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Home My WebLink AboutMedranoFrank Affidavit Disclosure 2010 .B.Y A k From the 4-26-10 Council Meeting Packet REFERRED TO THE BOARD OF CITY OF LANSING ETHICS AFFIDAVIT OF DISCLOSkECEIVED 2010 APR 21 ("M 3; 26 DATE:3— TO: CITY CLERK, AhdSl(dG CI i Y CLERK CITY ATTORNEY, or BOARD OF ETHICS I Nc rzry"o make the following disclosure under oath: (Name) PLEASE CHECK THE APPROPRIATE BOX OR FILL IN THE BLANKS FOR EACH OF THE FOLLOWING ITEMS Yes No 1, ❑ I am an ❑ elected or❑ appointed 0 officer or o employee of the City of La�King holding the position of tEu tt—� 4n� in the rKil , department ❑ 9 1 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. ❑ 0 1 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. ❑ 1 may derive income or benefit directly from a contract with the City or from any City action detailed below. (Charter 5-505,1) ❑ 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] ❑ ® I may have a financial interest in a matter proposed to be acted upon by the City of Lansing as described below [Chapter 290.04(1) of the Code of Ordinances] ❑ 9 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 or Ordinances and in the City Charter 3. This position is: ❑ Full time ❑ Part time (less than 25 hourslwk) ❑ Unpaid 4. My Address is: C 5. My Business (daytime) Phone#is: CONTINUED ON PAGE 2 ATTACHMENT A 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 I"e own? �Y nS« ,-Lsn oo Loo, 0/rL J0 n o~G Gin n GmN (ear-' a �1'� IJJSFnesS ■ Are you self-employed? N10 Who is your employer, if applicable? Li �tW��2)ti'J (�a LnI 5tS' ■ What are the things you actually do in the Ibusiness? r. Cho ac min Ctt1att) M 4 CLG[Jam'd tJOdS( O YLJ rrnt Gl llf�Tt�� j e.�o�-� � -IF'� 1��f�ict{C. C1�k-h•t t/J'r'n• • (Who are your clients and /Jwho receives your goods or services? I Yfint1-DES d f �{� �(lr�i a a5 Luc Vim`d �CL �edL L,Uo,j SJbvn Ac A,I� ��G� LCa C EKA-AA(AJ0,1- ■ How and where are your services performed? Joco(mr,n ina, Q 11 Page 1 of 3 • If you provide training or education as part of your business: Do you identify yourself to your clients or students as being employed by the City of Lansing? Do you include in any of the written materials or aids or reference in any way in your presentations reference to policies, procedures, methods or materials as being those also used by the City of Lansing? l o If so, attach a copy of the material or aid and explain the reference in your presentation. • Is there any additional information that you believe would assist the Ethics Board in its review of your business or personal activities for potential conflicts of interest? Igo If so, please describe:1 h1 s Is c+r, on cad_pow ,-n D-Q 46A Q arb PKzvrJ m I �C�e le CLnj woull nA 6 U luj In fU��Ur,s�tc �lUl1 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. Page 3 of 3 Emnl oyment:Qualifications Education: ■ An associate degree or equivalent from a two-year college, university or accredited technical school. _._____.__ ■ An_equivalcntaombination-o cducatonand-experience.— -- — Experience: Law enforcement experience of at least three years,or ■ Nursing background, or Certifcation as a Paramedic, or ■ Other medical background such as medical technologist Special Requirements: ■ Must be at least 25 years of age. Must possess, and maintain a valid State of Michigan Operator's License without record of suspension or revocation. ■ No prior felony convictions. ■ Ability to demonstrate a thorough knowledge of modern medical examiner principles,procedures, techniques and equipment. ■ Familiarity of the county geography. ■ Skill in the operation of the tools and equipment listed below. ■ Ability to maintain good physical condition in order to safely perform job duties. ■ Ability to communicate effectively orally and in writing. ■ Ability to establish and maintain effective working relationships with peers and supervisors. ■ Ability to exercise sound judgment in evaluating situations and making decisions. Ability to follow and give verbal and written instructions. Ability to meet the special requirements listed below. Internet access via personal computer is essential Tools and Equ.ipmeut Used: Standard office equipment,Universal Precautions equipment(including exposure to latex materials), automobile, digital.camera, flashlight,pager, cellular telephone, first aid equipment and personal computer. Other specialized equipment may include needles,syringes and temperature probes with adequate training. Physical Requirements: This job requires the essential functions contained in this description. These include, but are not limited to the following requirements. The physical demands described here are representative of those that must be met by an investigator to successfully perform the essential functions of this job. Reasonable accotmnodations may be nk'tde to enable individuals with disabilities to perform the essential iimctions. Title:Job Description far Medical Examiner hivw igaton Page?of 3 Tuesday,.lanwtrt'05,2010 oq-� -v OFFICE OF THE CITY ATTORNEY MEMORANDUM TO: CHRIS SWOPE, City Clerk FROM: JOHN M. ROBERTS Wk ty City Attorney DATE: APRIL 19,2010 SUBJECT: AFFIDAVIT OF DISCLOSURE; LPD OFFICER'S SUPPLEMENTAL EMPLOYMENT I have been asked by LPD to forward to you the attached affidavit about an officer's supplemental employment. I understand this is for the Ethics Board. Thank you for your assistance. 