HomeMy WebLinkAboutItem 4 - Attachment 5 Disclosure Statement D eve | Vprnent S erVic e Oep artnnemt
Planning Division | Development Processing
CITY Or
CHULA VISTA APPLICATION APPENDIX 8
Disclosure Statement
Pursuant to City council Policy 101-01, prior to any action on a matter that requires discretionary action by the City
Council, Planning Commission or other official legislative body of the City, a statement ofdisclosure ofcertain
ownerships,financial interest, payments,and campaign contributions must befi|ed The foUowinginformation must
be disclosed:
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1, List the names of all persons having a financial interest in the project that is the subject of the
application, project orcontract (e.g,,owner,applicant, contractor, swbcontractur, material supp|/er)
TADKXUR8(}KA STANTONH�3R|UCH/ '
KEN MURAOKA MICHAEL KINOSHITA
ROY MURAOKA
2. If any person* identified in section 1. above is a corporation or partnership, list the names of all
individuals with aninvestment of $2OOOormore 7nthe business (cmrpmratiom/partne,*Npentity.
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3, If any person* identified in section 1.above is a non-profit organization or trust, list the names of
any person who |sthe director ofthe non-profit organization mrthe names mfthe trusree beneOdary
andtrustor ofthe trust.
'
N/A
4, Please identify every person, including any agents, employees,consultants,or independent
contractors, nvhomyou have authorized turepresent you before the City |nthis matter.5, Has any person *identified in l 2 3 or above,or /1h this, , .' , , vv scontoact, project
orapplication, had any financial dealings with anmfMda!°°mfthe City ofChula \ �— as |tre|atestmthis
contract, project mapplication within the past 12 months? YesNo X
������
|fyes, briefly describe the nature ofthe financial interest the nfNcia|** nnayhave inthis contr�ct
N/A '
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276 Fourth Avenue A Chula Vista | California | 91910 | (619) 691.5101 Rev
0gYe / gpnnent Services Deparirnemt
tffti IF Planning Division | Development Processing
C"y OF
04A.A VISTA APPLICATION APPENDIX B
Disclosure Statement ' Page 2
6. Has any person *identified in 1.,2., 3., 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 ofthe City ofChula Vista Council ? YeyNo X
if yes vvh|chcound| mennber7 NIA
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7. Haaanypeoon *|demtified |n1., 2, 3, or4, above, orothemwbeassoc|atedwiththiscontmct, puoject
or application, provided more than $420 (or an item of equivalent value) to an official"of the City of
Chula Vista inthe past (12) months7 (This includes any payment that confers apersonal benefit onthe
recipient,a rebate or discount in the price of anything of value, money to retire a legal debt, gift, loan,
etc.) YesNo_X___
|fyes,which mhhda|" and what was the nature ofthe item provided? N0'
8. Has any person *identified in l, I, 3, or 4., above,or otherwise associated with this contract' project
orapp|ication, baenasuurceofincomeof$S0Oornomnetoano1fidm|**oftheOtyof Chula Vista |nthe
past (l]) months? Yes_____
|fyes, which of0da|" and the nature ofthe item provided?
Date
MICHAEL KINOSHITA
Print or type name of Contractor/Applicant
°
Person isidentified as:any individual,firm, co-partnership,joint venture,association, social club,
fraternal organization, corporation, estate,trust, receiver, syndicate,any other couinty,city, municipality,
district or other political subdivision, m/any other group or combination acting as a unit,
**
official includes, but |snot limited to: Mayor, Council member, Planning Commissioner, Member ofa
board,commission orcommittee ofthe City,and City employee o, staff members.
*�*
This disclosure Statement must be completed at the time the project application,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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