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HomeMy WebLinkAboutDelgadoVincent Affidavit Disclosure 2015 CITY OF LANSING STATEMENT OF FINANCIAL INTERESTS Basic Filing Information Name: G a aOffice or Title:kie) TV'r Ci �' b . ; Reports to: A in, SZ Z Address for � / �� �n Z 1 � � dl correspondence: �� �..� S►+� Sep Phone Numbers: Daytime contact:( If ; Work: �s/ By my signature, I certify that the information in this Statement of Financial Interest is true and complete to the best of my knowledge, information and belief. Signature: Date: ;elloo" Subscribed and sworn to before me this s Notary Public State of Michigan, County of Ltex Reserved for City Clerk's Office to Complete Date Received by Clerk's Office .2-34` Clerk's Office Acknowledgement: Ver:03/31/14 1 STATEMENT OF FINANCIAL INTERESTS 1. Organization and Entities: In the previous calendar year were you a part of an organization or entity other than the City of Lansing in which you are or were an officer, director, associate, partner, proprietor or employee; and, in the previous calendar year, received more than $2,500 in income from the organization or entity?? No X Yes: For each organization or entity please list below and complete "Attachment to Statement of Financial Interest" Type of Your Or anization's Name Address Organization Function/Title 2. Capital Asset: Except for your personal place of residence, in the previous calendar year, were you an owner or part owner of real property, business equipment, fixtures, furniture, inventory, or other capital asset located in the City of Lansing which you disposed of and realized a capital gain of more than$5,000? XNo Yes: Please complete the following: Asset Description 2 3. Governmental Employment except the City of Lansing: In the previous calendar year were you employed by a governmental unit or agency except the City of Lansing? _X_No Yes: Please state the unit/agency, and briefly describe the nature of your duties. Name of Agency Duties 4. Gifts: In the previous calendar year, did you receive a gift or gifts that totaled more than$500 or were you paid an honorarium more than $500 in which the gift or honorarium did not come from a relative by blood or marriage or was not a campaign contribution allowed under the Michigan Campaign Finance Act? _)(_No Yes: Please complete the following: Name of Donor Address Relationship to Donor 5. Business Interests and Supplemental Employment: In the previous calendar year were you or a member of your immediate family owner or part owner of a business entity(sole proprietorship, d/b/a, partnership, limited liability, company, or corporation) which conducts business in the City of Lansing other than holding stock in a public corporation? No XYes: Please complete the following and complete "Attachment to Statement of Financial Interests." Nature of Business Address noot Business ll_11Nature of Ownership �K. �-5►« i AV7 Wr'fC'S �iNCf 3 6. Real Estate: Except for your personal residence, in the previous calendar year did you own or have a financial interest in either real property in the City of Lansing, or real property outside the City of Lansing that has on it a drain or utility or anything else used or owned by the City of Lansing or the Board of Water and Light? _X_No Yes: Please complete the following: Address Type of Ownership 7. Permit, Zoning, License Franchise: In the preceding calendar year, did you or a member of your immediate family, or a business which you are a part, apply to the City of Lansing for a rezoning, a zoning variance, a license, a permit, or a franchise? XNo Yes: Please complete the following and attach a copy of your application or form Person's Name City Action Required Penalties for Late Filing Annual Statements — A person who fails to file a statement by May 1 of each year shall file his/her statement on or before May 31, along with a late filing fee of $20.00. Failure to file by May 31 is a violation of the Ethics Ordinance, unless the person has filed an extension. New Reporting Individuals —A person who first becomes subject to the requirement to file a statement within 30 days prior to May 1, shall file his/her statement on or before May 31 without penalty. If such person fails to file a statement by May 31, the individual shall file his/her statement on or before June 15, along with a late filing fee of$20.00. Failure to file by June 15 is a violation of the Ethics Ordinance, unless the person has filed an extension. Extensions —A person who is required to file a statement of financial interests may have one thirty day extension by filing a notice with the City Clerk by the date on which the statement is due. Failure to file by the extended deadline is a violation of the Ethics Ordinance. 4 Attachment To Statement of Financial Interests Please provide information about your employment, business, or your supplemental employment outside of your City of Lansing responsibilities. This information will aid the Board in identifying any possible conflict of interest that may arise between your employment or supplemental employment with your responsibilities as a City of Lansing official. Therefore,please answer all the questions so the Board will have a clear understanding of the activities of your employment or business. You are not required to limit your disclosure only to the following questions. Complete this form for each business and/or employment. 1. Other than your position with the City of Lansing, in the preceeding or current calendar year were/are you employed or self-employed? No XYes: What is the name, address and form of business entity(i.e. sole proprietorship, d/b/a,partnership, limited liability company or corporation, government agency, other?) Name of Business Address Form of Entity 1 36.E �oJke. ., Giro �' a� 'UGC ► 6 C : « xer H ✓crs�' J , 2. In the previous or current calendar year were/are you self-employed? A_No Yes 3. In the previous or current calendar year did/do you own any part of a business? \No Yes What is your percentage of ownership? % 4. Describe the nature of your business or employment. Please be specific. 5. What was or is the customer base or target audience of your business or employment? 6. Approximately how many hours a month do you spend in the business or supplemental business or employment?�hrs. Not city employed. 7. In the previous or current calendar year did/does your business or employer contract with the City of Lansing? _X_No Yes. Please explain the contractual arrangement. /�aT v rN46-VI +e X e4 to 8. In performing your work did/do you in the prior or current calendar year use any City of Lansing facilities or equipment? No Yes. Please explain what they are and why they are being used. -TO I r 9. In the prior or current calendar year was/is any of your business or employment conducted within the corporate boundaries of the City of Lansing? No Yes. Please describe what aspect of it is conducteA in the City of Lansing? 'H / r e C o�la i ve ry < < 10. In the previous or current calendar year did/do your business advertisements or circulars, if any, contain any reference to the City or your City employment? No X—Yes. Please attach copies of the ads and/or circulars. 11. Is there any additional information you wish to add that will aid the Board in its review of your business or personal activities in order to determine any possible conflict of interests? _X_No Yes. Please explain. In providing this information, the Board of ethics asks that you give special attention to the Conflict of Interest section of the Charter found at 5-505.1 —5-505.3. A copy is enclosed for your convenience.