City of Glendale
DISCLOSURE - CAMPAIGN FINANCE ORDINANCE
he City Council adopted Ordinance No. 5744, Campaign Finance Ordinance, which became effective on September 9, 2011, and amended it with Ordinance No. 576 which became effective on March 15, 2012 (the Ordinance"). he Ordinance prohibits: (1) A contractor* (including a subcontractor**) who has a contract with the Ci menter, and la mentin on ding on matin amang one win pain who has prost an a car an a one real is ing he lowest responsible bidder
o assist members of the City Council, EDD, and HA before they vote on a matter regarding a City Contract, the Ordinance requires City staff to prepare this report whi doses certain information about: the contractor receiving the City Contract, and the subcontractors) working under the City Contra A contractor must provide the information listed below when: A subcontractor must provide the information listed below when:
• The City Contract has a total anticipated or actual value of $50,000 or more: or • The subcontract through a City Contract has a total anticipated or actual value contract awarded to the lowest responsible bidder. of $25,000 or more: or • A combination or series of City Contracts have a value of $50,000 or more. • A combination or series of subcontracts, for the same or different projects have an aggregate value of $25,000 or
more. 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
Nancy K Bohl Inc dba The Counseling Team International 1881 Business Center Dr #11 San Bernardino CA 92408 Full Name Title Business Address City State Zip
Chairperson
Stephen Odom Chief Executive Officer / President 188I Business Center Dsr #11 San Bernardino CA 92408 Joel Edwards Chief Operating Officer 1881 Business Center Dr #11 Sam Bernardino CA 92408 San Bernardino CA 92408
Julie Koot Chief Financial Officer 1881 Business Center Dr #11 Board of Directors
More than 10% interest owner
Subcontractors)**:
Name Address
N/A
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
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 o 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 [I 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; : I have been legally authorized to submit this disclosure form. The information in this disclosure form (and any attachment to this form) is true, accurate, correct, and complete; and In total, this disclosure form (including attachments) is _ _ pages.
Executed on: _ 20_24, at: 11:00AM, SANGERNARDINO _ California.
Signature: Print Full Name: To Edwaros, L.0.0.
Address: 1881 INSIS COOTER DRUE SUE 11 SAN BERNARTNO LA 92408 Phone Number: 909 884 0133 E-mail Address: fedwards e the canseling team. co Rev. 6/7/12 J:FILESIDOCFILESIORDICAMPAIGN CONTRIBUTIONIDISCLOSURE FORM - CONTRACTOR - 6-7-12.doc