HomeMy WebLinkAboutAttachment 9 Disclosure Statement- D e v'e I o p m a n t S e r y l c c s D e p a. r t m a h t
Planning Division I Development Processing
CHL4AVISn APPLICATION APPENDIX B
Disclosure Statement -�— - -
Pursuant to City punc(I Policy 101.Oj prior tgany action offamatterthpteequiresoiscretlo.naryastion by the City
Council, Planning Commission of other official legislative body of the City,. a statement of disclgsgre:..q
ownership$,finandal Interest,payments, and ::€ampaign contribufons must be fled, The following lnformatlon must
be: disclosed.,
1. List the names of all persons having a financial interest in the ioroject that is the subject of the – - -
application, project orcontren(eq owner,applcant, contractor, subtontractor, mateir supplier),
flory?;.: Fbatbke aehavnrel Heads, ucrolaouyoHn`?a
byAesdia HsafttPreeampany ino,)`nIAW TH and
SeripLA Heallh Ban 111agq CA - _ _ -
Y, If any person*IdentifiedInsection .1. above is a corporation or partnership, list the names of all
- Individualswhh anfnvestment of $2000 of moreln the business (corporatlonlpartnershlp)entity.
AM& San Diego N Hoidines, LLC
. SMppa eohaybral Healgl VenNl[e, LLC'
- - 3, If any person' identifted l`n section 1. above is a non-profit organization or trust, list they names of
any peiabn who Is the dh'ectorofthe non-profitorganizatlon or the names of the trustee, beryeficloy -
and thAtor of the trust. - -
TopadetonninadbyAcadsn$an D*OJVHolding&LLC - -.
-- - _ mxl,'�dnppsBebaylural Haaab VeMuMLLc
4. Please identifyevery personilncludng ahyage05s,employees; consul tants;tij codependent.
contractors, Whom you have authgri;ed to represent you before the City In this matter.
Robirrlladalkr, ESD. Sen Dkgo Land.LaWyef - - -
$tepheoWon. ALA •SWAArehitede
- —5, Has any person "Identifled in ]., 3,e3., oro„ above, or otherwise associated with This contract, project
or application, had: any financial dealings with:an officiai"of the City of Chula Vista as it relates to this
contractrproject orapplication wirhlnthepasf12months? Yex.,—._, No,�/t�,
If yes, briefly describe the nature of the financial interest the official- may have in this contract:
40f9
276 Fourth Avenue I Chula Vista � California 1 91910 1 (619) 691.5101
pev-j�Iopment 50tVIF.as. D e p a rtment
Planning. Division I Development Processing
OF
CHUAVISTA APPLI TION A;PPEROWB
Disclosure Statement - Page 2
6.
7. Has any person 1dentlfletf1n'1•,3u3„ar4nAbove, or otherwise associated with this coffifact, project.
or appUcation, pro4lied hmretharr 4430 (p7-sroitem of equivalent value) tman official** of thea Cify of
Chula Vista in the past 1127 mohth32 (Thlsincludes any payment that confers personal benefit on the
reciplent, a rebate drdlscountfnthepttta 6f anything of valn6x money to retire a legal dept, gift, loan,
etc') Yes„_ No -/ If yes, which official** and what Was the hature of the Item provided?
S. Has any person "identified In 1 v 2.r 3., or4., above, or otherwise associated With this contract, project
-: or appifcation, been a source of Income of $500 or mote to an official*” of the City of Chula Vigo In the
past (127 months? Yes_,,., NO, _J.
- If yes, which official** and the nature of the Item provided?
Rate. May 1Y, 2019 C�L
_ - Signa m9fConr tpr/Appllcaht - -
- - - - :Anal Hamer l Eacaake eoWaral Heam:, tkc
-- Print or type. name of Contractor/Applicant..
* Person is identified„,as: any 041vit0al,firm,co-partnershlp,joint venturerassdelation, social club, -- - ----
_ fratarhalorganiz,ation,aorpofatior`F,estate,ttuit,receivoHtsy`hdtGata,anyothLieounty,rJtymunicipabty,.
district, or other political subdivision, ar any othet group or combination acting asunit.
**
official includes, but Is not limited' to: Mayor, Council member; Planning Commissioner, Member of
_board, commission of committee of the City, and City employee or staff Members._
*** This disclogure5tatOment must be_ completed at the time the Of.gjkt application, Or Conradi, Is submitted
to City staff for processing, and updated within one week prionto consideration by legislative body,.
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Last Updated; Match 76;201,0
Sof9 276 Fourth Avenue Chula Vista I Callfornia 1 91910 1 (619) 691.5101 wv4 1f