CITY OF CHULA VISTA DISCLOSURE STATEMENT
PursuanttoCouncilPolicy101-01, priortoanyactionuponmattersthatwill requirediscretionaryaction bytheCouncil, PlanningCommissionandallotherofficialbodiesoftheCityofChulaVista (the "City"), a statementof disclosureof certainownershipor financialinterests, payments, or campaigncontributions foraCityelectionmustbefiled. Thefollowinginformationmustbedisclosed:
List thenamesof all personshavinga financialinterestin thepropertythatis thesubjectof the applicatio or the contract, e.g., owner, applicant, contractor, subcontractor, material supplier. 09 2. If anyperson* identifiedpursuanttoitemone (1) aboveisacorporationorpartnership, listthenamesof all individualswith a two thousanddollars ($2,000) investmentin the business corporation/ partnership) entity.
N ( A
3. Ifanyperson* identifiedpursuanttoitemone (1) aboveisanon-profitorganizationortrust, listthe namesof anypersonservingas directorof the non-profit organizationor astrusteeor beneficiary or trustor of the trust.
tt/! Jq
4. Pleaseidentifyeveryperson, includinganyagents, employees, consultants, or independentcontractorsyou have assignedto representyou beforethe City in this matter.
N 119
5. Hasanyperson* associatedwiththiscontracthadanyfinancialdealingswithanofficial** ofthe Cityasit relatestothiscontractwithinthepasttwelve (12) months? Yes_ No X 69 21
QA_Profects1Sli'R0314 & 320 - MHRehabCOMBOIBidPackagelSpecifications1100%.SpecsWVR0314&320_Pt1 Specs_( FINAL)_ 2023. 06. 02.doc Rea3/ 3/ 1023
If Yes, brieflydescribethenatureof thefinancialinteresttheofficial** mayhaveinthiscontract.
6. Haveyou madea contribution of morethan two hundredfifty dollars ($250) within the pasttwelve 12) months to a current member of the Chula Vista City Council? NoX Yes _ If yes, which Council member?
Haveyou providedmorethanthreehundredforty dollars ($340), or anitem of equivalentvalue, to anofficial** oftheCityinthepasttwelve (12) months? (Thisincludesbeingasourceof income, moneyto retirealegaldebt, gift, loan, etc.) Yes _ No x
If Yes, which official** and what was the nature of item provided? N / g
Date: 7/ 27 / 2023
H+.7Cun / Ec. QL041C- c / Nt
Name of Company, Firm or Entity
ignat ontractor/ Applicant
94A^I 4ee-vv.riL'k- Print or type name of Contractor/ Applicant 1 KicS 06 C
Title
Personis definedas: anyindividual, firm, co -partnership, joint venture, association, socialclub, fraternal organization, corporation, estate, trust, receiver, syndicate, any other county, city, municipality, district, or otherpolitical subdivision, or any othergroupor combinationactingasa unit.
Official includes, but is notlimited to: Mayor, Councilmember, PlanningCommissioner, Member of a board, commission, or committee of the City, employee, or staff members. 22 Q:1_ProjectslSWR0314 & 320- MHRehabCOMBOIBidPackagelSpecificationsll00% SpecsISWR0314&320_PIISpecs_(F1NAL)_ 2023. 06.02.doca Rev. 31112023