ATTACHMENT “B”
Public Integrity Disclosure
CITY OF PALM SPRINGS – PUBLIC INTEGRITY DISCLOSURE
APPLICANT DISCLOSURE FORM
(Revised 05/16/19)
PUBLIC INTEGRITY DISCLOSURE
APPLICANT DISCLOSURE FORM
1. Name of Entity
2. Address of Entity (Principle Place of Business)
3. Local or California Address (if different than #2)
4. State where Entity is Registered with Secretary of State If other than California, is the Entity also registered in California? Yes No
5. Type of Entity
Corporation Limited Liability Company Partnership Trust Other (please specify)
6. Officers, Directors, Members, Managers , Trustees, Other Fiduc iaries (please specify) Note: If any response is not a natural person, please identify all officers, directors, members, managers and other fiduciaries for the member, manager, trust or other entity _________________________________________________ Officer Director Member Manager [name]
General Partner Limited Partner
Other ____________________________________
_________________________________________________ Officer Director Member Manager [name]
General Partner Limited Partner
Other ____________________________________
_________________________________________________ Officer Director Member Manager [name]
General Partner Limited Partner
Other ____________________________________
Vertosoft LLC
1602 Village Market Blvd SE, Suite 320, Leesburg, VA 20175 Virginia
✔
■
See attached ownership chart
CITY OF PALM SPRINGS – PUBLIC INTEGRITY DISCLOSURE
APPLICANT DISCLOSURE FORM
(Revised 05/16/19)
7. Owners/Investors with a 5% beneficial interest in the Applicant Entity or a related entity
EXAMPLE
JANE DOE
[name of owner/investor]
50%, ABC COMPANY, Inc.
[percentage of beneficial interest in entity
and name of entity]
A.
[name of owner/investor] [percentage of beneficial interest in entity and name of entity]
B.
[name of owner/investor] [percentage of beneficial interest in entity and name of entity]
C.
[name of owner/investor] [percentage of beneficial interest in entity and name of entity]
D.
[name of owner/investor] [percentage of beneficial interest in entity and name of entity]
E.
[name of owner/investor] [percentage of beneficial interest in entity and name of entity]
I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT.
Signature of Disclosing Party, Printed Name, Title Date
PENALTIES
Falsification of information or failure to report information required to be reported may subject you to administrative action by the City.
See attached list of owners.
Nur Rahman | VP, Operations | 04/20/2026
Vertosoft LLC Ownership List -
2026
Legal Name and Physical Address of Facility: Vertosoft LLC , 1602 Village Market Blvd SE, Suite 320, Leesburg, VA 20175
Taxpayer Identification Number: 81-3911287
Complete Name
(Include nicknames in
quotation marks)
All Current Positions Held All Citizenships
(U.S., Dual, Other)
(Permanent Resident
Alien Date)
Percentage of
Ownership
(Include
Beneficial
Ownership)
Howard Jay Colavita 19592 Glastonbury Lane, Leesburg, VA 20175 U.S. 51 Lynn Ronan Colavita 19592 Glastonbury Lane, Leesburg, VA 20175 U.S. 14 Chet D. Hayes 913 Tinsman Dr. NE, Leesburg, VA 20176 U.S. 10 John A. Severino 5421 Heredity Lane, Gainesville, VA 20155 U.S. 10 Joshua M. Slattery 40810 Erins View Ct, Leesburg VA 20176 U.S 10 David Ball 6 Laurel Ridge Rd, Scarborough, ME 04074 US 2 Hannah Xiu 44145 Seawolve Sq, Chantilly, VA 20152 US 3
I c
ertify that there are no other legal entity/individual owners other than what is in the chart above.
Vertosoft LLC
By: ________________________
Print Name:
Title:
Date:
Jay Colavita
President
03/26/2026