RFP Housing ComplianceR E Q U E S T
F O R
Q U A L I F I C A T I O N S
T O P R O V I D E A F F O R D A B L E H O U S I N G
C O M P L I A N C E A N D M O N I T O R I N G S E R V I C E S
Deadline: Friday, April 5, 2019 at 5:00 PM (PST)
Introduction
The La Q ui nt a Housi ng A uthority (Ho usin g A ut ho r it y) s ee ks R eq ue st fo r
Qu al ific at io ns fr o m qu alifie d fi rms w it h pr o v en mun ic i pa l exp erie nc e to p r ov i de
a f forda ble hou si ng admi nist r at ive , c omp l ian ce , an d mon i t ori ng se r vic es.
The Ho usin g A ut hor it y a s S ucc esso r Agenc y to t he f o rmer La Q ui nt a R ede ve lop m en t
A ge ncy , o verse es sev eral a f forda ble hou si ng progra m s. T he progra m s inc l ude a
h o m e own ershi p si le nt se co nd t rus t de ed progra m , s ing l e-fa m ily re s i de nt ial
pr o gr am, r es identia l r eh ab i l it at io n loan p r og r a m , a nd will b e pro vid e ove r s i gh t of
fu tu r e Hou si ng Auth ori ty progra ms th at are st i l l in t he de v elo pment p ha se.
SERVIC ES R EQUE S TE D , BUT ARE N OT LI MITED T O:
Sc r een p r og r am a pp l i ca nt s t o dete r m i ne e li gib ility
A pp l i ca ti on p r oc ess ing f o r r esale o f prop ert ies
A nnu al c o m plia nce moni torin g, c ertific at io n, and repo r ti ng
L oa n su bor di nation r evi ew/a ppr o v al/p r oc ess ing
P a yo f f proce s si ng/m on it ori ng
C oordi na ti on wi th prop ert y own ers, re alt ors, es cro w a nd t i t le c ompan ies to
pr o ce ss purc hase an d re f ina nc e
P repa r at io n of re qu i r ed f orms/p ap erwork
T en an t sc r ee nin g bo th in it ial and an nu al , i nclu din g c r ed i t ch ec k s, pe r son al
re f eren ce s , e mpl o y m en t v eri fi cation s, an d ot he r s uch me ans of ver ifyin g th e
q ua li fi ca ti on s of new an d ex is ti ng t ena nt s ap plyi ng f or or li v ing in va r i o us
Housi ng A uthority rental pro pe r ti es
P rovi de courte ou s , professiona l s ervi ce to pro pe r ty o wne r s an d a pp l i ca nt s as
they w o rk th r ou gh t he pu r ch a s e, ref ina nc e, and s ale proces s
Proposal Format
P r op o sa l s can b e su bmi tted vi a e -ma i l , h a nd de l ive ry , o r mai l . All p r opo sa l s m us t be
su bmitt ed b y F rida y , Apr i l 5, 2 019 at 5:00 PM.
P lease ad dr ess a ny q ue s ti on s t o:
A ngel a Fe rre ira, H ous ing S pe ci al is t
Ci ty o f La Q uin ta , C i ty Ma na ger’s O f fi ce
78-4 9 5 Ca l l e T amp ico
La Q ui nt a, C A 92253
(7 6 0 ) 7 7 7 -7114
afe r r eira @ l a qu intac a.g ov
P r op o sa l s r eceive d a f ter t he dead li ne wi ll no t be ac ce pte d.
A p rop osa l out l i nin g th e c o ns ult an t’s fe e sc hed ule s hall be s ub m i t te d w it h th e
Statement of Qua l if ica t i o ns .
C o ns ult an ts a r e e nc our ag ed to ke ep t he ir q ualifi cations brie f an d re l eva nt t o th e
sp ec if ic wo r k r eq uire d.
1. St a tement of Qualifi c a tio ns
(a) A l is ti ng o f pro pos ed p r oj ec t pe r son ne l, incl ud i ng r esu m es f o r
p r inc ip al s .
(b) C on sul ta nt’s exp erie nc e w it h simi l a r work , i nclu din g n ame s and
c urren t ph o ne nu m be r s of ref ere nc e fo r list ed proj ects.
(c) Sp ec if ic exp erie nc e w i t h mu nic ip al g over nme nt .
