- Page 3
091600143-NFH-0143
SCHEDULE C CALIFORNIA FORM 700
Income, Loans, & Business FAIR POLITICAL PRACTICES COMMISSION Positions Name
(Other than Gifts and Travel Payments) Park, Kevin
• 1. INCOME RECEIVED • 1. INCOME RECEIVED
NAME OF SOURCE OF INCOME NAME OF SOURCE OF INCOME
Tata America
ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) Edison, NJ 08837
BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE Technical Consultancy and Engineering
YOUR BUSINESS POSITION YOUR BUSINESS POSITION
Senior Manager
GROSS INCOME RECEIVED • No Income - Business Position Only GROSS INCOME RECEIVED • No Income - Business Position Only • $500 - $1,000 •$1,001- $10,000 L $500 - $1,000 • $1,001 - $10,000 • $10,001 - $100,000 X OVER $100,000 • $10,001 - $100,000 • OVER $100,000
CONSIDERATION FOR WHICH INCOME WAS RECEIVED CONSIDERATION FOR WHICH INCOME WAS RECEIVED X Salary • Spouse's or registered domestic partner's income • Spouse's or registered domestic partner's income (For self-employed use Schedule A-2.) (For self-employed use Schedule A-2.) • Partnership (Less than 10% ownership. For 10% or greater use • Partnership (Less than 10% ownership. For 10% or greater use Schedule A-2.) Schedule A-2.)
Sale of • Sale of
(Real property, car, boat, etc.) (Real property, car, boat, etc.) Loan repayment • Loan repayment
• Commission or • Rental Income, list each source of $10,000 or more • Commission or • Rental Income, list each source of $10,000 or more (Describe) (Describe)
• Other. • Other
(Describe) (Describe)
• 2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD * You are not required to report loans from a commercial lending institution, or any indebtedness created as part of a retail installment or credit card transaction, made in the lender's regular course of business on terms available to members of the public without regard to your official status. Personal loans and loans received not in a lender's regular course of business must be disclosed as follows:
NAME OF LENDER* INTEREST RATE TERM (Months/Years)
• None
ADDRESS (Business Address Acceptable)
SECURITY FOR LOAN
BUSINESS ACTIVITY, IF ANY, OF LENDER • None • Personal residence • Real Property Streot address
HIGHEST BALANCE DURING REPORTING PERIOD
• $500 - $1,000 City
• $1,001 - $10,000
• Guarantor -
• $10,001 - $100,000
• OVER $100,000 • Other
(Describe)
Comments:
FPPC Form 700 Schedule C (2021/2022)
[email protected] • 866-275-3772 • www.fppc.ca.gov
ATTACHMENT 4- PagO Y
091600143-NFH-0143
CALIFORNIA FORM 700
SCHEDULE D FAIR POLITICAL PRACTICES COMMISSION
Name
Income - Gifts
Park, Kevin
• consulate GeE ral of the Republic of korea in Sar • NAME OF SOURCE (Not an Acronym) Consulate General of
Francisco
ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable) san Francisco, CA 94118
USINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE Consul General of South Korea
DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFTS) DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFTS) 12 / 08/21 $. 110.14 $-
07 / 10/21 $. 80.00 $-
Dinner with the Consul
05/12/21 s. 100.00 General 1- 1- $.
• NAME OF SOURCE (Not an Acronym) • NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFTS) DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFTS) $- $-
/_ J. $- 1- s
1— $.
• NAME OF SOURCE (Not an Acronym) • NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFTS) DATE (mm/dd/yy) VALUE DESCRIPTION OF GIFTS) - $—
$. - $-
/ /_ - $
Comments:
1C Form 700 ScheduleD (2021/2022)
[email protected] • 866-275-3772 • www.fppc.ca.gov
AITACHMENT 4 - Page 5
091600143-NFH-0143
SCHEDULE E CALIFORNIA FORM 700
FAIR POLITICAL PRACTICES COMMISSION
Income - Gifts
Name
Travel Payments, Advances,
and Reimbursements Park, Kevin
• Mark either the gift or income box.
• Mark the 501(c)(3) box for a travel payment received from a nonprofit 501(c)(3) organization or the "Speech" box if you made a speech or participated in a panel. Per Government Code Section 89506, these payments may not be subject to the gift limit. However, they may result in a disqualifying conflict of interest.
• For gifts of travel, provide the travel destination.
• NAME OF SOURCE (Not an Acronym) • NAME OF SOURCE (Not an Acronym) Overseas Korean Foundation
ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable)
CITY AND STATE CITY AND STATE
Seoul, Na Na
• 501 (c)(3) or DESCRIBE BUSINESS ACTIVITY, IF ANY, OF SOURCE • 501 (c)(3) or DESCRIBE BUSINESS ACTIVITY, IF ANY, OF SOURCE and inform Koreans abroad and connect ther
DATE(S): 08 / 18 / 21 - 08 / 19/21 AMT: $. 1,190.00 DATE(S): -- --- 1- AMT: $. (If gifti) (If giff)
• MUST CHECK ONE: [X] Gift -Or- • Income • MUST CHECK ONE: • Gift -Or- •income * Made a Speech/Participated in a Panel Made a Speech/Participated in a Panel • Other - Provide Description Other - Provide Description • If Gift, Provide Travel Destination Jeju, South Korea • If Gift, Provide Travel Destination * NAME OF SOURCE (Not an Acronym) • NAME OF SOURCE (Not an Acronym) ADDRESS (Business Address Acceptable) ADDRESS (Business Address Acceptable)
CITY AND STATE CITY AND STATE
• 501 (c)(3) or DESCRIBE BUSINESS ACTIVITY, IF ANY, OF SOURCE • 501 (c)(3) or DESCRIBE BUSINESS ACTIVITY, IF ANY, OF SOURCE DATE(S): _ AMT: $- DATE(S: _ J_ __ AMT: $-
(If gift) (If gift)
• MUST CHECK ONE: • Gift -or- • Income • MUST CHECK ONE: • Gift -or- • income • Made a Speech/Participated in a Panel • Made a Speech/Participated in a Panel • Other - Provide Description • Other - Provide Description • If Gift, Provide Travel Destination • If Gift, Provide Travel Destination Comments: Reimbursed for travel to the Overseas Korean Foundation forum where I gave a presentation and participated in a discussion panel.
FPPC Form 700 Schedule E (2021/2022)
[email protected] •866-275-3772 • www.fppc.ca.gov
ATTACHMEUT 4 - Page 6