Exhibit 3
North Verdugo Road Multimodal Improvements Project
RFP No. PWA 2024-018
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 subcontractors) 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:
Contractors)*:
Name Address
Mark Thomas & Company, Inc. 515 S. Flower Street, 18th Floor, Los Angeles, CA 90071 Full Name Title Business Address City State Zip
Zach Siviglia, PE Chairperson 701 University Avenue, Suite 200 Sacramento CA 95825 Zach Siviglia, PE Chief Executive Officer / President 701 University Avenue, Suite 200 Sacramento CA 95825 N/A Chief Operating Officer
Kim Post Chief Financial Officer 2833 Junction Avenue, Suite 110 San Jose CA 95134 Matt Stringer, Matt Brogan, Sasha Dansky, Shawn O'Keefe, Board of Directors 95825 Ayson Watson. Cindy Milan 701 University Avenue, Suite 200 Sacramento CA N/A 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 names) of that person's, entity's, or organization'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, 104
exhibit 3
North Verdugo Road Multimodal Improvements Project
RFP No. PWA 2024-018
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.
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: N/A
Business Address City State Zip
CERTIFICATION
On behalf of the above-named [X] 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 24 ., at: Los Angeles , California.
Pa 1 dan
Signature: Print Full Name: _ Pat Somerville, PE
Address: 515 S. Flower Street, 18th Floor, Los Angeles, CA 90071 Phone Number: (213) 592-1570 E-mail Address: [email protected] 105
Exhibit 3
North Verdugo Road Multimodal Improvements Project
RFP No. PWA 2024-018
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 subcontractors) working under the City Contract.
Information that must be disclosed: • Name of the person, entity, or anization (i.e., the Contractor or Subcontractor) • Name of the Chief Executive Office President
• Chief Operating Oicer
• Chief Financial Off ser
• Chairp rson
• All mem. ers of the Board of L rectors
• All persor: who ow i more tha 1 10% of the person, entity, or organization • ame of a y camp ign comm tee owned or controlled by the person, entity, or organization Please complete the following disch sure form.
Contractor(s)*:
Ni ne 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 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, 104
Exhibit 3
North Verdugo Road Multimodal Improvements Project
RFP No. PWA 2024-018
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.
Subcontractor(s)**:
Name Address
Akel Engineering 7433 North First Street, Suite 103, Fresno, CA 93720 Full Name Title Business Address
City State Zip
Chairperson
Tony Akel Chief Executive Officer / President
7433 North First Street, Suite 103 Fresno CA 93720
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: Tony Akel
Title Business Address
City State Zip
President 7433 North First Street, Suite 103
Fresno CA 93720
CERTIFICATION
On behalf of the above-named Contractor Subcontractor:
• acknowledge that 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 2 pages.
Executed on: July 18 ., 2024 , at: Fresno
_ California.
Signature: Print Full Name: Tony Akel
Address: 7433 North First Street, Suite 103, Fresno, CA 93720 Phone Number: (559) 436-0600 E-mail Address: [email protected] 105
Exhibit 3
North Verdugo Road Multimodal Improvements Project
RFP No. PWA 2024-018
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 subcontractors) working under the City Contract.
Information that must be disclosed: • Name of the person, entity, or anization (i.e., the Contractor or Subcontractor) • Name of the Chief Executive Office President
• Chief Operating Oicer
• Chief Financial Off ser
• Chairp rson
• All mem. ers of the Board of L rectors
• All persor: who ow i more tha 1 10% of the person, entity, or organization • ame of a y camp ign comm tee owned or controlled by the person, entity, or organization Please complete the following disch sure form.
Contractor(s)*:
Ni ne 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 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, 104
Exhibit 3
North Verdugo Road Multimodal Improvements Project
RFP No. PWA 2024-018
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.
Subcontractor(s)**:
Name Address
Arellano Associates 5851 Pine Ave., Chino Hills, CA 91709 Full Name Title Business Address City State Zip
Chairperson
Genoveva A. Arellano Chief Executive Officer / President 5851 Pine Ave., Suite A Chino Hills CA 91709 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 protessional, 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
Not applicable
CERTIFICATION
On behalf of the above-named L Contractor X 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 •• 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: July 22 , 20_24 ., at: Chino Hills , California.
Signature: Print Full Name: Genoveva L. Arellano
Address: 5851 Pine Ave., Suite A, Chino Hills, CA 91709 Phone Number: (909) 627-2974 E-mail Address:[email protected] 105
exhibit 3
North Verdugo Road Multimodal Improvements Project
RFP No. PWA 2024-018
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 subcontractors) working under the City Contract.
Information that must be disclosed: • Name of the person, entity, or anization (i.e., the Contractor or Subcontractor) • Name of the Chief executive Office President
• Chief Operating Oicer
• Chief Financial Off ser
• Chairp rson
• All mem. ers of the Board of L rectors
• All persor: who ow i more tha 1 10% of the person, entity, or organization • ame of a y camp ign comm tee owned or controlled by the person, entity, or organization Please complete the following disch sure form.