2. F e e Schedul e
T he consu l ta nt is to s ub m it a de ta il ed f ee s ch ed ul e f or a l l s ervic es
c o nt ain ed wi th i n th is Re qu es t f or Qu alific at io ns (“RF Q”).
Selection Process
Statement of Qua l if ica t i o ns an d le tte r s of i ntere s t w ill b e revie we d b y a Con su l ta nt
Se l ec ti on Committ ee . The C ommitt ee wi l l r ank th e c o ns ult an ts fo r p ote nt ial co nt r act
n eg otia t i ons b a s ed up o n the mos t pe r ti ne nt e xp erie nc e and s pe ci fi c ove r al l
q ua li f i ca ti on s t o pe r form the servi ce s r eq ue sted .
The Ho usin g A ut hor it y w i l l o pe n c o nt r act n eg otia ti on s wi th t he t op ran k ed f i r m . T he
su cc es s fu l con su l ta nt wi l l be e xp ec ted to ente r into t he att ac he d Prof ess iona l
Se r v ic es Ag r ee m ent.
Anticipated Schedule
I ssu e R equest fo r Pro pos als Mar ch 2 2 , 2 0 1 9
D ead l i ne f o r writt en qu est io ns re gard i ng t he RF Q M a rch 28, 2 019
H ou si ng Au th ori ty r espon ses t o Co nsu ltan t Q ue stions Apr i l 1, 2 019
Qu alific at io n State m en ts Du e Apr il 5, 2019
H ou si ng Au th ori ty Co nsid eration o f Pr o fe s si on al Se r v ice s Ag reement May 10, 2019
Authority Rights and
Options
The so l i ci ta ti on doe s no t commit the Ho usin g A ut hor it y to aw ard a c o nt r act, to p ay
a ny cos t inc urre d w i t h p r ep aration o f th e pro pos al, or to p r oc ure o r con tract f o r
se r v ices o r s up plies . The Ho usin g A ut hor it y re s erve s th e r i gh t to a cc ep t or r ej ect
a ny or al l s ub m it ta l s r ec eiv ed in r es pon se t o t his re qu es t , t o ne go ti at e w it h any
q ua li f i ed s our ce , or c anc el i n w hol e or part thi s proces s in it s s ole an d a bso l ut e
d is cre ti on . Su bse quent to n egot iation s, pros pe ctive c on s ul t ants may b e re qu i r ed t o
su bmit re visions to thi s s ub m i t ta l. All perso n or entitie s r esp on di n g to thi s RF Q
sh ou l d n ote t hat a ny contrac t pu r suan t to th i s s oli citation is d ep end en t up on the
re commen da ti on o f t he ci ty s ta ff a nd t he ap proval of th e Housi ng A uthority.
The Ho usin g A ut hor it y re ser ve s th e ri ght to p o stp on e se l ec ti on f o r it s o wn
c o nve nie nc e, to w it hdra w thi s RF Q at an y time , a nd to re je ct a ny and all su bmitt als
w it ho ut i ndi catin g a ny r ea son f or th e re je ction. As a fun ction of th is RF Q proc es s ,
th e Housi ng A uthority res erve s t he r igh t to re m ed y a ny te ch nic al e r r ors i n the
re s ponse t o th is RFQ an d mod i f y t he p ub li sh ed req ue s te d se r v ices . The Ho usin g
A ut hor it y re s erve s th e r i gh t to re qu es t t hat sp ec i f ic pe r son nel wit h spec ific exp ert is e
be ad d ed t o t he project te am, i f th e H ou s i ng Au th ori ty de te r m ines t hat sp ec if ic
ex pe r ti se is la ckin g. Qualific ation sta te m en ts a nd o th er i nf o r ma t i o n (excep t for
pr o prie t ar y fin an cia l inform ation) sha l l not b e re tur ne d.
The Ho usin g A ut hor it y re ser ve s th e ri ght to a ba ndon th is RFQ p r oc ess an d/or
c ha nge i ts p r ocure m en t pro ce s s for th e c o nt r act a t an y t ime if it i s de te r m ined th at
a ba ndon m ent a nd /o r ch ang e w o ul d be in t he H ous ing Au th o r i ty ’s be st i nt ere s t.
