COLORADO STREET MULTI-MODAL IMPROVEMENTS RFP NO. PWA 2023-010 City of Glendale
MARK THOMAS
Page xxviii
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 an d business address.
Mark Thomas & Company, Inc. 4010 Watson Plaza Drive, Suite 240, Lakewood, CA 90712 N/A
Zach Siviglia, PE 701 University Avenue, Suite 200 Sacramento CA 95825 Russel Burgess 516 Gibson Drive, Suite 230 Roseville CA 95678 Kim Post 2833 Junction Avenue, Suite 110 San Jose CA 95134 Matt Stringer, PLS 701 University Avenue, Suite 200 Walnut Creek CA 94596 N/A
Please see additional page for additional staff
RFP No. PWA 2023-010
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 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 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 an d business address.
Mark Thomas & Company, Inc. 4010 Watson Plaza Drive, Suite 240, Lakewood, CA 90712 N/A
Zach Siviglia, PE 701 University Avenue, Suite 200 Sacramento CA 95825 Russel Burgess 516 Gibson Drive, Suite 230 Roseville CA 95678 Kim Post 2833 Junction Avenue, Suite 110 San Jose CA 95134 Matt Stringer, PLS 701 University Avenue, Suite 200 Walnut Creek CA 94596 N/A
Please see additional page for additional staff
Exhibit 2 - Campaign Disclosure Forms
Colorado Street Multi-Modal Improvements Project
COLORADO STREET MULTI-MODAL IMPROVEMENTS RFP NO. PWA 2023-010 City of Glendale
MARK THOMAS
Page xxix
COLORADO STREET MULTI-MODAL IMPROVEMENTS RFP NO. PWA 2023-010 City of Glendale
MARK THOMAS
Page xxx
Z&YEŽ͘WtϮϬϮ3ͲϭϬϬ
Name Address
Mark Thomas & Company, Inc. 4010 Watson Plaza Drive, Suite 240 Lakewood, CA 90712 Full Name Title Business Address City State Zip
N/A Chairperson
Zach Siviglia, PE Chief Executive Officer / President 701 University Avenue, Suite 200 Sacramento CA 95825 Russel Burgess Chief Operating Officer 516 Gibson Drive, Suite 230 Roseville CA 95678 Kim Post Chief Financial Officer 2833 Junction Avenue, Suite 110 San Jose CA 95134 Matt Stringer, PLS
Matt Brogan, PE
Board of Directors 701 University Avenue, Suite 200 Sacramento CA 95825 Sasha Dansky, PE Board of Directors 2121 N California Boulevard, Suite 260 Walnut Creek CA 94596 Shawn O’Keefe, PE, QSD
Alyson Watson
Cindy Milrany
Board of Directors 2833 Junction Avenue, Suite 110 San Jose CA 95134 N/A More than 10% interest owner
COLORADO STREET MULTI-MODAL IMPROVEMENTS RFP NO. PWA 2023-010 City of Glendale
MARK THOMAS
Page xxxi95
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** ʊZKRKDVD
contract with the City of Glendale (“City”), Glendale Successor Agency or Glendale Redevelopment Agency (“GSA”), or the Housing Authority of the City of Glendale
³+$´
DQGWKDWFRQWUDFWLVVXEMHFWWRDSSURYDOE\WKH&LW\&RXQFLO*6$RU+$ʊIURPPDNLQJDFRQWULEXWLRQWRD&LW\&RXQFLO 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: Ɣ Name of the person, entity, or organization (i.e., the Contractor or Subcontractor) Ɣ Name of the Chief Executive Officer/President
Ɣ Chief Operating Officer
Ɣ Chief Financial Officer
Ɣ Chairperson
Ɣ All members of the Board of Directors
Ɣ All persons who own more than 10% of the person, entity, or organization Ɣ 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 organization’s Board of Dir ectors, 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 an d business address.
