date initial filing 700 statement of economic in rests ...€¦ · fppc form 700 (2018/2019) fppc...
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011700170-NFH-0170 Date Initial Filing Received
CALIFORNIA FORM 700 STATEMENT OF ECONOMIC IN RESTS Official Use Only
FAIR POll nCAl PRACTICES COMMISSION EmiddotFiled 020712019A PUBLIC DOCUMENT COVER PAGE 182450
Filing 10 176560900Please type or print in ink
NAME OF FILER (LAST) (FIRST] (MIDDLE)
Chambers Thomas R
1 Office Agency or Court Agency Name (Do not use acronyms)
SAN MATEO COUNTY
Division Board Department District if applicable Your Position
Westborough Wa t er District Member
~ 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)
o State o Judge or Court Commissioner (Statewide Jurisdiction)
o MultimiddotCounty ________________ QJCountyof_S_a_n_M_a_t e_o______________
o City of _________________ o Other _________________
3 Type of Statement (Check at least one bOX)
o AnnualThe period covered is January 1 2018 through o Leaving Office Date Left --1--1__ December 31 2018 (Check one circle)
-ormiddot o The period covered is January 1 2018 through the dateThe period covered is--1---1__ through of
December 312018 leaving office
o The period covered is --1--1__ through the dateo Assuming Office Date assumed --1--1__ of leaving office
o CandidateDate of Election______ and office sought if different than Part 1 __________________
4 Schedule Summary (must complete) ~ Total number of pages including this cover page _3_
Schedules attached
[ill Schedule Amiddot1 bull Investments - schedule attached o Schedule C bull Income Loans amp Business Posffions - schedule attached
o Schedule Amiddot2 bull Investments - schedule attached QJ Schedule D bull Income - Gifts - schedule attached
o Schedule B bull Real Property - schedule attached o Schedule E bull Income - Gifts - Travel Payments - schedule attached
-or-
O None - No reportable interests on any schedule
5 Verification MAILING ADDRESS STREET CITY STATE ZIP CODE (Business or Agency Address Recommendedmiddot Public Document)
South San Francisco CA 9408 0 DAYTIME TELEPHONE NUMBER EmiddotMAIL ADDRESS
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 0207201 9 om-as C-hamb=ers-_-_--_-_-c-c--___Signature Thc Ro(month day year) (File theoriginally signed paper slatemenl with your filing official)
FPPC Form 700 (20182019) FPPC Advice Email advicefppccagov
FPPC Toll-Free Helpline 866275-3772 wwwfppccagov
Ol1700~70-NFH-0170
SCHEDULE A-1 Investments
Stocks Bonds and Other Interests (Ownership Interest is Less Than 10)
Investments must be itemized Do not attach brokerage or financial statements
CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION
Name
Chamber s Thoma s R
~ NAME OF BUSINESS ENTITY ~--------------------------------------~ NAME OF BUSINESS ENTITY
Vodafone Group PLC Verizon Communications Inc
GENERAL DESCRIPTION OF THIS BUSINESS GENERAL DESCRIPTION OF THIS BUSINESS
Telecommunications Telecommunications
FAIR MARKET VALUE FAIR MARKET VALUE
o $2000 - $10000 IRl $10001 - $100000 o $2000 - $10000 IRl $10001 - $100000
0$100001 - $1 000000 DOver $1000000 0$100001 - $1000000 o Over $1 000000
NATURE OF INVESTMENTo Stock llil Other _S_t_o_c_k_A_DR_________ NATURE OF INVESTMENT
lliJ Stock 0 Other ------------shy(Describe) (DeSCribe) o Partnership 0 Income Received of $0 - $499 o Partnership 0 Income Received of $0 - $499
o Income Received of $500 or More (Report on Schedule C) o Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE LIST DATE IF APPLICABLE LIST DATE
