HomeMy WebLinkAboutItem 2 - Attachment 4 - Disclosure StatementP l a n n i n g & B u i 1" d i n g D e p a r t m e n It
CITY OF Planning Division Development Processing
CHULA VISTA
APPLICATION APPENDIX B
Disclosure Statement
Pursuant to Council Policy 101 -01, prior to any action upon matters that will require discretionary action by the Council,
Planning Commission and all other official bodies of the City, a statement of disclosure of certain ownership or financial
interests, payments, or campaign contributions for a City of Chula Vista election must be filed. The following information
must be disclosed:
1. List the names of all persons having a financial interest in the property that is the subject of the application or the
contract, e.g., owner, applicant, contractor, subcontractor, material supplier.
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2. If any person* identified pursuant to (1) above is a corporation or partnership, list the names of all individuals with
a $2000 investment in the business (corporation /partnership) entity.
3. If any person* identified pursuant to (1) above is a non - profit organization or trust, list the names of any person
serving as' director 'of the non - profit organization or as trustee or beneficiary or trustor of the trust.
4. Please identify every person, including any agents, employees, consultants, or independent contractors you have
assigned to represent you before the City in this matter.
5. Has any person* associated with this contract had any financial dealings with an official" of the City of Chula
Vista as it relates to this contract within the past 12 months. Yes No
If Yes, briefly describe the nature of the financial interest the official'" may have in this contract.
6. Have you made a contribution of more than $250 within the past twelve (12) months to a current member of the
Chula Vista City Council? Nox— Yes _ If yes, which Council member?
276 Fourth Avenue I Chula Vista I California I 91910 I (619) 691 -5101
Attachment 4
u -�--�- P I a n n i n g & B u i l d i n g D e p a r t m e n t
CITY OF Planning Division Development Processing
CHULA VISTA
APPLICATION APPENDIX B
Disclosure Statement — Page 2
7. Have you provided more than $340 (or an item of equivalent value) to an official ** of the City of Chula Vista in the
past twelve (12) months? (This includes being a source of income, money to retire a legal debt, gift, loan, etc.)
Yes _ No Y
If Yes, which official ** and what was the nature of item provided?
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type name of Contractor /Applicant
* Person is defined as: any individual, firm, co- partnership, joint venture, association, social club, fraternal
organization, corporation, estate, trust, receiver, syndicate, any other county, city, municipality, district, or other
political subdivision, -or any other group or combination acting as a unit.
** Official includes, but is not limited to: Mayor, Council member, Planning Commissioner, Member of a board,
commission, or committee of the City, employee, or staff members.
276 Fourth Avenue I Chula Vista I California I 91910 I (619) 691 -5101