xxiii | David Evans and Associates, Inc.
FORMS
95 D. DISCLOSURE - CAMPAIGN FINANCE ORDINANCE – CONTRACTORS AND SUBCONTRACTORS
The City Council adopted Ordinance No. 5744, “Campaign Finance Ordinance,” which became effective on September 9, 2011, and amended it with Ordinance No. 5768, which became effective on March 15, 2012 (“the Ordinance”). The Ordinance prohibits: (1) A contractor * (including a subcontractor**)― who has a contract with the City of Glendale (“City”), Glendale Successor Agency or Glendale Redevelopment Agency (“GSA”), or the Housing Authority of the City of Glendale (“HA”) and that contract is subject to approval by the City Council, GSA, or HA― from making a contribution to a City Council member, GSA member, HA member, City Clerk, or City Treasurer; and (2) Council members, GSA members, and HA members from voting on matters concerning a contract affecting a contractor or subcontractor who has provided a campaign contribution.
The provisions of the Ordinance restricting Council members from voting on matters affecting campaign contributors applies to a contractor whose contract requires the City Council’s, GSA’s, or HA’s approval, and specified subcontractors. A contract with the City, GSA, or HA is known as a “City Contract.” The Ordinance excludes a competitively bid contract awarded to the lowest responsible bidder.
To assist members of the City Council, GSA, and HA before they vote on a matter regarding a City Contract, the Ordinance requires City staff to prepare this report which discloses certain information about: the contractor receiving the City Contract, and specified subcontractor(s) working under the City Contract.
Information that must be disclosed: ● Name of the person, entity, or organization (i.e., the Contractor or Subcontractor) ● Name of the Chief Executive Officer/President
● Chief Operating Officer
● Chief Financial Officer
● Chairperson
● All members of the Board of Directors
● All persons who own more than 10% of the person, entity, or organization ● Name of any campaign committee owned or controlled by the person, entity, or organization Please complete the following disclosure form:
Contractor(s)*:
Name Address
Full Name Title Business Address City State Zip
Chairperson
Chief Executive Officer / President
Chief Operating Officer
Chief Financial Officer
Board of Directors
More than 10% interest owner
* “Contractor” is the person, entity, or organization that is the party, or prospective party, to the contract with the City, GSA, or HA. In addition to the name of the person, or entity, the Contractor must also disclose the name(s) of that person’s, entity’s, or orga nization’s Board of Directors, its Chairperson, Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, any person with an ownership interest of more than ten percent (10%) in that person, entity, or organization, and any campaign committee that is owned or controlled by that person, entity, or organization. Please disclose these persons’ name and business address.
RFP No. PWA 2022-101
150
IV. DISCLOSURE - CAMPAIGN FINANCE ORDINANCE – CONTRACTORS AND SUBCONTRACTORS The City Council adopted Ordinance No. 5744, “Campaign Finance Ordinance,” which became effective on September 9, 2011, and amended it with Ordinance No. 5768, which became effective on March 15, 2012 (“the Ordinance”). The Ordinance prohibits: (1) A contractor * (including a subcontractor**)― who has a contract with the City of Glendale (“City”), Glendale Successor Agency or Glendale Redevelopment Agency (“GSA”), or the Housing Authority of the City of Glendale (“HA”) and that contract is subject to approval by the City Council, GSA, or HA― from making a contribution to a City Councilmember, GSA member, HA member, City Clerk, or City Treasurer; and (2) Council members, GSA members, and HA members from voting on matters concerning a contract affecting a contractor or subcontractor who has provided a campaign contribution.
The provisions of the Ordinance restricting Council members from voting on matters affecting campaign contributors applies to a contractorwhose contract requires the City Council’s, GSA’s, or HA’s approval, and specified subcontractors. A contract with the City, GSA, or HA is known as a “City Contract.” The Ordinance excludes a competitively bid contract awarded to the lowest responsible bidder.