---l---lJJl ---l---l1ll ---l---l18 ---l---l1ll ACQUIRED DISPOSED ACQUIRED DISPOSED
~ NAME OF BUSINESS ENTITY ~ NAME OF BUSINESS ENTITY
PGampE Corp Alliant Energy Corp
GENERAL DESCRIPTION OF THIS BUSINESS GENERAL DESCRIPTION OF THIS BUSINESS
Energy Utility Energy Utility
FAIR MARKET VALUE FAIR MARKET VALUE
o $2000 - $10000 IRl $10001 - $100000 o $2000 - $10000 o $10001 - $100000
o $100001 - $1 000000 o Over $1000000 IRl $100001 - $1000000 o Over $1000000
NATURE OF INVESTMENT NATURE OF INVESTMENT
lliJ Stock 0 Other ------------shy lliJ Stock 0 Other ------------shy(Describe) (DeSCribe) o Partnership 0 Income Received of $0 - $499 o Partnership 0 Income Received of $0 - $499
o Income Received of $500 or More (Report on Schedule C) o Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE LIST DATE IF APPLICABLE LIST DATE
---l---l~ ---l---l18 ---l---l~ ---l---l18 ACQUIRED DISPOSED ACQUIRED DISPOSED
~ NAME OF BUSINESS ENTITY ~ NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE FAIR MARKET VALUE
10 $2000 - $10000 o $10001 - $100000 o $2000 - $10000 o $10001 - $100000
0$100001 - $1 000000 o Over $1000000 0$100001 - $1000000 o Over $1 000000
NATURE OF INVESTMENT NATURE OF INVESTMENT
o Stock 0 Other ------------shy o Stock 0 Other ------------shy(Describe) (Describe) o Partnership 0 Income Received of $0 - $499 o Partnership 0 Income Received of $0 - $499
o Income Received of $500 or More (Report on Schedule C) o Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE LIST DATE IF APPLICABLE LIST DATE
---l---l~ ---l---l18 ---l---l18 ---l---lJJl ACQUIRED DISPOSED ACQUIRED DISPOSED
Comments _____________________________________________
FPPC Form 700 (20182019) Sch A-1 FPPC Advice Email advicefppccagov
FPPC Toll-Free Helnline 866275-3772 wwwfOOCCIUIOV
011700l70-NFH-0170bull
CALIFORNIA FORM 700 SCHEDULE D
FAIR POLITICAL PRACTICES COMMISSION
Income - Gifts Name
Chambe r s Tho mas R
bull NAME OF SOURCE (Not an Acronym)
Zach Deng
ADDRESS (Business Address Acceptable)
San Franc i sco CA 94 1 32
BUSINESS ACTIVITY IF ANY OF SOURCE
Student Lowell Hig h Sc hoo l
DATE (mmddyy) VALUE DESCRIPTION OF GIFT(S)
__- 0-- Costco Gift Card~1sectJJL $ 50 - 0
--1--1_ $____
--1--1__ $____
bull NAME OF SOURCE (Not an Acronym)
Lowell Soc i a l Committee ADDRESS (Business Address Acceptable)
San Franc isco CA 94 1 32 BUSINESS ACTIVITY IF ANY OF SOURCE
Lowell High School
DATE (mmddyy) VALUE DESCRIPTION OF GIFT(S)Oute r lands gift card for my retirement as teac he r
--1--1_ $ ____
--1--1__ $____
bull NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY IF ANY OF SOURCE
DATE (mmddyy) VALUE DESCRIPTION OF GIFT(S)
--1--1_ $____
--1--1__ $____
--1--1_ $____
bull NAME OF SOURCE (Not an Acronym)
Lowell Alumni Assoc i a ti o n
ADDRESS (Business Address Acceptable)
San Franc i sco CA 94 132
BUSINESS ACTIVITY IF ANY OF SOURCE
Lowe ll High Sc hoo l
DATE (mmlddyy) VALUE DESCRIPTION OF GIFT(S)
Amazon Gi f t Ca rd fo r my Re tirement
--1--1__ $____
bull NAME OF SOURCE (Not an Acronym)
Lowe ll Ma th Depa rtment
ADDRESS (Business Address Acceptable)
Sa n Fr ancisco CA 94 1 32 BUSINESS ACTIVITY IF ANY OF SOURCE
Lowell High Schoo l
DATE (mmlddyy) VALUE DESCRIPTION OF GIFT(S)Restau ran t Giftc ard for r eti rement as Dept Chai r
--1--1_ $____
--1--1__ $____
bull NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY IF ANY OF SOURCE
DATE (mmlddyy) VALUE DESCRIPTION OF GIFT(S)
--1--1_ $____
--1--1_ $____
--1--1__ $____
