HomeMy WebLinkAboutSorgBrent Affadavit Disclosure 2011 oc
CITY OF LANSING
AFFIDAVIT OF DISCLOSURE
____........•,��:��'�� DATE:
TO: CITY CLERK,
CITY ATTORNEY, or °
BOARD OF ETHICS
ff FWT M• s° make the following disclosure under„oat
(Name)
PLEASE CHECK THE APPROPRIATE BOX OR FILL IN THE BLANKS FOR EACH OF THE
FOLLOWING ITEMS
Yes No
1. ❑ 1 am an ❑ elected or ❑ appointed ❑ officer orR"employee of the City of
Lansing holding the position of Po-rce Dot c--Ir- in the
department
❑ 1 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. ❑ r 1 may derive income or benefit directly from a contract with the City or from
any 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(1) of the Code of Ordinances]
❑ A� 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 N 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
6. PLEASE DESCRIBE IN DETAIL YOUR REASON(S) . FOR SUBMITTING THIS
DISCLOSURE AND EXPLAIN WHY YOU THINKA CONFLICT MAY/MAY NOT EXIST.
TipjS k jLL JPT C7n1h16.r PVJ-Tt� M,1 19$ 6g jVtQc /PdgS'.
Ir Nis 4� CX17-,EVr4,Y 4e J Z-r r-jury $dt' / klIL-1- MOT- 1�r
I hereby certify that this disclosure is'corhplete and accurate to the best of my knowledge,
information and belief.
The foregoing Affidavit of Disclosure was executed on this 1`14� day of
-1�A . , 20 f l
Signed '
State of Michigan, County of
Subscribed and sworn to before me this B`'i day of J L- y 20 l
J N
IISON P+h.PIERCE Public%r Deputy Clerk
-
NOTARY COUNT'OF STATE OF N CHIGAN �+� County, Michigan
My Commission Expires Dec.12,2013
Acting in the County of Ingham My Commission Expires:
Z_ 12_ 13
PLEASE INCLUDE AND SUBMIT A COPY OF YOUR CURRENT JOB DESCRIPTION
DRAFT SA;REVISED 11.05.04
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? 'Iyl5 K A CP L GL M OuLr, �� GL�71�l E b /f'1�F 1,457-PU62AS.
15 6 NM JC A � i�i�D Pa��� IJFf I c�� Ti�i� ,��z v� lJ SI Dr PC-� L7
�ti�'GE �y �,��✓,QTE �lTi��l s. 7it�47 .wntrcq �F �.y �hli� p,��E.
■ Are you self-employed? �b
• Who is your employer, if applicable? 41-blfoEg� Wyg o
■ What are the things you actually do in the business? / SILL SpnJb
vATC
• Who are your clients and who receives your goods or services?
1,r5 5iEsrf t)P e C�uEr �C51'C��✓t G�4fS.
■ How and where are your services performed? 6xkl7pj b✓r`L
lQsTzy�,v�s
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?
S�-y l� /✓� l� �S PCB . �,f�cr�lst- y� �"y�I C�f'i"S
ff�OSC �)2-5
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? W'9 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:
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
y�N S 1 NG
CITY OF LANSING
AFFIDAVIT OF DISCLOSURE
cH1G �
TO: CITY CLERK DATE: February 5, 2019
I Brent Sorq 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. ❑✓ ❑ I am an❑ elected or❑ appointed ❑officer or ❑✓ employee of
the City of Lansing holding the position of Police Officer
in the Lansinq Police 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. ❑ a 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]
❑ ❑✓ 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. M 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 CONFLICT MAWMAYNOT EXIST.
No conflict will exist with this supplemental employment. I will serve as the men's assistant
soccer coach at Spring Arbor University.
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 5 y of February
20 19 .
T�
Signed
State of Michigan, County of
Subscribed and sworn to before this, ,�A day of ��v `" 20
G'
tary Publictor beputy CI rk
MICHELLE R REUD 5- t: County,11 ichl an
Notary Public - Michigan
Ingham County My Commission Expires:
My Commission Expires Oct 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?
Collegiate athletics
0
■ Are you self-employed?
No
• Who is your employer, if applicable? Spring Arbor University
■ What are the things you actually do in the business? Men's soccer assistant coach.
■ Who are your clients and who receives your goods or services?
Student athletes.
■ How and where are your services performed? Spring Arbor campus.
■ How often do you do outside work?
Varies from month to month.
■ Does your business or employer contract with the City? No.
■ In performing your business or outside employment, do you use any City facilities or equipment?
No
If so, describe:
■ Is any of your business or employment conducted in the City? No If so,describe:
■ Does your business advertisement or circulars, if any, contain any reference to the City or your
City employment?
No
■ Is there any additional information that you believe would assist the Board of Ethics in its review
A
of your business or personal activities for potential conflicts of interest? 'V o 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.