Contractor(s)*:
Ni ne 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 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, 104
Exhibit 3
North Verdugo Road Multimodal Improvements Project
RFP No. PWA 2024-018
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.
Subcontractor(s)**:
Name Address
CL Surveying and Mapping, Inc. 400 East Rincon Street, Suite 202, Corona, CA 92879 Full Name Title Business Address City State Zip
Chairperson
Lam Le Chief Executive Officer / President Same as above Chief Operating Officer
Daniel Calvillo Chief Financial Officer Same as above
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
None
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 • 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: July 10 ., 2024 , at: Corona _ California.
Xan A Print Full Name: Lam Le
Signature:
Address: 400 East Rincon Street, Suite 202, Corona, CA 92879 Phone Number: (909) 484-4200 E-mail Address: [email protected] 105
Exhibit 3
North Verdugo Road Multimodal Improvements Project
RFP No. PWA 2024-018
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 subcontractors) working under the City Contract.
Information that must be disclosed: • Name of the person, entity, or anization (i.e., the Contractor or Subcontractor) • Name of the Chief Executive Office President
• Chief Operating Oicer
• Chief Financial Off ser
• Chairp rson
• All mem. ers of the Board of L rectors
• All persor: who ow i more tha 1 10% of the person, entity, or organization • ame of a y camp ign comm tee owned or controlled by the person, entity, or organization Please complete the following disch sure form.
Contractor(s)*:
Ni ne 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 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, 104
Exhibit 3
North Verdugo Road Multimodal Improvements Project
RFP No. PWA 2024-018
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.
Subcontractor(s):
Name Address
Earth Mechanics, Inc. 17800 Newhope Street, Suite B, Fountain Valley, CA 92708 Full Name Title Business Address City State Zip
Alaheswaran I hurairajah Chairperson 17800 Newhope Street, Suite B Fountain Valley CA 92708 Alaheswaran Thuralrajan Fountain Valley CA 92708
Sathiyamoorthy Varatharaj Chief Operating Officer 17800 Newhope Street, Suite B Fountain Valley CA 92708 Denise Casad Chief Financial Officer 1/000 Newhope Street, Suite B Fountain Valley CA 92708 Enc Brown Board of Directors 1/800 Newhope Street, Suite B Fountain Valley CA 92708 Kandıah Arumol More than 10% interest owner 17800 Newhope Street, Suite B Fountain Valley CA 92708 ** "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: N/A (None)
Title Business Address City State Zip
CERTIFICATION
On behalf of the above-named • Contractor [X] Subcontractor:
• I acknowledge that I have a continuing obligation to update this disclosure form if I substitute— or if I select additional— architects, design protessionals, contractors, or subcontractors within ten (10) days of the selection or change; and • have identified all persons for which the Ordinarce requires disclosure; The information in this disclosure form (and any attachment to this form) is true, accurate, correct, and complete; and have been legally authorized to submit this disclosure form.
In total, this disclosure form (including attachments) is pages.
Executed on: July 19 - 20_24 at:_Fountain Valley , California.
Signature: Mahagnora Print Full Name: Alaheswaran Thurairajah Address: 17800 Newhope Street, Suite B, Fountain Valley, CA 92708 Phone Number: 714-751-3826 E-mail Address: [email protected] 105
Exhibit 3
North Verdugo Road Multimodal Improvements Project
RFP No. PWA 2024-018
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 subcontractors) working under the City Contract.
Information that must be disclosed: • Name of the person, entity, or anization (i.e., the Contractor or Subcontractor) • Name of the Chief Executive Office President
• Chief Operating Oicer
• Chief Financial Off ser
• Chairp rson
• All mem. ers of the Board of L rectors
• All persor: who ow i more tha 1 10% of the person, entity, or organization • ame of a y camp ign comm tee owned or controlled by the person, entity, or organization Please complete the following disch sure form.
Contractor(s)*:
Ni ne 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 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, 104
Exhibit 3
North Verdugo Road Multimodal Improvements Project
RFP No. PWA 2024-018
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.
Subcontractor(s)**:
Name Address
Kittelson & Associates 750 The City Dr, Suite 140, Orange, CA 92868 Full Name Title Business Address City State Zip
Karl A. Passetti Chairperson 225 East Robinson Street, Suite 355 Orlando 32801 Brandon L. Nevers Chief Executive Officer / President 11480 Commerce Park Drive, Suite 230 Reston VA 20191 N/A Chief Operating Officer N/A
Lawrence A. Van Dyke Chief Financial Officer 851 SW 6th Avenue, Suite 600 Portland OR 97204 See Attached. Board of Directors See Attached.
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 X 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 • 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 4 pages.
Executed on: July 12 , 20 24 , at: Orange , California.
Signature: Print Full Name: Timothy A. Erney
Address: 750 The City Drive, Suite 410, Orange, CA 92868 Phone Number: (714) 468-1997 E-mail Address: [email protected] 105