Pasadena, California
ISSUED FOR BID
DATE
TAXPAYER PROTECTION
AMENDMENT DISCLOSURE
Disclosure Pursuant to the
City of Pasadena Taxpayer Protection Amendment of 2000
Pasadena City Charter, Article XVII
Contractor hereby discloses its trustees, directors, partners, officers, and those with more than a 10% equity, participation, or revenue interest in Contractor, as follows:
1. Contractor Name:
2. Type of Entity:
Non-government Non-profit 501(c) (3), (4), or (6)
3. Names of trustees, directors, partners, officers of Contractor:
4. Name of those with more than a 10% equity, participation or revenue interest in Contractor:
Prepared by: ___________________________
Title: ___________________________
Phone:
Date: ___________________________