The Ho usin g A ut hor it y w i l l not b e li a ble f o r an y c ost s o r da ma ge ari si ng ou t o f it s
re s ponse t o th is RFQ .
AGREEMENT FOR CONTRACT SERVICES
THIS AGREEMENT FOR CONTRACT SERVICES (the “Agreement”) is made
and entered into by and between the CITY OF LA QUINTA, (“City”), a California
municipal corporation, and Name[insert the type of business entity, e.g. sole
proprietorship, CA Limited Liability Corp, an S Corp.] (“Contracting Party”).
The parties hereto agree as follows:
1. SERVICES OF CONTRACTING PARTY.
1.1 Scope of Services. In compliance with all terms and conditions of
this Agreement, Contracting Party shall provide those services related
_____________ , as specified in the “Scope of Services” attached hereto as
“Exhibit A” and incorporated herein by this reference (the “Services”).
Contracting Party represents and warrants that Contracting Party is a provider
of first-class work and/or services and Contracting Party is experienced in
performing the Services contemplated herein and, in light of such status and
experience, Contracting Party covenants that it shall follow industry standards
in performing the Services required hereunder, and that all materials, if any,
will be of good quality, fit for the purpose intended. For purposes of this
Agreement, the phrase “industry standards” shall mean those standards of
practice recognized by one or more first-class firms performing similar
services under similar circumstances.
1.2 Compliance with Law. All Services rendered hereunder shall be
provided in accordance with all ordinances, resolutions, statutes, rules,
regulations, and laws of the City and any Federal, State, or local governmental
agency of competent jurisdiction.
1.3 Wage and Hour Compliance, Contracting Party shall comply with
applicable Federal, State, and local wage and hour laws.
1.4 Licenses, Permits, Fees and Assessments. Except as otherwise
specified herein, Contracting Party shall obtain at its sole cost and expense
such licenses, permits, and approvals as may be required by law for the
performance of the Services required by this Agreement, including a City of
La Quinta business license. Contracting Party and its employees, agents, and
subcontractors shall, at their sole cost and expense, keep in effect at all times
during the term of this Agreement any licenses, permits, and approvals that
are legally required for the performance of the Services required by this
Agreement. Contracting Party shall have the sole obligation to pay for any
fees, assessments, and taxes, plus applicable penalties and interest, which
may be imposed by law and arise from or are necessary for the performance
of the Services required by this Agreement, and shall indemnify, defend (with
counsel selected by City), and hold City, its elected officials, officers,
-2-
employees, and agents, free and harmless against any such fees,
assessments, taxes, penalties, or interest levied, assessed, or imposed
against City hereunder. Contracting Party shall be responsible for all
subcontractors’ compliance with this Section.
1.5 Familiarity with Work. By executing this Agreement, Contracting
Party warrants that (a) it has thoroughly investigated and considered the
Services to be performed, (b) it has investigated the site where the Services
are to be performed, if any, and fully acquainted itself with the conditions
there existing, (c) it has carefully considered how the Services should be
performed, and (d) it fully understands the facilities, difficulties, and
restrictions attending performance of the Services under this Agreement.
Should Contracting Party discover any latent or unknown conditions materially
differing from those inherent in the Services or as represented by City,
Contracting Party shall immediately inform City of such fact and shall not
proceed except at Contracting Party’s risk until written instructions are
received from the Contract Officer, or assigned designee (as defined in
Section 4.2 hereof).
1.6 Standard of Care. Contracting Party acknowledges and
understands that the Services contracted for under this Agreement require
specialized skills and abilities and that, consistent with this understanding,
Contracting Party’s work will be held to an industry standard of quality and
workmanship. Consistent with Section 1.5 hereinabove, Contracting Party
represents to City that it holds the necessary skills and abilities to satisfy the
industry standard of quality as set forth in this Agreement. Contracting Party
shall adopt reasonable methods during the life of this Agreement to furnish
continuous protection to the Services performed by Contracting Party, and the
equipment, materials, papers, and other components thereof to prevent losses
or damages, and shall be responsible for all such damages, to persons or
property, until acceptance of the Services by City, except such losses or
damages as may be caused by City’s own negligence. The performance of
Services by Contracting Party shall not relieve Contracting Party from any
obligation to correct any incomplete, inaccurate, or defective work at no
further cost to City, when such inaccuracies are due to the negligence of
Contracting Party.
