City of Glen dale
DISCLOSURE • CAMPAIGN FINANCE ORDINANCE
The City Council adopted Ordinance No. 57 44, ·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• (includin �
a subcontrador .. )-who has a contract with the City
of Glendale ("City"), Economic Development Department ("EbD"), or the Hous,ng 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 Cler , 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 IHA 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 C�tract.
A contractor mustnrovide the information listed below when: A subcontractor must nrovide the information listed below when: II • The City Contract has a total anticipated or actual value of $50,000 or more; or • The subcontract through a City Contract has a to/El 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
Full Name Title Business Address Citv State ZiD
Chairperson
Chief Executive Officer/ President
Chief Operating Officer
Chief Fina ncial Officer
Board of Directors
More than 10% interest owner
• "Contractor" is the person, entity, or organizati·on 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 Directors. its Chairperson, Chief Executive Ofticer, 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.
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 profession.al, engineer, or general or prime contract, usually by a general or prime contractor. Subcontractor includes a.ny member ot 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, or or ganization, 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: ______________________ _ I
Business Address
I
City
I
State I Zip
CERTIFICATION
On behalff of the above-named O Contractor O 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: ________________ _ Dou &;1711')