To assist members of the City Council, GSA, and HA before they vote on a matter regarding a City Contract, the Ordinance requires City staff to prepare this report which discloses certain information about: the contractor receiving the City Contract, and specified subcontractor(s) working under the City Contract.
Information that must be disclosed: ● Name of the person, entity, or organization (i.e., the Contractor or Subcontractor) ● Name of the Chief Executive Officer/President
● Chief Operating Officer
● Chief Financial Officer
● Chairperson
● All members of the Board of Directors
● All persons who own more than 10% of the person, entity, or organization ● Name of any campaign committee owned or controlled by the person, entity, or organization Please complete the following disclosure form:
Contractor(s)*:
Name Address
Full Name Title Business Address City State Zip
Chairperson
Chief Executive Officer / President
Chief Operating Officer
Chief Financial Officer
Board of Directors
More than 10% interest owner
* “Contractor” is the person, entity, or organization that is the party, or prospective party, to the contract with the City, GSA, or HA. In addition to the name of the person, or entity, the Contractor must also disclose the name(s) of that person’s, entity’s, or orga nization’s Board of Directors, its Chairperson, Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, any person with an ownership interest of more than ten percent (10%) in that person, entity, or organization, and any campaign commit tee that is owned or controlled by that person, entity, or organization. Please disclose these persons’ name and business address.
David Evans and Associates, Inc. 201 S. Figueroa Street, Suite 240, Los Angeles, CA 90012 Al Barkouli, PHD, PE
Al Barkouli, PHD, PE
Cindi Polychronis, JD
Marcus McGarity, CPA
2100 S. River Parkway, Suite 100
2100 S. River Parkway, Suite 100
2100 S. River Parkway, Suite 100
2100 S. River Parkway, Suite 100
Portland
Portland
Portland
Portland
OR
OR
OR
OR
97201
97201
97201
97201
Exhibit 2 - Campaign Disclosure Forms
Colorado Street Multi-Modal Improvements Project
xxiv | David Evans and Associates, Inc.
FORMS
96 Subcontractor(s)**:
Name Address
Full Name Title Business Address City State Zip
Chairperson
Chief Executive Officer / President
Chief Operating Officer
Chief Financial Officer
Board of Directors
More than 10% interest owner
** “Subcontractor” is the person, entity, or organization that has entered into a contract for the performance of all or a portion of the work undertaken under an agreement with an architect, design professional, engineer, or general or prime contract, usually by a general or prime contractor. You must also disclose the names of the Subcontractor’s Board of Directors, its Chairperson, Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, any person with an ownership interest of more than ten percent (10%) in that person, entity, or organization, and any campaign committee that is owned or controlled by that person, entity, or organization.
Above please disclose these persons’ name and business address.
Campaign Committee owned or controlled by:
Title Business Address City State Zip
CERTIFICATION
On behalf of the above-named Contractor Subcontractor:
• I acknowledge that I have a continuing obligation to update this disclosure form if I substitute― or if I select additional― architects, design professionals, contractors, or subcontractors within ten (10) days of the selection or change; and • I hereby certify that:
I have identified all persons for which the Ordinance requires disclosure; CContontrractactoror((s)s)**: :
FulFulll N Namame CitCiyt
David Evans and Associates, Inc.
s
201 S. Figueroa Street, Suite 240, Los Angeles, CA 90012 BBusiusiness Aness Addrddresses
NaNammee
e TTititlele
AAddrddresses
s StaSteta te y
CChaihairrperperssonon
ip
Portland
Cindi Polychronis, JD 2100 S. River Parkway, Suite 100
OR
OR
OR
Marcus McGarity, CPA Portland
t Portland
OR
BBoaroardd of of D Diirrececttororss
97201
97201
MorMore te than han 10%10% iintntereresestt o owwnerner 97201
CChihieeff E Exxececututiivve e OOffffiiccerer / / P Prresesiidedentn CChihieeff O Operperatatiinng Og Offffiiccerer
2100 S. River Parkway, Suite 100
2100 S. River Parkway, Suite 100
2100 S. River Parkway, Suite 100CChihieeff F Fiinnancanciialal O Offffiiccerer Portland
97201
ZipZ
Al Barkouli, PHD, PE
Al Barkouli, PHD, PE
xxv | David Evans and Associates, Inc.