7MR/sp Attachments S:�Attomey_StaMOARDS&COMMMEEMEthics BdG4wope affdisclosureAm CITY OF LANSING .. AFFIDAVIT OF DISCLOSUREt_: :. I ' DATE: 3-2 U•- �� TO: CITY CLERK, - CITY ATTORNEY, or BOARD OF ETHICS I �� ,a,, �'1 �z ti make the following disclosure under oath: (Name) PLEASE CHECK THE APPROPRIATE BOX OR FILL IN THE BLANKS FOR EACH OF THE FOLLOWING ITEMS n Yes No 1. M. ❑ 1 am an ❑ elected or ❑ appointed ® officer or ❑ employee of the City of Larj5ing holding the position of l+�uk c in the (col L -T- department ❑ 9 1 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. ❑ 0 1 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, ❑ Q1 I may derive income or benefit directly from a contract with the City or from any City action detailed below. (Charter 5-505.1) ❑ 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] Cl IN I 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] ❑ ig 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 or Ordinances and in the City Charter 3. This position is: ❑ Full time ❑ Part time (less than 25 hours/wk) ❑ Unpaid 4. My Address is: 5. My Business (daytime) Phone#is: CONTINUED ON PAGE 2 AFFIDAVIT OF DISCLOSURE-PAGE 2 PLEASE DESCRIBE IN DETAIL YOUR REASON(S) FOR SUBMITTING THIS 6. DISCLOSURE AND EXPLAIN WHY YOU THINK A CONFLICT MAY/MAY NOT EXIST. +.O n. t G-Lk-s IAJ WG'{LI'iN VJ i-itt S :r-ow �"L TT1 s orL1ts- ,, L �-f( p"-E(,o Lo a r .now '11 t� ✓rJ)Cic7lZ., CCCYZ t d NJ' L✓/�d:/t 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 z day of Signed State of Michigan, County of �l Subscribed and sworn to before me this� day of �"( ll . 2010 Notary Public rotary Public%r Deputy Clerk pMchetie R.' n�ChauDtY mgheD+ -A-nc,l wr" County, Michigan State of Mk a MY Can t413/2Ut3 Acting 1n rpy of____ My Commission Expires: PLEASE INCLUDE AND SUBMIT A COPY OF YOUR CURRENT JOB DESCRIPTION DRAFT 6A;REVISED 11.06-04 ATTACHMENT A 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? rPc� �c/�ly a-nw ncr, n —t- c I'WS.ne-sS ■ Are you self-employed? NIa • Who is your employer, if applicable? 5D _'R� taw'r7t � 6�w 4 S • What are the things you actually do in the business? Oho�oaaH�h aYLJ 'O -�+ aYLJ i J (l W �t'iY?M 2AOc �6 � 11jejtcAL • Who are your clients and who receives your goods or services? 1-tES d f�� c�e.cea�e� i./v 1II ac'LEJ CJ,JC�S�k+K S C1��0 J'T •� �,Cl�lt�(Gc� • � ISM R �c�(Y�a�� c�Ii��crnte� • How and where are your services performed? �ocU rum�ina91 Page 1 of 3 • How often do you do outside work? UI, co u iGor"5'S a-r-I L W , is GL'i L) n exD 0'CC S (> a " S • Does your business or employer contract with theCity? ro� SUS �f 5P�MYew leu -h <� .- ev S • In performing your business or outside employment, do you use any City facilities or equipment? 0o if so, describe: • Is any of your business or employment conducted in the City? IU Oo If so, describe: • Does your business advertisement or circulars, if any, contain any reference to the City or your City employment? til o • If your business uses advertisements, circulars, applications, or order forms that you have designed or have had designed for you, please attach a copy of the applicable form(s). k(`A— Page 2 of 3 ■ If you provide training or education as part of your business: Do you identify yourself to your clients or students as being employed by the City of Lansing? Iv 1A- Do you include in any of the written materials or aids or reference in any way in your presentations reference to policies, procedures, methods or materials as being those also used by the City of Lansing? t O If so, attach a copy of the material or aid and explain the reference in your presentation. • Is there any additional information that you believe would assist the Ethics Board in its review of your business or personal activities for potential conflicts of interest? f O If so, please describe:-- is ; s cLy-) on call osj-staYo 46A Qljf-b CamrJ r,- FeaL) Icvr wok 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. Page 3 of 3 Medical Examiner's Office Title: Job Description for Medical Examiner -`Allegan,Barry,Eaton,Isabella,Livingston,. Investigators Muskegonand, Shiawassee Counties Last Reviewed: Tuesday. January 05, 2010 