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Andy Faber - Annual 2004 CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION COVER PAGE STATEMENT OF ECONOMIC INTER II:) cv ... MM~CE an QIJO'f. ~ (MIDDLE) L. I ~ Q 2'.1'\ DAYTIME TEL~ / E NUMBER .r? It:; '>.1/ ~~286-5800 OPTIONAL: FAX I E-MAIL ADDRESS Please type or print in ink A Public Document NAME (LAST) Faber (FIRST) Andrew MAILING ADDRESS STREET (May use business address) CITY 10 Almaden Boulevard, 11th Floor San Jose 1. Office, Agency, or Court Name of Office, Agency, or Court: City of Gilroy Division, Board, District, if applicable: Your Position: Acting City Attorney - If filing for multiple positions, list additional agency(ies)/ position(s): (Attach a separate sheet if necessary.) County Regional Wastewater Authority 2. Jurisdiction of Office (Check at least one box) o State o County of [JtCity of Gi 1 roy o Multi-County o Other 3. Type of Statement (Check at least one box) D Assuming Officellnitial Date: .----1.----1_ Q Annual: The period covered is January 1, 2004, through December 31, 2004. -or- a The period covered is .----1.----1_. through December 31.2004. o Leaving Office Date Left: .----1.----1_ (Check one) a The period covered is January 1, 2004, through the date of leaving office. -or- a The period covered is .----1.----1_. through the date of leaving office. D Candidate STATE ZIP CODE CA 95113 4. Schedule Summary (Check applicable schedules or "No reportable interests. ") - During the reporting period, did you have any reportable interests to disclose on: Schedule A-1 ot Yes - schedule attached Investments (Less than 10% Ownership) Schedule A-2 DYes - schedule attached Investments (10% or greater Ownership) Schedule B Real Property DYes - schedule attached Schedule C []eYes - schedule attached Income. Loans, & Business Positions (Income Other than Gifts and Travel Payments) Schedule D (Eliminated - report loans on Schedule C) Schedule E Income - Gifts DYes - schedule attached Schedule F DYes - schedule attached Income - Travel Payments -or- _ 0 No reportable interests on any schedule ,Total number of pages completed including this cover page: 3 5. Verification 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 certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date Signed -, fJ JR5:y, year) ~- Signature (File the originally signed statement with your filing officiaL) FPPC Form 700 (2004/2005) FPPC Toll-Free Helpline: 866/ASK-FPPC SCHEDULE A-1 Investments Stocks, Bonds, and Other Interests (Ownership Interest is Less Than 10%) 00 not attach brokerage or financial statements. CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION Name Andrew L Fabpr > NAME OF BUSINESS ENTITY > NAME OF BUSINESS ENTITY Building H Associates GENERAL DESCRIPTION OF BUSINESS ACTIVITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY Industrial luilding Owner FAIR MARKET VALUE D $2,000 - $10,000 0$100,001 - $1,000,000 0$10,001 - $100,000 DOver $1,000,000 FAIR MARKET VALUE D $2,000 - $10,000 D $100,001 - $1,000,000 D $10,001 - $100,000 DOver $1.000.000 C;!X Other Partnpr~h;g ( escribe) NATURE OF INVESTMENT D Stock D Other (Describe) NATURE OF INVESTMENT D Stock IF APPLICABLE, LIST DATE: IF APPLICABLE, LIST DATE: ---1---1~ ACQUIRED ---1---1~ DISPOSED ---1---1~ ACQUIRED ---1---1~ DISPOSED > NAME OF BUSINESS ENTITY Trade Zone Associates GENERAL DESCRIPTION OF BUSINESS ACTIVITY > NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE D $2,000 - $10,000 D $100,001 - $1,000,000 IX] $10,001 - $100,000 DOver $1,000,000 FAIR MARKET VALUE D $2.000 - $10,000 D $100,001 - $1,000,000 D $10,001 - $100,000 DOver $1,000,000 Q Other Partnership' ( escribe) NATURE OF INVESTMENT D Stock D Other (Describe) NATURE OF INVESTMENT D Stock IF A!:'PLlCABLE, LIST DATE: IF APPLICABLE, LIST DATE: ---1---1~ ACQUIRED ---1---1~ DISPOSED ---1---1~ ACQUIRED ---1---1~ DISPOSED > NAME OF BUSINESS ENTITY > NAME OF BUSINESS ENTITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE o $2,000 - $10,000 D $100,001 - $1,000,000 D $10,001 - $100.000 DOver $1,000,000 FAIR MARKET VALUE D $2,000 - $10.000 D $100,001 - $1,000,000 D $10,001 - $100,000 DOver $1,000,000 NATURE OF INVESTMENT D Stock D Other NATURE OF INVESTMENT D Stock D Other (Describe) (Describe) IF APPLICABLE, LIST DATE: IF APPLICABLE, LIST DATE: ---1---1~ ACQUIRED ---1---1~ DISPOSED ---1---1~ ACQUIRED ---1---1~ DISPOSED Comments: FPPC Form 700 (2004/2005) Sch. A-1 FPPC Toll-Free Helpline: 866/ASK-FPPC . , . . SCHEDULE C Income, Loans* & Business Positions (Other than Gifts and Travel Payments) CALIFORNIA FORM 700 FAIR POLITICAL PRACTICES COMMISSION > 1. NAME OF SOURCE OF INCOME Berliner Cohen ADDRESS 10 Almaden Blvd, 11th Fir., San Jose, CA BUSINESS ACTIVITY, IF ANY, OF SOURCE 95113 Prnvi~p l~eRl R~rvires YOUR BUSINESS POSITION Partner GROSS INCOME RECEIVED/HIGHEST BALANCE DURING REPORTING PERIOD, IF LOAN D $500 - $1,000 0 $1,001 - $10,000 o $10,001 - $100,000 g OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED Q Salary 0 Spouse's income 0 Loan repayment o Sale of (Property, car, boat, etc) o Commission or D Rental Income, /1st each source of $10,000 or more o Other (Describe) o LOAN RECEIVED (complete box 2) Name Andrew L. Faber > 1. NAME OF SOURCE OF INCOME ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSiTION GROSS INCOME RECEIVED/HIGHEST BALANCE DURING REPORTING PERIOD, IF LOAN 0$500 - $1,000 0 $1,001 - $10,000 0$10,001 - $100,000 0 OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED o Salary 0 Spouse's income 0 Loan repayment o Sale of (Property, car, boat, etc) o Commission or 0 Rental Income, lis/ each source of $10.000 or more D Other (Describe) D LOAN RECEIVED (complete box 2) ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME RECEIVED/HIGHEST BALANCE DURING REPORTING PERIOD, IF LOAN 0$500-$1,000 0$1,001-$10,000 D $10,001 - $100,000 0 OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED D Salary D Spouse's income D Loan repayment D Sale of (Property, car, boat, etc) o Commission or D Rental Income, fist each source of $/0,000 or more D Other (Describe) D LOAN RECEIVED (complete box 2) INTEREST RATE TERM (Months/Years) % D None SECURITY FOR LOAN o None D Personal residence D Real Property Street address City D Guarantor D Other (Describe) * You are not required to report loans from commercial lending institutions, 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. Comments: FPPC Form 700 (2004/2005) Sch. C FPPC Toll-Free Helpline: 866/ASK-FPPC