City of Glendale
DISCLOSURE - CAMPAIGN FINANCE ORDINANCE
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”), Economic Development Department (“EDD”), or the Housing Authority of the City of Glendale (“HA”) and that contract is subject to approval by the City Council, EDD, or HA― from making a contribution to a City Council member, EDD member, HA member, City Clerk, or City Treasurer; and (2) Council members, EDD members, and HA members from voting on matters concerning a contract with a person who has provided a campaign contribution.
The Ordinance applies to a contractor whose contract requires the City Council’s, EDD's, or HA’s approval. A contract with the City, EDD, or HA is known as a “City Contract.” The Ordinance also applies to a subcontractor who has a subcontract through a City Contract. The Ordinance excludes a competitively bid contract awarded to the lowest responsible bidder.
To 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 which discloses certain information about: the contractor receiving the City Contract, and the subcontractor(s) working under the City Contract.
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 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 subcontract s, 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/Pre
siden t
● Chief Operating Officer
● Chief Financial Officer
● Chairper
son
● All members of the Board of Directors
● All persons who own more than 10% of the perso
n, entity, or organi zation
● Name of any campaign committee owned or controll ed 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, EDD, or HA or any member of that person’s, entity’s, or organization’s Board of Direct ors, its Chairperson, Chief Executive Officer, Chief Financial Officer, Chief Operat ing Officer, any person with an ownership interest of more than ten percent (10%) in that person, entit y, or organization, and any campaign committee that is o wned or controlled by that person, entity, or organization. Above please disclose these persons’ name and business address.
EXHIBIT 4
Rev. 6/7/12
J:\FILES\DOCFILES\ORD\CAMPAIGN CONTRIBUTION\D
ISCLOSURE FORM – CONTRACTOR – 6-7-12.doc
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, enti
ty, or organization that has entered into a c
ontract for the performance of all or a portion
of the work undertaken under an
agreement with an architect, design professional, engineer, or gener al or prime contract, usually by a general or prime contrac tor. Subcontractor includes any
member of that person’s, entity’s, or or
ganization’s Board of Directors,
its Chairperson, Chief Executive Officer, Chief Financ
ial 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 or
ganization. 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 per
sons for which the Ordinance requires disclo
sure;
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 su
bmit 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:
Saik Choon Poh
Saik Choon Poh
Curtis Roth
Curtis Roth
Saik Choon Poh & Curtis Roth
1111 Corporate Center Drive, STE 303
Monterey Park
CA
91754
Same
Same
Same
Same
NA
1 March 30
25 Monterey Park
Curtis Roth
1111 Corporate Center Drive, STE 303, Monterey Park, CA 91754 626-693-2966
[email protected]
1111 Corporate Center Drive, STE 303, Monterey Park, CA 91754