COLORADO STREET MULTI-MODAL IMPROVEMENTS RFP NO. PWA 2023-010 City of Glendale
MARK THOMAS
Page xxxii96
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:
Karl A. Passetti
Brandon L. Nevers
Lawrence A. Van Dyke
225 East Robinson Street, Suite 355
11480 Commerce Park Drive, Suite 230
851 SW 6th Avenue, Suite 600
Orlando
Reston
Portland Oregon
Florida
Reston
See Attached See Attached
N/A N/A
October 5 23 Orange
750 The City Dr S, Suite 410, Orange, California 92868
Tim A. Erney
(714) 468-1997 [email protected]
3 32801
20191
97204
Kittelson & Associates, Inc. 750 The City Dr S, Suite 140, Orange, California, 92868
,
r 5
t D S S it 410 O C
COLORADO STREET MULTI-MODAL IMPROVEMENTS RFP NO. PWA 2023-010 City of Glendale
MARK THOMAS
Page xxxiii
List of Officers - 2023
Name and Title Address
Brandon L. Nevers, President, Chief Executive Officer, Director 416 Nelson Drive NE, Vienna, VA 22180 Karl A. Passetti, Chairman of the Board, Vice President 213 E Hornbeam Dr, Longwood, FL 32779 Lawrence A. Van Dyke, Chief Financial Officer, Vice President 8720 SW Lodi Ln, Tigard, OR 97224 Marc A. Butorac, Secretary, Vice President 3017 NE 13th Ave, Portland, OR 97212 David L. Mills, Vice President 5944 Herriman Drive, Clayton, CA 94517 Bailey R. Lozner, Vice President 638 15th Street NE, Washington, DC 20002 Jane Lim-Yap, Vice President 1297 Bennett Rd, Orlando, FL 32814 Anthony S. Yi, Vice President 8967 SW Greening Lane, Tigard, OR 97224 Board of Directors - 2023
Name and Title Address Expires
Karl A. Passetti, Chairman of the Board 213 E Hornbeam Dr, Longwood, FL 32779 12/31/2025 Brandon Nevers, Director 416 Nelson Drive NE, Vienna, VA 22180 12/31/2025 Laurence V. Lewis, Director 1411 Alice Street, Unit 212, Oakland, CA 94612 12/31/2024 Marc A. Butorac, Secretary 3017 NE 13th Ave, Portland, OR 97212 12/31/2024 Sonia Hennum Daleiden, Director 908 W Pueblo Street, Boise, ID 83702 12/31/2025
COLORADO STREET MULTI-MODAL IMPROVEMENTS RFP NO. PWA 2023-010 City of Glendale
MARK THOMAS
Page xxxiv95
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.
Not Applicable
COLORADO STREET MULTI-MODAL IMPROVEMENTS RFP NO. PWA 2023-010 City of Glendale
MARK THOMAS
Page xxxv96
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:
Not Applicable
0 September 29 23 Chino Hills
5851 Pine Ave., Suite A. Chino Hills, CA 91709
(909) 627-2974 [email protected]
Genoveva L. Arellano
Not Applicable
/uni2714
COLORADO STREET MULTI-MODAL IMPROVEMENTS RFP NO. PWA 2023-010 City of Glendale
MARK THOMAS
Page xxxvi96
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:
See additional attachments on the following pages
2 September 28 23 Sacramento
Gregory Fasiano
Margot Yapp 1003 West Cutting Blvd, Suite 110 Richmond CA 94804 Darren Leitzke
See next page for add'l info
See next page for add'l info See next page for add'l info See next page for add'l info
300 E. 2nd St., Suite 1210 Reno NV 89501
8975 Folsom Blvd, Suite 250, Sacramento, CA 95826
(916) 388-5655 [email protected]
Not Applicable/None
COLORADO STREET MULTI-MODAL IMPROVEMENTS RFP NO. PWA 2023-010 City of Glendale
MARK THOMAS
Page xxxvii1
D. DISCLOSURE - CAMPAIGN FINANCE ORDINANCE – CONTRACTORS AND SUBCONTRACTORS Please complete the following disclosure form:
Subcontractor(s)**:
Name Address
