HomeMy WebLinkAboutPuuriDan Affidavit Disclosure 1991 (2) 5. I hereby certify that, this disclosure is complete and
accurate to the best of my knowledge, information and belief.
6. I hereby certify that I have not solicited or entered
into any agreement with the City of Lansing prior to filing this
affidavit.
The foregoing Affidavit of Disclosure of Conflict of Interest
was executed on the 3 rck day of j o,n L-a p y , 1991
Subscribe nd/sworn before me the ` /!�� day of
19 `�, in �LF-z_ County, Michigan X
aRAC,\31TA `!. iicY lt, i;7T 'f r^C81i� , Notary Public or
Deputy Clerk
County, Michigan
My Commission Expires:
FOR CITY CLERK/CITY ATTORNEY USAGE
DATE FILED:
COPIES SENT TO: [ J Mayor
[ J City Council President
[ j Department Head
[ j Board of Ethics
DATE SENT:
BY:
4
G
CITY OF LANSING
AFFIDAVIT OF DISCLOSURE
OF
CONFLICT OF INTEREST
TO: [ ] CITY CLERK or
[ ] CITY ATTORNEY and
[ ] MAYOR and DEPARTMENT HEAD or
[ ] CITY COUNCIL PRESIDENT
(Name) Dori 191. PLA. U2= being duly sworn,
says under oath:
1. I am an elected or appointed officer or employee of the
City of Lansing, holding the position of (Title) C P—1 m F
keScl�cc('Cli 410c lySf in the Pc, L co
Department. This position is: K Fulltime [ ] Parttime ( less than
25 hours/wk) [ ] Unpaid.
2. [ ] I , [ ] and/or my (Relationship)
a member of my immediate family as defined in Ordinance 290 . 02 ( i ) ,
[A and/or (Name) Cc?l7f6-?,E'
a business with which I am associated as defined in Ordinance
290 . 02 (b) , (c) and (d) :
(Select the option or options that apply)
[ ] a. may receive a financial benefit of more than a de
minimus nature which is distinguishable from the benefits to the
person as a member of the public or as a member of a broad segment
of the public from a decision I would otherwise make or participate
in as an officer or employee. The decision involved is described
as follows:
The financial benefit will be received by the following persons in
the following amounts:
;and/or
[ ] b. intend to have business dealings with the City of
1
Lansing, either directly or indirectly. The business dealings are
specifically described in detail as follows (include names of each
party, the duration of the dealings, the financial consideration
between the parties, the governmental facilities or services
involved, the nature and degree of assignment of government
employees for fulfillment of dealings, and the nature of any
pecuniary interest) : -74, Acctwe bk5i17G?SS
Yo SfcraA�,, ,L/1ve2y o F
t"GGc2�/S ( l o,�os oic r2co' .
h � t�Ice gyre/e�n�n� �o2.s �
L..:, // he- l d 740 174AS"nCU SS OQtc/ii���
1�fJe-- ,174sc Z0 38 -2-95726 / �ve.2,FvSNc_ exis�nnrc��;and/or
[ ] c. may derive income or benefits, either directly or
indirectly, in addition to official remuneration, as a result of
Council action. The action involved is described as follows:
The income or benefits, in addition to official remuneration, that
will be derived, either directly or indirectly, is described as
follows:
;and/or
QQ d. may derive income or benefits, either directly or
indirectly, in addition to official remuneration, as a result of
a contract with the City. The contract is specifically described
in detail as follows ( include names of each party, the duration of
the dealings, the financial consideration between the parties, the
governmental facilities or services involved, the nature and degree
of assignment of government employees for fulfillment of the
contract, and the nature of anypecuniary interest) :
5?U/,cz2r u 9r¢einen7S � Gail; �� efS e:�oC'/c✓ 6e
Sid nc-c✓ n vSfo /Jt4151;7ess O�e4/i7,yS .
2
and/or
[ ] e. have a conflict between a personal interest and the
public interest as defined by state law, the Lansing City Charter,
or ordinance. The personal interest that conflicts with the public
interest is described as follows:
The public interest that the personal interest conflicts with is
described as follows:
3. I have attached additional detail on the reverse of this
form or on attached sheets, including copies of all relevant
documents, memos, resolutions, and contracts.
