2019_Q3;FSB_PUBLIC_AFFAIRS_INC;AMANTE, JERRY City of Anaheim
Office of the City Clerk
Please submit completed form(s) to:
Mail or in person: Office of the City Clerk
200 S. Anaheim Blvd. Ste. 217, Anaheim, CA 92805; or
Email: tbass@anaheim.net; or FFax: (714) 765-4105
LOBBYIST’S QUARTERLY REPORT OF ACTIVITY
CHECK APPLICABLE REPORTING PERIOD:
Q1: Due April 30 (January 1 - March 31) Q3: Due October 31 (July 1 - September 30)
Year ____________
Q2: Due July 31 (April 1 - June 30) Q4: Due January 31 (October 1 - December 31)
Lobbyist’s Quarterly Report of Activity Rev 06/19 Page ____ of ____
LOBBYIST INFORMATION
NAME OF LOBBYIST (Last, First, M.I.) NAME OF LOBBYING FIRM (if applicable)
BUSINESS EMAIL BUSINESS PHONE (XXX) XXX-XXXX
BUSINESS ADDRESS CITY STATE ZIP CCODE
REPORTING SCHEDULES CHECK ALL APPLICABLE
No Lobbying Activity Lobbying Activity/
Client Disclosure Report Campaign Contribution Report
I ddid not participate or engage in aany
fform of lobbying during the reporting
period.
Schedule A: Report aany form of
lobbying by the lobbying firm/ lobbyist
of the City of Anaheim or any regional
agency in which Anaheim has a voting
role during this reporting period.
Schedule B: Report aany ccontributions
made during the reporting period to
the Mayor or any City Council Member
by the lobbying firm/lobbyist.
Verification
I certify that I have reviewed Ordinance No. 6417, made available on the City of Anaheim’s website and reviewed
all applicable lobbying provisions. I declare under penalty of perjury under the laws of the State of California that
the information contained herein is true and accurate to the best of my knowledge.
SIGNATURE OF LOBBYIST PRINT NAME OF LOBBYIST
NAME OF LOBBYING FIRM (if applicable) DATE (mm/dd/yyyy)
2019
Amante, Jerry FSB Public Affairs, Inc.
Jamante@fsbcorestrategies.com (949) 336-4500
2099 S. State College Blvd.Anaheim CA 92806
Amante, Jerry
FSB Public Affairs, Inc. 10/31/2019
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Jerry Amante Digitally signed by Jerry Amante
Date: 2019.10.31 14:45:12 -07'00'
RECEIVED: October 31, 2019
City of Anaheim-Office of the City Clerk
City of Anaheim
Office of the City Clerk
Name: __________________________________________
SCHEDULE A – CLIENT DISCLOSURE
CHECK APPLICABLE REPORTING PERIOD:
Q1: Due April 30 (January 1 - March 31) Q3: Due October 31 (July 1 - September 30)
Year ____________ Q2: Due July 31 (April 1 - June 30) Q4: Due January 31 (October 1 - December 31)
Note: Complete this form for each client in which five hundred dollars ($500) or more was received in a calendar month.
Schedule A – Client Disclosure (Rev 06/19) Page ____ of ____
CLIENT INFORMATION Total Compensation Lobbyist
RReceived from Client: $
NAME OF CCLIENT (Last, First, M.I.) BUSINESS NAME BUSINESS PHONE (XXX) XXX-XXXX
BUSINESS ADDRESS CITY STATE ZIP CODE
CLIENT DDISCLOSURE
Describe the local legislative or administrative action(s) that the lobbying firm/loobbyist supported or opposed during the reporting period.
Disclose any form of communication by the lobbying firm/lobbyist during the reporting period. Use a separate entry for each
new contact.
1.DATE OF CONTACT NAME & TITLE OF CITY OFFICIAL OR STAFF CONTACTED NAME OF LOBBYIST
DESCRIBE PURPOSE OF MEETING::
2.DATE OF CONTACT NAME & TITLE OF CITY OFFICIAL OR STAFF CONTACTED NAME OF LOBBYIST
DESCRIBE PURPOSE OF MEETING::
3.DATE OF CONTACT NAME &TITLE OF CITY OFFICIAL OR STAFF CONTACTED NAME OF LOBBYIST
DESCRIBE PURPOSE OF MEETING::
4.DATE OF CONTACT NAME & TITLE OF CITY OFFICIAL OR STAFF CONTACTED NAME OF LOBBYIST
DESCRIBE PURPOSE OF MEETING::
If more space is needed check box and attach additional pages.
Amante, Jerry
2019
Kanne, Larry A2D Sports, LLC (562) 754-7237
14218 Aliso Ct. Chino Hills CA 91709
None during this period.
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City of Anaheim
OOffice of the City Clerk
Name: __________________________________________
SCHEDULE B – CAMPAIGN CONTRIBUTIONS
CHECK APPLICABLE REPORTING PERIOD:
Q1: Due April 30 (January 1 - March 31) Q3: Due October 31 (July 1 - September 30)
Year ____________ Q2: Due July 31 (April 1 - June 30) Q4: Due January 31 (October 1 - December 31)
Note: This form is to report campaign contributions made to any member of the City Council by the lobbying
firm/lobbyist during the reporting period.
Schedule B – Campaign Contributions Rev. 06/19 Page ____ of ____
CAMPAIGN CONTRIBUTIONSS
Disclose all campaign contributions by the lobbying firm/lobbyist during the reporting period.
DATE AMOUNT NAME OF CONTRIBUTION RECIPIENT NAME OF LLOBBYIST
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Amante, Jerry
2019
NONE
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