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Home My WebLink AboutShawa-DecookHeather Affadavit Disclosure 2016 Hometown People. Hometown Power. February 2, 2016 Mr. Chris Swope, Lansing City Clerk City of Lansing 124 W. Michigan Avenue 9th Floor Lansing, MI 48933 RE: Heather Shawa-DeCook- Affidavit of Disclosure Dear Mr. Swope: Attached please find an Affidavit of Disclosure prepared by Board of Water and Light employee, Chief Financial Officer, Heather Shawa-DeCook. This document is being forwarded to your office for filing. Respectfully submitted, At. Denbe q&q n M. Denise Griffin Corporate Secretary Electronic CC: BWL CFO Heather Shawa-DeCook (Electronically submitted to Lansing City Clerk on 2-2-16) S ��rG • CITY OF LANSING AFFIDAVIT OF DISCLOSURE CHIG TO: CITY CLERK DATE: Lt Ch' d-ot(p FT l 4 a(G r - k -- 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)?'/employee of the City of Lansing holding the position of CPO in the 6&)&) -- 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 ❑ x", 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) ❑ 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] ❑ 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] ❑ 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. W City of Lansing position is: Full-time ❑ Part-time (less than 25 hours/wk) ❑ Unpaid 4. PLEASE DESCRIBE IN DETAIL YOUR REASON(S)FOR SUBMITTING THIS DISCLOSURE AND EXPLAIN WHY YOU THINK A CONFLICT MAY/MAY NOT SGST. ` Zi-L r 'A.. 6.L &AI 2LZ r L t4 emu. =aj'�-s hereby certify that this disclosure is complete and accurate to the best of my knowledge, information and belief. itit The foregoing Affidavit of Disclosure was executed on this 20 _XO. Signed State of Michigan,County of Subscribed and sworn to before me this 7"�k day of 20 lt� Notary Public/or Deputy Clerk C),.w „,. County, Michigan My Commission Expires: A �_„ .�_ 5 , Zof� 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? zaz'-U_' ■ What are the things you actually do in the business?• Who are your clients and who receives your goods or services? l'- 4 ■ How and where are your services performed? > A -4 ■ How often do you do outside work? ( � ■ Does your business or employer contract with the City? - ■ In performing your business or outside employment, do you use any City facilities or equipment? q4If so, describe: ■ Is any of your business or employment conducted in the City? If so, describe: ■ Does your business advertisement or circulars, if any, contain any reference to the City or your City employment? ■ 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? 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. ." W _ l Er� �� _ w t 3 1 Hometown People. Hometown Power. JAI AFFIDAVIT OF DISCLOSURE TO: LANSING BOARD OF WATER & LIGHT: DATE: OFFICE OF THE CORPORATE SECRETARY � ,lt C 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 ❑ I am an employee of the Lansing Board of Water & Light (BWL) holding the p tion off in the i�G- e-,zw Department ❑ [ I am an immediate family member related to an employee of the BWL named holding the position of in the Department ❑ I am a Business Associate of an employee of the BWL 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 BWL (disclosed below in item #4) ❑ ❑ I may have a conflict between a personal interest and the public interest (disclosed below in item #4) ❑ ' I may have a financial interest in a matter proposed to be acted upon by the BWL (disclosed below in item #4) ❑ ❑ I make this disclosure because of a possible appearance that I may be in violation of or in conflict with the BWL Ethics policy 3. My B L position is: 15- Full-time ❑ Part-time (less than 25 hours/wk) ❑ Unpaid 4. PLEASE DESCRIBE IN DETAIL YOUR REASON(S) FOR SUBMITTING THIS D/SC�OSURE AND EXPLAIN WHY YOU THINK J CONFLICT MAY/MAY NOT EXIST. eJ- y r LJ ►� . 0,a ��l sdC LI — `—7 51 1 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 day of IiALUd 1h , 26 , Signed State of Michigan, County of Subscribed and sworn to before me this --iT day of , 20 Ica Notary Public County, Michigan My Commission Expires: o3 .05 L-7 SHONI GALATIAN NOTARY PUBLIC-STATE OF MICHIGAN COUNTY OF CLINTON My Commission ExpiLes Mar.5,2017 Acting in the County of