CITY OF CHULA VISTA DISCLOSURE STATEMENT
Pursuantto CouncilPolicy 101-01, prior to anyactionuponmattersthatwill requirediscretionaryaction bytheCouncil, PlanningCommissionandall otherofficialbodiesof theCityof ChulaVista (the "City"), a statementof disclosure of certain ownership or financial interests, payments, or campaigncontributions for a City electionmustbefiled. Thefollowing informationmustbedisclosed:
1. List the namesof all personshaving a financial interestin the propertythat is the subjectof the application or the contract, e.g., owner, applicant, contractor, subcontractor, material supplier.
N/ A
2. If anyperson* identifiedpursuantto item one (1) aboveis a corporationor partnership, list the names of all individuals with a two thousand dollars ($ 2, 000) investment in the business corporation/ partnership) entity.
N/ A
3. If any person* identified pursuant to item one (1) above is a non-profit organization or trust, list the names of any person serving as director of the non-profit organization or as trustee or beneficiary or trustor of the trust.
N/ A
4. Please identify every person, including any agents, employees, consultants, or independent contractorsyou haveassignedto representyou beforethe City in this matter.
N/ A
5. Hasanyperson* associatedwith this contracthadanyfinancial dealingswith anofficial** of the City as it relates to this contract within the past twelve ( 12) months? Yes No X N/ A
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If Yes, briefly describe the nature of the financial interest the official" may have in this contract.
N/ A
6. Haveyou madeacontributionof morethantwo hundredfifty dollars ($250) within the past twelve 12) monthsto a currentmemberof the ChulaVista City Council? No x Yes If yes, which Council member?
N/ A
7. Have you provided more than threehundredforty dollars ($340), or an item of equivalent value, to an official** of the City in the past twelve ( 12) months? (This includes being a source of income, money to retire a legal debt, gift, loan, etc.) Yes — No x If Yes, which official * * and what was the nature of item provided? N/ A
Date: S 10 / 7 62S
SCW Contracting Corp.
Name of Company, Firm or Entity Print or type name of Contractor/ Applicant Vice President
Title
Personis 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 otherpolitical subdivision, or anyothergroupor combinationactingasaunit.
Official includes, butis notlimited to: Mayor, Councilmember, PlanningCommissioner, Member of aboard, commission, or committeeof theCity, employee, or staffmembers. 29 Q: I_ProjecLOSWR0275 - ForceMain at GStreetPumpStationlBidPackagelzArehiveWWR0275-SWR0309Front End.docx Rev. 3/ 3/ 2023