4. (Select one) ( j I will not make or participate in the
making of the affected decision and/or governmental decisions
concerning the contract and/or governmental decisions concerning
the business dealings and/or governmental decisions concerning the
conflict, OR
A Despite the conflict of interest, I am able to make or
participate in the making of the affected decision and/or
governmental decisions concerning the contract and/or governmental
decisions concerning the business dealings and/or governmental
decisions concerning the conflict, fairly, objectively, and in the
public interest because: S¢ pre e,,o
Acrzr--s 7S 6e a con-41,c)` dif
-7'n l7ci//iL�'./ 4A )-d c. # - s¢e'-k-c1
3
SAFE RECORDS CENTER, INC.
9461 Coleman Road
Hasletl.Michigan 48840
(mailing address)
Business Location: 1305 S.Cedar St.,Lansing.Michigan
(517)482-8740
STORAGE AND SERVICE AGREEMENT
SAFE RECORDS CENTER, INC. (SRC) agrees to provide storage and service at its
location,for stored material
described as
that(Client)requests,subject to all the Terms and Conditions contained in this agreement,including those in
Attachments or Fee Schedules. Client agrees to pay SAFE RECORDS CENTER, INC. for its services
according to SRC's current fee schedule.
Effective Date
Client
Address
City State Zip
By:
Name(please type or print) Title
Signature Today's Date
SAFE RECORDS CENTER, INC.
By:
Date:
9461 Coleman Rd.
Haslett, MI. 48840
TERMS AND CONDITIONS FOR STORAGE AND SERVICE AGREEMENT
1.STORAGE AND SERVICE FEES
All fees for storage and service under this Agreement shall be specified in a current Fee Schedule,unless otherwise agreed upon by SRC and the(Xient
2 STORED MATERIALACCESS
a.Stored material shall be delivemdonly,to individual's identified in$RCAccessfomxs.Authority granted to any person onSRC'sAccess forms shall constlde IheCliem's representation that the identified person hasfull
authority To order a ny service f or or remova I of the Client's material,a nd to detrver and receive such material.A service request maybe given in person,by f elephone a in writing.SRC shaltrrot ba required to permit persons
other than those authorized to examine,reproduce or withdraw records.
b.When stored materials are ordered out,a reasonable time shall be given to SRCto carry out requested services.SRCYAfl take all reasonable measures to carry out requested services and SRC shall not be liable for lailureto
carry oul the service request.
3.SRC EMPLOYMENT
SRC shall have the right to employ any persons,ran or corporation for the purpose of pick-up,delivery and records management services for the Client.
4.CONFIDENTIALITY
SRC shag not privately or publicly,announce or advertise the agreement between SRC and the Orem,unless authorized by the Client.
PC wit take all reasonabie steps to ensure that all records or other items in storage will remain confidential and that all records in storage w ill not be examined,reproducedawhhdrawn by a third party who islrol identihoonSRC
Access Forms signed by the Client's Authorzed Agent,
5.AGREEMENT TERM
a.The initial agreement term shall be one year from the effective date.
b.IL following the expiration of The initial term or any subsequent term of this Agreement,neither SRC nor Client have given written notice of termination,then this Agreement shall be deemed to have been renewed for an
additional one(1)year ten and shall continue in face upon the same lams and conditions,inchMing any charges in the fee Schedule.
c.II this agreement is terminated and any records of Client remain in storage with SRC,Client shag contnu rtopayallappgcebtechargesuntlClient'srecordsareremovedandSRCshagcontinuetohaveallof its rights set forth
in this agreement.
6.AGREEMENT TERMINATION
This Agreement may be terminated by ether the Client or SRC by 60 days notice in writing,If this agreement is lermmated by SRC,CFent is rod held responsible for Permanent Release of Records Fee.
7.LIMITATION OF LIABILITY S DAMAGES
a.SRC's liability,9 any,for Im,damage ordeslrudionlopa tmalofthestoredmaterialshagbelimitedto$2.00perbox,container,Pape,cartridge adisk pack,unless Chad declares anexcessvdlualionand pays anaddhonal
monthly charge for the excess valuation.
b,In no event shall SRC be liable for any consequential or incidental damages,including less,unless such loss or damage resulted from SRC falure to exercise reasonable care.
c.The Client understands and acknowledges that normal deterioralion and aging of all stored material occurs with lime.
