HomeMy WebLinkAbout0392.092-
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september 3, 1992
THE HONORABLE CITY COUl./CIL
Palo Alto, Califor~ia
Geographic Information System. CIP 18(322, COr'!.§iultant AqreSlment
Report if'. Briet
This report requests that Council approve an a.greement in the
acount of $83,900 ... ith PlanGraphics r Inc. to provide consultant
services for the Geographic Information sys~em. Funds have been
appropriated in CIP 18B22 I the utilities Department's Capita 1
Improvement Program, and from the Storm Drainage Enterprise Fund.
Background
In FY 1987-88, Council first approved the Geographic Information
system elP, which wi1] ev~ntually convert the city's entire manual
mapping system into a fully computeriz.ed one. The project is
funded between the Utilities and Public works Departments and has
been phased over several years. Firs.t, a pilot area was chosen in
order to provide a!"l opportunity for evaluating and addressing map
conversion problell's on a small scale before proce.eding with a
citywide project. Since. 1988, staff has purchased the computer
hardware/software and also engaged the services of Aelytek, Inc. tc
accomplish the map conversion o:=: the selected pilot area. BSI
Conscltants vere se~ected to assist ~taff in the development of the
scope of work for the pilot area.
In order to proceed with mapping the entire
to retain the services of a. consultant
geographic info:.:-mation system field.
City, it is necessary
specializing in the
The attached agreement for $83,90,) ",'ith PlanGrdphics, Inc. includes
the following tasks:
• Evaluate the City'S existing data documents for their
usefulness. This w.'il1 mlnimize the need for creating new data.
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CMR:392:92
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.. Review the requirements for ground contro,~ for I'".ap fE-atures,
quality co~tral pr~cedures a~d evaluate ne~ teChnologies and
methods. Recamreendations will be developed which address the
level of su~vey control ne~essary to adeguate!y register the
Ci tyl s parcel irl!ormatior. to the comp'.lteriZ2d rnap.
• Frepare a Reque.st for proposal (Rf'P) for mapping the CitY4
PlanGraphics -will consider mapping methodologies ",'hich .... ·ill
allow· the Cit.y to accomplish its goal of creating an accurate,
curren.t digital baSE-map in a timely and cos.t effective manner.
This involves developing quality control and verification
proced"-xres for map production to ensure cot"Jplial1ce with the
standards specifi~d in the RfP a~j formulating specifications
for each data entry techrlique appropriate fot:" the prcj ect.. In
"ddition, PlanGraphics will revie ... · proposals submitted,
participat~ in vendor intervie",'s and ass ist in selecting a
mapping contractor.
• Assist in the technical managemer,"t. of the IT'apping project
including attending meetings with the City, the mapping vendor
and preparing reports; summarizing the project progress and
issues.
• Review the City's database design ,;;.nd forClulate administrative
procedures for :main"t.aining a single, corlsistent l city-wide data
resource and develop procedures for updating and disseminating
the information.
• Review and develop procedures for rr.3naging the flow of map-based
information between departments to support ongoing Ci ty
functions~ .such as permit revie'w, capital impro'",em~nt planning
and construct ion I and util i ty infrasT:ructure m3ir,tE'nance.
PlanGraphics, Inc. wa;;:: selected as the ccnsultant to accomplish
these tasks based on "their project C',anagement experience ..
1?1anGraphics is an independe~t professional ccnsulting firm
specializing in geographic information systems in the Bay Area and
is managed by Mr. Bruce Joffe. Mr .. Joffe previously served as the
project director for BSI Cc:nsultants in the first phase of this
project. PlanGraphics has served over 400 clie.nts during the
last 13 years~ including several with project.s l!sirlg the Sdltle
software prod~ct (Graphic Design system) selected for the City's
program. Because of these unique q~alifications, the Geographic
Info::-mation System Steering Corrunittee, consis.tir.g af staff from the
Public Works, Utili ties and Information Eesources Departments,
negotiated the attached ~greernent ',.,ith PlanGraphic3. The city
Attorney has revie' .... ed th~ fOrlT;at and content of the Agreement.
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Cfi'.R: 392: 92
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This project ..... as include.d in a list of consultdf'.t .... '0!"k f.or Capital
Improvements to be. reViEfWp.d by the Finance Committee ar;d W3S not
sele~ted by the Corn:mittee for further evaluation and approval.
staff will return to Council in Jece:mber for a .... 'a!"d of a cO:1sul tant
contract to do basemapping of the City.
This agreement is not a project for purposes of the: California
Environ."'1Iental Quality Act.
~onunendation
staff recommends that Council:
1. Approve and authorize the Mayor to execute the at~ached
con.sultant agreement -with Pl~nGrdphicsl Inc. in the amount of
$83,900 t<:\ provide consu 1 t.ing services for the Ge-:>graphic
Information System, elP 18822.
2. Authorize the City Manager or his designee to negotiate and
execute amendments for services related to or incidental to the
scope of w'ork or services I the total value of -which ~mendments
shall not exceed $12,000.
Respectfully submitted,
f./f-;~ £7
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GEORGE BAGDON ~
Assistant Director of P"'..lblic WorJt".s
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~CHARD YOUNG
?irector of utilities
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Assistant City Manager
Attachment: Agreement
CMR:392:92
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DAVID G. ADAMS
Director vf public Works
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A G R~L}( ______ ~ __ ~"._'r
PROFESSIONAL CONSULTANT SERVICES BY AND
BETWEEN TilE CITY OF PALO ALTO AND
PLANGRAPHICS , INC~
THIS AGREEMENT is !!lade and t;.ntered into this da ... of
, 1992, by and between ~ .... CITY OF P.~LO ALT0. a
~m"\J"n"iC:c;:"-i;;p;;."l';:;c-::o;;r;;:poration of California, h:. ·inafter referred tr.. as
"'CIT'l, III and PLANGRAPHICS, INC. (Taxpayer Identif icat ion
No. 61-0954403), a Maryland corporatioTi, with offices at 2JOO
Clayton Road, suite 1200 k Concord, CA 94520-2100, hereinaf~er
referred to as "CONSULTANT u ;
WHEREAS, CITY desires certain pr-cfessicnal ser'.,'l,:es
hereinafter described; and
WHEREAS, CITY desires to er.gage CONSULTANT to pro·J.l.de
these services by reason of its qualifications and experience for
performing such services. al",d CONSULTANT has offered to provide the
required services on the terms and in the manner set forth herein;
NOW, THEREFORE~ L1 consideration of their mutual
covenants, the parties hereto agree as follows:
SECTION 1 -DEFINI'I'IQJL~
1.1 ClT'i
The term ttCity" as used in this Agreement shall mean and
include all the territory lying within the municipal boundaries of
the City of Palo Alto, California, as presently existing, plus all
terri tory which r:1ay b,=-added thereto durin-g the terO!1 of this
Agreement by annexation or otberwise.
1. 2 ~l'r.'i MANAGER
The term "City Manager'! shall mean the du~ly appointed
City Manager of the City at Palo Alto, California, or his
designated representative.
1.3 CITY ATTORNEY
The tenll IfCity Attorney" shall roean the duly appoi.nted
City Attorney of the City of Palo Alta, California, or his
designated representative.
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1. 4 CJ TV CLERK
The term "City clerk" s~all mean the d'lly appointed City
Clerk cf the City of Palo Alto, Californi~r or her designated
l-e[lrcsentati ve.
1.5 .B1.PK MAN.:a.GER
The term "Risk Manager~ shall mean the duly appointed
RisK Manager of the City of Palo Alto, Califcrnia, or hi~ designat
ed representative.
1. 6 £!,OJ ECT
The term "Project" means the improveIr,ents described iT'.
Exhibit "An entitled "Scope of Project" attached hereto and made a
part hereof.
S F.eTI mL.1. -PROJECT COORD I ~AT.Iq_~
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The City Man30ger shall be representative of CITY .for all
purposes IJnde,. this Agreeme;,t. JAMES HARRINGTON and GLFNN LOO are
desjgnated as the PROJECT M~AGERS for the City Manager, and they
shall supervise the progress 2:r.d exe-:::uticn of this Agreernent r and
shall be assisted by DAVE MATSON, PROJECT ENGINEER.
2:.2: CONSUL'!'ANT
CONSULTANT shall assign a single PROJECT DIRE~TOR to hav~
overall responsibility for the progres:; and exacution of this
Agreement for CONSULTANT. BRUCE JOFFE hereby is des igna~ed as the
PROJECT DIRECTOR for CONSUL'r_l\NT. BRUCE JOFFE shall also be
assigned as PROJECl' COORDINATOR for COUSULTANT and shall represent
CONSULTJl_~T during the day-to-day ~.,;ork on the Project. Should
circumstances or conditions SUbsequent to the execution of this
Agreement require a substitute PROJECT DIRECTOR or PROJECT
COORDINATOR for a~y reason the PROJECT DIRECTOR or PROJECT
COORDINATOR desigr.ee shall be subject too the prior wri't.ten approval
of the PROJECT ENGINEER.
SECTION) -_SCOPE OF PRO.JEC'T
The scope of the Project to he e.xecu.ted by CONSULTA..""lT
under the phases of the Basic Services described in Section 4.1 of
this Agreement is as described in Exhibit "A" attached hereto and
made a part hereof.
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SECTIorl 4 -..Q.V~S OF CON~:vrANT
4.1 ~~SIC SERVIces
CONSULTANT I S Basi.'": Services
stClges of ,"'orY.. as described helm.'
described in E~hibit "AM.
shall be furn.i~r.ed in :'~e
and as more particul~~li
4.:Ll
in Exhibit 'I'IA".
CONSULTANT shall attend :m€"etings as specl! :ed
4.1.2 CONSUL'I'A.."1T Ehall sL:bmit t',/O {2) copies of all
reports and specifica.tions t.c tt-.e City.
4.1. 3 CO~SUL1'kNT shall consult .. ith CITY to ascerta. in
the requirements of the Project and shall confirm such requiremi;nts
~ith the PROJECT MANAGER.
4.1.4 Upon ,",':," i tten approval b):' CITY the technical
portion of th.c draft specifications CGNSU!..l'ANT shall proceed to
prepare final bid documents and requests for proposals.
4.1.5 Due to the uncert.ain nature of \fork to be
performed in sue-sequent Proj ect phases. further ... 'ork. i terns :may be
identified; at which t.ime and at the dJ.scretion of the PROJECT
MANAGER the CONSULTANT may be invited 'to negotiate for a fee to
implement any other services that may be agreed L'pon.
4.2 ADDITIONAL S~~VICES
CONSULTANT shall perform or obt.ain any and all of the
following additional services, not irlcluoed under .9asiC Services,
if so authorized in "wotriting by CIT!', and shall be paio. as provided
in Section 6 of this Agreement~
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special st~dies.
Providing financial fe3sibility of ot'her
4.2.2 Revising pre"iously approved drawings.
specifications or ot.h-o?r documents to accomplish changes. not
i rlitiated by CONSULTANT.
4.2. J Providing professional services. made necessary
by the defaiJ.lt of the contractor in the per-forI!1ance of the
construction contract.
4.2.4 Furnishing specia 1 photography. iT.odel s, printed
reports and additional copies of contract dra"lo,'ings and documents
~bove the number specified in this Agreement.
4.2.5 Incurring travel and subsistence expenses for-
CONSULTANT and its staff beyond those nor-mal1y required under Basic
Services.
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4.2 .. 6 Prep~ring ar .. operat ion and ma intenance mar'.ua 1.
4.2.7
c-,:.nr:-ection -with
proceeding of a
Pro'.liding service<; as an expert \o'itness
a!"l)" pucl ic hearing, arbitrat ion proceeding,
court of r-ecord.
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Phase I area.
,r..ssist CIT'i in oversight of ""ork by AelyteK in
·4;.2.9 Review of CITj:"s GIS =nanagern.ent structure,
procedures, and tra:i.r.in':I.
4.2.10
agreed upo:", by th.e:
1lgreement.
Performing any other
parties subseque!"lt to
4.3 GENER.a._I-~_Y,:!,ILS OF CONSUL~AN'I'
services that
the execution
may be
of this
4.3.1 C'JNSllLTAUT represents t.""lat it is qualified to
furnish the services described 1..!nder this Aoreement. CONSOLTANT
fUrther declares that on/! or mo:re member~ or -employees of his firm
and that of its s'Jbconsultants l if any, are licensed by the State
of California if required to perform thei= services and that these
services -will be performed by them or under their supervis iOi1.
CONSULTANT shall furnish to CITY for approval~ prior to execution
of this Agreement, a list of all fiz-:ms or rorpor'elItions to be
employed as subconsultants.
-4.3.2: CONSULTANT states that it is aware of the
requiremen~s of the federal and state la~ relating t~ access to
public buildings and accommod~tions for disabled persons, ar.d
relating to facilities for disabled persons. CONSULTANT shall
comply ...-ith such prC',visions in carrying out the terms of this
Agreement.
4.3~3 CONSULTANT shall furnisb CITY ,.,i't.h every
reasonable opportunity for CITY to ascertain that the services of
CONSl1LTANT are being performed in accordance with the re:qu iremef'_ts
and intentiC'·ns of this Agreement.
SECTTON"_ L::: DUTIES OF CITY
5.1 CITY shall provide full information regarding its
require~ents for the Project.
5~2 CITY shall eX<3.mine documents submitted by CONSULTANT and
shall render decisions pert&inlng thereto promptly, to avoid
unreasonable delay in the progress of CONSULTANT I S work.
5.] CITY shall furnish all such information as are in CITy1s
fi1es or are at its disposal, as listed in Exhibit "A", Section
III.
5~4 CITY shall fUrnish all services listed in E~hibit "A",
Section III, providing sufficient notice is given by CONSULTANT.
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5.5 TMc services, inforwation, s4rveys and repcrt~ reguJ~ed
by paragraphs 5.1 and 5.3 through 5.4 inclusive shall be furni~~ed
at CITY's expense~ and CD~SllL.TA}i'T' shall be E:!ltitled to rely u~on
the accuracy tnereof.
5.6 If CITY observes or otherwise becomes a~ara of any f~~llt
OJ: def<!ct in the Proje-::t or no.-;con!crroance .... ith the contl~ct
docurne!rts~ CITY shall g1'.·e prontpt written notice thereof to
CONSULTANT.
5.7 CIT'i shall furnish infol'"mation requ.ired by CONSUL'fAN'I as
expe(1i tivusly as possible.
SECTION 6 -P)!..YMENT
Paymer.:t shall be t'lade by CITY only for ser-vices rend<::red
and upon submission in triplicate of monthly progress; payment re
quests. Each invoice shall be itemized as to the type of paycent
described in this section.
In consideration for the full perfor~ance of the Basic
Services and reimbursable expenses described !on Section 4.1 of u,i::;
Agreement, CITY agrees to pay CONSUL'I'.~tn a fee not to exceed
$73,900.00.
6.1.1 full:2.(;;9nsul tantS. Fees for subconsl.11tants, hired
direct.ly by CONSULTANT, shall be approved b1' CIT'i' in advance ct
incurring such fees.
6.1.2 For Additional Services. For CONSULTANT's
additional services; as described i;-section 4 of this Agreement,
compensation shall be 21$ prescribed in Exhjbit "A II but not to
exceed SlO,aOO.oo.
6.1.] For Extra work or C: __ ll..~~§. Pd.ym.:::."",t far extra
"'ork or changes in the '.c,~k r.ot ir,itiatsd b)' the· CONSULTANT afld
aut.horiz.ej in ..... riting by the PROJECT ENGINEER shall be made upon
submission by CONSULTANT of a statement in tr-iplicate of itemized
costs covering such ..... ork. Prior to commencing such extra 'w'or-k or
changes, CONSULTANT and CITY shall agree upon an estimated not-to
exceed cost for such extra work. In no eVE'.nt shall CONSULTANT be
paid for design work or ~har.ge crder preparation which is necessary
because of CONSULTA1;'T' 5 errors or oversights.
6.1.4 ca1culation of QJ __ U!.<;.t _____ ~sonnel Jxpe~.
Direct personnel expense of employees engaged on the Projec.t by
CONSULT.lI.NT includes the worl<: of archi teets, ~ngineer5, designers,
job captains~ draftspersons, specificatiun ,.nit.ers and typists, in
consultatic..n , research and design, ar.:d in producing drawings,
specifications and other documents pertaining to the Project.
Included in the cost of di r-ect personnel expense of these empl,)},ecs
are salaries and rnandatory and customary bene:i ts $uch 3S stat"Jtory
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employee oenefits, ins1..:ran,c..e, sick leave. r-:olidf!Ys ar.d v3catic. ... ,;;,
pensicns and similar benefits.
6.2: PAYMENT SCH;::PYJ:.k
6.2 .. 1 Fo~ 8~sic _S_~_t:.y,i, __ r;:::.,g§. Pa1'ment~
Services shall be made in :rr<onthlY pc ogress p.Jyroents ).r!
to services performed L"1 accordance ..... i th Exhibit liS".
tor B;o:~.'::'c:
p .. -opo.rt: .:In
Final payment shall be made. t.y CITY atter CONSUL'!~_NT h.'!s
subl'!".itted all required reports and recei ved appro·..ral thereon.
6.2.2 f.Q.~ Additional Servi-:~s. Pdynents for;
additional services of CO~S~LTANT as defined i~ Section 4 shall be
made as part of the ::'.o,.thly progress pay~er.+.:s for sendr::2s
rendered.
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C0NSULT&~T's compensation on
damages, or other sums withheld
No deductions shall be made frvffi
account of pena 1 ty, liquidated
from pay!11ent~ to contractors.
6.2.4 Payment Upon SUSPJ~.tl§ __ ton or Aband_onrnent of
.fJ:ojec:t. If the Project is suspended for l'11ore t.han three 13}
months cr a,candoned :in ,,"'hole or ir. part, CONSULTANT shall be paid
its compensat.ion for services pe.rforrr,ed ~rior to receip-c. of 'Wcitten
notice from CITY of such suspens iort or a:bandor.~e!"l'::, t<:.Jgether '" i th
~dditional and reimbursable expense~ then d~e. If the Project is
resumed after !:leing suspended for more than one hundred t .... ej'':.y
(120) d(llYs, any change in CONSULTANT's compe!"ls.aticn shall be
subject to renegotiation and, if neces5ary, approval by the Palo
Alto Cit.y Council. If this A~reement is suspended (")r t.erminat.ed
for fault of CONSULTANT ~ CITY shall be obligao:ed ta compensat.e
CONSULTANT only for t~lat port ion of CONSULTJ.....I"lT I S servi ce5 which are
of benefit to CITY.
6.2.5 Reimbursable _.~X..P.~,~ Reirr,bursable expenses
are included in the co~pen5ation for Basic and Additional Services
and include actual expenditures made by COIISULTANT, its employees,
or its professional cn~sultan~s.
SECTION ? -PROGRESS AND COMPLETION
7.1 TIME IS Q.f--.THE ESSENCE
of the essence
of Notice to
tasks of ~t.udi
"A". ')olork en
It is understood and agreed that tit:'le is
of this Agreement, and that, following receipt
Proceed, CONSULTANT shall commence -.,.'0[")'. on initial
in accordance. 1.,Iith the tj-rne schedule in Exhibit
subsequent tasks shall proceed in accord~nce
schedule.
with said time
7.2 TII.'fE OF COMPLFTJDJL9J EACH PHASE
CONSULTAN1' aql."ees to perform t-he pha~>ed services ..... ithin
the time limits set forth in Exhibit "All provided~ however. that
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aT '~ange in the scope of s8rvices or olher changes due to cn," S
0] t.ing requirement"S:, or in connection ""ith other contractor:--_ CIt"
Cl ~ltants operations, Llay reguira a revised time table.
CITY agrees to exercise du~ diligence in performing Its
tasks to impleme.nt. CONSULTANT's time table.
Be'C.'\IIeen each phase of work. there. is G! rev i.e. and appr0va.l
p~riod by Cl'I'i. The CITi' ,.,.ill exe:rcise due diligence to cOnlplct.e
these tasKS; howe\ler r it is recognized that the interrehted
exchange of ir.formaticn i'llnonq CITY I 5 various departments make~ it
impossible to set a specific time schedule. Normally, the crn"s
estimated period of review and approval 'Will be furn.istl-ed to
COr,;SULTANT at t.he time of SUbmission of each phase of 'Work.
7.4. EX.T..!;NS_ION OF TIME OF cmlPLETIQ!!
In the event the services called fo~ under this Agreett~~t
are not ccmpleted by CONSliL'I'ANT within the time specified, CITY
shall have the option to extend the time of c~rnpletion. This para
graph dOe:!s not preclude th~ recovery of di:lmages for delay of either
party_
SECTIOt-"n_8 -CHANGES IN WORX
C.!TY may order major changes in scope or character of
\oIork, either decreasing or increasing the amount of CONSt)LT1>Jn' 5
services4 In the ever.t that such changes are ordered, CONSULTA..~T
shall ~e entitled to full compensClition for all work perfor-med prior
to receipt af notice of Change. Increased compensation for ~ajor
changes shall be determined in accordance .. oi th Section 6 of the
Agreement, )::ut in no event shall CITY be liable for pa:{rnent unless
the amount of such extra compensation shall fir~t have been agreed
t.o in 'ilriting by CITY.
In the event thClit major changes are o~aered pursuant to
this section, the sched":Jle for progress and completion in Section
7 of this Agreement and cmr.pensation shall be adjusted by negotia
tion between CONStlLTANT and CITY, subject to approval, if necessary
~y the Palo Alto city Council.
SECTION 9 -·I'.~RMINATrON OR SUS~ENSION_OF .~_GREEMENT
9 .. 1 Ci\.NCELt..a. '1'1 ON n Y !;.9.Nn$ULT.h1l1
CONSllLTANT :may terminate tr .. is Agreement or suspend · .. ·ork
on the Project upon thirty (JO) days' ... -ritten notice to CITY, but
only in the event of substantial failure of performance by CIT¥ or
in the event CITY abandons or indefinitely postpones the ProJect.
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Without liI'!'litation to 5uch rights or remedies as r:I'!"{
shall other .... ise have by la .... , CI'i''£ shall tHlo',te the right to terroir.~t(;
this Agreement or suspend ... ark on the Project for any reason, ',pon
fifteen (IS) day'S' .. ritten notice to CONSTJLTJ>.~~1'. or immedie:ely
after submission Lo CITY by CONSOLTANT of any completed iteu of
service ~pecified in Section ~ of this Agreel'l'.ent~ CONSUL1>J'H
agrees to cease all work under thi5 Agreement upon receipt of ~aid
..... 'r it ten not ice.