Comments _________________________________________________________________________________________
FPPC Form 700 (20182019) Sch 0 FPPC Advice Email advicefppccagov
FPPC TolImiddotFree Helpline 866275-3772 wwwfppccagov
Ol1700~70-NFH-0170
SCHEDULE A-1 Investments
Stocks Bonds and Other Interests (Ownership Interest is Less Than 10)
Investments must be itemized Do not attach brokerage or financial statements
CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION
Name
Chamber s Thoma s R
~ NAME OF BUSINESS ENTITY ~--------------------------------------~ NAME OF BUSINESS ENTITY
Vodafone Group PLC Verizon Communications Inc
GENERAL DESCRIPTION OF THIS BUSINESS GENERAL DESCRIPTION OF THIS BUSINESS
Telecommunications Telecommunications
FAIR MARKET VALUE FAIR MARKET VALUE
o $2000 - $10000 IRl $10001 - $100000 o $2000 - $10000 IRl $10001 - $100000
0$100001 - $1 000000 DOver $1000000 0$100001 - $1000000 o Over $1 000000
NATURE OF INVESTMENTo Stock llil Other _S_t_o_c_k_A_DR_________ NATURE OF INVESTMENT
lliJ Stock 0 Other ------------shy(Describe) (DeSCribe) o Partnership 0 Income Received of $0 - $499 o Partnership 0 Income Received of $0 - $499
o Income Received of $500 or More (Report on Schedule C) o Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE LIST DATE IF APPLICABLE LIST DATE
---l---lJJl ---l---l1ll ---l---l18 ---l---l1ll ACQUIRED DISPOSED ACQUIRED DISPOSED
~ NAME OF BUSINESS ENTITY ~ NAME OF BUSINESS ENTITY
PGampE Corp Alliant Energy Corp
GENERAL DESCRIPTION OF THIS BUSINESS GENERAL DESCRIPTION OF THIS BUSINESS
Energy Utility Energy Utility
FAIR MARKET VALUE FAIR MARKET VALUE
o $2000 - $10000 IRl $10001 - $100000 o $2000 - $10000 o $10001 - $100000
o $100001 - $1 000000 o Over $1000000 IRl $100001 - $1000000 o Over $1000000
NATURE OF INVESTMENT NATURE OF INVESTMENT
lliJ Stock 0 Other ------------shy lliJ Stock 0 Other ------------shy(Describe) (DeSCribe) o Partnership 0 Income Received of $0 - $499 o Partnership 0 Income Received of $0 - $499
o Income Received of $500 or More (Report on Schedule C) o Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE LIST DATE IF APPLICABLE LIST DATE
---l---l~ ---l---l18 ---l---l~ ---l---l18 ACQUIRED DISPOSED ACQUIRED DISPOSED
~ NAME OF BUSINESS ENTITY ~ NAME OF BUSINESS ENTITY
GENERAL DESCRIPTION OF THIS BUSINESS GENERAL DESCRIPTION OF THIS BUSINESS
FAIR MARKET VALUE FAIR MARKET VALUE
10 $2000 - $10000 o $10001 - $100000 o $2000 - $10000 o $10001 - $100000
0$100001 - $1 000000 o Over $1000000 0$100001 - $1000000 o Over $1 000000
NATURE OF INVESTMENT NATURE OF INVESTMENT
o Stock 0 Other ------------shy o Stock 0 Other ------------shy(Describe) (Describe) o Partnership 0 Income Received of $0 - $499 o Partnership 0 Income Received of $0 - $499
o Income Received of $500 or More (Report on Schedule C) o Income Received of $500 or More (Report on Schedule C)
IF APPLICABLE LIST DATE IF APPLICABLE LIST DATE
---l---l~ ---l---l18 ---l---l18 ---l---lJJl ACQUIRED DISPOSED ACQUIRED DISPOSED
Comments _____________________________________________
FPPC Form 700 (20182019) Sch A-1 FPPC Advice Email advicefppccagov
FPPC Toll-Free Helnline 866275-3772 wwwfOOCCIUIOV
011700l70-NFH-0170bull
CALIFORNIA FORM 700 SCHEDULE D
FAIR POLITICAL PRACTICES COMMISSION
Income - Gifts Name
Chambe r s Tho mas R
bull NAME OF SOURCE (Not an Acronym)
Zach Deng
ADDRESS (Business Address Acceptable)
San Franc i sco CA 94 1 32
BUSINESS ACTIVITY IF ANY OF SOURCE
Student Lowell Hig h Sc hoo l
DATE (mmddyy) VALUE DESCRIPTION OF GIFT(S)
