HomeMy WebLinkAboutHarkinsSamantha Affidavit Disclosure 2021 yPN 5 1 �C
CITY OF LANSING
AFFIDAVIT OF DISCLOSURE
CHIC'
TO: CITY CLERK DATE: December20,2020 ,r f
-- DE:C ZZ0 RD'=ate'
I,Samantha Harkins make the following disclosure under oath:
Name (please print)
PLEASE CHECK THE BOX AND FILL IN THE APPROPRIATE BLANKS FOR EACH OF THE FOLLOWING
ITEMS
Yes No
1. ❑ ❑ I am an ❑ elected or ❑ appointed ❑ officer or a employee of the City of Lansing
holding the position of Deputy Mayor in the Mayors once Department.
❑ ❑ I am an immediate family member related to an elected or appointed officer or
employee of the City of Lansing named , holding the position of
in the Department
❑ ❑ I am a Business Associate of an elected or appointed officer or
employee of the City of Lansing named
holding the position of in the
Department.
2. ❑ is/ I may derive income or benefit directly or indirectly from the bidding of,
negotiation of, solicitation of or entry into a contract with the City or from any City action detailed
below. (Charter 5-505.1)
❑ q� I may have a conflict between a personal interest and the public
interest, the nature of which is disclosed below. (Charter 5-505.2)
[Chapter 290.04(I) of the Code of Ordinances]
❑ ❑/"' 1 may have a financial interest in a matter proposed to be acted upon by the City
of Lansing as described below. [Chapter 290.04(I) of the Code of Ordinances]
ram ❑ I make this disclosure because of a possible appearance that I may be in
violation of or in conflict with the City of Lansing Ethics Ordinance as provided for in the Code
of Ordinances and in the City Charter.
3. My/City of Lansing position is:
dFull-time ❑ Part-time (less than 25 hours/wk) ❑ Unpaid
CL LC r:',(A(I li t�l� J I
4. Name of the activity/business in question:Hundred Place Lac
5. Do you have ownership or interest in the activity/business? Yesx No
Updated July 2019
6. Does this activity/business conduct business with the City of Lansing? Yes No X
If yes, please explain
7. Does the activity/business depend on you being an employee of the City of Lansing?
Yes No x
If yes, please explain:
8. Who are the clients/customers of the activity/business?
I currently do not have any clients..
9. Does this activity/business require your using equipment/facilities of the City of Lansing?
Yes No X
If yes, please explain:
10. Does the activity/business use any advertisements or circulars that reference your employment
with the City of Lansing? Yes No X
If yes, please attach copies.
11. Explain what you will be doing in the activity/business:
I am hoping to work on projects relating to strategic planning, membership engagement and lobbying for organizations
that focus on community and economic development.
12. Explain why you believe a conflict may/may not exist with this activity/business:
1 do not believe there is any conflict, and my LLC will not have a contract with the City of Lansing.
13. Is there any additional information that you believe would assist the Board of Ethics in its
review of your business or personal activities for potential conflicts of interest? Yes X No
If so, please describe:
I am filing this in December, but beginning in January I will no longer be Deputy Mayor. I will be a part-time city employee working no
more than 20 hours/week.
In providing this additional information, the Board of Ethics asks that you give special attention to the
Conflicts of Interest section of the Charter found at 5-505.1 —5-505.3. A copy is enclosed for your
convenience.
Updated July 2019
I hereby certify that this disclosure is complete and accurate to the best of my knowledge, information
and belief. The foregoing Affidavit of Disclosure was executed on this%Zday of D-u' , 20
ZV .
Signs ure of Filer
STATE OF MICHIGAN )
)ss.
COUNTY OF )
The foregoing instrument w s no dged before me thiswday of
(year), by c� % (Notary Signature)
(Print Name)
Notary Public, County,
Acting in yk County,
My Commission spires: _j
Updated July 2019