1.7 Additional Services. In accordance with the terms and conditions
of this Agreement, Contracting Party shall perform services in addition to
those specified in the Scope of Services (“Additional Services”) only when
directed to do so by the Contract Officer, or assigned designee, provided
that Contracting Party shall not be required to perform any Additional Services
without compensation. Contracting Party shall not perform any Additional
Services until receiving prior written authorization (in the form of a written
-3-
change order if Contracting Party is a contractor performing the Services) from
the Contract Officer, or assigned designee, incorporating therein any
adjustment in (i) the Contract Sum, and/or (ii) the time to perform this
Agreement, which said adjustments are subject to the written approval of
Contracting Party. It is expressly understood by Contracting Party that the
provisions of this Section shall not apply to the Services specifically set forth
in the Scope of Services or reasonably contemplated therein. It is specifically
understood and agreed that oral requests and/or approvals of Additional
Services shall be barred and are unenforceable. Failure of Contracting Party
to secure the Contract Officer’s, or assigned designee’s written authorization
for Additional Services shall constitute a waiver of any and all right to
adjustment of the Contract Sum or time to perform this Agreement, whether
by way of compensation, restitution, quantum meruit, or the like, for
Additional Services provided without the appropriate authorization from the
Contract Officer, or assigned designee. Compensation for properly
authorized Additional Services shall be made in accordance with Section 2.3
of this Agreement.
1.8 Special Requirements. Additional terms and conditions of this
Agreement, if any, which are made a part hereof are set forth in “Exhibit D”
(the “Special Requirements”), which is incorporated herein by this reference
and expressly made a part hereof. In the event of a conflict between the
provisions of the Special Requirements and any other provisions of this
Agreement, the provisions of the Special Requirements shall govern.
2. COMPENSATION.
2.1 Contract Sum. For the Services rendered pursuant to this
Agreement, Contracting Party shall be compensated in accordance with
“Exhibit B” (the “Schedule of Compensation”) (the “Contract Sum”), except as
provided in Section 1.7. The method of compensation set forth in the
Schedule of Compensation may include a lump sum payment upon
completion, payment in accordance with the percentage of completion of the
Services, payment for time and materials based upon Contracting Party’s rate
schedule, but not exceeding the Contract Sum, or such other reasonable
methods as may be specified in the Schedule of Compensation. The Contract
Sum shall include the attendance of Contracting Party at all project meetings
reasonably deemed necessary by City; Contracting Party shall not be entitled
to any additional compensation for attending said meetings. Compensation
may include reimbursement for actual and necessary expenditures for
reproduction costs, transportation expense, telephone expense, and similar
costs and expenses when and if specified in the Schedule of Compensation.
Regardless of the method of compensation set forth in the Schedule of
-4-
Compensation, Contracting Party’s overall compensation shall not exceed the
Contract Sum, except as provided in Section 1.7 of this Agreement.
2.2 Method of Billing & Payment. Any month in which Contracting
Party wishes to receive payment, Contracting Party shall submit to City no
later than the tenth (10th) working day of such month, in the form approved
by City’s Finance Director, an invoice for Services rendered prior to the date
of the invoice. Such invoice shall (1) describe in detail the Services provided,
including time and materials, and (2) specify each staff member who has
provided Services and the number of hours assigned to each such staff
member. Such invoice shall contain a certification by a principal member of
Contracting Party specifying that the payment requested is for Services
performed in accordance with the terms of this Agreement. Upon approval in
writing by the Contract Officer, or assigned designee, and subject to
retention pursuant to Section 8.3, City will pay Contracting Party for all items
stated thereon which are approved by City pursuant to this Agreement no
later than thirty (30) days after invoices are received by the City’s Finance
Department.
2.3 Compensation for Additional Services. Additional Services
approved in advance by the Contract Officer, or assigned designee, pursuant
to Section 1.7 of this Agreement shall be paid for in an amount agreed to in
writing by both City and Contracting Party in advance of the Additional
Services being rendered by Contracting Party. Any compensation for
Additional Services amounting to five percent (5%) or less of the Contract
Sum may be approved by the Contract Officer, or assigned designee. Any
greater amount of compensation for Additional Services must be approved by
the La Quinta City Council, the City Manager, or Department Director,
depending upon City laws, regulations, rules and procedures concerning public
contracting. Under no circumstances shall Contracting Party receive
compensation for any Additional Services unless prior written approval for the
Additional Services is obtained from the Contract Officer, or assigned
designee, pursuant to Section 1.7 of this Agreement.
