By submitting this [application/proposal], or supplying any goods or service.s to the city. trrc laipticanWeniorlmntricior/consutianil nereny attests under penalty of perjury, personally..and/or on behalf oi in!'entity tsuUmitting this application/proposal or supplying an-y goods or services to the Cityl that no City of Rialtc elected oi appointei otficiil, employee or consultant has a financial or non-financial interest, as such ternls ai'e defined in Caiifomia Govemmeni Code Sections 1090 and 87100 and in City of Rialto Code of Ordinances Section
2..48.145, in the [applicanwendor/contractor/consultant], except as specifically disclosed herein.
NameofPerson/entt1, A4rcta-- l)a.V,ti)
Relationship Between the
Two
Title
Sig
Name of City Elected or
Appointed Official, CitY
Officer, a City EmPloYee or
Consultant
Name of Your Organization's
Affected Member, Employee,
Paid or Unpaid Officer, Paid or
Director or OwnerU
Form Date 1111112021
Y1
/o 4 >-f
CITY OF RIALTO
DISCLOSURES REQUIRED BY PERSONS OR ENTITIES
CONTRACTING WTH THE CITY OF RIALTO-
pursuant to City of Rialto Municipal Code Section 2.48.510, all persons or business entities supplying any goods or s'ervices to the city, or seeking a loan or grant awarded by the city, whether through an appti"rtion or proposal, shalldisilose in such application or proposal whetherany city officer, employee. oi consultant may have a flnancial 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 Californ a Government Code Sections 1090 and 87100, and California Code of Regulation Section 18700 ei seg.
. A non-financial interest shall mean any interest that is prohibited by City of Rialto 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 organizatioin, please disclose below whether you or any of your members, employees. paid or unpaid ohcers, paid or unpaid directors, or owners are (or are related to) a City elected or appointed official, a City officer, or a City employee or consultant' Date:
2.48.450 Employee conflict of interest.
(l) No covered person shall participate in the making ofa grant or contract by the city in which the covered person has a conflicting interest.
(2) For purposes ofthis section, the following definitions shall apply:
(a) A "covered person" includes any person who holds an elected or appointed City office, a City ofliccr'. a City employee, and any person who is a consultant to the City. (b) A "conflicting interest" includes, but is not limited to, those decisions where:
(i) A covered person holds or has held within the previous twelve months a position with a potential grant or contract recipient;
(ii) A close relative ofa covered person holds or has held within the previous twelve months a position with a grant or contract recipient;
(iii)A close relative of the spouse or domestic partner ofa covered person holds or has held witliin thc previous twelve months a position with a grant or contract recipient. (c) "Position" includes the status ofa member, employee, owner, paid or unpaid officer of, paid or unpaicl leadership position in, or had an ownership interest in, a grant or contract recipient. (d) A "close relative" includes a spouse, parent, grandparent, child, grandchild, aunt, uncle, or cousin. (e) "Participate in the making ofa grant or contract" includes participation in: drafting a solicitation or' contract; negotiating, voting on, approving, or executing a grant or contract; discussion of same r.r'illr any city officer or employee; or attempts in any way to influence the making ofa grant or contract. (3) This prohibition shall not apply to a contract let by wriuen competitive bid where the contract n,ill be awarded to the penon or entity who submits th€ lowest responsible and responsive bid. (4) Except for the Mayor or a member of the City Council, a covered person may request a waiver of any potential conflict of interest in writing fiom the City Manager. Any request for such a waiver must include tirli disclosure of the potential conflict of interest and a statement detailing any mitigating factors. The request an(l the City Manager's response shall be provided to the City Council prior to any vote to approve the contract oi grant, or if City Council approval is not required, at least five days before the contract or grant is approved. Thc request and the City Manager's response shall be considered a public record. (5) The prohibitions in this section are in addition to any applicable federal or state conflict of interest laus. including but not limited to Govemment Code section 1090, and Govemment Code section 87100 e/.rerl. (6) Any person who violates this section is subject to the following:
(a) Public censure;
(b) Ifthe conflict of interest was in the making ofa contract, a prohibition from participation in the' making ofa contract by the city for a period of time up to twelve (12) months from the date ofthe imposition ot' the discipline;
(c) If the conflict of interest was in the making of a grant, a prohibition from participation in the making ofa grant by the city for a period oftime ofup to twenty-four (24) months fiom the date ofthe imposition ofthe discipline;
(d) An administrative fine pursuant to Chapter 1.10 ofthis code. (7) The discipline specified herein may be imposed:
(a) By the City Manager in the case of any employee or consultant who violates this section. (b) By the City Council in the case ofany person who holds an elected or appointed City otlice. i-rt any Ciry officer who violates this section.