S.PERMANENT RELEASE OF RECORDS
a.Upon Permanent Release of Records,Client is required to reviewand inspect stored material to be released.It recorristir be permanently relimsed aredeenned not bstorrwl damaged,client is required to sign the Permanent
Release of Records Form,Attachment 2.
b.Claims by the Client that pad of or all of the records have been lostor damaged must be presented in wri ingtoSRCwithin60daysaflerthereturnof fl estoredmaterialtotheChim.Failure to present a daim to PCwthin the
set time period constitutes acceptance of released material as
9.LIEN
SRC shalt have alien on all stated material for charges and advances made under this AgreemmilL AH expenses incurred in colliding charges and advances which arein arrears,including;reasonable attorneys'fees,shallbe added
to the arrears to which SRC's lien applies.
H.NON-PAYMENT--SRC'S RIGHTS WITH REGARD TO STORED MATERIALS
It the Client fails to pay SRCs'chargefora period of thirty days,PC may,attergivingten(10)days notice bycerlMed mail,at itsoplion:(a)redeliverthe stored material to the Client at itsaddress heminc(b)refuse access to stored
material,(c)sell any mall oflhestored material and containers at public or private side,and apply the proceeds of the sale to the unpaid balance:and(or(d)destroythestoredmalimi 1.InlheeventPCtakesaclionspursuanitothis
Section B shall have no Bali fry to the Client or anyone claiming by a through the Client.Nothing contained in this agreement predates SRC from pursuing other remedies by statute or otherwse.
11.SERVICE FEES
An interest charge at the rate of one percent per month charged monthly,commencing 30 days after filling YAP be made on the entire unpaid balance of the account
12.DESTRUCTION OF RECORDS
Upon wdlen insWetions from the iniffridual fisted an the SRC Access Form,SRC may destroy the requested stored material.SRC will verity all requests fa destruction of records with the Client's Authorized Agent.
13.TITLE WARRANTY AND INDEMNIFICATION OF SRC
a.The Client warrants that l is the owner or legal custodian of the stored material and has fug authority to store said material in accordance with the tens of this Agreement
b.In the event that PC should be made party in any[ligation by reason of having possession ofthemaleriat,the Client agreestoindemnilyand hold PC harmless from any and all liabilAy which may result from mid possession
and to pay all costs and adaneys fees incurred in connection with the litigation.
c.The Client further agrees to indemnify and hold harmless SRC,its officers,directors,shareholders,employees and agents foramyfmblity,cost orexpense,indudmgreasonadeatlomeys fees that they may suffer or incur as a
result of daims,demands,costs or judgements against them arsirg out of this Agreement with the Client unless caused by the negligence of SRC or SRC's breach of this Agreement
14.STORAGE BOXES
The Client shall,unless otherwise agreed,utiPbe storage boxes provided by SRC.
15.STORED MATERIAL—PROHISITED MATERIAL
a."Stored Material"shall include all documents,records a other material stored by SRC for the Client.
b.PCieservesthe right to refuse acceptance of any materials such as muctifics or materials considered to be highly Parrumble,toxic,exIdesive,radicactive,organic material which may a0iact vermin or insects or any other
materials which are otherwise illegal,dangerous or unsafe to store or handle in a closed area.SRC reserves the right to refuse acceptance of any matenalsfor reasons of Client's failure to compy vAth SRC's operating
procedures,
16.OTHER PROVISIONS
a.This Agreement shall be cornmed according to the laws of the State of MichigarG
b.In the event of bankruptcy proceedings are instituted either voluntarily byor involuntarily against The Client,or in the event of the making of an assignment bythe Client forthebeneMof creditors,PC,inaddition to all other
remedies availablelo0by statute orolhervrise,shag have the*LatRe option totenninalethisAgreeme itupon10days,written notice to the Client,by caddied mail.Upon suchlernimafion,PC shall have all the remedies
available to it under this Agreement.
c.The failure of PC to enforce any right,remedy,orcond0ion of this Agreement shall not be deemed a waiveriherecd nor shag it void or offierme affed its Not to enforce ftsame*L remedy or condition at any subsequent
time.
d.This Agreement binds the heirs,execulms,adminislmtors,andassignstherespedivepartiesandmimdbechangedadly.AllpriorunderslandirgsandAgreements between the Parties am merged inlhisAgreementwhich
fully and completely expresses their agreement.
e.Reference to SRC shall include all of he directors,officers,shareholders,employees and agents.