9.3 COMPENSA:.O:..9!L:9f Cm.rSULT;\J"T JJL_TKJ;
.£'\I-__ ;:N'T __ ..Q~INATION Of TJ1:IS AGREEMENT
In the event of t~rmination of this Agreement or
i\lspension of ~ork on the. Project by either CIT'i or CONStiLTI<..ST r
CONSULTANT shall receive compensation as follo· .. 's~
S.3.1 For 2ppcoved items of service under Section 4
of this .a.greement, compens~tion shall be in the arr,OIlt\t o'..ltlinE'.d
under Section 6 of this Agr~ernent for the items of service tully
performed by CONSULTA.NT.
9.3.2 For ite.ms. of service on "lNhich a not.ice to
proceed has been issued by CITY, but "Which have not been fully
completed and approved, CONSULTkNT shall be compensated for said
service in an amoont which bears the same ratio to the total fee
otherwise payable fer the perfOl"Ir-.&nce. of said service as the
service actually rendered bears to the total service necessary {or
the full performance at said item of se~vice.
9.3.] In no event shall the total compensation pdid
in the immediately preceding paragraphs e~ceed the pal~ent
specified in Section 6 for the respective items of service to be
furnished by CONSULTANT.
9.3.4 Notwithstanding anything in the preceding para-
graphs, upon termination for fault of CONSULT..A..NT, CITY sha.ll be
obligated to pay for only -chat portion of the service which C·3n be
inco~porated in the Project.
9.4 OUTIES or CITY~ND CONSULTANT
UJ.:.on termination of this Agreement or suspension of .,(ork
on the Project by either CIT'i or CONSLILTANT, and tinal payment to
CONSULTANT for "Work done up to t.ermination, all duties of CITY and
CONSULTANT. as set forth in Section:; 4 and ::; hereinabove, shall
terminate.
Records of the following expenses pertain.ing to tt"le
Project shall be kept by CONSULTANT on a gener311y recogrJlZcd
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accountinq basis and shall be available to CITY at mutl~,'dly
convenient times:
10.1 Direct par-sennel ~xpc!"lses, including consu 1 tant expe:,,;es.
(See Section 6 of this Ag~ee~ent.)
lC.2 Expenses pe!:taining to Jo.dditional Services. (See Sev:ioll
6 of this Agreement.}
11.1 Subject to the provisions of P~ragraph 11. 2 belo~, the
original drawings, ~aps, plans, designs, records of survey, ~ork
data, specifications, and other documents prepared by CONSULT}oJ;r in
the pc.:-formance of this A9reem~nt, although instrl..lntel"!ts. of
professional service, are an~ shall be the property of CI~Y ~h~~her
the Project for which they are made is executed or not.
11.2 Upon termination unde~ Section 9 of this Agreemen~ and
upon CITY's payment of the ar,\ount requir-ed tu be paid under sat\..e
section, the originals and all drawings, calculations~ specifica
tions and similar documents become t,he prop~rty Cif CITY. and
CONSULTANT shall transfer them to CITY upon request ",rithout
additional compensation. CITY shall have the riqllt to utilize any
completed or uncompleted drawings, estiro~tes. specificztions, and
other documents prepared hereunder by CONSULTANT; however. CIty
shall inderonify CONSULT.~T against any 1055 Which may be caus~j to
CONSULTANT by such use: i'JInd reu.se. CO]'J511LTANT shall have the Tlght
to retain copies of all dOCuments prepared under this Agreement 3S
a record of its professional activities.
SECTIO/i 12 -INTEREST OF SONSULTANT i CONSUr,,:;rPoJ:l:1._INO">,?EN
DENT OF CITY
In accepting thi 5 Agreement, CONSULTA!n covenants that it
presently has no interest, and shall not acquire any interest,
direct or indirect, financial or other;,..rise, w,<hich wO'..lld conflict in
any manner or degree with the performance of ~he services here
und~r. CONSULTANT further covenants trlat, in the performance of
this AgrE:,:u,ent, no subcontrC:lctor or person having S"\Jch an interest
sholl be ell1ployed. CONS\JLTANT certifies t.hat no OTIe: "Who has. or
will have any financial interest under this Agreement is an cfficer
or employee of CITY.
It is expressly agreed that in the performance of t.he
professional service.s required under th is Agreement CONSULTANT, and
any of its subconsultants or employees, shall at all times b~ con
sidered independent contro"lctors aono not agents; or-employees of
CITY.
SECTION 13 -OU'rsIDE CONSULTANTS
CONSULTANT shall be l"esponsible for employiT,g all ou'tside
consultants {subcons'..lltants) necessary to aid CONSU[.TANT in the
performance of the servicEs listed in Section 4 of this Agree~ent;
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provir!ed; ho .... ·ever, that all such subcons",ltants shall receive prior
approval of CfTY in writi.ng and sha 11 remain ac..;eptable to ClTY
dur.ing the te:i."rT'l of this Agrec:r.\E'_nt.
sECTION 14 -,U-lDEMNITX
CONSlJI·TANT a~rees to 1 l"'laerr.n 1 fy; defend and hold harrnles'S
CIT'{, its officers .. age.nts. a[l.d emploJ'e.es from any and all demar-.ds,
claims. or liability of any nature, including death or injury to
any person, property damage or any other lass, cauSE"d by or arising
out of CONSULTANTfs, its of!icen;l. agents'. subcontractors 1 or
employees' negligent act.s, errors, or omissions, or t,.'illful
misconduct, or conduct for which the lay imposes strict iiability
or. CONSllLTANT in the p€rfQr!'l'.ance or failure to perform this
]I.,qreerner. t .
SECTION .lL __ =_ n';St:RANCE
15.1.1 COlllSULT}ljI,lT, at its sole cost and expense:, shall
obtain and maintain, in full f0rce and effect throughcut the entire
term of this Agreement, th~ insurance coverage described in Exhibit
'fen, attached hereto, insuring nc-t only CONSt1LTANT and its
subcontractors, if any, but alsa, .... ith the exception of workers'
compensation and employerts li~bility i!"!suranc€. C!T'i, its
officers, agants and employees, ~nd each of ttlem, with respect to
act.ivities and service.s performed by CONSULTA.NT for or on behalf of
crT,{ under the provisions of this Agreement.
lS.1.2 Certificates of such insurance, preferably on
the form$ provided by CITY, shall be filed 'With CI'l"i concurre.ntly
loIi th the execution of this Agreement or. with C1TY I S approval,
~ithin ten (10) ~orking days thereafter. Said certificates shall
be subject to the "approval of the CITY Risk Mandger and shall
contain an endorsement stating t'i'.at said insurance is pyimary
coverage and -""ill not be cancetled or altered by ~h.e ins.ur~r 8;.{cept
af~er filing '",ith t.h~ City Clerk. thirty ()O) d?oys' prior · ... 'rit.ten
notice of such cance]la~ion or alteration, and that the City of
Pale Alto is na1'r.~d as an OIddj tional insured t except in pol icies of
professional liability insur-dnce}. Cu~rent certificates of such
insurance shall be kept. on file at all tirr.cs during the tenn of
this Agreement .... ·ith the Cit! Clerk.
15.2 COR.~E.£rION OF ANY ERRQRS, OMIS5!~_N_P AM8IGUTTIES
IN CONTRACT DQuG.Y11EN'IS
Any errors, ornissions, or ambiguities in the cDntract
documents .... hich are discovered before the PLoject is out for bid
shall be corrected by CONSULTANT without CC5t to CITY.
SECTION 16 -um_"'!Y.BKERS I COMP~J::l..~_A..TION
CONSULTANT, by executing this Agreement, certifies that
i~ is aware of ~he provisions cf the Labor Cede of the State of
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California 'Which r.equire every ernnloyer to be insuz ed aga. :"1st
liability for ,*orKers' compens'3:tion or to undertake self-i.r:sunl~.;:;:e
in accordance .... ith t.he provisions of th;~t Code, and certifies t~.nt
it will comply ~ith such provisions before commencing the pert~rm
ance of the 'Work. of this Agreement.
The terms, covenant.s, and conditions of ~his }I.greet:..cnt
shall apply t~. and shall bind, the heirs l successors, exec~t~rSt
ad!Tlir..istratot."s, assigns, and subcontr~cto~s of both parties.
Both parties hereto recognize that this Agreem9nt is for
the personal services of CONSnL1'ANT and cannot be tr:'3nsferr-eo,
assigned or subcontracted by CONSULTJI..NT · ... i thout the pr ior wr i t ten
consent of CITY.
18.2 SERVICES OF 5UBCOt{SU'4.'[AN'! AND TKEIR EM.P.kQ.X.EES
CONSULTANT shall be re:::;pon;;;ible for employing or engaging
all persons necessary to perform the services ot CONSULTANT h~re
under. No su'bconsulta;'lt of CONSULT.~NT wi 11 be recogr!:i zed by CITY
as such; rather, all suhconsultants are deemed to he employees of
CONSULTANT, -and it agrees to be responsible for their performance.
CONSULTANT shall give its persor:al attention to the fulfillment of
the provisions of this Agree~ent by all of its eroployees and sub
ccnsultants~ if any, and shall keep the ~ork under its control. !f
any employee or sUbcvnsultant of CONSULT&~T fails or refuses to
carry O'..l't the provisions of this Agreement or appoears to be
incompetent or to act in a disorderly ~~ iDproper rn~nner, he or she
shall be discharged immediately fz-crn the work under this Agreer..ent
on demand of CITY.
~~_CTION 19 -RELIA...-~Cc U'POJ! PHOFE'SSrONAL SKU-L OF
CO N S UL T ,AN'r
It is mutually understood and agreed by ann bet~een the
par-ties hereto that CONSULTAN"r is skilled in the professional
calling necessary to perform the ~ork agreed to be done hereunder
and that Cl'rY ralies upon the skill of CONS"JLTANT to do and perform
the 'Work in the most skill ful manner, and CONSULTANT agrees to thus
perform the 'Work.. The acceptance of CONSULTANT' s 'IoIork. by CITY does
not operate as a release of CONSULTANT fro1'l1 said obligation.
SECTION 20 -WAIVERS
The waiver by eithE",r party of any breach or violation of
any term, covo:!'nant, or concU tior~ of this Agreement or of any
provision l ordinance, or 1a\o' shall not be deemed to be a -waiver-of
any other term, covenant, condition, ordinance, or law or of any
subsequent breach or violation of the same or of any other ter~,
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covenant, condition, ordinan-:e. or law. The subsecruent acceptance
by either party of any fee or other money 'w'hich -rnd}' become due
hereund-er shall n·~t be deemed to be a 'Waiver of any preceding
breach or violation by the other party of ani term, cove~ant, or
condition of this Agreement or ,:,f any applicable laW' or ordinance .
.$~ECTION 21 -NO IMPLIKD WAIVER
~o payment/ partial payme!'lt, acce.rt.ance, or partial
acceptance by ClTY shall operate as a 'Waiver on the part of CiTY of
any of its rights ~nder this Agreement.
S~CTION 22 -COSTS A..'iD ATTORNEYS ' FEE~
The prevail ing p~rty in any action brcught to enforce the
t.e,rms of this Agreement or arising out of this Agreement may
recover its reasonable cosls and attorney fees expended i~
connection with such an action from the other party.
?ECTICN ~ ___ L.:: ___ . NONDISCRrMrNAr19 __ ~ . ..L _ ~ENALTY
23.1 QYIY OF CONSULT.A.NT
ND d:i.scriminatio!'1 shall be rr,ade in the employrr,£:!1t of
persons ~nder this Agreement because of the race~ color r national
o.l-~9~n, ancestry, religic-n or sex of such perso-"'l. If the value of
this Agreement is, or may bel Five Thousand Dollars ($5,000) or
more, CONSULTANT agrees to met all require~ents of the Palo Alto
Municipal Code pertaining to nondiscr ';"mination in employment,
including completing t.he "Compliance Report--Nondis::::rimination
Provisions of City of Palo .ll"lto Contrac'ts'" on t.he fc,rm furnished by
CITY and attached hereto as Exhibit ;'D~ and made d part hereof by
this refere.nce.
CONSULTANT agrees that. eacr. agreer:,ent fc-r se.rvices fr-om
independent providers shall contain a provisiD:1 -substa:-ltial1y as
!oll:Jws:
.rpROVIDER shall provide C0NSULTlUlT with a
certificate stating that ne (or she) is currently in
compliance ~ith all Federal and State of Califurnia laws
covering nondiscrimination in employment; thFl.t: he (or
she) wi 11 pursue an aft irrnati ve course of action as
required by the Affirmative Action Guidelines of the Ci'ty
of Palo Alto; and that he (or she) will not discriminate
in the employment of any perscn under this contract
because of race, color, national origin, ancestry, sex or
religj on of such person. 11
23.2 PENAvr'i FOR DISCRIMIN.~'l'IDN
If CONSULTANT is found in violation of the nondiscrimina
tion provisions of the State of California Fair Employment
Practices Act o=-simil.:lr provisions of federal law or executive
order in t~e performance of this Agreement, it. Shilll thereby be
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found in tllate!'ial breach of this Agreement. The!"E'upol"J. CITY 5h-1l1
have the po .... er to (.;ancel or suspend t_his Agreement, in t",rhole or tn
part, or to deduct from the. anou.nt payable to CONSULTANT the sur!' o(
'fi,.·enty-Five Dollars ($:25) (or ea::::h person for each calendar rJ.i\y
dur ing lribich such person "'Ias d iscr iroinat(,j against, as dam3ges 10r
said breach of contract, or both. Only a finding of the State of
California Fair Employment Pnl;ctice5 Coml'!':issio:'"1 or the equivalent
(ederal agency or officer shall constitute evidence of a violatlon
of contract u~der this section~
If CON'SULTANT is found in violation of the nondis
crimination provisions of this Agree:!:'If':!l"lt or the applicable
a!firI:lati ve action guidelines pertainil1.g to t.his l.greement,
CONSULTA.:. ..... T shall be found in material breach of this Agreement.
There·i.lpon, CITY shdll have the pO\ole!" to cancel or suspend tJ"!.is
Agreement, in whole or in part, or to deduct from the amount
payabl~ to CONSUL'rANT t.he sum of Two Hundred Fifty Dollars ($2S0)
for each calendar day durine; -w,..ich CONSULTANT is found to have been
in such noncompliance as damages for said breach of contract, or
both.
SE~rQ.N 24 -ARBITP..ATIQli
Upon agreement of the parties any controversy or claim
'!rising out of or relating to this Agreement may be settled by
arbitration in accordance with the Rules of the American Arbitrd
tion Association, and judqr'"Lent l.<pon the a .... rard rendere:d by tne
Arbitrators may be entered in any court having jurisdiction
thereot.
SECTION 25 -NOTI_!:;_ES
All notices hereunder shall be given in writing and
mailed, postage prepaid, by certified mai 1, addressed as follolols:
To CITY: Office: oE the City Clerk
250 Harr:ilton AvenUe
Palo Alto, CA 94303
To CONSIJLT.ll.NT: Attentj on of the PROJECT DIRECTOR
at the add:-ess of CONSULTANT recited ;above
~_f,:_gl.Ql"" 26 -ALL COVENl'.NTS ARE CONDITIONS
All proYis ions of this Agreen:ent are expres~ly~ t!1ade
conditions.
SECTION ?3 -J>.GREEJofENT CQNTAljl[_S ____ ~_L_1:
gNDERSTANDINGS; AMENDMENJ'
This document represents the entire and integrated
agreement bet .... een CITY and COj~S1JLTANT and supersedes all prior
negotiations, representations, and agreements, either written or
oc g 1 .
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This docul!lent may be aIr,ended only by written instruTlIent,
si,gl"l<&d by both CITY and C0~SULTANT.
,2_~~..I.Q_~ :: e. -GQYJ:RN! NG~,,!
This Agreement shall be governed by the la\lols of tr,p' state
of California.
IN WrTNESS WHEREOF, the parties hereto have executed this
.Agreement the day and year first above ..... 'ritte.n.
ATTEST:
cH,y Cler;';
APPROVED AS TO FORM:
Sr~ Assistant City ALtorney
APPROVED:
Assistant City Man~ger
Director of Fina":::.c"'e----
Risk Manager
APPROVED AS TO CONTENT:
Department of Publ~c Works
Departrnenf---ot Uti lities
Attachments:
EXHIBIT "'A":
EXHIBIT liB":
EXHIBIT "ell:
EXHIBiT "O'j:
EXHIBIT "E" :
C.!TY OF PALO ALTO
SCOPE Of PROJECT , SCHEDULE
RATE SCHEDULE & PAYMENT SCHEDULE
INSURANCE
NONDISCRIMINATION COMPLIANCE FORM
STATEMENT OF ECONOMIC INTERESTS
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E:K..l-£IBIT "A" PlanGraphics Scone .9.i...Ro.rk(ver. 6.3)
SCOPE OF WORK
The primary objective of this Project is !o creale basemap data to be used with the Cit)'"!!
Geographic Infcrmatiofl System (GIS). The sleps leading to t!1e creatie>n of this informa[ion an::
listed in following tasks. Other tasks included in this. !.Cope of work shall be tre.attd as
additional sendces.
Review~lre.menlS for Ground Survey _~Q1HJol for Mao Fealures. and
Eyaluate .t\-ruili . .;able New Tecl-nolcoies andmMeJb_Qds for Proiect
A_QJ~iljon?l Work Ta'Sk~
~jjiiL!:_H.J'j!1. .. 9 .. yers;ght of WorJLDSmA_elytck in Phase T Area _Q.;. ____ y~.rif;catiQn of
CiJy Data Created by Aelytek
These tasks are described on the pages which follow,
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EXHIBIT llA-1:'lanGraphics ;;.';9pe of WorJs.(ver. 6.3)
CONSULTANT (PlanGrd.phlcs) shall begir. their work by revie'}"ing the Cl!ITent statuS
of the project. PlaroGraphics shall !\pend up to two and onc-ilaif (2.5) days meetir,g · .... 'lth City
of PaIo Alto :;taff on-site and revitwing specific ..... ork pnxTu::ts a:nd to obtain staffs input
regarding L1e work done to date and the problems encountered. By delermining firsl-,hand from
staff whiit [heir experiences were alld whal their Sougg;estions are for carret,ting problems these
is.sues can be avoided in future work Topics of discussion ""'ill in(;lude:
-revie','.' of Phase I dara documents
-applicabiiity of current specifications to meet Clty'S needs
-currenl -csage t,f G1S by City staff
PlanGraphics shall also re .... iew the progress cf olner relalcd departmental a12tomatlon
efforts. such as the digital bascmap created by the Cily's Fire Dcpartmel1t as part of their "Run
Map· project. This map may be useful to many City depanmcnls for GIS applications until the
more detailed' and accur-.He map products have been created.
Adc1itionally. efforts by ol~er agencies including Stanford Univer!>ity and the County of
Santa. Clara shall be reviewed for their potential t:'5efulnc.ss. As a large portion of Stanford's
land lie in or adjacent to the City of Palo AlIo, prosveets for a joint project should be
invesLi gated.
P~ELlVERABLE PRQPIK::[£;
Technical memorandum status report c,n Phase I p[Qgr~ss and the applicability of current
specifications to meet the Cily's needs.
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Assist the City in ReSQlving U.D.5..obb~:~tl~s v,"1Ih Aelytek Inc.
A~lytek, Inc. is the firm which was ~lecled 10 dQ m::p the pilOl project area in Phase l.
'WInje tlleir deliverable products are incomplete, some of t!"lcm ma.y be usable: in f'.It:J.re pha')C.s.
PlanGraphi.:.s sr.a11 review the \.VOrl< done by Aelytek aIld determine to what extent these producls
should be tJ . .-.ed in future phases. These prodncts include:
1. .sur\'ey Control Aelytek established 4 number of survey control poirHs throughout the City
or PaJa Alto, These points are shown on a rna;> and described on separate sheets which
describe them.
2. Auiai Photographs Aelytek performed aerial phCJiogrdpny of both the Phase r and p~
II areas of the City. Prior to performing photography. utility features and ground control points
were painted ~ thai they would ~e more easily idenllfied in these phOIOS. In 3.ddition Aelylt!k
has created digital planimetric and uti lily maps in the Phase 1 area.
P!anGraphics shall ascertain v.hether these products are a suitable base upon which to build or
if this area must be remapped by the new mapping vendor as part of future pha.s.e-s.
PlanGraphics shall attend one (1) full day meeling with Aeiytck in iheir offi(;es to gain a bet!a
understar;ding of how this. information was created and whe:ner it wili be.an appropriate icsource
for future work. Depending on the outcome of these meetings and Aelylek's· f;Jture progress
PlanGrap'hics may be rC'Juesled to attend f\,;nner meetings and become more involved in the
oversight of Aelytek's Phas.e 1 work. Such work will be considered under additional services
and is more fully described under Task 7. If funher, independent e~!aJuatiol1 of these products
the Project Managers will dire:t PlanGraphics to proceed as described under Tas.k 7 of this
Scope of Work.
Technic.;J memorandum evaluating applicabihty of Aelytek deliverabJ( producLS to futu.re
City map pha.'ieS and recommendalions for future cours.e of aClion regardIng Aelytek"s current
Cily c()!ltracts.
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EXHIBIT "A" PlanGraphics sCQP...§;_ 9!" Work(ver. 6.})
Review Requiremel1lL.fQL.(j10UJJt! Sur~,J~_J:~ill!!'O! for Map r~1..\g~_,,-finQ
Evaillate Applicable New ___ T~~1I1.Q_1Qgies and Me!j,ods for Proi~_t
PJanGraphics shaJl dete:-mtne the e:IO'.Ieflt of addltional g(uund cor.trol IT!onumenlalion
required to adequalely register map katllres to this s.ystem. Particu.lar attention mus! be paid
to how cadastral information is registered to physicai features. The City has created a digital
measurement "ased cadastre which depicts all parcels ba~ on inform.ation from subdivisio"
maps, parcel maps and other legal documel1t~. Re.::ornmendations will be developed which
address the level of survey control ntx:essary to adequately regisl~r t!le cadastral i>lformation.
ptanGraphics shall attend HIo.'o {2) m{'-e~jngs with the O!y staif 10 r~ .... iew map control
monumentation resources already in place and additional f"J..:eds. Cit)' staff will work with
PlanGrapnics in analyzing these e':(L~ting resources and d'::lermin[ng whal additional ties are
required to register GIS map info:mation !O ex!sting cadaslral information.
