CONFLICT DISCLOSURE FORM
CITY OF RIALTO
DISCLOSURES REQUIRED BY PERSONS OR ENTITIES
CONTRACTING WITH THE CITY OF RIALTO•
Pursuant to City of Rialto Municipal Code Section 2.48.510, all persons or business entitles supplying any goods or services to 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 consullant may have a financial or non-financal Interest in the person or business entity, or in any member, emplayee, owner, or officer of the business entity. • A financial interest shall mean any interest that is prohibited under stale lew, including Califomia Government Code Sections 1090 and 87100, and Califomla Code of Regulation Section 18700 et seg.
• A non-financial interest shall mean any interest that is prohibited by City of Rialto Municipal Code Seclion 2.48.450.
For the purpose of helping the City understand 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 directors, or owners are (or are related to) a Cily elected or appointed official, a City officer, or a City employee or consultant.
Relationship Between the
Name of Your Organization's Name of City Elected or
Two
Affected Member, Employee, Appointed Official, City
Paid or Unpaid Officer, Paid or Officer, a City Employee or Unpaid Director, or Owner Consultant
N/A
By
the
applicant/vendor/contractor/consultant] hereby atlests under penalty of perjury, personally and/or on behalf o he entity (submitting this application/proposal or supplying any goods or services lo the Cityl that no Cily of Rialt Name of PersonvEntly: Inland Empire Landscape, Inc.
Title: President
Signature: Date: 5/11/2022
Form Date 11/11/2021
-84- [LMD, Parkways, Median Islands Landscape & Ground
Maintenance
ID FORM