HomeMy WebLinkAboutItem 2 - Attachment 7 - Disclosure Statement�LA �M
Disclo -Ure Statement
Development S ervir-es pep. a rtrrr, rl
PEarar?ing Riv'rslan I Development P,raressing i
APPLICATION APPENDIX a
Pursuant to City Council f'ol€ey 1( 01, prior to any action On , -a natter that requires d€screti4nary action by the City
Enuncii, Planning Cariimisislon or vthoT official legislative body of the City, a statement of disclosure of cha in
be this ships, firtail�ill intere PaYrstertks a.rsii caMpaign contributions must lie filed. The f011owIDO (nforrha tinn must
be disclosed: '
x. Clst the names of alI'pet$phs having a financial interest In the project that ss the•subjectoftine
applich`fon,. pt0j;eC or cbntract [e.g., owner, appkant, contractor, subcontractor, materia Ip
sup
Z. if iany persoit* Identified in section 1, above is a corporation or partnership, list the names of all
fndfvl yais wltfr art InVestrnent of $2000 or rrio - in the business (corporattonlpartnershfial entity.
3. If any persan*i ldettitified in section 1, above is a non-prcafit arganixation or trust, its the names of
any person who Is the director of the rion-pro0t organlution or the names of the trustee, ber:eficlary
and trustor of the trust.
4. Please Identify every person, tncludtng arty agents, emplaxees, consultants, or independent
contractor's, Whom you have author€red to represent yow �efcre te City in this matter.
S. Has any person 4.14 in 1„ 24 3.1 or 4„ above, or otherwise associated with this contract, project
or app€i
DeveIoprnent Services Depar'trrlent
Planning Division I Development processing
APPLICATION APPENDIX 13
Disclosure Statement - Page 2
6. Has any.person *Identified in 1„ 2„ 3,, or R., above, or otherwise associated with th€s contract, project
ar applications made a Campaign contribution of more than $250 rvlthirl the post (12) months to
current memb&'of the City of Chula Vista Council ? Yes hto ►�
If yes which council member?
7. Has any person "identified In 1., 2, 3., or 4., above, or otherwise associated with this contract project
or application, provided snore than $420 (Oran item of equivalent value) to an Acial** of the City -of
Chula Vista in the past (12) months? Mill Includes any payment that confers a personal benefit on the
recipliem, a rebate or discount 1n the•priceof a hang of value, money to ret€re a legal debt, gift, town,
etc.) Yes -
If
If yes, which official'* and what was the nature of the Item provided?
8,
-Has any person 9dentif ed in 1., 2., 3., or 4., above, or otherwise associated with this contract, project
or application, been a source of income of $500 or more to an official*" of the City of Chula Vista in the
past (12) months? Yes sic
If yes, which official`* and the nature of the iters provided?
Date A A&n
Signature of Co D
r/Applicant
Print artype name of Contractor/Applicant
'a Person is identified as: any individual, firm, co -partnership, joint venture, association, social club,
fraternal organization, corporation, estate, trust, receiver, synd€tate, any other county, city, municlpaiity,
district, or other political subdivision, or any other group or combination acting of a unit,
+r* official includes, but is not Iimited to; MayciT, Council member, Planning Commissioner, Member of a
board, commission or committee of the City, and City emPloyee or staff members.
**� This disclosure Statement must be completed at the time the project application,r rr contract, is submitted
to city staff for processing, and updated within one week prior to consideration by legislative body.'
Last Updated. March 16, 2010
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Mr Okla
276 Furth Avenue I Chula Vista California 1 91Bt0