EXHIBIT 1: Campaign Disclosure Forms
B. 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 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, 7545 Irvine Center Drive, Suite 200, Irvine, CA 92618
Jordan P. Carter
Jordan P. Carter
Jordan P. Carter
Jordan P. Carter
Jordan P. Carter and Jim Anderson
Jordan P. Carter
Blais & Associates, LLC (B&A Grant Services & Software) 7545 Irvine Center Drive, Suite 200
7545 Irvine Center Drive, Suite 200
7545 Irvine Center Drive, Suite 200
7545 Irvine Center Drive, Suite 200
7545 Irvine Center Drive, Suite 200
7545 Irvine Center Drive, Suite 200
Irvine
Irvine
Irvine
Irvine
Irvine
Irvine
CA
CA
CA
CA
CA
CA
92618
92618
92618
92618
92618
92618
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:
Title Business Address City State Zip
CERTIFICATION
On behalf of the above-nam ed 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:
NONE / N/A
NONE / N/A
NONE / N/A
NONE / N/A
NONE / N/A
NONE / N/A
NONE / N/A
NONE / N/A
2 April 09
25 Irvine
7545 Irvine Center Drive, Suite 200, Irvine, CA 92618
949-589-6338
Jordan P. Carter
[email protected]
B. 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 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, California Consulting, Inc.
214 Main Street, Suite 102, El Segundo, CA 90245
N/A
Steve Samuelian, CEO
N/A
N/A
Steve Samuelian, President/ Secretary
N/A
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:
Title Business Address City State Zip
CERTIFICATION
On behalf of the above-named Contractor Subcontractor:
• I acknow
ledge 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 25
El Segundo
Steve Samuelian, CEO
[email protected]
214 Main Street, Suite 102, El Segundo, CA 90245
NOT APPLICABLE
NOT APPLICABLE
April 9th
(323)728-9002
RFP No. PWA 2024-027
57 B. 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 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, Evan Brooks Associates, Inc. 750 E. Green Street, Suite 301, Pasadena, CA 91101 Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Harold Suetsugu 750 E. Green Street, Suite 301 Pasadena CA 91101 Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable
RFP No. PWA 2024-027
58 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:
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 Not Applicable
Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable Not Applicable
Not Applicable Not Applicable
2 November 1 24 Pasadena
Harold Suetsugu
750 E. Green Street, Suite 301, Pasadena, CA 91101
(626) 799-8011 [email protected]