FORMS
96 Subcontractor(s)*
*:
Name Address
Full Name Title Business Address City State Zip
Chairperson
Chief Executive Officer / President
Chief Operating Officer
Chief Financial Officer
Board of Directors
More than 10% interest owner
** “Subcontractor” is the person, entity, or organization that has entered into a contract for the performance of all or a portion of the work undertaken under an agreement with an architect, design professional, engineer, or general or prime contract, usually by a general or prime contractor. You must also disclose the names of the Subcontractor’s Board of Directors, its Chairperson, Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, any person with an ownership interest of more than ten percent (10%) in that person, entity, or organization, and any campaign committee that is owned or controlled by that person, entity, or organization.
Above please disclose these persons’ name and business address.
Campaign Committee owned or controlled by:
Title Business Address City State Zip
CERTIFICATION
On behalf of the above-named Contractor Subcontractor:
• I acknowledge that I have a continuing obligation to update this disclosure form if I substitute― or if I select additional― architects, design professionals, contractors, or subcontractors within ten (10) days of the selection or change; and RFQ No. PWA 2022-100
88 Subcontractor(s)**:
Name Address
Full Name Title Business Address City State Zip
Chairperson
Chief Executive Officer / President
Chief Operating Officer
Chief Financial Officer
Board of Directors
More than 10% interest owner
** “Subcontractor” is the person, entity, or organization that has entered into a contract for the performance of all or a portion of the work undertaken under an agreement with an architect, design professional, engineer, or general or prime contract, usually by a general or prime contractor. You must also disclose the names of the Subcontractor’s Board of Directors, its Chairperson, Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, any person with an ownership interest of more than ten percent (10%) in that person, entity, or organization, and any campaign committee that is owned or controlled by that person, entity, or organization.
Above please disclose these persons’ name and business address.
Campaign Committee owned or controlled by:
Title Business Address City State Zip
CERTIFICATION
On behalf of the above-named Contractor Subcontractor:
• I acknowledge that I have a continuing obligation to update this disclosure form if I substitute― or if I select additional― architects, design professionals, contractors, or subcontractors within ten (10) days of the selection or change; and Not Applicable
THE CONVERSE PROFESSIONAL GROUP, dba Converse Consultants 717 S. Myrtle Avenue / Monrovia, CA 91016 Hashmi Quazi
Hashmi Quazi
Hashmi Quazi
Ruben Romero
Please see the attached page.
Please see the attached page.
717 S. Myrtle Avenue Monrovia CA 91016
717 S. Myrtle Avenue Monrovia CA 91016
717 S. Myrtle Avenue Monrovia CA 91016
717 S. Myrtle Avenue Monrovia CA 91016
717 S. Myrtle Avenue Monrovia CA 91016
717 S. Myrtle Avenue Monrovia CA 91016
The information in this disclosure form (and any attachment to this form) is true, accurate, correct, and complete; and I have been legally authorized to submit this disclosure form.
In total, this disclosure form (including attachments) is 0 pages.
October 6Executed on: , 20 , California.
Signature: Print Full Name: Steven Anderson, PE, PMP / Associate 23 , at: Los Angeles
Address: 201 S. Figueroa Street, Suite 240, Los Angeles, CA 90012 Phone Number: 714.665.4554 E-mail Address: [email protected] xxvi | David Evans and Associates, Inc.
FORMS
Converse's Board of Directors is as follows. Please note that Converse Board Directors are also the only ones with more than 10% ownership.
