CITY OF
CHULA VISTA 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 of disclosure of certain ownerships, financial interests, payments, and campaign contributions must be filed. The following information must be disclosed:
1. List the names of all persons* having a financial interest in the project that is the subject of the application, project or contract (e.g. owner, applicant, contractor, subcontractor, material supplier).
None. Eastlake Behavioral Health, LLC is jointly owned by Acadia Healthcare Company, Inc., Franklin, TN and Scripps Health, San Diego, CA
2. If any person* identified in section 1. is a corporation or partnership, list the names o ıll individuals with an investment of $2000 or more in the entity Acadia San Diego JV Holdings, LLC
Scripps Behavioral Health Venture, LLC
3. If any person* identified in section 1. is a non-profit organization or trust, list the names of any person who is the director of the non-profit organization or the names of the trustee, beneficiary and trustor of the trust.
To be determined by Acadia San Diego JV Holdings, LLC and Scripps Behavioral Health Venture, LLC
4. Please identify every person,* including any agents, employees, consultants, or independent contractors, whom you have authorized to represent you before the City in this matter.
Robin Madaffer, ESQ - San Diego Land Lawyer
Stephen Wen, AIA - SWA Architects
5. Has any person* identified in 1., 2., 3., or 4., above, or otherwise associated with this contract, project or application, had any financial 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 X
If Yes, briefly describe the nature of the financial interest the official** may have in this contract.
6. Has any person* anyone 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 twelve (12) months to an official of the City of Chula Vista? _ If yes, which official?
276 Fourth Avenue Chula Vista California | 91910 1 (619) 585-5722 Revised 010714.DTD
CITY OF
CHULA VISTA DISCLOSURE STATEMENT***
7. Has any person* identified in 1., 2., 3., or 4., above, or otherwise associated with this contract, project or application, provided more than $460 (or an item of equivalent value) to an official** of the City of Chula Vista in the past twelve (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 No X
If Yes, which official** and what was the nature of item provided?
8. Has any person* identified 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 twelve (12) months? Yes_ No X
If Yes, identify the official** and the nature of the income provided? ( He lit
Date: November 22, 2021
Signature of Contractor/Applicant
Isa Diaz Eastlake Behavioral Health, LLC
Print or type name of Contractor/Applicant
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 the legislative body. * 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, and City employees or staff members. 276 Fourth Avenue Chula Vista California 91910| (619) 585-5722 Revised 010714.DTD