CITY OF CHULA VISTA DISCLOSURE STATEMENT
PursuanttoCouncilPolicy101-01, priortoanyactionuponmattersthatwillrequirediscretionaryaction bytheCouncil, PlanningCommissionandallotherofficialbodiesoftheCityofChulaVista (the "City" ), astatementofdisclosureof certainownershiporfinancialinterests, payments, orcampaigncontributions foraCityelectionmustbefiled. Thefollowinginformationmustbedisclosed:
1. Listthenamesof allpersonshavingafinancialinterestinthepropertythatisthesubjectofthe applicationor the contract, e.g., owner, applicant, contractor, subcontractor, material supplier. l nJ0N' 11
2. If anyperson* identifiedpursuanttoitemone (1) aboveisacorporationorpartnership, listthe names of all individuals with a two thousand dollars ($ 2,000) investment in the business corporation/ partnership) entity.
C-/
A)
3. If anyperson* identifiedpursuanttoitemone (1) aboveis anon-profitorganizationortrust, list the namesof any personservingas directorof the non-profit organizationor as trusteeor beneficiary or trustor of the trust. (- 411% )
4. Pleaseidentify every person, includingany agents, employees, consultants, or independent contractorsyouhaveassignedto `representyoubeforetheCityin thismatter. 6A- t >=% A-) o .
St%
tb1 ST
1- Ion . 1-1 SS* 1
5. Hasanyperson* associatedwith thiscontracthadanyfinancialdealingswith anofficial** of the City asit relatesto this contractwithin the pasttwelve (12) months? Yes No (/ 26 Q:1_ProjectslTRF0415 -TelegraphRaisedMedianImprovementsWidPackagelTRF0415&TRF0411PrevailingWageBidPackage 2014. 08. 12). docx
Rev. 811212024
f Yes, briefly describethenatureof thefinancialinteresttheofficial" may have in this contract.
6. Haveyoumadeacontributionofmorethantwohundredfifty dollars ($250) within the past twelve 12) monthstoacurrentmemberoftheChulaVistaCityCouncil? Noleles _ If yes, which Council member?
7. Haveyouprovidedmorethanthreehundredfortydollars ($340), or an item of equivalent value, to an official** of the City in the past twelve ( 12) months? ( This includesbeing a sourceof income, money to retire a legal debt, gift, loan, etc.) Yes _ No If Yes, which official** and what was the nature of item provided? Date: V V " / — [
TRI - GROUP
CONSTRUCTION AND
DEVELOPMENT, INC.
Nameof Company, FirmorEntity
Signature of Contractor/ Applicant
RANI ASW
Print or type name of Contractor/ Applicant
Title
9ECRRTARYfF QORPORATION
Personis definedas: anyindividual, firm, co -partnership, joint venture, association, socialclub, fraternalorganization, corporation, estate, trust, receiver, syndicate, anyothercounty, city, municipality, district, orotherpoliticalsubdivision, oranyothergrouporcombinationactingasa unit.
Officialincludes, butisnotlimitedto: Mayor, Councilmember, PlanningCommissioner, Member of a board, commission, orcommitteeof theCity, employee, orstaffmembers. 27 Q: I_ProjectslTRF041S -TelegraphRaisedMedianImprovements0idPackagelTRF0415& TRF0411PrevailingWageBidPackage 2024. 08. 12). docx
Rev. 8/ 12/ 2024