PlanGraphics s.hall evaluate al!emative methods of creadng bas.emap data and make
recommendations regarding their use. The.s.e shall include:
-Ground SUf"'w'cy using convernional and GPS technology
-Aerial photogrammetry
-Digital Orthophotography
-Trace digitizing of e"isling map~
-Attribute key eiltry from exisii~g maps and documents
-Sea.., digi~iz.IH& of maps: and documents
-COGO data entry of cadastral data or engineerir.g drawings
In o,e Phase I Pllot Project area the goal was to map all features of mterest to the City
at once within ii defined geographic area. PlanG,aphics should evaluate alternatives 10 this
approach; specifically whether mapping of the entire eily with Tes.s features is a preferred
approach.
DELIVERABLE PRODUCTS:
Technical memorandum evaJualing CHi"S. project methodology. recommt::nding re\li'Sions
and providing recommendalions regarding Ci.:lernative applicable technologies and the rlC'.e.d for
additional ground sUf\iey control and monumentcHion
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EXHIBIT "A-PlanGr_~ .... Q.tL.i._~ __ $ Sco2e of WorK.{ver. 6.))
PlanGrap:'ics shall spend up 10 t'Wo (2) days evalu2ling revisior.s to the RfP for d'H.aba:~
construction. in makieg these revj~lons, PlanGraphics ~hall consider changes in mappi:'l£
merhodo!og:y which would alI0"-A' the C!ty to accomplis.h its. goal of <:reafmg an O1cct!ra~e, curren!
digital b&emap nf tlle City of PaID Alta in a timely a • .,d cost effective manner. RFP
requirements ::.hall be revised or formulated for each data entry technique that is determined to
be appropriale for this Projecc ~1lJltiple daLJ. e01tr)' techniques, if required, will b.-: packaged
i:i a singie request for a "prime cO!lsultant~ to take r~spon-"ibili'y for all the necessary sub
components.
PlanGraphics shall develop quality control and verification procedures for (unire ma.p production.
They .sohall formulate a strategy to verif), Cl.nd enforce Lie data quality standards s~jfied in the
RFP and contracts.
Plan Graphics 'shall submit two (2) copies of all RFPs to the ?roject Engineer for review and
comment. FO[Jowing revision based on City input PJanGraphics shall submit one (1) final durt
prepared on healiY Nnd paper suitable for reproduct;on and two (2) regular copics 10 the Project
Engineer. City shall be resp0n-sible for reprod'Jction and b;nding of all RFPs to be sent to
prospective mappin~ vendors.
Proposal Review and EvaluJtion
Upon receipl ofproposah from prospective mappil'lg vendors, PlanGraphlcii shall re .... iew UP!O
four (4) of these proposals and recommend '.;,:hich firms should be "short-listed" to be
interviewed. PlanGraphics shall spend up to one (1) day reviewing proposals, attend one (l) full
day of presentations by prospective consultant:;, and attend one (I) full day meeting !o discuss
these interviews a.'ld make recommendations regarding their ~Iection. PlanGraphics. will present
its recommendalions to the City at t~ese meetl:lgs.
DEliVERABLE PRODUCTS:
I. Draft Requc'!'l for Proposal
2. final Reqtjest for Proposal
3. Review of .... endor proposals
4. Recommendations regard~ng vendor 5Cleclion
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PlanGraphics shall d~si5l the-City jl) the tex:hnical management of the mapping projecr.
They shaJl attend one (1) problem solving and staws rn~til1g(~) per month for a t1erlod of t'.,ltlch'e
(1:2) montlls with the City and the new mapping vC!1dor during the e.'\ecution of the mapping
.... enc!or·s work. Management asshtance u~ks pcrfOr1iied by PtanGraptm::s sl'iall ~nc\\lde:
-Recommend processes for p:il.'>duct deli .... 'cry from n:ap vCrldcr, review and qua.l:~y
control of pruducts bj' the City in a timely manner, and sub.seqt.:er'! editing by map ve:-.dor .
• Assist in coord~nMi{m. (If muh.::ple vendors if more tb"n CIne RFP is ~ss\jed.
-Facilitale communk.ations belween tl'1e City and the mapping vendor; c1arify issues
enco1jnlered in the complelion of the contra.::t rhl$ rna) indude arbilration of dJspu:es arising
bet~.'een the City and the mapping vendor.
-Working with software application developers who are ~:orl...ing for the City [0 create
GIS applicatiorls whic111nregratc map iniofmation with data from other sources.
DELIVERABLE PRODUCT,l;
L Monthly repons summarizing Project prof.res) and isslJes.
2. Technical memorandum to be slJbmiaeJ: 'Y'.;hen Project b) mappmg
vendoo:(s) has been completed summarizing resollts":lf 'pn.:~iect .and recommendmg future r.as.ks for
optimal GIS ~mplemelltation,
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EXHIBIT "All ~DGr.z.phic.s SCOpe of Wo=x (ver. 6.3)
Review of CHy's GIS Pa\ahas.e Desi~i'otil..Q.L~ ___ Administration Procer1-.!.!1C~
In addition to cO:1ducting regula Project S13tu:s and probiwl sohing Jt1eetings w!th CliY
staff, the following activities shall be conducted (01' supervised) to develop the other componl:nt~
of the City's Geographic Information System (GIS) .
. Review and r.1odify the graphic a."ld a!tlibute database designs, including obJe.,;.( nami~g.
file organizaLion. ftle e')l(tent, object attrib"wtes and default .... alues.
-Review and fo~muTate database administration procedures for maintaining a consistent.
single, City ...... ide data resource; procedurts for changing t11e d;ltabase structure in a systematic
monner; and procedures for updating and disseminating tr.e data.
-Revk:w or devefopprocedlJres for managing '-he flow ofGlS-b.;:.scd information betwccn
departments !o support appropTl3te City functions; for example, permit review, captlal
improvemenl planning and ~onslnJction, and uLility/infrastruc!!-lre maintenance.
-Review or develop standards for data exchange with private developers Ihrollgh CA D.
-Propose requirements for application programming.
Tecnnica: memoranda with rec'Jmmenda,ions regarding the topics li~ted in this us!.:.
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EXHIBIT PlA" Pl;;tPGr~"phics Scooe of Work(ver. 6.3)
Assis.t in Ov!:[sig.biai Work by AeJ ... tek in e.h.~~ ___ L~and Verilicaiicn aj CiiY
Data Crea!~ __ by Aelytek
In c:t! effort to resolve ongoing difficulties with the work by Ae.lytek, Inc. tn thei,
mapping of the PlanGraphics shali attend up to four (4) additional problem solving meetings with
AeIytek and if necessary advise Cilyon the best course ofacuon to complete ta~ks not completed
by Aelytek FlanGraphics shall develop a detinition of pnx:!ucls and a schedu!e for product
completion. They shall also d~velop procedures for quality checking and signoff by the City.
ff the City deems it necessary. PlanGr.lphics shall formuhue and manage the procc);s of dat;!.
verification on samples of City data utilizing technical service prm'iders wi:hin the a\'ailab!e
budgetary allocation. This verification process will recompile samples of City data previously
processed by Aelytek to analyze the accuracy and precision of this dala and ie's usefulness in
future project phases. The COSI (If services by ot~er technical service providers is not included
in this conlIacl.
12!:LlVERABLE PRODUqS,
1. Teclmi~J memorandum with re.cord of agreements ani~ I.S~ljes discussed by Aelytek
and the Cily.
2. Technical memorandum describing the n:s.uits of t!-:e data \'critication process and
recommendation regarding Lr,e use of City map data crealed by Aelytek.
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7"""~t'-" 'WI AS $(1 i P --
TASKS
1.,111
T •• 1(2
l.,113
T •• 1I4
1 •• lt6
TII*"6
Taak 7
Palo Alto Phase II GIS Project Schedule
REVIEW CURRENTBTATUS
AEL YTEK REVIEW
09 REQUIAEt.tEHTS
RFP:II a. EYALUATION
f"ROJECT MANAGEMENT
DATA8ASE SEFWICE9
A(;LYrf:K OVEASITE
MOIfTH
r~~' -~ '-1 ,. rr11~ ~
LL~ '"-:g :L~ i~ I :== ,,)
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Palo AIIo Phil!:!'" II SchedUle
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Exhibit "E" m~ent Schedule
Q
PALO ALTO GIS IMPLEMENTATION PHASE II R., 4
Proposal Budget
T~k: SerJ&s HOCT$ LABOR EXPENS.E.S TOTAL
Series 1 Review Current Slaws 40 $4,700 $1.300 $6.000
5er1es 2 Ae~y:ek Re~-ew 55 $0,200 $500 55.700
Series 3 DB RequiramenlS 137 $i4,000 S2,3DO $17.100
Senes 4 RFf's. & EYaluation 178 $18.500 $1.700 520.200
Series: 5 Project Man4gei~',ertt 97 $12,000 $1.1 00 $13,100
Serf.es. 5 Da~ Services 81 SMOO $1,800 $10,800
[Su,,",""'1 588 $65,200 $3,700 $n@
ser1e.&; 7 AIeytei( ~rte 5: Verification 74 $9.200 $800 510.000
TOTAL 5<;2 $74,400 $5,500 $83,90Y
Bruce Joffe, PM 429
Paut Durgin, Excc ConsuJ!af1t 30
Amy Purvis, Sr. Ana:yS! 20
Jim Cann.istra, Sf. Procrarnmer 132
Haiyan Z~ang, Reseaich Analyst 54
EdittlrQI, Word processJI'Ig 7
BID/Palo Alta summary 6/31/92
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SCHEDULE OF HOURLY RA US FOR AM/GIS SERVICES
Elfecti .. ,~ September 1, 1992
Principal
Executive Consultant
Senior Analyst I Programmer
Systems Analyst I Programmer
Resean.:h Analyst
Research Assistant
Secretary/Support 501 vices
Direct Expenses
$150 per hour
$125 De! hour
$100 per hour
585 per hour
S7Q per hour
$30 per hour
537.50 per hour
Direct expenses dire-ctly attributable to the work including.. but not limited to,
the -examples hsted below ,",,;'ill be charged at C05t times 1.15.
Rer:tal o( Special Equiprnent
Acquisltion of Data Files
Reproducfion
Special Freight and Fostage
Tra.vel F.xpenses
Tra vel ~1ileage $ '0.32 per mile
The individual hourly rates ~nclude salary. uverhead, administration, and
profit.
Pa:yrnents are due within 30 days of date of invoice. Thereafter a late p .. yment
fee 'h'ill be charged on the outstanding balance at the ra!e-of 18% rer year.
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ti :HENAULT • HQGE, INC.
'I P. o. BOX :J ;1 fRANKFORT ICY 40601
COMPANIES AFl'OAOING COVERAGE
II ,""'" _ _ I
t)-1="8 .~ •.. 1: LA."'iGRAPHICS INC I e::w.. ... 'M' C
J
;I:' g~T~~~O MAIN STREET ~~-=-o",,-. -0-
RM'KFORT, ICY 40601 I ~,~. I
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r-~~.1""""'~F~·
~~ "'""":. """"" .. no. I ~0ftRI.' UUIl..ITT
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EP1<09532004
ECA09065559 p4/01ln
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~41 0 119 3 I""'"'.' ""~. I I~~ .. >= _ -.t~-1.000 00,
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PTOf,,~.o;lrnlal Li.ab:.llt} is spec~fica:ly e:·~c100e2.
Cit:] t:Jf .Fal('l Alte. Californld is S~O~.T, as an. Acldi-;iot:al l!1s1..Jr('~ i:-. c(.n:n€r::-.iC>l ",;i~:"1. jeD
Cl7t OF PALO ALTO
CALIFORNIA.
250 IlAMILT'ON AVENUE
PALO ALTO, CA 94301
'~;~ . .' ~=~i~~~~ ~~C·~~EDPOl;~/~5 B~~~C'~~f~ ~';;~'~E ,'."'
EXPrt\Aw,.. OAT!: T'1:~a;, TH'E ISSUI"G COJr,olP,l,NY 'HIll. f.NUt;AVOR TO
~IL --1A0AY'S ~rr:€N Ncncf. TLl ..... E cr;::;;f',CATE t-'CL.D"~ N./<1oI£D ,0 ~E
<.Ln, 6.IT FAJcl,lr<£ 10 JAA.il suet< NcrlC~ S>lALl ~",:>os.E IIlC OiJUGo.'1T!ON 010
UA.!l1!.rrY OF" AUf ~~tl J?CN. Tl-iE-CO ~l",.I!'N, iTS ,10Efrn: 00 F1;:-rrMt'_:;;D(T~TrvE-&,
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AFFIRMATIVE ACTION GUIDELINES
A. PRE·AWARD PHASE OF CDNTBAQ
1. !n addition to the Certificate of Nondiscrimination required to be fired under
Section 2.30.090 of the Palo Arto MuniCrpal Code {h2reinafter "PAMC"}, the
bid1er snail complete a questionnaire furnisf'ed by the City setti0g forth the
affirmative actions the bidder has taken cr will take t'J:
8. Re-::.ruit minorities. irl itS \ccation for at! levels of jobs.
b. Se'ect methods aSS'.Jr'ng equat employment opportunity for an
Der~ons.
C. Establish a training program for flew hires where necessary to assure
a.mple opportunity for the le,ss qll8tified <;0 more f'-Jtly q'Janfy.
d. Provide adequate opportunity for upgrading and further training to
aSSure equal opportunity iii advancement and promotion.
f'. Provide counselling seivice for all who may need help to advance,
eS;leciaUy raew emplo'tees>
f. Educate SUP'3rvisors regarding nondiscrImination practices.
2. ~n addition 10 furnisn~ng the completed Questionnaire caned for under #1
above, each b1dder for a construction or service project within the City shail
submit the following information for himself and 5uOcontraC10rs. This
lr.formation shall constitute the bidding contractor's r,,1inority Empioyment
Program (hereinafter "MEP"l.
't:
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a. The estimated 'tOtal number by job c(assificatior, of personnel who
sr-,ati be used by the contractor and each subcontractor in psrfo.-marlce
of tr.e contr3ct. Tt'lese numbers sl1all inClude the estimated breakdown
b..,.-one month for the life of the contract. No estimate furnished under
this subparagraph shall be construed or enforced as a hiring qum:a.
b. In preparing thes.e estimates it is expected th.e btdde( will take, O(
agree to take, these 3dditiona~ steps to assure affirmative actio") In the
freld of minority employment.
Pl Recruiting for needed help in the local areas inhabited by
minority members, lnc[uding open advertising and use of various
Sheet 1 ot 3
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established public and private ager,cies. [lists and 8(;vice
fl'rnished b, the Pa~o Arto ~Liman Relation5 Councii {hereirlaft~r
P~I-IRCIl
(2) TrainL19 t!lose less qU2lifled to assure adequate oromOl!0na~
opportur.ities for 811.
(.3) Pro ..... iding necessary counseling for upgrading, includir:g 'Jse
(I~ outside traini:lg 1acLIities in this ai'ea (lists ~vailabre from the
PAHRC),
(4) Assigning an EO'..Jal Emp~oyment Opportunity (EEO) coordinator
full time or as add:tfona~ duty and assuring !hat 311 supervisors are
aware of their responsibilit:es and that union representat]yes... __ ._ .. ~_
recognize their respons~bijities in the flqual employment progfal'T)~~=.-=::~:_·~. t· --._..::-:---
(5) Assuring that :;il s=.;bcortt;actors are in ccmpiiance witH t Ie ~
federal and Cailfornia state laws and regulations relatfn~ =
r,ondiscrimination. f. ~
(6) Whe~e ihe contract is of s':JHicient duratio'i . .ass 'ri
development of aoprenticeshjp programs with union cooper ti
, E::::::~~
17) Upon request, furnlshjng the City a copy of the latest F
Form fEO-'. or equivalent form.
IS) Providing the name and address of arl suppticrs whose
supDlles andlor equipment exceed 5% of the total supply COS! for
each contract and subcontract for the performancl:;' of the
cor;tracL
c. Any bidder not submining an MEP shail not be defined :::s a
"respo~sible bidder" and hi5 bid shail be disregClrded in the ma,,:1e: liOW
prescribed b,( 'the City.
d. The City Manager wHi analyze the MEP submitted by each bidding
contractor with the objective of deterr,,:,nmg i~ the program submined by
the contractor for himself and ,",is subcontractors presents a reasonable
effon to further mtnority emp!oymenr.
e. If the Cjty Manager has questions about a pa~t;cuiar bidder's
proposa'!, he may address such Questiorls to the bidder, The City
Manager wii! be avajiable to ans~".,rer questior"Js relative 0 the guidelines
and to advise those seeking assistance of resources known to him. He
shall nDt be responsible for the se[v~ce or lack of service rendered by the
resources recommended, nor shan he be respofl.sible for devefop'll1g an
ME? for any bidde~. or to serve as a recruiter for any bidder,
Sheet 2 of 3
~-............ X
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f. Bidders sl1all be anowed to revise their MEP atter consf(1eration. If
bidders withdraw their MEP for relJisio:l, their revised prografl"'l mus.t be
resubmined by a date wbch shar! be established by the City Manager.
Bfdders faljjng to have t!leir rev!sed MEP submitted by the establ'lshed
date shall not be c!assified as a responsible bidder.
g. The Cjty Maflager. pur3rJant to the guidelines, shall make a decision
as to the responsJbWty of each bidder.
9. AWARD PHASE OF CONTRACT:
Upon a· ..... ard of the contract by trle City, the recipieni's ME? which has been
app~oved and accepted by the City shall be an integral part of '.he CCn'lr2ct and subject
to Section 2.30.093 of the PAMC. No contractor shall be deemed in materia~ breach
61 contract under PAMC Section 2.30.093 when he has made a reasortable and
substantial effort to comply with tr,e MEP.
C. POST·AWARD PHASE OF CONTR,o.CT:
1. The contractor shall post in conspicuous piaces, availab'e to employees and
applicants for employment, no[ices to be pro\lided, sening fonh the law prohibiting
discrimination and ad ..... ising ar:Vone who feels he IS bei,:",g discriminated against to
adv~se the FEPC.
2. The cont:aCl0r shall make written progress reports on the performance of
his MEP at 1nteorvals estab';shed by the City Manager. The contrac"'Wr, however, is
encouraged to subm't written reports as often and wt,en he deems it relevant to his
MEP.
3. The City Manager s~aH monitor the performance of the MEP untH
completion of the contract and will re.:lort to the PAHRC on the progress af the
contractor in living up to his MEP.
4, Any Questions of possibre breachjng of MEP shc::JJ be dfscussed with the
c.ontractor by the C~ty Manager.
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Resolutions No. 4144 and4f48
Palo AfrO M;;nicipal Code 2.30.090
Ordinance No. 2420
Sheet 3 of 3
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FCiU1J\.NCE OF" CI'T'i CON'J'RACTS
71':e COLlncil cf the City c-f Palo )..1::0 cloes ORDAIN ~s Iollc· ... ~:
§CTION 1. T.I,.~t sec'::.ion 2.3a.O:;'~ of t'he Pal.:l ;.,lto ~I.l~iclpal
·2.J~.~'C lcwest resoo~sible bidder. !~ ae~~tion to p~lc~.
in d.elermin:U".q I:he 'J.o ... es::: :X-lls-ponsiE.!<l--!:liadcr,· consiaer~tion
will be given t.o Cj1Jality ~n~ per!cJ:'r.la~ce o! t.r,e !l:llppli~s toO
be p1Jrc.tHII~ed cr :services f,rovic.e~ by t!11'! :'iel~"'T. Crit.erii!l
for ceter.:1'inil".g 10·'" ~id .:;ha:!l i:'lcl'.la:e, b'.lt r1;;,t bllO l'::;'r:'lited to
the !ollowin.,
il, 'J'he ability, capacit:t ;.>r;d skill of the b.idder, to
perlo~ t~e contract or P~-,)'-'i:9 .. the s·"'pplies ox serv';.r,'es
l:eq",Lred.
[2} The ability of the 'bid~e>:: to p::c!lride U.a supp1iE-s
or servi(;es p::-=ptly, or ... itl'lin the-ti."e ~pecifiE"d, ",ith~\J.':
delay or interfe~ence.
(lJ 'rh!!= charactc:·, ir.t.!:!g':::itl-', rep'.ltatio:1, j;.:aJnH~r.t,
experience and ~fficie~~y o~ th~ bidj~r.
,~) Tt-. .... qUlIlity of .oich'Iex', ., .. ::-forman::-e 0:1 pn:viO"oJfI
purchas~$ or cor-tracts ",i~h the city.
(50) The ability of the bidder ~o p:::ovic!e !ut-.c:re TT.~::'n-
t:t'!nance, r,=pa.il: pa-.:-ts and se:::vicl!!-s fOl" tr.~ loBe o! th~ supplies
i'lll"chaSlfd.
i5} Curr"nt cO"'r,:iance b)' the bidder with .federil.l ilcts
ane executive orde>::s and State of Califorr.i& St~tut~s g'ove>::<.
ing-the lubject I:'! l"Ion<U.serill'1inl';ti:>n in .mployr:.etll;., p:o·Ji~~i!.
thilt the city "'_lInager s;ha!l reco'1ni:'1iii as i'!"o",! of no~co",pliance
only the £i:"IIll deeis;icns Il.nd o:::de:::s of tl'lo:;e fe<ler .. l I!r--.!
state agenciC!s ernpol,·o:.-".,d ul"".ecr ':.~.e law to ",~}a~ such fi,.. . .!,ings.
(71 Certific.1tic.n by th-c: bidder th<llt h" ... ·ill pu:rsue
a:l af!'ir-l':\.at.ive: course o! action as l"eguilll'~ by af.fi:"1'1at.l.lic
ac"'-iol' gaidc-lin'i!!:$ provide~ he::-pin<'l:ftcr z:-e~sonably p-ertain_~"'g
to tile ~':-::-k of the contract a,,~ to the na't\lre a-nd s~~.e of his.