3. PERFORMANCE SCHEDULE.
3.1 Time of Essence. Time is of the essence in the performance of
this Agreement. If the Services not completed in accordance with the
Schedule of Performance, as set forth in Section 3.2 and “Exhibit C”, it is
understood that the City will suffer damage.
3.2 Schedule of Performance. All Services rendered pursuant to this
Agreement shall be performed diligently and within the time period
established in “Exhibit C” (the “Schedule of Performance”). Extensions to the
-5-
time period specified in the Schedule of Performance may be approved in
writing by the Contract Officer, or assigned designee.
3.3 Force Majeure. The time period specified in the Schedule of
Performance for performance of the Services rendered pursuant to this
Agreement shall be extended because of any delays due to unforeseeable
causes beyond the control and without the fault or negligence of Contracting
Party, including, but not restricted to, acts of God or of the public enemy,
fires, earthquakes, floods, epidemic, quarantine restrictions, riots, strikes,
freight embargoes, acts of any governmental agency other than City, and
unusually severe weather, if Contracting Party shall within ten (10) days of
the commencement of such delay notify the Contract Officer, or assigned
designee, in writing of the causes of the delay. The Contract Officer, or
assigned designee, shall ascertain the facts and the extent of delay, and
extend the time for performing the Services for the period of the forced delay
when and if in the Contract Officer’s judgment such delay is justified, and the
Contract Officer’s determination, or assigned designee, shall be final and
conclusive upon the parties to this Agreement. Extensions to time period in
the Schedule of Performance which are determined by the Contract Officer, or
assigned designee, to be justified pursuant to this Section shall not entitle
the Contracting Party to additional compensation in excess of the Contract
Sum.
3.4 Term. Unless earlier terminated in accordance with the provisions
in Article 8.0 of this Agreement, the term of this agreement shall commence
on ___________,and terminate on __________ (“Initial Term”). This
Agreement may be extended for three (3) additional year(s) upon mutual
agreement by both parties (“Extended Term”).
4. COORDINATION OF WORK.
4.1 Representative of Contracting Party. The following principals of
Contracting Party (“Principals”) are hereby designated as being the principals
and representatives of Contracting Party authorized to act in its behalf with
respect to the Services specified herein and make all decisions in connection
therewith:
(a) Name and title
Tel No.
E-mail:
(b) Name and title
Tel No.
Email:
-6-
It is expressly understood that the experience, knowledge, capability,
and reputation of the foregoing Principals were a substantial inducement for
City to enter into this Agreement. Therefore, the foregoing Principals shall be
responsible during the term of this Agreement for directing all activities of
Contracting Party and devoting sufficient time to personally supervise the
Services hereunder. For purposes of this Agreement, the foregoing Principals
may not be changed by Contracting Party and no other personnel may be
assigned to perform the Services required hereunder without the express
written approval of City.
4.2 Contract Officer. The “Contract Officer”, otherwise known as
the [ENTER NAME OF DEPARTMENT MANAGER OR DIRECTOR] or
assigned designee may be designated in writing by the City Manager of the
City. It shall be Contracting Party’s responsibility to assure that the Contract
Officer, or assigned designee, is kept informed of the progress of the
performance of the Services, and Contracting Party shall refer any decisions,
that must be made by City to the Contract Officer, or assigned designee.
Unless otherwise specified herein, any approval of City required hereunder
shall mean the approval of the Contract Officer, or assigned designee. The
Contract Officer, or assigned designee, shall have authority to sign all
documents on behalf of City required hereunder to carry out the terms of this
Agreement.
4.3 Prohibition Against Subcontracting or Assignment. The
experience, knowledge, capability, and reputation of Contracting Party, its
principals, and its employees were a substantial inducement for City to enter
into this Agreement. Except as set forth in this Agreement, Contracting Party
shall not contract or subcontract with any other entity to perform in whole or
in part the Services required hereunder without the express written approval
of City. In addition, neither this Agreement nor any interest herein may be
transferred, assigned, conveyed, hypothecated, or encumbered, voluntarily or
by operation of law, without the prior written approval of City. Transfers
restricted hereunder shall include the transfer to any person or group of
persons acting in concert of more than twenty five percent (25%) of the
present ownership and/or control of Contracting Party, taking all transfers into
account on a cumulative basis. Any attempted or purported assignment or
contracting or subcontracting by Contracting Party without City’s express
written approval shall be null, void, and of no effect. No approved transfer
shall release Contracting Party of any liability hereunder without the express
consent of City.