IN WITNESS WHEREOF,the parties have executed Phis Agreement by the hands of the persons duty authorized an that behalf.
e
AFE RECORDS CENTER, INC.
9461 Coleman Road
Haslett, Michigan 48840
(mailing address)
Business Location: 1305 S. Cedar St.. Lansing, Michigan
(517)482-8740
STORAGE AND SERVICE AGREEMENT
SAFE RECORDS CENTER, INC. (SRC) agrees to provide storage and service at its
location,for stored material
described as
that(Client) requests,subject to all the Terms and Conditions contained in this agreement,including those in
Attachments or Fee Schedules. Client agrees to pay SAFE RECORDS CENTER, INC. for its services
according to SRC's current fee schedule.
Effective Date
Client
Address
City State Zip
By:
Name(please type or print) Title
Signature Today's Date
SAFE RECORDS CENTER, INC.
By:
Date:
9461 Coleman Rd.
Haslett, MI. 48840
TERMS AND CONDITIONS FOR STORAGE AND SERVICE AGREEMENT --
1.STORAGE AND SERVICE FEES
All fees for storage and service under this Agreement shall be specified in a current Fee Schedule,unless otherwise agreed upon by SRC and the Client.
2.STORED MATERIAL ACCESS
a Stored material shall be delivered only to individual's Identified in SRC Access forms Authority granted to any person on SRC's Access Forms shall constitute the Client's representation that the Identified person has lull
authority Is order any service for or removal of the Client's material,and to deliver and receive such material.A service request maybe given in person,by telephone or in writing.SRC shall not be required to permit persons
other than those authorized to examine,reproduce or withdraw records.
b When stored materials areorderedoul,a reasonable time shall be given to SRC to carry out requested services SRC will take all reasonable measures to carry out requested services and SRC shall not be liable lotfisure to
carry out the service request
3.SRC EMPLOYMENT
SRC shall have the right to employ any persons,lion or corporation lot the purpose of pick-up.delivery and records management services lot the Orient.
4.CONFIDENTIALITY
SAC shall nor privately or publicly.announce or advertise the agreement between SRC and the Client,unless authorzed by the Client
SRC will lake all reasonable steps to ensure that all recordsar other items in storage will remain continental and that all records in storage will not be examined reproduced or withdrawn 4athird party Mois not installed on SRC
Access forms signed by the Client's Authorized Agent
5 AGREEMENT TERM
a The initial agreement term shall ce one year Iron Intellective date
It 11,fallowing the expiration of the initial term a any subsequent term of this Agreement,neither SRC nor Client have given written notice at termination,then this Agreement shall be demand to have been renewed for an
additional one(1)year lam and shall canWuer in face upon the same terms and coaddions,including any changes in the Fee Schedule
c If this agreement is terminated and any records of Client remain in storage add SRC,Client shall conlinueto pay all applicable charges wild Chad's records are removed and SRC shallcoalinue to have all of Is rights at lwlh
in this agreement.
6.AGREEMENT TERMINATION
This Agreement may be terminated by either the Client or SRC by 60 days notice in writing.It this agreement is terminated by SRC,Client H not held responsible lot Permanent Release of Records Fee.
7.UMITATION OF LIABILITY&DAMAGES
a SRC'sfirtility.it any,lot loss.damage or destruction to pad wall of the stored material shall be limited to$2D)per boA container,tape,carlorge or disk pack,unless Client dedaresan excess valualionand pays an additional
monthly charge for the excess valuation
b In no event shall SRC be liable lot any consequential or incidental damages,Including loss,unless such loss of damage resulted from SRC failure to exercise reasonable care
c The Client understands and acknowledges that normal deformation and aging of all Stored material occurs with time
6.PERMANENT RELEASE OF RECORDS
a UpoaPermonenl Releaseol Records,Clientis required to review and inspect Shared material to be released.(I records to be permanently released are deemed car lost or not damaged,client is requiredtosign the Permanent
Release of Records Fan,Attachment 2.
b Claims by theChenl that pan of or all of the records have been lost or damaged must bepresented in writing to SRC within 60 days after the return at the stored material Is the Client Failure to present a claim to SRC within the
sal lime period constitutes acceptance of released material as is
9.LIEN
SRC shall have a lien wall stored material tot charges and advances made under this Agreement.All expenses mcuned in collecting charges and advances which are in arrears,including reasonable attorneys'fees,shall be added
to the arrears to which SPC's lien applies.