'"'Or;'; fore!:!", to el'lSl.lr'i!!: that aF~::'iC"aT1ts are: so:.!g"t and er.r1o·,e:':,
a::'le th-lt CJ'!1p~oyees a:re t:::~ .. t_~·a ~t.:::-ing el':'pl",y;r,cn.t, ... ·it}:;:;>;;';;
reg-arc :e their ;race, co'.·::>%" "'i!lti':::1'Ia1 o:rig .. ,.. . .Jr ar-,~'"stry. 0..::
rc'l i"S' iOI"!.
(a) tJ"n.o.er ll'.is se::t':'or •. s?~.:::i:"::c: g:l;.deli-,.,es ... ·i~l
:oe ac'Opted by ccunt;:il ret,olutic:,\ ~:::.::.;n ti."e to ti="e,
iaenti!yir.g the nO!tl.::::e ar.<:l SC(;,P~ oi: 'affirmative 1'.ct.lon·
:gesir'i!!:d by the city.
[oj 51l':h sn.'iaclincs sl-.o:ll1 be-!'lade avai!.a~l'" to
all peUiOIlS oesirir ... to bir! Ol'. city busir:e.ss.·
~:"n.i~ip<'ll Cede to rca~ 25 follc""s,
·~.li:,.09.l. Certifl.c.1.te of r!:>:ldi~eri~.ir.<!tior .• £iI','h bi:5de:r
sl':~ll er.closc ... :thhri~1l coort.lE~----s-ta::in; :"·;-,,"::']-,oor
he .1.5 ,=u:::ren~!:i' Jr. c:c:-;plie;'lci!: IOU, e!l .fecel:lI.! and St.l~t" o!
Ca!if·::-:-nia la ... ·s c:c\·ering !l:::·~::'.~c;::irri:-.i'!~':'on. i." c?':'1.,lc::';"1"'~~' at'ld
t.h,,'. he "tll ptJ:t'stJe an <If[.;~,,ti\'e co:.!:-se e-f action .. s ::-e'l:!-.:.ir"d
by af!ir~,1lt~~·c IIcticn o;;:.;i.:;::el.i.r.cs a::; s~'t forth in Secti,:m
2,3C.090 dn;:! r<'"sD!.,tio.ns .acc~":ed PLll:S1.Jilnt tr.cre"'o, an~ ,"hollt
J.! a ... ·3:-,::('d tr.~ cO(l.'::l"act:. 2",0:: ... .lll r.o,,: d;'scrt'l1il"1ate i:'l ":~'" (";:1-
pl-oy:r.ei1~ of ar.y per;.on "\l:-.:O~:= t"'~ c,-'nt::-i'!C~ b..,.=ause of r"c;<.
colo::, !la~.iol'l.i!.l or:ig:":-. 0::-a'lC"<;,s':.:ry. 0::: r,,-li .. :"on of 5 .. =:'
pC"~:;o~. and thi'!t hc will Pd::t~cipatP, if rc;'-'c~ ~a, in r::-
a""ard ::-c .... ie~ of hi.! o;:';"~';'[l:; .. tior.!). \.l:;ccr i'::-o~·[s O:lS o! t~ s
secti,,;,. The re""or"<,.C"c:;ts of t~:." SCC~.l.O"', sl,,,l apply 01"1. :"
to C·DT.tr.i!.ct" in c"ce,.s Of !!ve t:'OU'i-an,:: :5.:;,lla:$ for .sen'i .. s
c.r fer .1 c:;, .. ·:ir.",,~o:'\ of scr'.riC".:s il'd "·..:,, ... lie.s."
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~:Jn.i.cipal Code to .rea~ as (,,110""$:
:~.~;';;"~~~,r 5~~l!.!-~H-i-{~-r !~:~~r:~l~.~~,i~~ 1. ;,~. '~~~~L:"~.~~d ~ S~l'!
er_i:r,i"'''T.ion p:::ov~sio~.s elI t~e, 5ta~ ... 0;: Ca::'if:::::;nia fair
1'.':T'plop,ent Pract.ice!;: kc't 0::: sl.~l.! .. r P;,?V .. Slt:':lS o! fede::al
1,. ... or eY,ee'-l.ti"Je on'.: .. :; i...-,. t!'l~ pel"fo~anee of a:-.y c,o~t::./I~·~
·.ri~h t~e "::1.t:t, t.h .. r .. b.t sl'1a:i..l be :-o,~:-.j in matet~o!!1.. bre;::-:::h
of $uci-, co,:tr"ct 3r::d thc::!!:l,lpo:<':: the city shall have O'C'o'12r
:::,"'l '.<::c.;e1 cr s;·:;!Jp!"I'.t t::1.e ccntl::<!.c'., in .;hc::'e or irl part, .or
to :;IHl.l..l'::::: :-ro~ th~ I!.......,OU1"t payaele ":0 5'..:eh cor,tractor tne
S\!;'I1 o! ~'"'en:::Y'-live do!.laro.s ($:1::;. OOf for '!'!"!eh per-scI'. for ea<::-.
cale:-:da:: day c:u:dn, ... ~i':h such pers-:>r. ,,"'dS. d:"s:::ri:o:o.i:-':"':ed
f.:,ei:l!Ot, as ~dm",,"es for .!H..i~ bre.c::::::~ of ec:-':::r.:!ct, or 00::)0,.
0;11y.a. fin:!ir.g o~ 't~e S:::ate ot C.a.!.ifor'r.~! F~t~ ".C".,:;Oi~~;1t
Pr-Ac~.s.ces C,::ll'".",issio!l Or' the eqt;)''-'ale,-,':; !e!e::::al e-;e!'.cy or
off'::'.::er £'1-: .. 11 cN-,!;::it\':te evide,-,ce c! .a. ':iola::ion o~ CO;"L':;!"C'ct
~~~e! tnis ~~ctlCn,"
-':<:,30.05'3 Pe.,.,altics for \·.toll-tier; c,! a.~fit~~".i"--~ It.:-eion
~.~~~!!~ CJ-~6· be "f~~t~~~~_~~,~r 0 ~~~i!~'~~;e~~c-~~~~,~ ~~r ~~~ ;~~-y
",ff.i=-rna't'::'".·c -::CI.:.!:se o~ e,;;-:..ior: -::>r' ir. vic!.et~c:1. of 91,y F::-cvis~or,
:,! the a~fir:':li!·.;i .. 'e lIc'tion S'llioe.!i.ne$ pe:::~_.ai;-''::'l''.g to to.is co::
::::act 5).,,<111 be !o\.l.n~ i:-: :n<:~eri.al b::each o~ suc?'1 centract ~n:!
t~ereJPQn the Ci"ty sl'lell I-.eve .,o",'er-"to cancel or s:.::o;.f.'",,-.ci t;,e
c-ol1trae::'. ir. 'Whole or in 'p~r"t. or t~ Cled':..ict fro," the iI.:o:lOl.:.nt.
payable to s\Jch C"_Or1~ra-:.,:;o:: t:~e S''':''"I1 o~ t"'o h..;:-_~.ea !If'::~'
dC!:'<"l.r-s (~;:5C, Oi:'J f::)r ~ac;h .:::ale"'~aI OdY cl.:.::rii1.g ""l'1ic~ t:be
C"on:-!"ac;t.or i:o fo-..:.ncl: to have bt:er: ir. l'loncc-:tlr.!illr.ce. as 0111'-'-
a .. ~s fOI:: saic:! breCieh o! <;;"o:".tract., or-both ,"
J.YES: II::-ncld, E" .. n.r~, .Berv.':iI:d, Cl<l-:-k, Com~~::lC]", Cc~iey. D'''s. G";:.'rL-::-,
Peil!So:" S?:l .. ~h, ,n"Cilt,c,-
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COMPUANCE REPORT Non·Discrimination Provisions of Palo Alto
Contracts
iMPORTANT
This report must be completed by prime
con1.ractor and each subcontractor.
Complete all items unless Otheiwise
;nstructed. Use extra sheets if
necessary. SUBMIT ORIGiNAL OF THIS
REPORT DIRECTLY TO;
Direc(o;'" of Purchasing Services
Civic Center
250 Harr.ilton Avenue
Palo Alto, CA 94301
Circle One: Prime Contractor
'---
Part I Complete the Following:
1. Fur! name and address of firm
Name of Firm ______ _
--~41h,;·? . '},~
Telephone (::Xc))4 -~O (,0
Name of person preparing form.
person to contac.t.
k'1I/'< Ext.c2</" ~UtO
Subcontractor
or other reportIng unit cOllered .--->
by thiS report.
2. Name and address of prtncipal
official or manager. • •. >
3. Name and address of principal
office of company. _ .. >
4. Name and address of parent
company if an affiliated --->
corporation.
5. N~me and address of prime
contraCtor (complete oniy if
this !s a subco:",\tractor's
report.
6. Signature and title o!
authorIzed representative.
BY:
DATE:
~c.
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pa'n (1"'+'&.'-' '.~./ SCi-;Ioo ~ 1.1~ W. {;~a,...... Sy-,
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··· .... _ ... --lIfF.IIIC,.· .... '-'--"' .... _.,_ ..
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Part III
@NO
4. Yes No
III A
5. Yes @
'I t
Attach a statement of V'JUr company's pO!Jcy an equal emploYrTI(;:"t
opportunity to ail persons 'Ntthout regard to race, creed. color. naIior,al
origin, or ancestry, and describe \vhat steps have b·?en taken to put H"s
ponc..,. into effect.
C'lrcl,e the Proper Answer.
Ha .... 6 you inform08d compa:1y offlc:~:lls .a~d 'epr~sentatj\.ies regarding ;h e
non-discrimination provisions of City of PaiD A!!o Con!>ac!s?
Have you examined your company's practices regarding assignments,
layoHs or transfers of "lour employees from one job to 2110ther for
evidence of a pra.ctice or en-Iployment pattern thct might appear to be
discriminatory and based upon race, religion or national origin? Are they
non-discrimi natory?
Do yow have educationar or V8',ning progra~s sponsored Dr financed ior
the benefit of emproyees or prospectrve employees.
a, __ How marly peopie participate in th~s€ programs?
b. ___ How rnany are minorities?
l)oe5 your help wanted advertising sTate that yow are an equal
opportunityemp:over? -B;.oti./1 ~l.1/..."i~'v
Ar~ any apprentices ob:ained from sO'Jrces outside the employer's work
force? If yes, have you circulated information about apprenticeship
openings or opportunJties to the (oHowing,
Yes No
Yes No
Yes No
Yes No
Yes No
S~ate EmpjoYnient Ofiices
Newspapers or other med'ia
High Schools, including those in minorit.,.· group areas.
local trade or vocationar sci;ools, ~ncluding those with
minority group st'-ldems.
Agencies andlar organization spscial'izing ln minority
empioyrnem
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e, Yes No
rJ{ P<
7. Yes No
rJI Pr
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Part IV
Yes No Federal or State apprenticeship represent.atives'.
VVho?
Others _____ _ ----------
If you are a prime contri'lctor have ali subcontractors covered by these
compliance ins.pection reports been instruc--:.ed as to their contractual
obfigations relatrng to non-dJscrimination provisions of C,ty of Paro Alto
Corltracts?'
Exp~ain
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Have ail recruitment sources been adv[sed that all qualified app"cams
wiil receive consideration for employment without regard 10 race, co'or,
creed or national origin?
Identify (names and addresses) the employment agenCles, personnel
recruitment organizations, newspaper advertising or other non-union
SOl.Jfces from which the company lecru~ts 'IS personnel.
L Yes B Have yo~..J a collective bargairJing agreeme;":t with a labor union or o1:her
organization?
If yes, specify the Unionfsl or organizationlsl
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2. Yes No
N/A
3. % --
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4, Yes No
M'{Ie
5, Yes No
~---.
Have you advised the tabor union and lor worker organization ot the
CO'1"lpany~s responsibi~:ty under the non-d;scrinlinatlon provisions Of City
contracts.
Approximately what percentag€l of your emp'o~'ezs c(lvered by U"'1.'ron
agreements are referred by or rJlred through the unions?
Expla'in procedure far hiring bafarce.
Does the company's cOiiective bargaJr,ing agreement or other contract
or undersrand!ng wrth a labor union [or unions) or other worker's
orgnnizat;oo incfude a provision for non-discrim,nation in employment?
Is there any labor union or worker's organization policy which prevents
you from fulfilling your obl'gations under the non--dJscrim:natlon
provisions of City contracts? !t so, specrfy. ____ _
-.. -.. -----
6. Yes No Spe::::ify the tradeis) cr craft(si involved in this con~ract,
rJi Fl
Use this space for comr:ien! on a.'ly arJ$VVers you have su~pfled.
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RACIAL MAKEUP OF REPORTING UNit
Name-of Firm_
hoject ~am~
Contract , _____________ \Indi:ete 1')!"1\'1 fo( monthly Fepcft, No. 3l
Three tYpes ot bfeakdown are req~iied. ThIs ~orm is useD for al! three. (Ct'1ec~\
{1f'-2~ Est~mated mak.eup tor this project.
(,1·3~ MOf';.tht'l report tOf_J.(;.JLf,,,,,,¥d"-'.-_, 9_Q..:2. Submit 'Jr.ce pee m.on.th fOf duration a~ project
1 = Pe.rmartent. 2. ::::: Estimate for prtJlect, 3 := Monthly or,ty.
Be sure to include 2!!. emptoyees in first COlumn. not j'."Jst minorities, r-Jos , and 2 belov.' are requ!~ed' to be
fiUed in and submitted wlth Compliance Report.
-. --Tatal an ASJan American Spen-Isn
JQ~ ~AT'GQRIES emp'oy~ Female Black Amedcan _lndian Surnamed , 2 3 , 2 i 3 1 2 3_ =±. 3 1 2 . 3 , " .
I I -I Managi!rr.en~ , / -
Prote~_c;.i ona I ~ ~q 1, '! /.::> -'-J ;< I ~ ---I II i~ CI .. io.,-0fflco j ,-' ~ ,,-c, I , I
1=1 ----
Field Suoervisor , ---
Ski1led • 1151
f .. --t-b. ----
c. ---,
d. ----
Unsk.il!i!;d -1151
a. ---~--~-
b.
c. ---+ ,
d. I 1 ['-1 o/~ (, NI (1 ~ ! --T
TOTAL OF ABOVE ~ F} I ;C 1,2 ) ~ I
Thi3 report must be completed by cont:actor arod each subc;onttactOL
The term "Spanish Surnamed" includes all persons of Me)(ican, Puerto Rican, Cuban, latin American or
Spanjsn origin.
Report only employees erlrolle.j in formal or,-the job training programs
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B. Conditions of Employment
Employee Status
Employees are paid in accordance with the Fair Labor Standards Act. Each
Employer: is tompo:nsated for the responsibiJities of their position.
Employees are clusified as fuJYtime, parHlm::. tempurary or contracted as follows:
• Full-time ~ employees hi.n:.d to work a minimllm of 40 hours per week on
a. regulM, yea.r-rour.d basis. and \~dl/e full ~nefits .
.. Part-time -employees a:e hired to work 1ess than 40 hou:s per week on a
regular, year~rouncl bao;is. and may receive prorated benefilS.
Temporary -persons hired to accommodate increases j" business related
to spa;.ific cuent project requirer:.ents. a:ld receive no benefitli.
Contracted -persons engaged in specific client project aCtl"lUes.
Comracre:es are compensated on an hom-Iy basis, receive no benefits, have
no taxe5 withheld, ar.d are required to ~ign an agreeme:nt with the
company.
Ne,"' Hire and Pl'"ilbation
A variable probationary p(!r1od is determined at employment_ During this period.
inadequate perfonnance will result in terrPination without the use of a fonnaJ verbal
and written notice procedure,
Equal Opportunity Statement
PlanG.c.phics is an equal opportunity emptc)'er. !ndi\lidl..lal.i will be chosen for
employment andlor advancement without regard to age, S!!,l\,. race, creed, color.
national origin. marital Sl1I.t'.lS, sexual preferences, or the presence of any physical
disabilities. If you feel you have been dts,crimina(cd against an any of these bas~s.
please: notify your super.-isor (or, if that is inappropria:e, a Vice President)
lmme<ii.t<'y.
Outside Employment
An employee who accepts full--time employment w!~h PlanOraphics win be
exp-:.cted to consider thi~ as his/her primary employment and to fulfiH the
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1991-1992
STATEMENT OF ECONOMIC INTERESTS
FOR DESIGNATED EMPLOYEES
FORM 730 AND INSTRUCTIONS
IF YOU ARE AN OFFICIAL OR EMPLOYEE WHOSE POSiTION IS DESIGNATED iN A
CONFLICT OF INTEREST CODE, USE THE FORM 730 TO FILE:
fill ASSUMING OFFICE STATEMENT
iii ANNUALSTATEMENT
ra LEAVING OFFICE STATEM£NT
[ji INITIALSTATEMENT
liiI CANDIDATE STATEMENT
P~epare-d by the
Fall Polltl.::al Prac::ces. (or1n11'i-;10n
p () Sox 807
Sacrame;.to. c.c", 9580.! -elSe)
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Gift limit'3tions
Elected ~_t_ate Officers rr.di nc,t accept gifts wi~h a vah .. H~ of mOH~ than $250 in <J (aicr1daryear
from a single source
Local EleGed Ofii~~r:1 may not ac(ept gifts and honoraria with a value cf mor(' -:hi)Ji $1,000 in a
tal~ar year 1rom a s.ingle-source-.
State Board and Commiss.ion Members, and S!i!te Agency Otficials
n
Cln
n
d D~~ign~ted IC!lP_LQ~~
may not accept giftS with a .... alue 01 more tnan S250 in a caJendar ~earr~om a, ~Ingie s.ource, tf the
member or employee would be required to report the receipt of tnco:-ne or gifts from that sourc€'
on h.is. or her statement of economk intere'SH.
Thi-s. prohibition does l"''I'ot appl)l to a pa!1;-time member of t.he go ... err'.i~g oo.afd of a public.
it'lstitution of higher education, unles~ the member is also an eiected officiaL
ExceptiDns To Gift limit:
The following are not prahib,ted or limited by the Political Reform Act
The it-ems (isted in "Exceptior.s. From Oisdosule" l~ the IIlstrIJcticr,s for "Completing
Schedule F _. Gifts" of this disdosure form
Payments, ad .... ances. o~ reimburserneljts fc·r travel and related lodging and 'Subsistence as
described in "Tri3've~ Payments," However, many payments fortrc\,:ei,lodglng and
subsistence must be disclo'Sed.
Gifts From lobbyists: Elected state officers and certain state board and comm1'Ssio(l members
and state agenc~ otficials and empJoyees are p(Ornbited fromMcepting a gfft or gd"ts, including
wedcr.ng gifts., aggregating more {han S 10 In a rr,ont.h from a lobbyist or lobbYing firm registered
with the Secretary of State ..
"G~ft .. means afly:hjng of valuE', v'.'heth~r tang!ble or intang1b!e, for · .... hr(h equal Dr gr--ea"er-
valuo:: is riot prololided You must dl;,close gifts \fI;lth an aggregate ... alue of S50 or mc~e received
during the reporting perJOd from a Single so..;ru· .. · .... ,t_~out regard to 't~neJ...9_catlon of the dOr1n~
inside or oiJ_~side your lurisdictior.l. Any r\.umber Of 9 d"ts from one per:.oll, the va.:l:E'<; o'i wt'\;<.h
ad up to 50 O~ mor€ dUring the ~eportl[)g period, must be disclosed.
Honoraria Prohibition
Elected State_ Officers may nat .Kcept any honorarium_ "Honorarium" means, with the
exceptions noteO"E,=,low, any payment made in .conSideration for any speec.h given, ar-tic.it:
published, or attendance at any publiC or pri .... 8te conference, cOr'h'ention, meetillg, :;o<.:al e",er.t,
meal, or hke gathering
Lo-:al EIE'c!~_d Off~(ers may not accept honoraria for ar,y speech given, art:cle publ;<;hed. O~
QttendancE' at any public or private conierencE', cOl'1ventlon, meeting, socai e· .. ·er-t. meal, or :I'.:e
g~hering. or gifts which aggregate more than S 1,GOO from;'l slng!e Source In a calC'nd.a~ J'~,";r
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Members of Stat€; Bonar(js and CO"'1mi~<.iiQns. and_ Employees of Stat€ __ '='.Q.€nciei mC'lllot accept
an honorarium from any source. dthe r!'le-mbe, or.emplo)'ee wou.d be r€qu~to repc:t the
receipt of If'Kame or gifts fram th.:::.f 'iource on his or her .. ta.temer;tof economic Intere:.ts
ihis prohIbition does I":-:>t appl~ to any part-time member of the Jc-':erning beard of any pub:ic
Institution af higher educatj~n unl'2'ss the member is also.an elected official.
Exceptions To Hunoraria Prohit:ition:
1 ... Honorari:.Hr. ... does not indude earned income for per~onal s.ervJces wh,ch are custom~riill
provided in connC'ctior. with the practice of a bona fide business, tracie, or profession, such as
teaching. practking law, m€'dicir..e, insl..:ran<.e, r-eal.cs.tate, b?.n.kin.g, or buildil'19 c.o,r"ltracting,
un less the-sole or predomi na nt activity of the busin ess. trade, or profes'.:ion Ii malo:;m 9 ~peed,es.
2. This p,oh:bi'tion does not apply to paymf':nti, advances, ar.d reimburs.ements for travel and
related todg'!r"'jg and 5ubs.istence, a'i d.es..::r'r'oed in "Trayel Paymenu." below.
3. This; prohibitloil doE''i not apply to any honorarium which is not used and. within 30 days.
after receipt. is eith~r returned to the donorOf delivered to the Contro!!er fordor-!ation to the
General FUr'ld, without be,ng claimed asa deduction from income tortal( purposes.