Sparrow--Health Systems Forensic.Padiology:; Job Title: Medical Examiner Investigator Reports Directly To(Position): Medical Examiner,Forensic Pathology Administrator of Sparrow Hospital and the Chief Medical Examiner Investigator of the County (where applicable) l 1. Purpose of Job: Performs a variety of routine and complex investigations for the Medical Examiner. Investigates and reports the conditions surrounding unexpected, unattended and traumatic violent deaths reported to the Medical Examiner's Office if.Principle Duties and Responsibilities: • Respond to scenes of reported deaths and perform skilled investigative work involving all unexpected, unattended and traumatic violent deaths within the County. • Is acquainted with the Michigan Medical Examiner laws and knowledgeable about which deaths are within the Medical Examiner's jurisdiction and require investigation. • Maintains availability by pager or telephone during on-call periods. • Facilitate the secure removal of human remains from death scenes to the morgue at Sparrow Health System,Lansing:Michigan. • Communicate effectively with emergency personnel and law enforcement investigators in order to obtain accurate and comprehensive information regarding the circumstances surrounding a death. • Obtain medical history from physicians, medical records, emergency personnel, relatives, witnesses, police and other involved persons. • Speak and write in a professional manner;maintain a professional appearance. • Submit clear, accurate and objective reports to tine office of the Medical Examiner in prescribed format in a timely manner for all death investigations. Makes an effort to locate the appropriate police agency to make notification of the next of kin when an autopsy is to be ordered. • Maintain and upgrade professional knowledge, skills and development by attending continuing education seminars, training programs anti appropriate:course,. Attend the Michigan Association of Medical Exanniners conference on at least a bi-annual basis. • Comply with policies and procedures established by the Medical Examiner and the Forensic Pathology Administrator. • Submit monthly repots and time accounting to the Chicf Medical Examiner Investigator as required. • Other duties as assigned by the Medical Examiner or Forensic Pathology Administrator. This list may not be inclusive of the total scope of job functions to be performed. Title:Job Description for Medical Examiner Investigators Page I of 3 Tuesday,January 05,2010 Emplrnvment Qualifications Education: • An associate degree or equivalent from a two-year college, university or accredited technical school. • An equivalent combination ofeducation and experience. Experience: • Law enforcement experience of at least three years, or • Nursing background, or • Certification as a Paramedic, or • Other medical background such as medical technologist Special Requirements: • Must be at least 25 years of age. • Must Possess, and maintain a valid State of Michigan Operator's License without record of suspension or revocation. • No prior felony convictions. • Ability to demonstrate a thorough knowledge of modern medical examiner principles,procedures, techniques and equipment. • Familiarity of the county geography. • Skill in the operation of the tools and equipment listed below. • Ability to maintain good physical condition in order to safely,perform job duties. • Ability to communicate effectively orally and in writing. • Ability to establish and maintain effective working relationships with peers and supervisors. • Ability to exercise sound judgment in evaluating situations and making decisions. • Ability to follow and give verbal and written instructions. • Ability to meet the special requirements listed below. • Internet access via personal computer is essential Tools and Equipment Used: Standard office equipment. Universal Precautions equipment (including exposure to latex materials), automobile, digital camera, flashlight, pager, cellular telephone, first aid equipment and personal computer. Other specialized equipment may include needles, syringes and temperature probes with adequate training. Physical Requirements: This job requires the essential functions contained in this description.These include, but are not limited to the following requirements. The physical demands described here are representative of those that must be met by an 1. investigator to successfully perform the essential functions of this job. Reasonable accommodations may be 1. made to enable individuals with disabilities to perform the essential functions. Title:.lots llcscription for Medical EmlMine hivetigators Page?of 3 Tuesday,January 05,2010 • While performing the duties of this job, the investigator is frequently required to sit, talk and/or