HomeMy WebLinkAboutItem 3 - Attachment 3 Disclosure Statement D e v e l o p m e n t S e r v i c e s D e p a r t m e n t
Planning Division Development Processing
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CHuwVISR r W APPLICATION APPENDIX B
Disclosure Statement
Pursuant to City Council Policy i of-01, prior to any action on a matter that requires discretionary action by the City
Council, Plan ning.Commisslon or other official legislative body of the City,a statement of disclosure of certain
ownerships,financial Interest,payments,and campaign contributions must be filed, The following information must
be disclosed.
i, List the names of all persons having a financial interest in the project that is the subject of the
app!€cation,project or contract(e.g.,owner,applicant,contractor,subcontractor,material suppller).
Otay River Buslness Park Development,€LC
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2. If any person"identified In section 1.above is a corporation or partners.hlp,list the names of all
individuals with an investment of$.2000 or more irk the business(corporation/partnership)entity,
3.. if any person*identified in section 1.above is a non-profit organization or trust,list the names of i
an.y person who is the director of the noes-profit organization or the names of the trustee,beneficiary
and trustor of the trust.
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4. Please identify every person,including any agents,employees,consultants,or independent E
tontractors,Whom you have authorized to represent you before.the City In thls matter.
5, Has any person fldent€fled in 1., 2.,3.,or 4.,above,or otherwise associated with this contract,project
or application, had any flnancial dealings with an official**of the City of Chula Vista as it relates to this
contract, project or application within the past 12 months? Yes No V
If yes,briefly describe the nature of the financial interest the official"may have€n this contract.
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X76 Fourth Avenue I Chula Vista California 1 9191.0 1 (619) 691.5101 " Ti
D eveIopm e n t Services Department
Planning Division I Development Processing
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CHULAVISR APPLICATION APPENDIX 6
Disclosure Statement - Page 2
6. Has any person Nd.entified.€n 1.,2.13.,or 4,,above,or otherwise associated with this contract, project
or application,made a campaign contribution of more than$250 within the past(12) months to a
current member of the City of Chula Vista Council ? Yes- No
If yes which council member?
T. Has any person*Identified in.1.,2.,3.,or 4,,above,or otherw€se associated with this contract,project
or application;provided more than$420 for an item of equivalent value)to an official**.of the City of
Chula Vista in the past(12)months? (This includes any:payment that confers a personal benefit on the
recipient,a rebate or discount in the price of anything of value,money to retire a legal debt,gift,loan,
etc.) Yes I+lo V
If yes,which official** and what was the nature of the item.provided?
S. Has any person Ndentified 1n i.,2.,.3.,or 4.,above,or otherwise associated with this contract, project.
or application,been a source of income of$500 or more to an official**ofthe City of Chula Vista in the
past(12)months? Yes No V I.
if yes,which official" and the nature of the item provided?
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- ...Date.-
Signoture of Contractor/Applicant
Rich$inions-Otay River Business Parkdevel+5p W,LLC .
Print or type risme of Co ntractodAp.plicant
* Person is identifled as:any individual,firm,to-pa rtnership,}oint venture,association;social club,
fraternal organization,corporation,estater 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,and City employee or staff members.
*** ThIs disclosure Statement must be completed at the time the project appllcatlon;or 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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276 fourth Avenue j Chula Vista California 1 91910 1 (619) 691.5161