Travel Payments
With the following exceptions, payments and ('"eirl'lbucsement~ for ti.<.,'.'el are subjel..."1. to the gift
limitations set out abo .... e:
Payments, advances, or reimbursement:. for tra' .... e{ inc.iud,r.g actual transportation and related
lodging and.subsisten<:e whic.h is reasor, ably related to a 1egislatlve or governmental purpose, or
to an issue of state, national, or international publi.: poliCY. aie not prohibited or Jim~ted, if either
of the following apply:
(1) The travei is in connection With a sp€:ec.h gi\,len by tn-e e~ected ofil(::er 0' nzte emp!oIJee, thE'
:odgtng an.d sl;b~i'S.te!'i.(.e €):.pem.es. are !Imlted to the dalj immedIate!), precedmg the da~ o( and
the day Immediately foi!owing the sp~<ch. and the travel IS Within the United States
(2) The travel is provided by a government, a gO\lE'rnmental agency, a foreign go"e~nment, a
gO\lernmen~dl authority, a bona fide puD1:c.or pn, .. au~ educational In::.tdution, as deftrl€d in
Ser.tion 203 ofthe Revenue and Taxation Code, or i! rlof1proflt charitabi€ or re!lg!OUS organization
which is EXempt from ts;(ation under Section SOHe) [3J of the trlte-mai Reven\.Je Code. or by a
person domi<:ii-ed o..ltside the United States whic.h substantFa!!y sat.isfies. the requirerr1e~ts. for ta;.::
€,yempt status under Section SO, (cl (3) of the Interna! Re','er'lue Code
{3j Tra'!el costs paid from campa·lgn funds.
(4) Tra ..... ei pro ..... ided by the agency of ar. eiected otiieN, member of s state board or
commission, or deSignated employee ofa state agency.
(5) Travel whic.h is. reasonably necessary in conr,ection with a bona fide business, trade, or
profession and whic.h satisfies the criteria for federaf income tal( de-duction. for business ex.penses.
in Sections 162 end 174 o-!the lnrernal R,e\,leI1ue Code, urlless the sole or predomina~t actl'vity of
the business, tracie, or profe<;slon IS. maklr)g speeches
(6) Travel wh~ch i$ excluded from the deffllition of a gift by any other prov'ls.ion of the Political
Reform Act
NOTE· Tra'.'€1 payments which are not proh !blted or lliTlit'20 r:l3j' h.d"t': ~o ::'Ie GI<..cio<;eo Re1o:f '.0
the instrur:tio:ls for completing Schedule D·' for deta!!ed l:lforma:lo'·,
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TYPES OF 5TA TEMENTS AND WHEN
STA TEMfNTS MUST BE FILED
FAILURE TO FILE STATEMENTS ON flME MAY RESULT IN PENALTI15
INCLUDING Bur NOTUt,-1ITED TO LATE FINES.
Assuming Office Statement:
FIle if )/OU aal.irT1e a pO~ltiOI1 de.ign.aled' in ,.our itgef1(Y'" (onfljC~ or interes.t (ode
a. P01,ticn~ s~bjen to State SenaH.? ton~trrr,.ation -F"i1e riC r"(<,!f ~han 30 days after 'jo~r .~poi!'lt-nl'nt or
r"lominat'lon by t!"le GO\lernor.
b. Aij olher po~ition$ -Fil e no I ater than 30 dillYs aher ,.ou a~~ume oUi<.~.
Annual Statement:
file at thetil'!'le ple~r.:n~d in :-",)Ui" agenCY'1"ror.f1i.::; of IF't~re>t (ode (April I for r"1ost fliers)
Leaving Office Statement:
Fire no laterthan 30 day~ atter "OIJ 'E-a .... e 'Youf desi gnated po~it;on
Initial Statement:
If your "'gl!'ncy has a newly-adQP.J..eg cOllfhct of intf'f(>st code, file no later tnarl 30 days aft<!r the eHe<t'lle date of
~our agency'", c.onilict of :nterest code. It I'O'.Jr po~ltlall was newh, dE'~ign,Heil ir: your agenci~ {o"flin or ;nte~e>t
code, file no laler L"lan 30 dilYs after the-02'ffe.:tll.e date of the amendment 1.0 th e (ode.
Candidate Statement:
file no I.ater thar~ the fl1">al tiling deadl,ne tor yOUf deci4lratlo("o cf candid .. c)' (car;d;dates krelectilfE' oH,(€'~ ("oc.t
specified fn Gov. Code Section 872;)0 mU$t file a "randid"1e-" ~taH'r.ent ,Farm 730) onl, :1 requrred bjo' U~e
agency'~ conflict of interest code.,
WHERE MUST STATEMENTS BE FILED?
AH statements, eJ.cept those filed b)l State A~sembl)' staff rT'€mbers. are-f,red wi~h yo"r 0 .... ;-, ager-c)I. board "r
~omm;s~on u:1len o,ne ......... jse spe~died in yO'Jf agency's cantlin of i~t~re1t (oce.
State AsseiT1bly .tillf members fi Ie the,r ~,c: liOm=nu d! reel, With the Fair Poll~ical ~ract:ces Com;'!" ',w~"
'tOu must me al"1 or;gi...,.iI!y siSjl"leJ statemen! of e(.onomic interests ' ..... 'rtM each aSE:ncy. board or commis~'lcn with
which yo<.l halc!!!1 desisnolted positio,"') cO'<l~'-ed toy a confiict of interast (ode
CONFLICT OF INTEREST CODE DISCLOSURE CATEGORIES
Sefore compreting this form, (ontad. your agency, board or commis~lan to receive a copy ~f yOlJr di.cio!iu~e (i!lego~,
which outlmes tr,e type a~ inf Qr'nali on you must dl:><:lose •
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Statem!n~~~n!rr~c?nterests \
For Designated Employees I
A
1991192 I 3LIC DOCUMENT 11
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!lAY'I:-.If ~El,.tP~'JIIi! l'UMIHP:
,(,'-' '''-<It f}j(iJ
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ASSUMING OFFICE 51A TEMENT:
o D."--,===-,,,-=~ POSition'S subjen toSt.:tte'Sena:e u.mfirm;;tiof'l --~l:-eo no 1ater th.i1r. 30 days aftt'r iOI,Jr appornt'Tlerit
o Dati!
Al! other po>ltiom file no I .. ter than 10 days aher yo," ,/I!S~ume office.
You must d;~IDSeOr'l Schedules A, 8. C-'. (,2. and':' all r@p<jrtabjein"'enme-nts, rnte-res!j in rul prO~r1yand
bus.ines'S po~rtions required by '"our di~(!o~i.tre C.ttegory. herd 0" tho!! date you a~sumed your position. In addiOof1.
you must d;scICM~ on Schedules D, 0-1, E. F, H-1~ H·l and H·1 income from ~J1 reportable lQUrreS recei'w'#!'d during
the 12 mOl1t1!s ~ lo :he date yOLl ;usumed office.
ANNUAL STATEMENT: (Req~ired to be filed 10r uch yPar tT,.a'l you hold "OUf c:!e~igf)ateJ po~itJon.}
o ¥au are reqUlr~d to r,l'S' a natemen! riO later than d'lsdos':I"g all re~ortab;e" ;nvestmems,
inlerest5 ir1 feal propenyand Dus.ne!>! po~it~cr,~ hel"(fat"ld Irt(ome 'ecelved du ring the peflod hom
Jat:uary ,. l!i.S'l thrOIlgt', Derl!'mber 3', '991
LEAVING OFfiCE STAT£MENT: (Required to be riled when )IOU iea\le your designated P05ltio,,)
o You are lea\l~ng or have ieft yOur posftian 0(1 """d must file a statement flO ra~er them 30 days after that
date, You muSl d''i(i05,e ,,11 reportdbl!!! :r' .. e~trnen~, I rlter!!~,~ l:'1 real property Clfld b"Sl !'1e~~ po~itICH,\S helO <i:fl.d
H'1(ome ,e<e;ved du.-i"9 the peri c,d (r01"1 January " 1991 rhrc .. gh tne dare yo .... left yOU! desjgnated position
INinAL 51 A TEMEN:; {Chec\( 'O';E' baJ below 0 ~J L Y ~ f your po~~tio~ 'h.u b~en r~celitl 'I de~i gnated or If you are fill ng
/ u!'1der a ~ Co .. flirt oi 1.'1:er€$< Code for '1C';jr age!"'1c'l r
51he c::o!"'1flict of I nlerest (ode fc~ your age!'1c)' be~ame ~.1eC1:ive or your po;.itioli was r1ewly designated (In
You mu~t fi!e.a statemeMt!"'10 ialr;or theln 3Q da,., ilfter :hi~ date You mu~t dl~c:I"s.<1! Or1 S,hedule~ A. 6. c-~. (:}""ancr--
G alJ reportable m\le~tments. interest!. in real pr;:,perty, and bU5lne~5 po~it:oJ"ls held on the date )'our age ... ',.· ..
cod@or yOu( d~ignatlcn be-::ame -effective In ~ddi~ion, you must disclose on $cf'ledtlles n, ~t, f, F, af'!d H-1. H
2 and H·3 income from all reportable source'S rec:eiv#!'d durin,; tlIe '2 months 2!!Q! to tne d~te your agency's
,ode Of' your dtsjg .. ,at;on bE-'oime effective.
CAN010ATE STA nOMEN!: (If reqlJirec' by th ... conJhct of Inlc-re5t code c,{tr,e Jurlsd,n;on Ir". whlch you are
seeki,'g erect;\le OffrCi!)
o The ("o!"'1f 'lct of 1.'1teren (ode ~pe(1 fi ('~ the t)lP"~ of ·I'.lt?re~~s ~ 0" m ... ~t dis(iD~e ':' 'ell-' may be reQurred 10 ~O'T: pie to'
S(hedulesA. B (-1. (-2 3r.d G
'" THE FOLLOWING 5U~ARY MUST BE COMPLETED BY ALL FILERS
(Do not comple-te rlli:;; ~ummcry until you hJ ... ·e carr:fu!!y reviewed the
instru::tlons for f'ach }chedu:E')
SCtlEOUU:': A·· lNVESTM ENT5 (Which A.re No~ H€'1d Ry A Housine.ss F..ntit)' Or T"ustl
O 0 0 'C'I.':";"~· ,_,_'1""", .... ·('T,·p,"L', COkll'l.l;1'J::D MW A 17,"OO:V NO RI-;PORT ... nr.E 1!',"Tn/f.s",' 5 TO My~;rSCLOSt:RE C~ ~TCOR Y
SCtU·:D\JU:: B -I'fTl:Rt:Sl'S iN RE.lIL PRO'P'EKTY (Whl'Cb .&.a Not \1f"td By A £'usi.ness ~:nlil)r'
~ Or TruS1)
O C()J(PU;1'FD AN!) A1'T."C.'UD l'If) RJ,:"ORTII.BU J¥nfl.ESTS 0 SCJJt:DUU DOI£S-",OTI,PPLY
TO MY DISCw,~·!...'ra! C~jt:GOR'I
SCHEDULE C·I·-INTERESTS IN REAL PKOPE-:RTY HELD BY A ~USrNESS E!'JTlTY
CRTR\JST o COMPU7EO A,"'D A TT/o, Clf ED ~£PORn\81..E IN':'F.RE$TS o SCHEDl':...E [..0.:_".<; Nor APPi..Y
TO MY [)lSCWStlR£ C)'iECD"·Y
SCHEDULE C·2··INVESTf',tENTS HE'LD BY A Bl)Sl:-.lESS ENTITY Ok TRUST
o SCNHW!.E O<..."'F.S .... OT;..PPl.Y
TO ,.,.,,..-iJISCU)SURE CAiECORY
SCH~LE D·-[NCQMl-: (Other Thl'''' Loans. And Guts)
EfCOMPLET"ED MW ,,,"ITIICflED ....-.,0 fa;pORT;..Btt: INURE-S1'S [J fiCII£nU!.l OOESr.;O;"'~,"U'
1'0 "MY DiSCl..OSf.,'RE CATEGORY
SCHEDIILE: D-l-U"COME .TRAVE~ YME~'fS. AUVANCES, REIMBURSEMENTS
. ':. .:-.NJPUTED "'-.... 0 A ITACJ1ED ~ RE-PORTABU INTER ~S'j'S 0 SeriF;DUL£ DOES ,'Io'OT APPL Y
-TO MY DlSCLO:iLiRE CATf-GORY
SCHEDULE E -INCOME· LOANS (Kec.eived Or O",!.,standing DunngThe Reporting-Period)
o COMPUTED n',"o ATTAC!JED ~ R£P08TABU; rr..'Tf.R€STS [J SCH£DUU: DO£S."IOTAPPl-Y
TO MY DISCLOseR£: CA.TEGORY
SCHEDIJLE F-INCOME-GWrS / o CO:'{PLET!D .A. .... D A1T.I,CHED &NO REPORTAB~E r,",U'RESTS o SCHlc:fJt",F DOES ,"01' A.PPLY
j·O MY D!5CLCSt.'RI:; CA TEGQ!?Y
SCHEDULE G -BUSINESS POSITIONS
SCHEDULE H·l ··COMJ\'IISSION INCOME RECEIVED BY BROKERS, AGENTS
,~ND SA LESPERSOSS
ij :,CHr:ln:u ~OES !;OT APf'LY
-... "fO ,\.0' D,·SCLO$UR E C,.lo TrDO.t?,.
SCHEDULE H·2 ··INCOME ANO LCA~S TO BL:StKESS E:\T1TlES OR TRUSTS o COMPLETE!) ASD ,J,.TTACH£D ~~P')RTABL£ i!I,TERESTS 0 SC.'-iEDL'I..E DOES "Of APPLY
TO MY DJSCL.OSt;?,E [:,~.'j£GCGY
SCHEDULE H·3 -INCO~'£ FROM REN1'AL PRGPEHl'Y
o COP.P£,£TJ;:D AII.'!) ATTACHED ~PORTA8U INn:Rf:!iT8 0 SCHEDU!..L DOES NQ fAP?LY
=============~====""":c:,=,,:,:=,"===,,,======T~O~"\{'/1L~O~!SqLC:Sl~.R.E CA TECOR Y
VERIFICATION
I have used all rE'asOr""lable diliger"'1c€ t'1 prepar rig tm~ s.t.)'-ement I h.,i'lle r"viEwed the Hatement arid 10 the
bes.t of my knowledge the Information contained here.;-, ard In the at13(hed ~c;'ledules I~ t~LJ~ ~'l':
tomplete
! certify under penolJty of pe-rilory under the loIws 01 the State oj CaJ,fo"~la :h.=l! !he-lorego,ng I~ t;'JE' and correct
",M.d on B /.:1 } __ , I9_L~ "' _ ... ~.~ "-~"'(~_:lG 4 ______ _
"..JJ.'" .• , .. '", .:-.. ,~,
/2' /j /1/
SIGNATURE /~~--/;~ -1/, ... .,...
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INFORMATIO, .!'OR COMPUTING SCHEDULl .' !nvestmenl',
ONtllch Arf.A Not He'd B.Y A Busineu Entity Or Trust)
BEFORE COMPLETiNG THIS SCHEDULf. CO ...... SlIl. T YOUR . .ttGfNCY·S CONFLICT
Of INTfRfHCOOE TO DET£RMtfoE THE rYPES OF lNV£STMfNTS YOr) Musr DI5Ct.O~{
YCI.l mUj.tre-porta~ an Jnve''i.."Tlent any fmanci;,1 in:erest • .-: o:'!f1y busir,lI!'i'> entit}' !oc<'lted IrJ or dOlr,;. ~lJsi,..,e~> ir, "our
juris.dinfon in ~hi(h \I~u or 'rOLl.r ml'l'Iediate lam.ly (}'our spov~e and )-'our depend€,,)t Children) hoi-=:.a dlreO, inoire(t
or beneficia' intj!"t£>St CJggr~gal:ng Sl.00a or more dvm,g the reponing perrod lr~ addit,on. if ("JJ h.)d a HJ% O(
greatef ir'lter~t in a bl.ls.nes-. ent.t)l. plea~e se-e-Sc:.heo",l!!'S Co,. (-2 and K-2.
A business entity is located in or doing blJsiness in the jLiri5diction if it. a parent Of subsidiary. or
a related business entity:
• Mant,lfactl.!~es, di!itriblJte~, 5.e111 or purd'!.a~e1 prodl-l~~s ~( 5er\l=ce~ (lli a fe-gurar bC!>i~;,., the jl.HI ~;C'.1 on; or
• ~ans to<;:i() bl.l\;f'\2-~S in th". Il.!risdiction; Of
• Has dc>1'\e oU1ines~.n th ~ junsd1ction wi~h.n -.he previOL'S ~wo y~.ars; or
• Has ~~ inte-r~t if'! rebl property or. '.he-j\"lrisdiC1!Cf'I; cr
• Kasan.offireinthejl;·Is.::iictiol"
The most (ommon types at investments are:
• 'Sote proprictorShips
• F'art"er~hip§
• Stod:s, bOr1d~, wa~t<,nt5. ?;i"Id -optiof'1~ ·f\d'..Iding tho!.e he1d in margin or brokerage ac(o, .. "I.s
• Indiv:-dl-la! Retirement Acco:;nts (I RA~) which are invested In repan.able bus.iness er;tlties or t~a~ pr':lperty
You are!'!Q! required to-disclose the following investments:
• Bank .o(ount~. Wl'!r.g~ a(CoVf1ts ar-·d mO"'''')1 marke. accountS
• !ns.urance policies
• Shar~ in a credi t '_mion
• GO'lernmeM bOr"ld$
• D~ver~if:e-d mvtual funds. regi.terE-d ...... ith the Secufities and E'(chaf'tge Com mi-;Sloli (SEC)
• Common vv\t hJr1d~ crealed .. mder Coil;forl"1la F.nar1C1al -Code SectIon 1564
• i;,di",idu-al Retiremeflt ACt;cun:~ (IRAs) inlle>ted ,n flon.reportable i,.,teres:~ ~uc'h as Ir\:..:~c~ce pol,ci~'!o.
dill~r~ified m\Jtw.al f,..nds or gOllerr1:11I':I1t t.>r.ond'i.
EXAMPLE. SCHEDULE A
A.ssume thOle
• You have a SD'YII part'1l:'r .. hip mteren in ASe. l.and Delteiopets. '.ralued a\ 1-lS0,e!)D. wh;.:n yo· ... did not acqu;, ...
or dispose of du,ing t.!-'e ~~pcrtlng pE'rlod
You' par1rtenhip i" ABC Lard D'l'lleloper) rr.us~ be dis;:loioed
5-:hedde A \.howl:j 0,," ccr,pieted a'i. fcl'c'""s'
NOTE: You. may ~ reql,l.Ited-to repor. or. S<:n.edu!e 0 al'lj' salary, comm!~SIOI",. dl$.t~lbu.t\ol"l Of ctt\er II",<-cme
(525<) or more) recei .... ed by yo .. or )lour spouse f~om bu~ine$5. entities listed on S<:hedule A
"If you halte chet;k:ed this bOI(, you mu.t rer;:cv! any intere~1i in rea! property-and in\le~trr.!wt .. r.eld by IJ'E.
bV~lr,e~s entity c; trun on S<.hedu!es Co, and C-2 1r"1 CJdClt'OI1, If your ~ro rata .. hare of trle (lfOS> ,ncome frorn
anyone >o;jrCewa~S10.000 or moOre, you mal' be requaed report the name 01 tha!~o'Jr( .. eof', )c,..,e(J~.e H-l
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:JAME i3tv (~J-,'l!(0 __
Schedule A -Investmects
(Which Are No! Held By A Busine.s.s Entity Or Trus:t)
(SEE INST;>.\JCTIONS ON PRECEDiNG PAGE)
~ .. ~T"!'>"·. ""1 ... 11 I lfA~~d Or Cl'I;>OS",d Du,,"'; T.,,,,
I<.e ;>an:".,s P.e' ,04 You M,," Irld {,a"",
f.----__ . __________ ~' Mon.'" Ol~ Ar-GI 11tH
GEN(F.JI.L DE~OW't~ON Of-8U)IN~5S 1..(TIVIf'r I Duelo~q",,~ __ _
O~I", D'lpol.tCl
I , ,
--' i ;' 01. Q"Il",-"': 0, ?,,\.po~ee ;)". '''5 T r.1!' !
~=~ __ ""~_~=~_~~_~~ __________ I :",;:::~~:e~~Q:~::: M",. -;'~,(a~~ Ii c;eNEAAlDE.S("'IPtIO~OF BU)I'II~~).Q.CT!I.'I''I' j DatOf .c..t;!;I'U"I!Cl _______ •
1 tl,lf Dltp~I"'~ -------I
o ~1,OOO,ll0,:.:..J o I-l0,OOl-~lr/. .''X1 o O">':f'PO'J,'...v.J
o [""<It'; .. ",,,",. o qJ'" l;" ~''''''t··
. ,,<=<, UE
o S U100-1 "J !i00 o \H),Oa1_s,:r/J litlQ o Ow",r!.IO(,l,J:iJ
o o liI!H~r'I.a~ ~a',
'0% 0' g'u~-e"'
o S1000~~C" o S~O'JC'-~-S,c;:<Hj
fJ O.r'<'; 00 c'"
o L~n1r,~" 'C··. r, " .. 0' ;'·n'-
o S~ :),)J-S ,~e,.>:, o 'S '() c,,~, -~' 'j'.' ,'OJ
[J O.~r S~(}J IJ,j.w
o Ll'utr .. "·()·~ o 10~cr':O'~II~""
h'01"E: TOU MA'r IE ~fQUIRm TO RlI"ORf ON $(rlIOUt.E lJ "'~'f S-loLARl', COMMISSION, DlnrI.r!Io(JTIO~ 011 OHHR; INC"OMl :"::50 OR
MOR£j '1,-UIIo'EO fa'( ,"tOU 011. '~~IJfl. S;POUSl: fAOM "'-1('( '!U~lNlSS: UniTY U'iHO ON SC~EOlJl( ~.