hear. The investi.ator will be required to operate a motor vehicle to/from death scene investigations. The investigator is occasionally required to stand, wall:.handle of operate objects;controls or tools listed above; reach with hands and arms, climb or balance, stoop,kneel, crouch and crawl. • The investigator must occasionally lift and/or move more than 100 pounds, including the physical strength to lift and reposition cadavers. • Specific vision abilities required by this job include close vision, distance vision,color vision,peripheral vision depth perception and the ability to adjust focus. Working Conditions: • Exposure to biohazardous material necessitating the use of Universal Precautions. Respiratory protection required under specified conditions. • Exposure to traumatic death victims and frequent handling of cadavers. • Exposure to noxious odors. • Exposure to various elements of weather. • Occasionally required to work near moving mechanical parts and in precarious places. • While performing the duties of this job, the investigator may encounter dangerous situations and unruly individuals. Talc:Job Description for Medical Examiner lnvestigaton Page 3 of 3 Tuesday,January 05,2010 CITY OF LANSING AFFIDAVIT OF DISCLOSURE � TO: CITY CLERK, APR 16 �G10 CITY ATTORNEY, or BOARD OF ETHICS I F2nt4 E-rcz a make the following ifisel d�Ic b tl ttc)rr1� (Name) PLEASE CHECK THE APPROPRIATE BOX OR FILL IN THE BLANKS FOR EACH OF THE FOLLOWING ITEMS Yes No 1. 10 ❑ 1 am an ❑ elected or ❑ appointed ❑ officer or® employee of the City of Lansinr�gg holding the position of LLFU�� -r in the ipE C department ❑ i 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. ❑ m 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. ❑ a I may derive income or benefit directly from a contract with the City or from any City action detailed below. (Charter 5-505.1) ❑ o 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(1) of the Code of Ordinances] ❑ o I 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] ❑ ■ 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 or Ordinances and in the City Charter 3. This position is: ❑ Full time 0 Part time (less than 25 hours/wk) ❑ Unpaid 4. My Address is: f 5. My Business (daytime) Phone # is: CONTINUED ON PAGE 2 AFFIDAVIT OF DISCLOSURE-PAGE 2 PLEASE DESCRIBE IN DETAIL YOUR REASON(S) FOR SUBMITTING THIS 6. DISCLOSURE AND EXPLAIN WHY YOU THINK CONFLICT MAYIMAY NOT EXIST. `7ko are- -6 n.r�s a U ex e c m2 o Gov s . Ni o g_r , Ajrw I Tt 1 a r C 0 v f jE» �Tfl S S �C_N iS �k�fiti 1J a L) hM-c/h- w t—a- c��.}J D 0(Z 1-SClc_."R 6� 1 NSirj 4d1, �_x a- L I hereby certify that this disclosure is complete and accurate to the best of my knowledge, information and belief. �7" The foregoing Affidavit of Disclosure was executed on this day of Rfi,2� 20_L. Signed State of Michigan, County of Subscribed and sworn to before me this . AZA day of 2010 Notary P Ibliclor Deputy Clerk County, Michigan My Commission Expires: 13 PLEASE INCLUDE AND SUBMIT A COPY OF YOUR CURRENT JOB DESCRIPTION Putft DRAFT 5A;REVISED 11-05-04 Mf611e ;Fj..ReddiBrl, N S&Niq of mwd9w County ofn _ ghm *CWM*Ston E*k"lotJ12013 ..Ac"In M0 COUrdY 0f • How often do you do outside work? 6N (i LL 6oSf s on Ju �.V n 4�< LS CLrt UAf E'CQf:C-+CJ Op- '5PLI-LDOS ■ Does your business or employer contract with the City? ttt�o� 6A rnsA .rn4�toyr W0'j ) �thA enSi< IGt frl0�c • In performing your business or outside employment, do you use any City J facilities or equipment? �6 0 r If so, describe: • Is any of your business or employment conducted in the City? N6 If so, describe: • Does your business advertisement or circulars, if any, contain any reference to the City or your City employment? IQ N c • if youi business uses advertisements, uli'cuiaib, appiivatiuns, or order forms that you have designed or have had designed for you, please attach a copy of the applicable form(s). lQ6nt Page 2 of 3 • If you provide training or education as part of your business: Do you identify yourself to your clients or students as being employed by the City of Lansing? N� Do you include in any of the written materials or aids or reference in any way in your presentations reference to policies, procedures, methods or materials as being those also used by the City of Lansing? �0 If so, attach a copy of the material or aid and explain the reference in your presentation. • Is there any additional information that you believe would assist the Ethics Board in its review of your business or personal activities for potential conflicts of interest? If so, please describe: III rus is cor, oti CCaL(C Po- i-no,) '�rt-4� wo2K) Y�wn� wvj Ra�ftvjlc�r Wo2k SjLpkUU DyLj Wooij "Cr)- 6Q 0—T)U2ecj In1 CPI) J1J2tSdt'-MGe) 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. Page 3 of 3