Nichols Consulting Engineers, Chtd (NCE) 17050 Bushard Street, Suite 200, Fountain Valley, CA 92708 Full Name Title Business Address City State Zip
Michael J. Leacox Board of Directors 8795 Folsom Blvd, Suite 250 Sacramento CA 95826 Gregory Fasiano Board of Directors 8795 Folsom Blvd, Suite 250 Sacramento CA 95826 J. Ryan Shafer Board of Directors 1003 West Cutting Blvd, Suite 110 Rich mond CA 94804 Jason Drew Board of Directors 224 Kingsbury Grade, Suite 203 Stateline NV 89449 Margot Yapp More than 10% interest owner 1003 West Cutting Blvd, Suite 110 Richmond CA 94804 Michael J. Leacox More than 10% interest owner 8795 Folsom Blvd, Suite 250 Sacramento CA 95826 Gregory Fasiano More than 10% interest owner 8795 Folsom Blvd, Suite 250 Sacramento CA 95826 Kevin Senn More than 10% interest owner 300 E. 2nd St., Suite 1210 Reno NV 89501 ** “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.
COLORADO STREET MULTI-MODAL IMPROVEMENTS RFP NO. PWA 2023-010 City of Glendale
MARK THOMAS
Page xxxviii
SafeProbe, Inc. 3303 Wilshire Blvd., Suite 1250, Los Angeles, CA 90010 COLORADO STREET MULTI-MODAL IMPROVEMENTS RFP NO. PWA 2023-010 City of Glendale
MARK THOMAS
Page xxxix
SafeProbe, Inc. 3303 Wilshire Blvd., Suite 1250, Los Angeles, CA 90010 Oct. 3, 2023 23 Los Angeles
Mauro Poyaoan
3303 Wilshire Blvd., Suite 1250, Los Angeles, CA 90010
(213) 251-5960 [email protected]
N/A
N/A
N/A
N/A
COLORADO STREET MULTI-MODAL IMPROVEMENTS RFP NO. PWA 2023-010 City of Glendale
MARK THOMAS
Page xl95
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
* “C ontractor” 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 an d bus
iness address.
COLORADO STREET MULTI-MODAL IMPROVEMENTS RFP NO. PWA 2023-010 City of Glendale
MARK THOMAS
Page xli
COLORADO STREET MULTI-MODAL IMPROVEMENTS RFP NO. PWA 2023-010 City of Glendale
MARK THOMAS
Page xlii95
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.
CL Surveying and Mapping, Inc. 400 East Rincon Street, Suite 202, Corona, CA 92879 Lam Le
Daniel Calvillo
400 East Rincon Street, Suite 202
400 East Rincon Street, Suite 202
Corona CA 92879
Corona CA 92879
RFP No. PWA 2023-010
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’sBoard 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.
C
ampaign 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: P rint Full Name:
Address:
Phone Number: E-m ail Address:
2 September 22 23 Corona
Lam Le
400 East Rincon Street, Suite 202, Corona, CA 92879
(909) 484-4200 [email protected]
COLORADO STREET MULTI-MODAL IMPROVEMENTS RFP NO. PWA 2023-010 City of Glendale
MARK THOMAS
Page xliii
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.
C
ampaign Committee owned or controlled by:
Title Business Address City State Zip
CERTIFICATION
O
n 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:
2 September 22 23 Corona
Lam Le
400 East Rincon Street, Suite 202, Corona, CA 92879
(909) 484-4200 [email protected]
RFP No. PWA 2023-010
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 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 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.
CL Surveying and Mapping, Inc. 400 East Rincon Street, Suite 202, Corona, CA 92879 Lam Le
Daniel Calvillo
400 East Rincon Street, Suite 202
400 East Rincon Street, Suite 202
Corona CA 92879
Corona CA 92879