"'If you hallE" c:he(k@'~ thl~ ben:, you ".,'U~t rep-o~ Or"1 SChedules C-l ",n::! Col ~liy Inlere,H i'l reo~ proper't)l and
irwestmenh hel-j by the bu.mesi entit}'. 1n ~dd;t"lor"1_ 'If your pro rata .hare of ,)-,e grm~ Ir,(ome lro~ ar;y o'-'e
Sl;lur(e was SlO,OOa or more. 1I0U may be required to repe" the r.ame cf1hat source Oli S(hE'd'J~e H-2
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I~·FORMATION fOR (-"MPLETING SCHEDULE B -IrH.-r"ts Irl Real Property
{Whictr-Ar~ r:!_Q_t Held 8y A Business E~tit::i (;. Trust}
SHOFf£ COMPLETING nilS SCHEDULE, CO,'J5UL T 'fOUR AGENCY·S CONFUCT
Of INTERES"TCODf TO DHEIIMrNf THE n'i"fS Of INTERf.5.TS: YOU MUST DISCLOSE
You mustfEpr'lr"1'(nerl'sts 1:"1 'ea! pro~eIT, IO(aled u'\ .)lour ru',~diC1'Oll, ir, wl-.lch r'O\! 0' YO'Jr Im""I"~ •• '1(' i<i~I=y ",,~d
~ d:r~C\. in.Clr,<!Cl or t.erlef,(,al H",al e .. t aggreg"tlrl9 S t ,OCU Q( (T1.0~e <It any I,H'ne d,HI,"lg ~ne repon,'f'-g ~I'-' ?d
JLlrisdiction for reporting interests in real property:
Judge-1, court' commi~5i()ne~ 1tate Ofij(i!hold~r~ arid sHte age(\(,v oif;ci;::;is and ... mpioJlee~ -,,,lie 5:a~ewid~ iUrlsdictJ~n and n:-ust r.etlon Te.al property ~o-<aled .a".,......ner~. w;t~"n ~~e State of Cal,fornl;i, Ar ~ter ... ~t In rear
~roperty 11 in \l"It J\Jr>~(hnlon I')~ 11: city or ~o\Jm)' If}\ l!o Io<a~ed m, N wl',hlr, b .... 'o mile!> 0#, the (Ity o. '"::'-"""',y, or wlthm
two miles of aflyland o~ed or us.ed by the elII Dr COI .. mty.
Interests in real propi!:rty indude:
• A leClSehold ir'lte~e-st-
• A benefiCIal owne!~hi'p ;ntere--st
• A dt'e'd of trust
• An V-~fii!J"r1-£nt
• An option to acquire an)· o! the at-eve
• Art irltertKt in rcai property held by an IRA in which yo" have a , 0% or greater ;~tE'rl'!~l"
YOI.: are ~reqlJired to disclose the forlcwing interests in rear property:
• Any rt"Oident.e whi{h ,ou oJtil12_e e;ldu\j."e1y a'.i.your perlon')) n:\IOeMe, \.mlf>~~ it i1 aha a pl"ci:' o~ bU§'Ir>e~;" e g.,
family fa,rm, retail !'Jusine'.i.!o, Or vaci!otiol'1 r<?n~a!, ,l" wn!ch (d\~ 'i0'-' are r€.qv;red to d:S-(I~se 0"1')' th~ valuE of
that par1,ton Q( 'the property whid"t'\ ", .. ed i('t cOr'l.nec',c-n ,tIIlh 'i~l..!r b"'imoe~s act,'iltl€'\-
• lnteres.tsi:'\f!?"iill propert~·acquired byabJind tr"·.;s( ;:h",nllanttc. FPOl( ~E'gui<HI.:iM 18235
Reporttn91nterests in Rental Property and lncome from Rental Property
If you or your immediate family have an intereH m a fi!ntal property direr:t!y. j e., riot through ~ ~usiness entity,
you-m u S"t re-port:
• T~e prOpt'rty on xhedule B;
• Your~hare -:lfthe total amount c;f rental !n(ome received from the prOPerty on Schedule D; and
• If YOl.·r owr::er~hip imerest i1 10% Of greater, the na:T1e of ar'1)-' tenant wj'l'j paid rent of whiCh .,.our ~hare """,H
S' 0,000 'Or mot..,. M Schedule H·3.
If you cry:)ur immedt,HII!' family OW'1 a '0% or g[Edt~r ;,lt€re~t in ~ bUSiness i!nt~ty, such a~ a par:"',er~hip or JOint
venture, which owns rt'al prOperty, yow m .. at ri"por',;
• 1h ... bu'Si1"le-s~ eMit\! on Scheduli! A;
• 1he property held by the busi"ess entity 01"\ Sched~le C-1,
• Your sha.e of the l.otal amourH of Ifl'Come. inCI ud~r"'g e'-'':S, rete:I,'ed hom tr,e bu~'ne~~ entlt! Ori 5c~:edu Ie D,
• ihe r'1ame of any client 0' customer wile prov;ded l"Icome 1-0 the business efl(!t)l of whlc'1 }Iou' ~ro ratc ,hOI'':
...... as S 1 0,000 or mort Or'l Schtodule H·2
-A." interest in a :ea~e <.111 real property;~ reportable If th~ 'Yillue of the lea~ehord interest IS SI,COQ Of more T"")'?
value of the,le<!~ehold interest i~ the total arnoullt of rent ¢wed by you d:Jring tl"le re~rtlng penod, or 01'1 c,
a'jsumil"lg cfiH;e <;utemel"l1.. tluril"lg the pnor ',2 montt'1." No r .. awhold Interest wit" iii value of le~s H~an 'So' ,COO ~;:-,",d
be feported. When reporting iii lea~ehold inlere.t, you mu~t rnc!ude the add'e~5 'Jr otr,er precise lo<itt:or cf ~~e
lea~-ed prOpo!"fty and the ca~e upon whlcr"1 the lease became effec-:we, ,f tr.\~ o(cur<"eC -O'Jrln.g the l'epOr,l:"',g p~i·.:!d
EXAMPLE, SCHEDULE S
A~sume tria!'
• VOl..' ha'iE ri!I 2:'''.-;' Inter€'st in a .:ommproal r€nt.,1 building at 14738 Spr\,Jce Street, lJt:le Tc,wn ~"'e fa:r rr:a~,_~:
val'Ut of your 'I"IH~re\t in :he bUlld'lrl9 i~ $85.000 ar'ld y'OL. did n,ot a(qujre c·r dl~p.o .. e of the proper'.)' dUring ::"1e
report''"'gperroc
Sche-dur~ B shcl,;id be completed t~ forlQw~
snu:n AClDP.~S5 0" "~ECiSE lC<A r~ON Of "'ROPF"~1. It. ''1''.'
14738 Spruce Street ~:-!:-:; wttle Town
N<I..'1'IJ~[ OF 'N.nl\to~!, 'l G., ~t~10N, OWNERSHIP LEA';H,(:)l~, ChD-0F !"'J~T --~ FAIR
,,'ARKE'T
'.ALU"
o S',OO().·j,1C:,{JoOCI
00 $'O,OO~'~'DO :,,;'J o Q",,' s.: GO OI~O
0';"'1'1 e rsb.io
If ,ll.cq ,,"e-d Or D'IP01ed ~ """9 in",
fllI!por·t;ng ~lI!rrOod YOu M ... ,~ jnC,l;~:e
Mtjl\.t!\, !)~) "'1'i~ '1,")f
D"le t.'q .... "j!d
D ~ Ie C;.IPOU:'C
ri R:f'n:~~ p'OP€ct~.
O""nl/"\~ D rl1tl/""lt I,
I o LIi'Ul~~~ 1[' ....
[Xl 10' (lrq r u 1 ... •
NOTE, You may be required to report on S<-hedul.@D;!In)'lncOme[S25DOr morE) r<!'~€'lved by 'jOw Of yOur Spouse
f'C!il rental propi!~y il:5ted on SCtledule B
"I~ you have 11 10~ or grea:C'r Intere-~l jn a r€'n:"r i=\rop;:,r1)o', ,.OlJ ma).' r-alle acd,t:.o~a' r('pOrt -g rec",'I''''''t'r'lt~ OM
S(hedl"leH·l
...
-:T1 ' :-ll ---1 .. ,~ . ~ -' ---
-'
l .' t
-
o
Schedule B -In!erests I" Real Properly
(Whi<:h Are ~ Held By A Business Entit:y Or Tru.:;.t)
(S£E INSTRUCTiOnS ON P~ECEDING PAGE)
HR':~:-APO~ES~ OJ;, .. ""mE lOC,ATIO", o~ "'I<O,~EJi''!' JCITY 1
1--_-'(/,,'-'0'-, ~Y\,-f-/~,c-,-c',,-_c--.:-:-:-::---:cc-:---------.l-__________ -;1 M::J:LT o S.~,QDO 1.~(),UCoO
"'U" 0' I.""".' , . 0'''". 0''''''''''' ,'," ~o'o. DeW 0' ""If 1'"1\'
~--.-------
o " Cl,OCIl I' C{1,.C.OO o O~ .. r 10: 00 ClOQ
:i :"':Ihm~<,)' D>:H~';j'D".·,..';i~~'"
.REopo"'tIf'''1l Penro :-,,,~ M,-,I"': :"dJ,,,I.e
Mo"t,., 0 .. )' Ar>d Y"(l;;O';
~t .II.,~q"'lreO 0, P'Spcl1.I!'t! D~rl n ~ ',.,e
ReportJ"Il"emxl YOU" M'U11 It,,::, (.,Ie
IJIOr.lh.u.ayll.;,CYur
Ii A<:OIJ 'red 0, 0 ,~pcxed p~" "if' T.~e
P.¥?Q"-'''9 "..,,,0<:1 "'00" "-I\\lS'( I~,d'ulte
rw'Io"tr.. 'D~J' ,c,."d rUr"
Dalt-Acq",tN;!
-:;al~ O,spc:ed
lClr'f'
!
/ ~,~,,\,.: 9 <{).M .... ,'.
""""f"'''''' IM ... ,elll'
o 1 e~~ ~r,"''' ,,,"" o 10"" C' ;1E'~ter"
----------;1 M~;:ET o \',OGIl <;'-0,:10(1
01.'0,00; 1-1 Oil DOC· o O'.ri!' 5100_000 1 VALUE
I
tr"'I!"l.1~P'OOl~I1.~. 0 lwtni'" !(l!of,
O ..... "';!fl"'.;> 1(>~~,E'U 'S 0 \0'"" 0.' 'ire.tlllr"
I '~TP, 0 Sl,DOO ,,\0 COD
------. iIIItdh-E'f 0 ~10.0CI·S:(K',OO':' I VAt\.JE n O .. i'" 5 ~ 0~ 0<)0
1 o ·'-'~'!t."" '\]"'-o I'J'" Q. ;'(';ue,"'
i ~",", 0 5',('·0., ~'() ~~,: 1 ·.""'~":T
I • .:.::..,{
_____ 1
o L,,",j:"~"1C'~ o J.J', o· ;'~~:oer"
NOTE. You may be required to report on s<l'1edule D a~lI'~tome ~S2s{) or mar..-) recel\{cd 011 yOI.. or )lour spowor;e
from rental property iisted 0'" x~edule B.
"If you h,j:lve a 10% Df greater !r.teri'~~ in a rerl(,a.i property. ~';:)'..i m ... y hcl\.'e addfliorlc! rC'port~ng ;equ"emerll.~
on S~hed.;le H·3.
o If additiOriar spac.e IS 1"Ieeded, "he",; b.J1Ii "fief ,:it't;;lci'l ... r. addi:lon.a: S,,-hedule B.
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INFOR"",~'rION fOR COMPLETING SCHl_ulE C-1
lnterests In Real Property Held By Busine" entities Or Trusis
BEFORE COMPLETING rkl$ SCHEDULE, COf.l5UL T YIJt)1l AGENCY'S CONFLICT
Of INTERfS T CC-O£ TO DE TtJ;MIUE TH£ rYPf Or INTE.RESTS YOU ML'~ r DISCL05E
If. durir::g thE' ,p,por1.ir1g period. yOu or }o",~imme(fia\o; filroll)' had a '10% or gr~a\er ir'1'ere~' ':1 i: ~'JS'lne~> '!nll\Y cr
In iii Uu~t. and
If, durir.g the r~pcrting pe!'od, the bU11~es~ entity or trust helc! ir.teres~ u, rear pf(1perty'
YO'j mu<;:vep.c~.s .. ,l':h ~"\.er(!'<:.t..s ~('. r~a! p~OP-E'!f1..:J If )'O,Jr pro ratd sha.r-e in an'l i('ltecest in rea! ;,-?per'!,y 1'\ '\\,000
or mort a~ 11 the lea! property i .. io<ated in )'our jurisdiction.
In addition, yOll !'"'lUit repurt the busif'eS5 ent'it)' hold'ing ~u(h "!mereSf,s in real property a~ ~r. ;l'\veumel'1t 01"'1
Scht'duleA
ReporJn-g As,,;r:1S Held By A Trust: YOu tnu'1 d~S(lo~e interesu. ;~ (ea! pro~.'1,. heid by al"'1)' :·..:~l in which )'0"
hay," jJ 10% or greCllter ~(",tere~l. jf }'our pro ral.,a share of the if1ter?>1. in feal prop.ert)' is S.I,O~'O Of rr.:lre', P'..:r~.;.;!r,t:o
fPPC Regulat~on '8234, you hoVE' an intetest in a trws'. If yOu are'
1. Amak"!rand:
a, un revo,,-:e or terminate-thE' trust; or
bo. have n!,t.a.ined on.)! r;,ghu to, the in.come O~ prinopa.i -of 'J".~ tillst or re·"a;ned any rever'i.'(''',ary or ~em~indl;r
;nterest; or
<:. have retained any pOwer of appoint.ment includtr-.g the power to ch.ange lhe O~ ,~fiC:Q.n~
1. A ben~ficraf)l and:
... prE.5ently r~:eive income; or
b, have an 'rrel'"~cable future rig"tt to receive inc:>me or prll·.,,~pal
If Jlou are .,r.ly Co trws:!'!!!', you do no. halle a reportable inteTi:st ir1 the tIUs.t.
EXAMPLE, SCHEDULE (-1
• YOu h.ave a 1>0% partnerShip 'Interest i,.,. ABC land Oe"lle1operswort'" S25C,OD.o.
• ABC lal"ld De'le\opli!~ OWf"I! real property wonh S3QO,O(!!) \CY.at@d y,/r"I.hif'l )lOLJt j u~hdl ction -:he real property
was r"lot o!(quired a":!lspo~~d of dUri ng the repOrting pe'r'od
"'cllr 50% iMereS1 ir, ABC I.a~d Oe-ve!opes must be reported C~ Sched'.J:e A
)ev~lopE!'rs mu~t be lepClr(ed c.:'l xnedi,;re Co, a. fciiow~
.NTERESTS IN REAL PROPERTY HELD BY: ABC Land De",lop." _
tt .. ame Of E..ames. Entity Or T (ust Holel ng The Rt'ai Property)·
:i7RElT ADOj:!;<J.S OR ,oftec.! .... E ,OCATIO ... CF F'ROF'fl'ITY
[1 1 1 ,00Q'1il0.DOO
u,~ 0 1il~,DO'·~100,OO," .... "~,.
,~, '" :x ,J'e1 5.100 0(10
. ~ .
,
•
,1\ ";:.
":-"
'_c
Schedule (-1 -Inter~'\' In Real Property
f-Ie!d By A Business Entity Or Trust
(SEE iNSTRUCTIONS ON PRECEDING ?AGE)
INTERESTS!N REAL PROPERTY HELD BY:
II ACQ\.l1 rl!'d Or ,,~pCl>l!'d c' .... " n C '-,I'
"e-po.,,,,g?-.r'()~ "'c.~Js!~r7:. JI~
MO'1t" ::-~~t.n.~'f"4'
L
p,'~A".",,'e-Q
p., I t OllOo~ed'
D.Itlt'At:, .. Ned
D .. w Ollp()\~d
PH' ':"-:;,J,r .. d
:10:' :)":;""I!':
\ ''''
I
I
_J
FIIo,,1l
MIIo,~I<Ef
'il:..l.WI:
;~IJI
w,(,o.l':rn
'~AcUI:
fA.IR
"",,,,-FlXE'
VA,wE
f».,1l.
~-,;"';>,K::'
"I,.W€'
SI,WO 1'0",OOQ
1'0,1)01 ~11.),r;r::Q
O';!!, '5 "'J<),C,C'O
o ~"OOO ~:c~,c,o o S'O ~O' }l')(',CDC o O,e' S'M Grt{!
" U o o
B
[]
n
[]
o
'51,(lOQ ~~Q C'C'Q
S·,Q,OO' ')',",0,,-,0,,
0~t'li1,CDlJO
lj.l.C"JO li 1 C GC'J
~1')"I)'·1~[;U,r}:t
lj.l~ e,er'.5 1 C'C, 'JC,'J
Cr,,!!,::.: i!0 ODD
.... ~~~:,-, ..... ..
-
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INFO~MATION fOR COMPLETING SCHEDULf C-2·
Investments Held By Business Entities Or Trllsts
a1EFO~E COMPLETING 1WS SCHEDULf, CON';UI.. r '(OUR A.GENCY·S CONFL!CT
OF JNTER£STCOOf TO DET(RMiN£ THE TYPE.S INrEREsr:; YOU MUST DISClOSE.
If, during the reporting period, '{OU 0; tour im.-,ed,at-e iail"'. II' h,:,d i! 10',;' or gredter interest'l1 iI b'~~-"(>H e~\lt)' or
i", a trust. and
tf, ~urin9 the repertl:"1g pe6od. Vie b 'JsineS5 entity or tru'St herd inllearT'l('n·.s·
YO'4 m .. nt rep(lrt ~ud"l in\/estments if your pro rate share of iln}! inlle~tmel1t is $.1.000 or more and the
inIJoe"Stment;$ in a busme~s enti1)' locat~d irl, Of doing bLJ .. ~neH i", .. YC\Jr jurl~di'tion (repon this on Schedule (.
2).
In addition. you must repor<, ~he bu.int"$S e.nli!), hold~ng <;uch irwestmi!:ns. 3S an i~\lestme('!t Or'l Sch<"dule A
Reporting Assets Held 1>0''' Trust: YOu mu>t disclose ;n'.estmer-,H and ;nlerE"SH 1I'1 iea! property r.e1d by any tltJ~1
in which you ha .... e a 10% or gre;Jter ~nterest. rf yOUl pro rala sha~e of the ir"r.'estme~t or intersn in real propE'rt)lIS
S'l,OOO Of ;nore. PUI:UiOo"'·. 'to f'?PC Re-gulatior-. i8-~34. you )-,e,\/e. til'" in\-ere'\.\;:'1 i!. vwstlfyou a.rllt:
1. Amakel"no:
a,. can re"ok.e or t~c>l'lnate the tn.l'\.~; Of
b have re-tai.,ed any righ!SlD the irn:r.me or pnf'1(ipai ct the tr,J)t or retajned a~y relo'en-ionary or remc;r"lder
intE're~t; Or
t. have fe,liIoi"'~d an)! power of appomtme,",' mcludir>9 U'\e P.ower '.Q (I:\ange th~ benefi(iarie!r.
2. A beneficiary and:
a. pr£~e-l"'Itl)" r'l!!(ei'l'i! liKome-; or
b have an irrevO<.lIb:e f",turp flgh.t to rece: .... e ir"{or'l'.e cr pr:nCJpal
I{you afe only a vu~tee. I"OU do not ha\le iI reportabre Ir'lter~\t ,f"\ t!'e tru~t
EXAMPLE, SCHEOUlE C-2
Ass.ume that:
.. ABC Land Dcel<lelo-pers C-Wf'.';. (ommon ~\O(\( wQfth ~3,OOO in A:ax 61J11d<ng M8terials, Wr.ICtl \lo~!. b'J~\r\ess. ~n
your jurisdiction, The im{estment \Na~ not acquored Of di~po~~d oi duri ng the feportlng period.
Your 50% interes<.:n. ABC land O~>.Jelopen must be repor1,ej 011 xhf'o",:e A.. The ~ommo!'l ~to6 he;G by ABC Laf'c
Delleloper5 mus: be r~ported on xlieduie (·1 a1 fO::"''''5
!N\lESTMENTS HELD 3Y.
FAIR:
!'.',l"i'iKOT
\,'lI,llJE
[Xi S 1 .ClOP>S' 0 V'j"' o 1.10 DQ1'1100,~C'CI o 0.'.' '\ ~{)Q C~I';,
,-
NAME /~
Schedule (-2 -Investments Held By A Businps'; Entity Or Trust
(SEE JNSTRUC:-IONS ON PR ECED!NG P .. '\GE)
GfNfRJi. L DE S(R!PTIOlli Of ! U~I i'O~~s. t;.(T1 V! T'r
NATUR[ OF INVtSTME~T. € (j.. C.OMMO,; ~'O(I<' !>ARTtoi:"S"lf
~~M.f.. Of Bl:~INE'S.\ [N'l~_' '-o--,,--,---,---,~-" .. . .... ~
N/ .. TLri'CE OF ,r-,,,nTMENT. E G (OMMON $iO(K "A~T:jE"~,",IO I ,1 A(Q""t'd Or :l",pOled Ou',o; :-~e I
p.eP01"".l"';l I't:·,c~ Yo,", ·,·,Ol\.t ',..,e.".tt' I
--::-;-: -:c:;::--:-;c:::::-::-;---------1' MD~~", :;)ar A:iC '!'",!o,
GlNEAAt DE"iiC1'llnIQNO~ B\.J~lTO='S~J:..G\\'<I!'f I t>~le .t..,q"",,·ri ·1
I D~lt D",'o;",d _ i
'L
f!:..lP:
MA~K':T
""'I.-'JE
fA:R
/I,~ARKET
VALUe
~A!F!
M ... RxFT
1J:'Lu;:
o
B
lJ o
lJ
R
[J
B
o
lj
__ ,_""",.,.s:.
St.OOC 'J.'(i,('OO
$IO.OOI,S1[);J.DOc
501 ,OC'D·j. ,0 !);{,
S:O,C.O<·,.'·:O we.
