CONFLICT DISCLOSURE FORM
CITY OF RIALTO
DISCLOTRA TING WITH THE ER OF RATTIES
Pursuant to City of Rialto Municipal Code Section 2.48.510, all persons or business entities supplying any goods or services lo the city, or seeking a loan or grant awarded by the cily, whether through an application or proposal, shall disclose in such application or proposal whether any city officer, employee. or consultant may have a financial or non-financial Interest In the person or business entity, or in any member, employee, owner, or officer of the business entity. • A financial interest shall mean any interest that is prohibiled under stale law, including Califomia Govemment Code Sections 1090 and 87100, and California Code of Regulation Section 18700 el seq.
• A non-financial interest shall mean any interest that is prohibited by Cily of Riallo Municipal Code Section 2.48.450.
For the purpose of helping the City undersland whether City personnel might have a conflict of Interest In you or your organization, please disclose below whether you or any of your members, employees, paid or unpald officers, paid or unpaid direciors, or owners are (or are related lo) a Cily elected or appointed official, a City officer, or a Cily employee or consultant.
Relationship Between the
Name of Your Organization's Name of City Elected or Two Affoctod Momber, Employoe, Appointed Official, City
Paid or Unpald Officer, Paid or Officer, a City Employeo or Unpaid Director, or Ownor Consultant
N/A N/A N/A
By submitting this (application/proposal), or supplying any goods or services to the City, the [appicant/vendor/contrector/consultani] hereby aliests under penalty of perjury, personally andfor on behalt of the entity (submitting this application/proposal or supplying any goods or sorvicos to the City! That no City of Rialto elecled or appointed official, employee or consultant has a financial or no-financial interest, as such torms are delined in California Govemment Code Sections 1090 and 87100 and in City of Riallo Code of Ordinances Section
2.48.145, in the [applicant/vendor/contractor/consultam, excepi as specifically disclosed herein.
Name of Person/Enüty: Roy Perez
Titlo: Owner
Signature: Date: 5/12/2022
Form Date 11/11/202
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