10.NON-PAYMENT—SRC'S RIGHTS WITH REGARD TO STORED MATERIALS
II the Client lails10 pay SRCs charge for a period of rhirly days,SRC may,after giving ton I 10)days notice by certified mail,at its option(a)redeliver the stored material to the Client at as addresshereiR(b)refuse to stored
material,act sell any or all of the stored material and containers at public or private sale,and apply the proceeds of[he sale to the unpaid balance;and/or(d(destroy the stored material In the event SRC takes achons pursuant to this
Section it shall have no liability to the Client of anyone claiming by in through the Client.Nothing contained in this agreement precludes SRC from pursuing other remedies by statute of otherwise.
11.SERVICE FEES
An interest charge at the rate of doe percent per month charged monthly commencing 30 days after billing will be made on the entire unpaid balance of the account.
12.DESTRUCTION OF RECORDS
Upon written instructions from the individual listed on the SRC Access Form,SRC may destroy the requested stored malernal.SRC will any all requests lot destruction of records with the Client's Aulhonzed Agent
13.TITLE WARRANTY AND INDEMNIFICATION OF SRC
a The Client warrants that it is the owner or legal custodian of the stored material and has full authority to store said material in accordance with the terms of this Agreement.
b. In the event that SRC should be made party in any litigation by reason of having possession at the material,he e Client a g r e s s t m n d e m n ly and hold SRC harmless from any and all liability which may Mail I r o m Mid p D s s e s s Q n
and to pay all costs and attorneys lees incurred in connection with the litigation
c TheClienl further agrees to indemnity and hold harmless SRC,its off icers,dfreclors,shareholders,empfoyers and agents for any liability.cost or expense,including reasonable attorneys'lees that they may suderor incur asa
result of claims,demands.costs or judgements against them arising dui of this Agreement with the Client unless caused by the negligence of SRC or SRC's breach of this Agreement
14.STORAGE BOXES
The Client shall,unless otherwise agreed,utilize storage boxes provided by SAC.
15.STORED MATERIAL—PROHIBITED MATERIAL
a "Stored Material' shall include all documents,records or other material stored by SAC Im the Client
b.SRC reserves the right to refuse acceptance at any materials such as narcotics or materials considered to be highly flammable,toxic,explosive,radioactive,organic material which may allraci vermin or insects or my offer
materials which are otherwise illegal,dangerous or unsafe to store or handle in a closed area SAC reserves the right to refuse acceptance of any materials for reasons of Client's failure loomply with SRC's operating
procedures
16.OTHER PROVISIONS
a.This Agreement shall be construed according to the laws of the Slate of Michigan
b.to the event of bankruptcy proceedings are instituted either voluntarily by or invofunlarlryagainsl the Client,or in the event of the making of an assignment by the Client lot thebenart atcredird s,SRC.in addition to all other
remedies available toil by statute or otherwise,shall have the right,al its option to terminate this Agreement upon 10 days,written notice to the Client,by caddied mail Upon such termination,SRC shall have all the remedies
available to it under this Agreement.
c.The failure of SRC to enforce any might,remedy of condition of this Agreement shall not be deemed a waiver thereof nor shall it ad orolherwiseallKt its right to enforce the more night,remedyorcondlfienal any subsequent
lime
I This Agreement binds the heirs,executors,administrators,and assigns the fespeclive winter;and cannot bechanged orally Allpfior understandings and Agreements between the parties are merged in this Agreement which
fully and completely expresses their agreement.
a Reference to SRC shall mcluda all at its directors.offices.shareholders,employees and agents
IN WITNESS WHEREOu.the panes have executed this Agreement by the hands of the persons duty authorized on that behalf