O"Ii"S!O,J,O~..c
S' ,MO S, 0 "C'G'
'!.·,O,C~\\ 50 ',nc, \lCe,
O_e, S' 0'] Gel;'
!ol ,~,,[I,S'O ~.:O
SIO C,O;.:!,'::;o "'0'0
:'~~''''U''J''J(l
'S'C,C;J-'S·'n ~·:CG
O~~, So'.OD I>~'['
S'.OOO·S'SIIJJ.J
S : O,il<)~· S, Cle.., J'~ J
O"il'r Sl t,,),:;'::-.:l
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I~JFORMATION fOR COMPLETING SCHEDULt D· IrlCor.1e
{Ot"'er Tki;ln 'l.v.ans. GI~ts. And Honoraria)
EEFORE COMPLEn.~G fHIS SCH[Dll1f, CONSULT YOUR AGENCY'S CON,cl~cr
Oc rNTfR£SiCOOE TO O£TfRMI~E THE" rYPES Of INCOME. YOU MUST DISctOSE,
!rr')Jot1?D.t. U.,der tr.1;' P'':llitlcal Re!o:ll'm A,i. reportabl~ .f,co'!'e is drfj~rer1t IrO'T1 ';'1~Dme ~Dr taJ: pu'p,=,\e~
YO\J mun (P-port J'O'-'~ ~ income and your communit., property 'Interest III jour >pouse'~ gro~~ ,r.c:ome. ~
~r\(ol'Tle is the total am_o •• mtof""incomE-befClr~ deducting e:o:per:~es !o~~e> orJa:r.ei. In(ome aggreg'Hlr.g S2S0 or more
r~~1'Ii¥d t~om a.~"Y <;.oIJrcot io<ated trI cr oo;-r;-g O'.JSjm=",~!n. 'Jour J'.J.ri'sd!Glon :11'i~ Jj,';(to~Ed
A source of incqme Isloc,atecf in or dOing busiI"'JeS5 in the jurisdiction if L· .)r a parent, s:..bsidlary.
or a related bl,lsmess entIty:
• Manufactures, di~t!iblJ'ts, .~eH!o or pur<hases products or ~ervirei on a regular basis In the juri~d~(lior:
• P!an!. \0 do b\Js;l'\t.,.~ In the J tJ1\sdict;on.
o 1-1810 done bws~!"\e~~ ir, the juri~dlction withil"1t,.re pr,;o .... ;olJ~ two years.
• Has a" iflte(e~ 11"1 re.al property;n the jun~dlc-'lOil.
.. H. ... s an Qffi.ce in the furisdlCtion.
Reportabre income ind;Jdes.:
• CQmmi~sior;ir"\~Qmo!'. (SeeS.che~ule K·'-C"om~rHssio~ 1(1(Qme}
• Salal)liwa9~s, p~r diem, reimt-u!sem(>r'l 'o~ eXP'('f'lSes (5{;e ex(lu~io"'s be row Als.o !:ee Schedul e D-l·ln(oJ"'~ -
Travej P~:7lena, Advances, I<eimbursemeilt.s.)
• Ir"lcc.me ,rom a ~:lI. .. s.lness entLty a:lod your pro rata share ",f the to-tar g~o~s payf'T",ents re<e~'J.d by a busine~s
eroLty ('Induding ~er,tal propert.y) or a tn.m in whieh you or !lour SPOU\E' hila af'l O'Nrit'f!>nip 1r"11He\t of '1')% or
mo'e.
• Your community pro?:erty intere .. t (50''', I "1 yo .. r $90uSe'\ ineonl_e
• Proceeds from arj ~ ... Ie, .nc!uding the Selie aT a hou$E' or car [rl'1e toto!:1 ~dl~ price i~ repor-::at;.le rl::'garclle~s o~
any obligation )Iou m'9ht ha\!E' to ¥oy on to.;.ns ~enI~ed by the properw.)
• Rental jf'leo m e
• Pri1.es. or awards liOt d~5.<lo~ed.)s ~ih~
• Forgi .... enf!$~ of a loan Qf other ino(!t:lte<tn@s~
• loa,... pa~m-ents rl!«';ve(l by you.
You are !!Q!re.quired to dLsdose thefo!lowir.g types of in<ome:
• Sal.ary or reimblJrsemenu for e.o:pt>n~e. 3nd per ciem from a federar, sta'e or 10(1iI1 governmer'H ilgency.
• Rell't!our~eme.nt fa, :~.ra .... e\ ex:pero.~es. an.d P!!f d:em rec-e.ived from a bona fide ed.,,I(::af.ional, aca~lI>,mic. C~
charltabre organization
• CampaiQn cnl"1tnbu::i.ons
• A. devis.e or inher'lt.<lneE!. (H'O ollie lI'er, jflherir~nc~ of 8111 invesfment or an intereJt iii rea! PIOperty mdll be
requited !o be reported on Schedule A 0/ S.) .. _ ~
• OLVld~:---;o;., inH!(e'>t or Otrlll!:r retUI"c"' on a '\.tCl.iriW wtvch \S regl~ti!red '#,Iltn ",he SeCl.Jfltlt., :In.,j E~cha!"lge
Commrss, on.
• Payments received ~nder an i;:sura:l':oe-pol,,,,
• Interest. dn(lder;d~ or premiums on a trr"le or demarld' deposit in a fl"',al"(lal In;tl'ution, shares iI"', a -.:red,~
union, an jn~uf.irI(e pchcy. or il. bond or other a~bt Instrumen! I$~ued by ~ go.'ernm@ntageM_y
• 1nc::ome of dli!'per'l~e:'\t (~ildrel".
• Payments :ece: .... e-d' under a d-efi,.,ed b~f'1efil pensIon pi.:;.n qu,e.lifi@d ur!der lnternal Revenue Code Sec.'on
401(a).
EXAMPLE. SCHEDULE D
AHume that yo.; re(<!i\'eci c'""!(orne ![om l.h~ fC.tlO>Nin9 so.urce~ a.:.rir'l9 the tep()r1.in9 penod:
• $4,800 i~ ,eta: ref',:a; i."l(ome f;-om iii dupin, which;5 If". your iuri,:jiC1io!"'
• ':'-our sp(Ju,,~ ~er:el.'e.d 'So' 8;:)GC ,n .alar., frlJr'rI Gene:ra, :elE:p.hQne Com:;).an", a ma.'1<J fac't"r,ng ~.rm ... ~hich >~:
producu I n 'lour Ie. ~I~dlctl on
GROSS INCOME RECEIVE~:
.OF • .-"",. ""',-;,c'
-Ji~' .-,/;}>::
.-...... '
l ...... . .. r-:. '---.,", ~
.--.
NAME
Schedule D . Income
{Other Than LOaf!5. Grfts And Honoraria)
(SEE iNSTRUCTIONS ON PRECEDI~,G PAGE)
GROS~ IN'COME RiCtNED.
PoIAM[ OF THE SOUFtCf OF !iII(Ot.'f PI ("'"' 6 r"/I.~_ I ~.k"'''/-<;1 (I'<',.v-..
ADPR£S!; v T0' . ;-/k1Pi 0 1250 -11 .')Q()
7_;' 00 (f}<-<;~ I (_~k /lro (el-vCr" (n I 0 iliA tU-RE" OF D .... Slr.~~S AC'T"'~r'l'. ,F ANY 11.00t -111;),D'l0
c~J!..Ii.j ---I ~oer5:0,CiOr:J De5.(RIf'T.oN Of !"!-if (ONS'DfR:ATrON ;:PI: WHICH INCDM£ WAS ~E(P\"'E::;
..s'C<..£-t..,"\.--,
~Mf OF"" E SOlr~e Of I"(OME -l ADOfl;[SS --0 ~~SO -S 1,GCC-
-. 0 NATURE O~ e:ujrOJ£5~ ACTIV!T\', If A~rv I !.:,Ntl-'S-lO,~
i 0 OESC'<I"'TlON Of "1'1-'-( C01'::>'iD~I'.A~h:;N f'OK Wl-'.~C" il'«OMt: w"-s !!,£-':tl~'(O---------------1 Over 51J3iD::'
I
~AME OF THE SOU~CE Of INr:OME I
-. -.. .-. --j ADCR:E~!io 0 52'50-51 r;OJ
-I
NATuRt: Of eUSINESS ACTI'bn.IF .:.,r,y I 0 "-1.00\· ""He,':,
I 0[5(11I1P-;'10'" OF !~~ (ON$rDE:;:':' n,N FO~ WHIC"" -
1 0 "N((JME W.IIS ~ECEI ;, ~' ,::"'er Sol 0 O,:,~
I
NAME O~ THE SOU~« OF' IN(O'I'E I ,
AOCR.ES~ ----I 0 ~251~ ·SI.e'C'u
-.. 0 NATUIIE Of 8lJ;H~'c)S AC'I"IH. iF ArJ'T' S1,0[',' -S"~,Q{jO
-i 0 DESC~IPTION O~ T"'~ C(1NSID~U TION ~O~ ''''',,11;'1 ,"'cor.l~ WA3. .~r([l"rD l '),,~'S:O,000
L
-
--
-
.::".
..
INFORMATION FOR COMPlEHNG SCHEDULE D·'· Income·
Travel Payments. Advances. Reimbursements
8fFOR£ COMPl..EnNG THIS ."CHEOUlf, CONSULr YOUR AGENCY'S CONFLICT
Of jNTEI1£5T CODE TO OfT(RMrN£ THE TYPES OF lNCOME 'fOU MuS r DISCt.05£.
S<he-dule D-! i~ for di~clo~i"g p3yment!li, adva('l(es., or (i:·imbu·serTIenu for :[a\"~!, ir"1c!wd: .... g a(tu3i l'dr'1\porl~tIO~
and re-\;lI":.ed lodging ano subs.i"f,',entt: In I·I~IJ of (\1'\.(\0;ir.9 tr3'te\ pa~~en~> on S(;-,e1jul~ D-i, h!(1'1 po';Mer.',!, may hI:!
dis.d~ ~t gih50n Sc:hedu:e F, Of ih income Qr"1 xhedule 0
Genefa-ily. \ra .... e\ pay!'":'lentl. are "~ihs.~ aflO ~y"1. ~ di'>(io":i2'c If 101; flKei .... e \500 01 mnrf: in SI.l(l"l ?d'ilT\er'.t~ fro~ a.
~in"Jt! Klurct'
Trav~I paymtf'>U ila "\f),cme" if yO'. "'avi: p.ro'<lidec ~!".Iice~ which '.Nef~ equa.l 'to. Of grS'olter in '"Ol:UI! \h.an thi!
pa:.rmen15 for the travel. lncome C'f $250 Ot more re-cej"e-d from a 'lngle 50u~~e mU~l be c'i,'\.c1osed
GO\J .. rnm~r.l Code Sec~icl"l 8'4028 pro..r:des t:l"'':"" ar'.'{ perscl"l, ot~~<e.r tha .... a cefendant if', a (;\i"T,;n,,' iKtlOl"l, whc
claims that .. palmeflt is r"1ct ... g~ft by re.a~on vf reoceipt of c.om:ciNation h,;tt thE burden 0' prO"ll"Ig tl"lal the
consideration rll!'ceived is of equal or 9' eater \I.;lut:
Payment at reimburs.ement for travel wi\hln Callf!':r,.,ia fn (or.neniol'1 with an event.at which )lOCI ~,i'<le a s.pe~d"l.
participated in a panei Of .eminar or performe<! :a: similar service ii not 'equaed to oe c:!·I).(losed. Ho .... ever. t:avel
paymer1.ts jn CQr"lne('tlon ....... ;tn sud''', ar"1 e'o'er'1t o ... t.s.ide ea!i for:"''H3 must b~ dijclo~ed
Travel payrr.ents (e-<e;v~ Irom a state, lo(;J!, or lederal gO'<lt!r.iment a9~r1cy, for wh'l(h "au have provided ~qual
Dr greater (OO$ideratlon. are no! req,uired to be CI!Klosed If you haYE not provided equal or greener con~ideratror'1
for the pay menu, )leu mcy be r.equir\':!'d to dlsclo~e {he payrl"lt!nU i!!i gift\.
Tr .... "'el paJiment< re<e;'.;;od from 3 bona fide e~u(i!tic"'.,,!, acaCE'f'Tli(" or charitable organ I zation, fo( w"lch 't0u na'o'e
pro ... id~ eqlJal or ~re.net consideration, are r"O~ req:.Jir",d to be d~~c~o~ed 'T you rlc1ve not p:o'<ljced ~Quili or gre-ater
(onSIl,aratiol"'l fer 't~ payme~t,>, re'; m:.'J bE' reql.llred to diSt!O!.~ the payme1"lt~ a .. ogitu
EXAMnE. SCHEDULE D-'
As'5ume th~t '{ou addressed the 9raduat~ng class of :r:e Amerir:al1 lJr1i ... efSlt)l in Mudvdle, ~e ...... Yor~ ~he unrver~'ty
paid you:
• $,550 to reimb~r$e younrilv('1 e:o:pet1'Sl'.
.... "·,or'K,.~.a
"me-ncan UnI,,'er~ily
~" 77 Grter. Larle. Mudl,lille, New York
.... Iy~f 00 .u,,,.[~\ .. ~""f' ..... ". w~ College
; 11'\ Oi ~"'''U'1 \(>,\t. ()to!. \ 0 G"I
. \
DATE(SI
''''0 d<!l &.,' AMOUNT(S)" , , .
I
I 5/15,,91
I $~5C
I
I
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I
I
PURPOSE Afo.oD
LOCATJON OF
TRAV"'l' "
KeynQ~ $peaker
MudviJle, New 'fork
. ,
~Ar"E 6'V.«f.Jr it
Schedule D-1 -Income --Travel Pilyments, Advances, Reimbursements
{SEE ~NSTRUCT!ONS ON PRECEDING PAGE)
t'UkPOSE ANO
DAnIS): lOCAT10N OF
AMOUNTiS}" T~ E I
I
l
I
I
I
,"1'C, 1f~\, IS vr} AV L: --
NAME Of seLl"'t iJ/A j I
i ,.. Dl)l\£5.S
----
NATUil:f D~ IIUSINfSS "CTNITV, u: ANI"
r----i
T':'i'E OF ~.a. "'MENT CCl-l E 0:: OM) 0 Grn 0 Il\:C'JI'.'f. j
~Il.M' f" .. ~ SOV!'.C~ i I
I I ~S~ ~ \ -
NAoTUII£ O~ 'IIU'SoINtS" ~CTl'JfT't. If />..N"f
1----l
i"'P~ Of-P"'''fM'tIo1'l". [CrI£CJ( ONE) 0"'" 0 IN(OM!: I
NAME OJ' SOL'J((£ I I ,
r;oci-~S'So --
I I I I --------,
\
,
NATUJl:E Of 8VSI~.tS' ACTIViTY, JF .D..NI'
I I . I
ry"t: OF "A'r'Ml:Nl: (C~EClC ON£) 0 GIn 0 IN(OilE I
NAME Of-O;;:CURCi. I I ,
ADDRESS
--,--I ! I ,
-----< I ,
N.t.j'';''~ O~ ~\..I51~liS' ':"(-\>1', ". If t<1'H
I ---1
,'I't>~ OF I"AYM.N~· 10,:'CA. ONE:, 0"'" 0 I~KO!;1f I I
I\IAMi OF S.QuRCF , i
1-;;:c1..!l.E:'S
I I -,
I
'M,IJi'iEOF S;L'SIN;:H AC'Tll,mr.lf A.N', -l
\
I ---I !
T',"E Of P,o,YMEIII: I:(r<rc~ Clr'f,. 0 GIFr CJ ir.CO·~' I I ,
"
I
•
L . ..J If <306,:,on,,! ~OdC~ I~ r,cede-d. (he:.k 00)( aCId attaci-,,an add!tional )("ecL •• le D-l
L
-
-
INFORMATION FOR COMPLETING SCHEDULE E -I",ome _. loan,
(Received Or Outstandir"lg During The Reporting Per·lod)
8H-Oj:lf COMPunNG THIS SCHfOULf, CONSUL r YOUR AGfN'::Y'S CONfL:CT
OF JNTEIUST CODE TO DETfRMINE THE TYfES OF INCOME YOU MUST DISCLOSE.
'(0;'; must re~ort loam, ii1duding real estare roan~ and m':'rg:n accounts. recei .... ed t;.)1 either yc.u,·~elf or lIo"r
1pouse .;u;grPQating-SZSO or mote from ... 5in~le ~oun::ewhjd"l!~ located ir"1, or doing bu~ineH ;n, )lour !ur,id1cticn Ail
re~rtableloar:Heceived or oUI.$tand'''''g during the repo~ing pe~,od mwst be diSClosed Nete: Ml.;itlp,e lOUIS hom a
single sour...:e must be aggregated
A. source-01 inc.om~ is 'o(at~d in or d<;)ing busin-ess in the j'IJri>dlction if it or a parent. subsidiary.
or a related business entity:
• Mar.uf<!ctwre-s, -dlstribute-<o, sells or pun:hase!. products or 5.etvic~ Or"ll reguL<u ba~'IS;'" the Juri~d:c:, en
C" P'ans. to do b.u~inen ~n the juri~dicti on.
• HC!~ done busine~s i,.. the j~.ni~ic;tion within tl"-e pre\lwl.'~ two yea" •.
• Has ... n interest in real propc"W in the juri!.d~(tion
• Has an cHi(e-lr. t~e-juri-.dkt1ol"'..
"1ou are not required to disdose the following loans:
• Any loa" frum a ComrT"'erci.el lending in~\itu~ion u~ed '!o p ... ~(ho1~e, 'efrnanr::e t~e purd·',ue of, or 1o(
improve-menu to, your principal place of ~e-s;;dence-it the loan w,,~ made in the ler-de{'s regJ~ar <-ourse 01
bU5inen or: lerms av.oilabie to member5 of the public INlthou( regard to offici~1 status
• Loans. from a commercial lerlding 'institut'lon in the r"'1ormal Coune of bu~in~~s wh;ch d~d no: e.HeeC; SIO,O{JO at
any tim:e c!!. .. ring the reportin9 p~~iod (MuJ-,ipie loa~s f~om a comm.e"cial ler"'1ding instdutior"'1 IT!'uH be
aggregat~ )
• Ar'I'J ind~bte<l(\oe1.' created as pa;-t of it (eta~( mo;.talit:"1ent or ued'i\ card Har',sacr.;o~ made \1"\ the Ge~l\or·S
regular course of b~iness on terms av.utable to the pubri< wj~.hout regard 10 official stoitu5 if t~e aggreogate
amount o ....... ed to ~he credItor did not eJ:.c;eed S 1 0,000 at ar:~ time: durirlq .. r,e reoorting p-eried"
• Any !oan from your spouse, child. palent, 9rar"'1dpa~ent. grar,do·"rd. brot1"le~, s,<..1er, par~r"1t·rr"'1-jdw. brothc!r·in~
Is""", s;~t"e'r.il"".-\aw, I"\e?hew. nieo;;e, ilUl"".t, \.lnc1e, or fi'st (Q\.I,,;I"; Of .he <..po\.;,>" Of 'H1~' weI":. person, eJ:(@-pt t;c-,at a
loar; fn)m iI..,y ~uch pehor-.!~ repcrtab1e if the persOM i~ a{ti .... g a~ ar. u'termo!'d,ar)o' or "gen~ for any per;Qi1 no~
<o .... ered by U11~ pro ... ·;.ior"l..
EXAMPLE, SCHEDULE E
Assume that:
• You rec~ived a'"1 equity loan in t~e amount of S15.0CO !r/Jm Greale.t Sav~r"1g~ ar1d lc;.an or,),rJur ",rir"'1Cip~1 pl"c.e
of residencE' to conscridate ),o.;r bills and to take a vaca:ion.
You <"n .. ~t report:
• Th.e eq:.nty loan 01"' yOUf" orlncipar pl"c:e of re-~ide"'ce be~,aui",," :"'o!' ioar"l 2~T;O\H~t ""Co, ;:..'N S~J,:J(J'J 2.nd -:.he
man.,.,.. wa~ r"lOI lI~ed to refl na nee or for ',mpr(j'o'e-mer"la to jlOu~ P'I '"lO pal res, cel"';::e
AMOU""T Of t-;1(iH(ST •• ' A,,"(.e
DURiNG THO:. ""fPORT!NC; PE;l:IOO:
o s2Se -'p ,ooe
o ".", "'00
,C"C,",",Cs·-;: ... -·-;t---o ~;(',,;:
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NI'.M[
Schedule E -Income --loans
(Recelv€d or Outst~r.ding During th~ Reporting Period)
(SEE INSTRUCTJONS ON PRECEDiNG PAGE)
ACORESS
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o "1,00'·SIOC,0,"
o ° "II!' ~ID,')';C
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INFORMATlor_"':JR COMPLETING SCHE[)ULE /'-Income --Gift,
BEfORE COMPLETING THIS SCHEDt)LE, CONSUL T YOUR AGENCY·S CONfliCT
Of INTERHT(ODE ro DETERMINE. THE TYPH OF INCOME 'IOU MUST DI5CL.05E
~Glft" mea!"., znyth·ng of va: .;E', ..... heth .. r t~ngi ble or inta,"g,b'e. ror w"l.(!'1 equ,)1 or greJtN val ue ". c, ~'. pro~ ,6 o:-d
You m-='it d1~clD5e 9""'-> wit;' <lJ"\ a9grega~e .... ,ltue of 5.50 or m:)rE' relei"ed .Q~r~t1g tr.o;> r~pc.rti""g :-.:r:oG fwm
s~f'1gle source, wltnout r~~d to the IOC<ltHH' 0/ the_~n'Jr fins-ide or outsi<'ie YO;Jt 'uri,.d;ctiQ_r.!l. Ar:.V r'1wr'r,ber of gd'u
f~om C'rH! perSOr"l. the \lQlve~ of which add up to SSO or mare during the (p:porting perIod, rn ... st bE drs(iD\.ed
tI is the a~(eptan(e o~ ~he g'lh. and riot t',"e L nimate use 'to wljid-= 'rt is p\Jt, that impo'.i@,~ <!II repc~m; obli9a'ticn en
you Thus, you rnu'it report a 91 h ('"en 1 f )'ou nel(/:r make use of it (unie~~ 'lou return th~ gi ft or donatl! ,t to a char It)'!
or it yo>.! give '1\ dway \0 another ptnol'1. (No,e: 1'hert e'lle !.?ec.ial r'J\e~ for l~pOrtl"g gih.!. oi ~ree p .. me"'~ iH ti<.:.\r.~u..
(Commission Regulation 181263 J) If the e7.act amOunt of the 91ft is not I; nowI'1 , ,.cu ri"u. .. st mD~e a good fai'J~
i:!.'"lma\e of the it~m', fair malk~\ 'o'alu't us~ing the value ~f tl-:e gih liaS ·o\ler '\:;O~ or "-';<iI\,.J~ ur-.\,,· .. owr." IS. r.cf.
adequat~ dis.clC)';ur~ Gifts are rep;)rtable without rt-g;ard to where the donor is IQ<:ated.
