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HomeMy WebLinkAboutLomkoskiJohn Affidavit Disclosure 2017 f^J l r- 0 „ CITY OF LAN� (f AFFIDAVIT OF':ISCLOSURE CLER ICHIGP TO: CITY CLERK DATE: — 7 make the following disclosure under oath: (Name) PLEASE CHECK THE BOX AND FILL IN THE APPROPRIATE BLANKS FOR EACH OF THE FOLLOWING ITEMS Yes No 1 ❑ 1 am an ❑ elected or❑ appointed ❑ officer or Eii�employee of the City of Lansing holding the position of Po /•e-9. in the G :z_ 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 ❑ LE- 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. ❑ 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 and City action detailed below. (Charter 5-505.1) ❑ ,4 1 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] ❑ chi 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] ❑ 0_ 1 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: o-Full-time ❑ Part-time (less than 25 hourslwk) ❑ Unpaid 4. PLEASE DESCRIBE IN DETAIL YOUR A CONFLICT MAY/MAY SUBMITTING MIT T IN THIS DISCLOSURE AND EXPLAIN WHY THINK l IZZ r"- I hereby certify that this disclosure is complete and accurate to the best of my knowledge, information and belief. The foregoing oin Affidavit of Disclosure was executed on this_�day of ~� 20J-7-. / Signed G / - State of Michigan, County of 20 1 sworn to before me this >`S day of Subscribed and swo � to Public/or De t County, Michigan MICHELLE R. REDDISH NOTARY PUBLIC-STATE OF MICHIGAN M Co mi ion Expires: A COUNTY OF INGHAM Y My Commission Expires October 3,2019 Acting in the County of ATTACHMENT TO AFFIDAVIT OF DISCLOSURE Please provide additional information about your outside business or employment. Of special interest to the Board is how the activities of the business or employment may directly or indirectly affect the City. This disclosure is about information and is not an indication of any anticipated conflict of interest or suspected wrongdoing. Therefore,please describe for the Board what it is you actually do and be detailed and specific. You are not required to limit your disclosure only to the following questions. For each business, include in your answer such things as: ■ What is the form of your business entity and what percentage do you own? ■ Are you self-employed? ■ Who is your employer, if applicable? ■ What are the things you actually do in the business? r' ✓�PS� ■ Who are your clients and who receives your goods or services? A44 ■ How and where are your services performed? ■ How often do you do outside work? ■ Does your business or employer contract with the City? ILIc5 ■ In performing your business or outside employment, do you use any City facilities or equipment? /t/J If so, describe: ■ Is any of your business or employment conducted in the City? //t/)o If so, describe: ■ Does your business advertisement or circulars, if any, contain any reference to the City or your City employment? /1/ ■ 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? /t/ If so,please describe: 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. LANSING CITY CHARTER (excerpt) 5-505 CONFLICT OF INTEREST .l At least ten (10) days prior to the first of any of the events set forth in (A), (B), (C), (D), and (E) below, a City officer or employee who may derive any income or benefit, directly or indirectly, from a contract with the City or from any City action, shall file an affidavit with the City Clerk detailing such income and benefit to be derived: (A)The bidding of the contract; (B)The negotiation of the contract; (C)The solicitation of the contract; (D)The entry into the contract; (E)Any City action by which the City officer or employee may derive any income or benefit, directly or indirectly. The above provisions shall not apply to individual or collective bargaining agreements pursuant to which a City officer or employee directly or indirectly receives income or benefits in the form of official remuneration as an officer or employee, or any City action pursuant to which a City officer or employee directly or indirectly receives income or benefit as a member of the public at large or any class thereof. At the first regularly scheduled City Council meeting following the filing of an affidavit pursuant to this section, the City Clerk shall notify the City Council of such filing. In particular cases and for good cause shown, the Board may waive the ten(10) day prior notice requirement contained herein. .2 An officer or employee who has any other conflict between a personal interest and the public interest as defined by State law, this Charter, or ordinance shall fully disclose to the City Attorney the nature of the conflict. .3 Except as provided by law, no elective officer, appointee or employee of the City may participate in, vote upon or act upon any matter if a conflict exists.