ATTACHMENT "C"
REQUEST FOR PROPOSALS (RFP) #22-053
ON-CALL POTHOLE REPAIR AND
ASPHALT MAINTENANCE SERVICES
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 entities supplying any goods or services to the cily, or seeking a loan or grant awarded by the city, 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 prohibited under state law, including Califomia Govemment Code Sections 1090 and 87100, and California Code of Regulation Section 18700 et • A non-financial interest shall mean any interest that is prohibited by City of Riallo Municipal Code Section 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 unpaid officers, paid or unpaid directors, or owners are (or are related 1o) a City 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
N/A N/A N/A
Name of Person/Entity: Hardy & Harper. Inc.
Title: Michael Murray. Vice President
Signature: Date: March 7. 2022
Form Date 11/11/2021
RFP #22-053
Attachment "C"
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