DocuSign Envelope ID: 10E8CE32- 5300- 4073- gDED- EC10A64BB045 Heritage Road Bridge Replacement STM0386 &
Main Street Widening STM0388 Projects
CITY OF CHULA VISTA DISCLOSURE STATEMENT
Pursuantto Council Policy 101-01, prior to any action uponmattersthat will require discretionaryaction by the Council, PlanningCommissionandall other official bodiesof the City of Chula Vista (the "City", a statementof disclosureof certainownershipor financial interests, payments, or campaigncontributions for a City election must be filed. The following information must be disclosed:
1. List the names of all personshaving a financial interest in the property that is the subject of the application or the contract, e.g., owner, applicant, contractor, subcontractor, material supplier.
Not Applicable
2. If any person* identified pursuantto item one (1) aboveis a corporation or partnership, list the names of all individuals with a two thousand dollars ($ 2000) investment in the business corporation/ partnership) entity.
Not Applicable
3. If any person* identified pursuantto item one (1) aboveis a non-profit organizationor 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.
Not Applicable
4. Please identify every person, including any agents, employees, consultants, or independent contractors you have assigned to represent you before the City in this matter.
Not Applicable
5. Has any person* associatedwith this contracthad any financial dealingswith anofficial** of the City as it relates to this contract within the past twelve ( 12) months? Yes No X Federal Aid: BRLS- 5203( 039) 48
QA_Projects\ STM386 Heritage Bridge\ Bid Package\01 Front End\ source\STM386 - Federal Wage Bid Package.docx ocuSign Envelope ID: 10E8CE32- 5300- 4073- 9DED- EC10A64BB045 Heritage Road Bridge Replacement STM0386 &
Main Street Widening STM0388 Projects
If Yes, briefly describe the nature of the financial interest the official* * may have in this contract.
6. Have you made a contribution of more than two hundred fifty dollars ($ 250) within the past twelve ( 12) months to a current member of the Chula Vista City Council? No X Yes _ If yes, which Council member?
7. Have you provided more than three hundred forty 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? Date: September 4, 2024
Flatiron West, Inc.
Name of Company, Firm or Entity
Signa re of Contract r/App i
Mario Martinez
Print or type name of Contractor/ Applicant
Vice President
Title
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, employee, or staff members.
Federal Aid: BRLS- 5203( 039) 49
Q:\_Projects\ STM386 Heritage Bridge\ Bid Package\01 Front End\ source\STM386 - Federal Wage Bid Package. docx