Hashmi Quazi Chairperson, CEO/President, COO 30.85%
Ruben Romero CFO
Kathiravetpillai ("Siva") Sivathasan Senior Vice President
16.67%
(Less than 10%)
Senior Vice President 18.5%Norman Eke
Kurt Goebel Senior Vice President (Less than 10%)
717 S. Myrtle Avenue, Monrovia, CA 91016
717 S. Myrtle Avenue, Monrovia, CA 91016
717 S. Myrtle Avenue, Monrovia, CA 91016
••I I he herrebyeby c ceretriftiyf ty thatha:t:
e;I I hav have ie identdentifiified aled all l pe persrosons nsfo fro wr whichich th the he OrOdirdinancnance ree rquiequirerse dis sdiclscosluroseur; TheThe i infnforormmatiationon i in tn thihiss di discslcoslosurure fe orform m( (and anyand an aytt atact hacmhment entto tto hitshi fsor fmor) ims) t irs tue,rue, acc acurcaturea, tce,o rcroecrrt,ec at, and cnd complometple;ete; and and I I hav havee been l been legalegallyly aut authohorizrized ted to so sububmimt itt hitshi dis s dicslcoslosure urfe orfmor.m.
IIn n ttototalal, t, thihiss di discslclososurure efo fromrm (i (inclncludiuding atng attactachmhmentents)s i)s i s 02 pa gpagees. s. , Ca, l Caifornia.lifor
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August 8, n ia.
P riPntrint Full Ful Nl Namame: e:K
6 220 0 2 : Los Angeles EExxececututed on:ed on athiravetpillai ("Siva") SivathasaSteven Anderson, PE, PMP n , a , t:
/ Associate
23 2
AAddrddresess:s
2, Monrovia
:
3 Oc tOctober 6ober a t:
717 S. Myrtle Avenue / Monrovia, CA 91016201 S. Figueroa Street, Suite 240, Los A ngeles, CA 90012 :
554 PPhone Nhone Numumberbe :r6: 26-930-1275714.665.4 E-mE-aimlai A l Addrddresse :s sks: [email protected]@converseconsultants.com xxvii | David Evans and Associates, Inc.
FORMS
96 Subcontractor(s)**:
Name Address
Full Name Title Business Address City State Zip
Chairperson
Chief Executive Officer / President
Chief Operating Officer
Chief Financial Officer
Board of Directors
More than 10% interest owner
** “Subcontractor” is the person, entity, or organization that has entered into a contract for the performance of all or a portion of the work undertaken under an agreement with an architect, design professional, engineer, or general or prime contract, usually by a general or prime contractor. You must also disclose the names of the Subcontractor’s Board of Directors, its Chairperson, Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, any person with an ownership interest of more than ten percent (10%) in that person, entity, or organization, and any campaign committee that is owned or controlled by that person, entity, or organization.
Above please disclose these persons’ name and business address.
Campaign Committee owned or controlled by:
Title Business Address City State Zip
CERTIFICATION
On behalf of the above-named Contractor Subcontractor:
• I acknowledge that I have a continuing obligation to update this disclosure form if I substitute― or if I select additional― architects, design professionals, contractors, or subcontractors within ten (10) days of the selection or change; and • I hereby certify that:
I have identified all persons for which the Ordinance requires disclosure; The information in this disclosure form (and any attachment to this form) is true, accurate, correct, and complete; and I have been legally authorized to submit this disclosure form.
In total, this disclosure form (including attachments) is pages.
Executed on: , 20 , at: , California.