4.4 Independent Contractor. Neither City nor any of its employees
shall have any control over the manner, mode, or means by which Contracting
Party, its agents, or its employees, perform the Services required herein,
-7-
except as otherwise set forth herein. City shall have no voice in the selection,
discharge, supervision, or control of Contracting Party’s employees, servants,
representatives, or agents, or in fixing their number or hours of service.
Contracting Party shall perform all Services required herein as an independent
contractor of City and shall remain at all times as to City a wholly independent
contractor with only such obligations as are consistent with that role.
Contracting Party shall not at any time or in any manner represent that it or
any of its agents or employees are agents or employees of City. City shall not
in any way or for any purpose become or be deemed to be a partner of
Contracting Party in its business or otherwise or a joint venture or a member
of any joint enterprise with Contracting Party. Contracting Party shall have
no power to incur any debt, obligation, or liability on behalf of City.
Contracting Party shall not at any time or in any manner represent that it or
any of its agents or employees are agents or employees of City. Except for
the Contract Sum paid to Contracting Party as provided in this Agreement,
City shall not pay salaries, wages, or other compensation to Contracting Party
for performing the Services hereunder for City. City shall not be liable for
compensation or indemnification to Contracting Party for injury or sickness
arising out of performing the Services hereunder. Notwithstanding any other
City, state, or federal policy, rule, regulation, law, or ordinance to the
contrary, Contracting Party and any of its employees, agents, and
subcontractors providing services under this Agreement shall not qualify for
or become entitled to any compensation, benefit, or any incident of
employment by City, including but not limited to eligibility to enroll in the
California Public Employees Retirement System (“PERS”) as an employee of
City and entitlement to any contribution to be paid by City for employer
contributions and/or employee contributions for PERS benefits. Contracting
Party agrees to pay all required taxes on amounts paid to Contracting Party
under this Agreement, and to indemnify and hold City harmless from any and
all taxes, assessments, penalties, and interest asserted against City by reason
of the independent contractor relationship created by this Agreement.
Contracting Party shall fully comply with the workers’ compensation laws
regarding Contracting Party and Contracting Party’s employees. Contracting
Party further agrees to indemnify and hold City harmless from any failure of
Contracting Party to comply with applicable workers’ compensation laws. City
shall have the right to offset against the amount of any payment due to
Contracting Party under this Agreement any amount due to City from
Contracting Party as a result of Contracting Party’s failure to promptly pay to
City any reimbursement or indemnification arising under this Section.
4.5 Identity of Persons Performing Work. Contracting Party
represents that it employs or will employ at its own expense all personnel
required for the satisfactory performance of any and all of the Services set
forth herein. Contracting Party represents that the Services required herein
-8-
will be performed by Contracting Party or under its direct supervision, and
that all personnel engaged in such work shall be fully qualified and shall be
authorized and permitted under applicable State and local law to perform such
tasks and services.
4.6 City Cooperation. City shall provide Contracting Party with any
plans, publications, reports, statistics, records, or other data or information
pertinent to the Services to be performed hereunder which are reasonably
available to Contracting Party only from or through action by City.
5. INSURANCE.
5.1 Insurance. Prior to the beginning of any Services under this
Agreement and throughout the duration of the term of this Agreement,
Contracting Party shall procure and maintain, at its sole cost and expense,
and submit concurrently with its execution of this Agreement, policies of
insurance as set forth in “Exhibit E” (the “Insurance Requirements”) which is
incorporated herein by this reference and expressly made a part hereof.
5.2 Proof of Insurance. Contracting Party shall provide Certificate of
Insurance to Agency along with all required endorsements. Certificate of
Insurance and endorsements must be approved by Agency’s Risk Manager
prior to commencement of performance.