__- 0-- Costco Gift Card~1sectJJL $ 50 - 0
--1--1_ $____
--1--1__ $____
bull NAME OF SOURCE (Not an Acronym)
Lowell Soc i a l Committee ADDRESS (Business Address Acceptable)
San Franc isco CA 94 1 32 BUSINESS ACTIVITY IF ANY OF SOURCE
Lowell High School
DATE (mmddyy) VALUE DESCRIPTION OF GIFT(S)Oute r lands gift card for my retirement as teac he r
--1--1_ $ ____
--1--1__ $____
bull NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY IF ANY OF SOURCE
DATE (mmddyy) VALUE DESCRIPTION OF GIFT(S)
--1--1_ $____
--1--1__ $____
--1--1_ $____
bull NAME OF SOURCE (Not an Acronym)
Lowell Alumni Assoc i a ti o n
ADDRESS (Business Address Acceptable)
San Franc i sco CA 94 132
BUSINESS ACTIVITY IF ANY OF SOURCE
Lowe ll High Sc hoo l
DATE (mmlddyy) VALUE DESCRIPTION OF GIFT(S)
Amazon Gi f t Ca rd fo r my Re tirement
--1--1__ $____
bull NAME OF SOURCE (Not an Acronym)
Lowe ll Ma th Depa rtment
ADDRESS (Business Address Acceptable)
Sa n Fr ancisco CA 94 1 32 BUSINESS ACTIVITY IF ANY OF SOURCE
Lowell High Schoo l
DATE (mmlddyy) VALUE DESCRIPTION OF GIFT(S)Restau ran t Giftc ard for r eti rement as Dept Chai r
--1--1_ $____
--1--1__ $____
bull NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY IF ANY OF SOURCE
DATE (mmlddyy) VALUE DESCRIPTION OF GIFT(S)
--1--1_ $____
--1--1_ $____
--1--1__ $____
Comments _________________________________________________________________________________________
FPPC Form 700 (20182019) Sch 0 FPPC Advice Email advicefppccagov
FPPC TolImiddotFree Helpline 866275-3772 wwwfppccagov
011700l70-NFH-0170bull
CALIFORNIA FORM 700 SCHEDULE D
FAIR POLITICAL PRACTICES COMMISSION
Income - Gifts Name
Chambe r s Tho mas R
bull NAME OF SOURCE (Not an Acronym)
Zach Deng
ADDRESS (Business Address Acceptable)
San Franc i sco CA 94 1 32
BUSINESS ACTIVITY IF ANY OF SOURCE
Student Lowell Hig h Sc hoo l
DATE (mmddyy) VALUE DESCRIPTION OF GIFT(S)
__- 0-- Costco Gift Card~1sectJJL $ 50 - 0
--1--1_ $____
--1--1__ $____
bull NAME OF SOURCE (Not an Acronym)
Lowell Soc i a l Committee ADDRESS (Business Address Acceptable)
San Franc isco CA 94 1 32 BUSINESS ACTIVITY IF ANY OF SOURCE
Lowell High School
DATE (mmddyy) VALUE DESCRIPTION OF GIFT(S)Oute r lands gift card for my retirement as teac he r
--1--1_ $ ____
--1--1__ $____
bull NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY IF ANY OF SOURCE
DATE (mmddyy) VALUE DESCRIPTION OF GIFT(S)
--1--1_ $____
--1--1__ $____
--1--1_ $____
bull NAME OF SOURCE (Not an Acronym)
Lowell Alumni Assoc i a ti o n
ADDRESS (Business Address Acceptable)
San Franc i sco CA 94 132
BUSINESS ACTIVITY IF ANY OF SOURCE
Lowe ll High Sc hoo l
DATE (mmlddyy) VALUE DESCRIPTION OF GIFT(S)
Amazon Gi f t Ca rd fo r my Re tirement
--1--1__ $____
bull NAME OF SOURCE (Not an Acronym)
Lowe ll Ma th Depa rtment
ADDRESS (Business Address Acceptable)
Sa n Fr ancisco CA 94 1 32 BUSINESS ACTIVITY IF ANY OF SOURCE
Lowell High Schoo l
DATE (mmlddyy) VALUE DESCRIPTION OF GIFT(S)Restau ran t Giftc ard for r eti rement as Dept Chai r
--1--1_ $____
--1--1__ $____
bull NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
BUSINESS ACTIVITY IF ANY OF SOURCE
DATE (mmlddyy) VALUE DESCRIPTION OF GIFT(S)
--1--1_ $____
--1--1_ $____
--1--1__ $____
Comments _________________________________________________________________________________________
FPPC Form 700 (20182019) Sch 0 FPPC Advice Email advicefppccagov
FPPC TolImiddotFree Helpline 866275-3772 wwwfppccagov
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