Signature: Print Full Name:
Address:
Phone Number: E-mail Address:
0 October 6 23 Los Angeles
Steven Anderson, PE, PMP / Associate
201 S. Figueroa Street, Suite 240, Los Angeles, CA 90012 714.665.4554 [email protected]
RFP No. PWA 2022-101
151
Subcontractor(s)**:
Name Address
Full Name Title Business Address City State Zip
Chairperson
Chief Executive Officer / President
Chief Operating Officer
Chief Financial Officer
Board of Directors
More than 10% interest owner
** “Subcontractor” is the person, entity, or organization that has entered into a contract for the performance of all or a portion of the work undertaken under an agreement with an architect, design professional, engineer, or general or prime contract, usually by a general or prime contractor. You must also disclose the names of the Subcontractor’s Board of Directors, its Chairperson, Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, any person with an ownership interest of more than ten percent (10%) in that person, entity, or organization, and any campaign committee that is owned or controlled by that person, entity, or organization.
Above please disclose these persons’ name and business address.
Campaign Committee owned or controlled by:
Title Business Address City State Zip
CERTIFICATION
On behalf of the above-named Contractor Subcontractor:
• I acknowledge that I have a continuing obligation to update this disclosure form if I substitute― or if I select additional― architects, design professionals, contractors, or subcontractors within ten (10) days of the selection or change; and • I hereby certify that:
I have identified all persons for which the Ordinance requires disclosure; The information in this disclosure form (and any attachment to this form) is true, accurate, correct, and complete; and I have been legally authorized to submit this disclosure form.
In total, this disclosure form (including attachments) is pages.
Executed on: , 20 , at: , California.
Signature: Print Full Name:
Address:
Phone Number: E-mail Address:
AUGEST 24
ADVANTEC Consulting Engineers, Inc. 1200 Roosevelt, Irvine, CA 92620 Leo Lee 1200 Roosevelt Irvine CA 92620
Carlos A. Ortiz 1200 Roosevelt Irvine CA 92620
N/A
N/A
N/A
Leo Lee, Pauline Yip, Carlos Ortiz, Joe Harake, Keith Rand 1200 Roosevelt Irvine CA 92620 1 Irvine22
1200 Roosevelt, Irvine, CA 92620
Carlos A. Ortiz, CEO
[email protected]
949-861-4999
October 6 23
xxviii | David Evans and Associates, Inc.
FORMS
96 Subcontractor(s)**:
Name Address
Full Name Title Business Address City State Zip
Chairperson
Chief Executive Officer / President
Chief Operating Officer
Chief Financial Officer
Board of Directors
More than 10% interest owner
** “Subcontractor” is the person, entity, or organization that has entered into a contract for the performance of all or a portion of the work undertaken under an agreement with an architect, design professional, engineer, or general or prime contract, usually by a general or prime contractor. You must also disclose the names of the Subcontractor’s Board of Directors, its Chairperson, Chief Executive Officer, Chief Financial Officer, Chief Operating Officer, any person with an ownership interest of more than ten percent (10%) in that person, entity, or organization, and any campaign committee that is owned or controlled by that person, entity, or organization.
Above please disclose these persons’ name and business address.
Campaign Committee owned or controlled by:
Title Business Address City State Zip
CERTIFICATION
On behalf of the above-named Contractor Subcontractor:
x I acknowledge that I have a continuing obligation to update this disclosure form if I substituteʊ or if I select additionalʊ architects, design professionals, contractors, or subcontractors within ten (10) days of the selection or change; and x I hereby certify that:
I have identified all persons for which the Ordinance requires disclosure; The information in this disclosure form (and any attachment to this form) is true, accurate, correct, and complete; and I have been legally authorized to submit this disclosure form.
In total, this disclosure form (including attachments) is pages.
Executed on: , 20 , at: , California.
Signature: Print Full Name:
Address:
Phone Number: E-mail Address:
The Alliance Group Enterprise, Inc.
Andy Duong, PE
Adrian Troncoso
Gebran Duran
3435 Wilshire Blvd., Suite 920 Los Angeles CA 90010 X
01 October 3rd 23 Los Angeles
3435 Wilshire Boulevard, Suite 920, Los Angeles, CA 90010 213.505.0295 [email protected]
xxix | David Evans and Associates, Inc.
FORMS