S" xhedu:e D-r-Inc-eme --;rallel Pa:.-menu, Adl(ance~. PeimOur-..emena !or informat,on con<:err-"ng paymerns,
indudi .... g a.d",an(l!~ al'ld rtlm!Y.Jr!.el"<el'lts; {or ·,ra," ... !l
IMPORTANT: 'f you rec.~;lIe .ill gdt through a.-, iMermed'lary" )'ou m~$t dl~(;o~E' the natne. addre~!i and bu~il'1f"H
acti.my of both the donor and the .ntermediary.
You are nctrf:quired to disdose the following types: of gifts:
• Gifts of ~o~pitalily inllolvlng foorj, dri.-,k or oc(a~lonal lodging pfo\l.ded i!'1 an Ii",dl",idual\ ho~e
• Gi~ e"qual in value e1ch.:ln9~;j tJe\we-en )Iou al'1d an ind',v'ldual, Olher than .. Itlbby.~t, 011 hol,o.a,'s. birt'hdays,
or ~I mil a r oaG~' ons
'" Gift!. 01 ,r ... ior~a .. ior,a\ m.n_i!'fI"\, !ouch as boo'.:s. pamphle'!'i, reports, calendars ~ penodlcals
• ~ifts from your !iPOus<!'. Chl!.d, Pdrent, gran.doaliOnt. 9~<H'Ld(hiid. ~rother. ~i~tt'r, parer1l-i,-,·1alo'.,. ~rot:"e;-'r .. raw,
S-ls.1er-It'\-\~w. illJI'\. uncle. ~it':(I!'. r\~cha".. or [1T';t (ol..!sin: 0: \f,es.):>o.u,>E' 0.' :,r-'1 S\l-::h pefson, ofl,>lIldoed th3\. a gift
from any 'Such ~non must b.e dls.:::lo~ed if the per~on a ,ao,;-tlng a~ al"1 ager1~ o( ,ntermed,ary for a reportaOle
'So"H(e ollrl<ome
• A bequest Of inher.tanc.e (However, an inheritan<e of 3n i,-,,,estment Of an interest in real property m~:f bi!'
required to be reported on. Sc~edule A or B.)
• G'!f"o_s WtIlCf'1 are no! ~sed and ..... h:c~. wlth,/'1. 30 days aher r€'(elp!, are I-eturned ,0 ".he dOjnor -or delllle'lird ~o a
cr.aritable orgdnlldllOr"1 ....,,1 hout bemg claimed a5 .; {harllable .. ontr:butl on for ta-: p",rpo~e~.
• Personal.zeci pi aque\ .BInd vaph'I.e~ WI ~h an Indillid uallial ue of les. than. i250
• Campaign contributions.
• Food. beverage, ar:d ::l-eC(>1sary accommodations receIved d,rec::ji i(l (onne<t~of"\ With al"l e\(~ ... t at w!"1;("1 'Joe.!
gave a ~peech, ;:Jart;(lpated In.; pane;. or provided a Simile( ~er"ICi!'
EXAMPLE, SCHEDUL€ F
A~sume ~hat:
--,
• Yo,u t~(e.ll(ed 'ieaso'1. ~_"r;:~eli .... or..r. S2JO tc ;)roie~si-:ln~! b.as~bail game"i from \la.11ey ?I po:: 5'iHe:T\\ 'I' 0<.1 ' ... 'J.C i
the tic.kets
Scroedule f should be lompieted as fOi!owS
...... t 0-0Q0<0fI
VaHey Pipe Systems
-_.------
"';.01\1."
2M E. Filth. Hometo,"'n -_.-
."",,", 00 ."r.. .. "1 ~ .~,
Manufll{"tur'!'S rrri.~>lliOI)..t L'llIrnbing Surpiit'~ I
OATEISI
RfCE.lV£D'
(mel d .. a Y'I ,
!YIarCG I. 199 t
VA.LUE(S)·
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ADDRESS
Oll~-
rvA. rURE o'~ 8U~IN(SS "'GI\I~T'r'. If ANl'
NAME O~ SOUR(~
AOORE-SS
lIIA"fURE-Of S:LJ51NE5S A.(TWfn',lf A~'f
NI1..ME Of SO\J~c.(
~s-~ -
NA"I'UitE Of IHJ!;~N"S~ ACTI\lITY, I~ ..:I.),.,.
~AMl< OfSO-."CE
Schedule F -Income .. Gifts
(SEE JNSTRUCflONS ON PP.ECEDj~JG PAGE)
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"'-"'-TURf o~ aUSIN£SS A':Tj\,i'T'Y. If AN'( , ,
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~Mf OF SQ'JI'.CE I I ~-'S5 -------1 , , , ,
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P~S'~lPTION
OF GIFT(S)-
o if adat!!onal spi!J(e r~ r1ceded, (hee" bo~ ~,.,d i"t",a~r ar.add-tior.d. S<:.kedule F·
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I
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'"formatiorl for SCHEDULE G: B'",si".ss Positions
BEFORE COMPLfnVG THIS SC~EDULE. CONSUL T }' OUR AGENCY'S CDNFLICf"
OF INTEREST CODE TO DETERMINE THE urH OF poslno,,,,,s YOU M'.J'3T DISCLOSE.
• You mvst ~eport the nam~ cf an)' busjnes! el"'1tity covered b)' yOI..'r di5{iO'iWre .::al~gC'r)l for , .. ,~,1(::h ,.ow are a
dir~or, officer, p~rtr"'1er, tru!.\E'I!, empioyee. or hold any pO~'ltlon cf management.
• Po~itlom held ir] non-profit or ,n,iJri~able (lrganiza~'lor.s. or ~~mpa'ign com~l:tt"-E!'s are not rep O"',K,I e
EXAMPLE, SCHEDULE G
AsS-lime th.at:
• Your diKlo-sure Calf'!gory requires. yc-u to disclose bus:nes~ p<:lsitiorli in e.ntiti~ which are ,ontracton., ,and
develope~. or :nanufactur ... ri of equipment used by your ag{>~(y. You ra\'E' bee,; a partner In ABC Lar"lc
De~'e'opers during the entire ~eport:ng ~riod You would repo.r1 that pOSition as forlo"." .. :
xhedule G should be cO'11plete-d as "ollows·
NAME OF ilVSIN[S~ E"'TITy j ... OOltf;>Of "~rH'I' I
ABC La".d Developers 5744 Tentl:! SlTeet, Little To .... ·~
-NATl,;"~ OF lusr~HSS AC"TiVlTY. IF ANY .,..Oi.:1t JOS rIT~~ ~I" ro:;JTION
Lane: E:eveloper ParL""ler
~S:rTION >iElD TH"CUG'" ENTIRE REPORTING ".IItIOrJ1
'F","O ~O~JT ION (OMY E N ~~ 0 OfW
00 yES o NO PlEA)( INf)i(.l.Tt PO~I,IO'" TEIIt""~l,D, ,e co ON -
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~AMr O~ E~TlfY
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I' .(ASE I!>4DIC':'''E
f>O>~TIO!l; (OMMEN(E!) ON
IIO~IT:ON TE~o.ll1>.> .... 'l~:>cr;
I,ilDcH;'US O· U .. ~;~;'
1--_ -------!yOUif JU," i r.l '~~ ~c~",o~.
'i
o If add4tional s~a(e is needed, (l"1ed: bOil: and attach an additlo"ar S{hE'dule G.
"UE u c,
INfORMATION fOR COMPLETiNG SCHEDuLE H-l--Commin,on Income
BE,r:ORE COMPL~nN~ THiS 50ffDULE, CONSULT YOUR AGENCY-S CON;lICT
DE If_TERESI (00£10 D~TE;'(MINE THE TYPES ~F INCOME YOt.) MU5T O;SCLOS!:.
Bf\;,lr;fr~. agents. or ~ale~PE'r'ions are requ~red to dr><IQ~e :he I'1dmes of SOl'f(eS 01 com··tu~!.jDr1 Ir'~"'e rt ',heir pro
rata ~h¥e of the grO~i (ommi~s:on 1t1(Qme amoun's to SlQ,OOO Clr mOle from a ~ingle 'Sou"'='. NO o""r!~~h;p interert
in I busi"e~s entily IJ necessary !Q require disclosure 0' disqJa/irlc~tion under this provis;~n. ~Com""'\~!on I n(ome~
m~ansgro~s p .. yment> re.::e;ve-d as a (esL:it of ser.i(e$ rendered as a broir.er ... genl. Of s.a1esperson, PC"~m who rr,u.t
report <:ommj~~jon ir"'1:::ome include' il"lSl.IfanCe brekers or agel"lts. real e1-tate-brokers or ;'9EnU., t:.a\lel ager'lU Of
salnpe","on$. ~tOCkb(o".er~. and reta:) O( whcle!ale sales~er$or"1~ The a\ourc~~ of {OrT1mis~ion incomr may be a c!lel"t
or (Ustomf!t or It may be;) b~oker, a (omp:;~y Of n,her b\.l~in(>\!. en,;,}, through whi<h the go-ods Of ~rvite .. were "\0:-0,
Ol' it mi!lly be beth.. (Se"t ~ .. a'llp~e-he:;ow.) NOH: \f )'01..1 ha"'l! repon.~d youn,e!! Of ,/OIJf empLO'ftr a!. II "!.cwrCI! of
«)mmii~ion i~.come 01"". S<:twc\.Iil:!; D. you are not reql.l\red to itemiZE :,·ol.l(wtf Of yO\.lr emplo)'oer~ .. a • ... >In;:e 'Of iricom~
0("\ S<. .... eduloe H~ {.
During the ~t'po"""g OE"":OO, did you or your .. pc ... ~e r"!~el\le comrW~~Ori ii1Come~ for ",er'w'ICt"'> rende~@'d as a
broker, agent. 0( saJespenor,?
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NO ~ You are not reG~ired to C:lmp:ete xno:odlile H·1.
YES~ You must pro~id-e tM.1a" flaml! of "'a(.~ \(\c;"td.u.ai or en.'.;w .... hi(!..,·
Is loc.Hed :ri, or dOlr'9 busines~ i ri, your luri.dlC"'.ion. !.!Ei.
Wa$ a ,>curce of income, pro ... ided theH your pro rata j"h.are of such receipts wa~ $10.000", more
~sume that:
• You are an. at;,,"[I't for "i.m(\h and jo:lrie .. \ri~IJCal"\'::oe. CCrT1.?;i(\Y Yo>,; ~e\d 11 2u'\.;~.e<; .. ;."..,e,,'s. \r.su~~t\(:e (ompa",y
ins.ura,."e policy t;:, XVZ (om~.aon'f. VO\.l r~(ei ... ed 'Qmm'~!i=on Income of $ 15.0t},'J trom. thE. 'tran\.o1lction
• YO\.lf spouse is a rea.l estate ~roker for Goldwater Realty and ~ecefvf'd a ,ommis~io:'"; of S10,OOO from the
Grand Compar.y
• I'..epoi't \lo"\.h X¥Z Camp-any ano e~sines."mer.·s 11"I~l.Jrlonce Compar.'f as. sOI.)f<e'" of CO<'nm\~"'iOr. .... com@ be(;~ws@
<ea(h wa\a source of $10,000 Ot mere. Smtth and )Qr·L~\ IS Ot'>(iosed on Sd"'LE-du(e 0 a~ a .... O\J.r<..e of <.om .. 'T't<;sicl"l.
Income, al"ld on. $chedu~e H·l a~ the bu.sinesi entiw thro .... gh ",,"wen ,,0'-1 rece .... 1!:'d the rncame:
• fiepo" GrjJ"d COl'rlpany, yO\.lr .pouse'~ die~t. bt'(alJ~e your comf'"lUrirty proper1:y ~I-)a~e (500:,,1 of the g'O~5
({lceipu amounted to SID,COO and wourd meet the rep-Ortrf'19 th(~5hoid You "",,ouJd O1;!io ~eoun "o ... r
c:om."Tjul'llty prDperty sh.<lre or )'owr lipO'-'H"~ income from Gcl;jw.:i1er REa;ty or, S-chejui", J J~ a lio:...r(~ o~
Ir.(::lmE
"
NA.'.1f Gf eUS~Nns i,.,liTY
Smith and Jo,.,es Insurance Campeny -------
NAMES O~ iOURC1S a~ I-':(.OWE
X'tI Company -
Bu,if'lessme~'11nS\Jran""e -Compaf1Y
NAME Of 8lJ'.INfSS (10.1"1"11 'I'
Goldwat~r Realty ---
"JAI'JlE~ 0; s .. :a .. RCi5.·Jf IN(DM~
Grdl1d Com?ar,y -
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INFORMATION FOR COMPLETING SCHEDULES H-] AND H·3··
Intom" And Loans To Bus,ne<s Entities Or Trusts
And Income From Rental Property
BEfORE COMPLETING nNS SCHW{)I..E, CONSUl j' YOUR AGENCY'S (ONFt.i'..7
OF l'-TERfST (OD~ TO 0ETfRMrNE THE fYPES OF lNCOME YOU MUSTD1SCI..05f,
~f, d~fi ng lhl;: repOr1,ing pe~iod, )Iou .3r'1d your ~pouse owned ar'1 aggregate I nt~rest of 10% or r:".c;'re in dny bLl,ines5
entity rirxluding rer,~.!J prQ~fly) 0( a tn.at, )IOU must provide the name of eath indilliduai Of entity which:
a Was ~,~ource o~ '~nLO!"!'ie. in-:;l Lld'rng loans rf"{!'i'.lec or o\Js1.~nding. to tr.e bu:.;n<:~!. en,!,,)! Of tT..,~t, p1o .... ided t1.,at
your pro r<'!tashare of5.u<-h p2'lm~ni.S or r"{e!pl!. was S! :1,0.00 or Mor", [S(hedlJle H·2l, or
tMPQR~NT: The reQuirement to repOn. !>ources of Hl(ome to a bl.JSlne~s entity or 1.!u .. t i~ de~!i!rm~ned by the
100atiof! of the wurce of ~oar: 0< i{l(omc-·not b,. t.he Icca't.rCr", or the bl,.1~inl::;~ emilY cr trust whrc~
"eer'lIed the loan 0'-jnco'TIe or by the iOCa"iOt'f 0; t~e rental proper' . .;
If Li-1e b .... ~in~'S entity in whith you hall'!!' a 10% or grta!er in:ere.~ i~ located in or doing bu~i,..e'S~ i7'
'lour juri~cinlon,:t must .al~o be report'!!'d on S::~edule A ar,d ,.ou may be required to (or.lpl~te Sch.t>duie.
c-! and C-l Your pro rata 'Sl1are of the grO~5 income to the bl..'sjr,e$s er,tl11 m .... H aha be reponed on
S<hed'Jie. o.
!~ ':one I ef'1\al property In which I'O~ havl! ill I D% or gre<l'\.er inter",.,t i\ \!Xa1eo in yeur jUfi ... d'c~ior:, it
mus.t also be reported on xhedule 8 Your pta rata s.hOl'e of thE' gro5~ rental ,!",come from the p;op'?rw
mu5t alro be repo;1ed on XM.edule D
FPPC P:eg'Jldtlon 18740 pro'.lide'S a pro(edure for obta'lmng art E-iterr;ptlon tram t:"·,e ~1~cl01"re
r~qu.i~e:nent of (.lienU· narr.~s WhiCh. are legat1y recog:"lll.oe:d a!i. p(;lIi!eged under Cai,'onua laW Yo\..!
may obtain.a <:opy of RcglJtal.lOn 18740 by contacting the r'aJ~ por,ti.a i Practices Comrfli .. s~o"1.
NOTE: jf '(owr ~ro ,ata 5f1are oi intor::e or a I021i to i3 =,.;,:r;€~5 oe:i:;',:( 0'-tiL.J'it IS '!.2SG or ::'"'O'!i' , ~'O!; mal
t,e !t"-qulrecito dhG:l.lcilf)i 'jc"f~~',f f~om dpo<;:'Slon, aHeC';'IIi!",j t~i\l ~Ol"rce of Ir.,ome N lean, ~'1e.., the'.,;;":-\. )"0 ....
are riot r'?qwired!o repor. it
EXAMPLE. SCHEDULE H·2
A$'S.\lmetnat:
• Dl.Jring the reportl:1g period, ABC Land DelieiopeH. in .... hi{h ,'Ow ha',e a 50% ;:::<lrt~erSI'\IP in:erest. receiltr:d a
loan fro:'1i tr.-e Llt'Je Town Ba('. __ in the amO\Jr\t at SlQ,OOO Tt-,€ ban~, h~ .... "" br<l(\(h w~,.;:t> i<:. IQcate¢: In )lour
juriSdiction.
• ABC Land Deloit-lopeno recE:'I .... €'O a. 9rO)1 payment 1rDm Jc~n ~ 6:0' .... n. a C,H\OmE'r. ,n \"1e al"T".()W;"1t of S~"DOt;
Mr. Brown ,S d~in9 busrnt"sS I.r. !i0i.,lr l:;rl~OI(t.cn
• Your ~pol.ise Qw~S ,00% of.; IJI/'Ii f.rm A ell"':"11 calc .")'" ';Jo.l\e 1.'::;) OD,:' CI-,r,ng: lne "€-po'":!'"; per;o,~ "'I~
clllaf\t i~ COl 1',9 bl.l~lrv",!.~ '.!'\ 'JG',.)r ; "rlc,d,c.\o~.
L
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• Report l~e loan lO AilC l<lind !)e".elorer~ IrOrT: the l~ttle Town Bank be(3l.JSe )'o ... r pro rata sr'Q e (50%) of :'he
S30,OOC ~oar,;, S 15.000 l-nd mec'.~ the S '0,000 reporti'lI) t:":rnh')ld
• Not repor1. t.he n3me Gf ~()h .. \ H, Bro ...... n, a Cu~lomer. becau\e yOiJf pro rata !lih¥e (SO~..i.) or ,,,> S I S,Q{)Q g.ro~~
payment'S only $1,501) and dop~ not m~t ir...e S 1 0,0.00 repor.:i Ilg threshold, Howelier, Mr £::1 =,WI'"I I~ ill ~o .. rc;.e
of income to you. and. you may h,g'ole to di\quO'Ilify yoursel"f ,ro'1'l de(;":.iQns ",Heeling Mr Br~ .... r,
• ~ej.lortyour\pouse·~ law fitrT'l an.d 115. -.liel"lt berau.e your pro rata .hare (50%) ot the $20,00(' ~aid to tne law
firm is. $10,00'0 aru:ilT'le-eU thlt r:!!'porting t~r~hold
Schcodule H·l would bE (ompleted as to11o~·
fAME OF BUS'''''E"SS ENTITY OATIII:JS""!'
ABC Land Oeve:lup-e1'S
NATl!RF OF BUSINESS. If AN,..
land Developers
""AMi: O~ a\Jsl~t~. iN"l"lT't o !'I T~l)n ,.t>D~l!r.S o~ BUSINESS E:'Ilil,y Oft TR~ST
r.::-::.,.,,~s~m~i~"'::7..~n~d~J7.o~n~"=-_______________ ,-_\2_'~'_H~i9,--h Stfi~~t, i~rttl~ 10'#:\
I,ATUnE OF BUSINESS. If ANY
k law Firm
INAMES OF SCU~(E5 Of IN(OMr AND lOANS TO THE BU'il/IiESS iNTI,.., 0111 T~u~T
JOSe-p" BrOwn and AnCJdat~s ,
EXAMPLE, SCHEDULE H-3
• You OWrl 25% of a ':Qmm~r(ial bUlld·1 ng located in yOur '1.."r'I~d·''';G01 ~!O"'" wh'l(h rental 'I ncome Wi'll re(ei v@d
from a SIngle tenant 11'1 the arrll)unl ofS.eO.OOO.
• Recort the r'l~me cfthe rer-'al teniJni: who prOVided pay~E'nU It' :he amO:..!1t of S.ev,OOO to the corr:mer(la;
b~ildin9 bC!(a\;~e yaur pro rata share \25% of thi-(er1tal PJ)'ment.~) j~ S' D,OOO and would meet :"e repor" •• r"1g
thre .. hold.
xhed"le tJ.-l woule .~ .(ompleted. as follow~c· _______ ,
AOO/l:E~S O~ RENTAL ~Fl:0;>fFl:TY ·c,-ry
14738 Spruce Street
NA~~;O~~E~Te~s ----------
tittle To ...... n '---~---------,
r-_--"s-'-y~"/al'!c Taylor, M.D. L __ _
---..., QJII'rc"-------
\
-
•
Schedule H
(SH INS,gUC,IONS ON PRECEDiNG PAGES)
Sc~edule H·'
Commission Inteme Received By Brokers, Agents And Saiespersons I NAil<!" Of BVSj~~~5'S~"'~ln
j 1------
1
Schedule H-2
Income And Loans To A Business Entity Or Trusl.
N .... ME Of e.U~IN~S'::. iNTIfY::p, H;'I)S' /(v"~ t :..C;::'I'«S5 C~ a"SIN~~'::.lI'Hln 011. T?:U~'i I
-iliA T~RE Of 9UW.!E SS
N.&..M£S o~ SOIJ".Ct'i c~ ItKO',-' ",,!-or.. '~O""N~ 'il) T 1-1£ ~';.!'i.IN£~" E :.,11: ~
1 OF! T"tJST ---------,
I , ------
I ------b-------r--
-
Schedule H·,
Income From Rental Property
Vow m:.s1. di.(:.,)t !I1e name(s) or an)! rente~(sJ who milde ,,,""1 ;H:;"'en!~, pro"'ced :r.a: )'Ouf pro rat" ~hare oi ~L':~,
re(~ipts !~o~ ,)"y (Jr1e rE-r:~!;'~ was S1 O,OUO or m :)re
A!)D~f5S O~ I\tNIAJ.. "'~OPEFl:i'f
I~'" ,.,"'"
, ,
L
u
A vr---«--/ L'''' ~---I----
----I
j C. TV
----.~---!---
I
--3
-----
t '., • ! , ,
,> .-
•
i
1
-
of the American NJ.tlonal Swndards !nstitute. {ANSI) and tIle ASSOC!<:3ltnn
(or lnfnnnEl!!or. rmd Image .Managti~·,ent (Al:'\,'1)
Dale produced
PL"S~. S __ L,J_DDj<Y01_r,:_, __ Cl\~ __
Cit)' S'.<1'LC
_ 2.4_~6
7lp
·· .. ·.·L··.·· .
...
-
-
IMAGE EVALUATION
TEST TARGET (MT·3)
______________ , 50mm _______________ I
-6" --------~--l
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