6. INDEMNIFICATION.
6.1 Indemnification. To the fullest extent permitted by law,
Contracting Party shall indemnify, protect, defend (with counsel selected by
City), and hold harmless City and any and all of its officers, employees,
agents, and volunteers as set forth in “Exhibit F” (“Indemnification”) which is
incorporated herein by this reference and expressly made a part hereof.
7. RECORDS AND REPORTS.
7.1 Reports. Contracting Party shall periodically prepare and submit
to the Contract Officer, or assigned designee, such reports concerning
Contracting Party’s performance of the Services required by this Agreement
as the Contract Officer, or assigned designee, shall require. Contracting
Party hereby acknowledges that City is greatly concerned about the cost of
the Services to be performed pursuant to this Agreement. For this reason,
Contracting Party agrees that if Contracting Party becomes aware of any facts,
circumstances, techniques, or events that may or will materially increase or
decrease the cost of the Services contemplated herein or, if Contracting Party
is providing design services, the cost of the project being designed,
Contracting Party shall promptly notify the Contract Officer, or assigned
-9-
designee, of said fact, circumstance, technique, or event and the estimated
increased or decreased cost related thereto and, if Contracting Party is
providing design services, the estimated increased or decreased cost estimate
for the project being designed.
7.2 Records. Contracting Party shall keep, and require any
subcontractors to keep, such ledgers, books of accounts, invoices, vouchers,
canceled checks, reports (including but not limited to payroll reports), studies,
or other documents relating to the disbursements charged to City and the
Services performed hereunder (the “Books and Records”), as shall be
necessary to perform the Services required by this Agreement and enable the
Contract Officer, or assigned designee, to evaluate the performance of such
Services. Any and all such Books and Records shall be maintained in
accordance with generally accepted accounting principles and shall be
complete and detailed. The Contract Officer, or assigned designee, shall
have full and free access to such Books and Records at all times during normal
business hours of City, including the right to inspect, copy, audit, and make
records and transcripts from such Books and Records. Such Books and
Records shall be maintained for a period of three (3) years following
completion of the Services hereunder, and City shall have access to such
Books and Records in the event any audit is required. In the event of
dissolution of Contracting Party’s business, custody of the Books and Records
may be given to City, and access shall be provided by Contracting Party’s
successor in interest. Under California Government Code Section 8546.7, if
the amount of public funds expended under this Agreement exceeds Ten
Thousand Dollars ($10,000.00), this Agreement shall be subject to the
examination and audit of the State Auditor, at the request of City or as part
of any audit of City, for a period of three (3) years after final payment under
this Agreement.
7.3 Ownership of Documents. All drawings, specifications, maps,
designs, photographs, studies, surveys, data, notes, computer files, reports,
records, documents, and other materials plans, drawings, estimates, test
data, survey results, models, renderings, and other documents or works of
authorship fixed in any tangible medium of expression, including but not
limited to, physical drawings, digital renderings, or data stored digitally,
magnetically, or in any other medium prepared or caused to be prepared by
Contracting Party, its employees, subcontractors, and agents in the
performance of this Agreement (the “Documents and Materials”) shall be the
property of City and shall be delivered to City upon request of the Contract
Officer, or assigned designee, or upon the expiration or termination of this
Agreement, and Contracting Party shall have no claim for further employment
or additional compensation as a result of the exercise by City of its full rights
of ownership use, reuse, or assignment of the Documents and Materials
-10-
hereunder. Any use, reuse or assignment of such completed Documents and
Materials for other projects and/or use of uncompleted documents without
specific written authorization by Contracting Party will be at City’s sole risk
and without liability to Contracting Party, and Contracting Party’s guarantee
and warranties shall not extend to such use, revise, or assignment.
Contracting Party may retain copies of such Documents and Materials for its
own use. Contracting Party shall have an unrestricted right to use the
concepts embodied therein. All subcontractors shall provide for assignment
to City of any Documents and Materials prepared by them, and in the event
Contracting Party fails to secure such assignment, Contracting Party shall
indemnify City for all damages resulting therefrom.
7.4 In the event City or any person, firm, or corporation authorized
by City reuses said Documents and Materials without written verification or
adaptation by Contracting Party for the specific purpose intended and causes
to be made or makes any changes or alterations in said Documents and
Materials, City hereby releases, discharges, and exonerates Contracting Party
from liability resulting from said change. The provisions of this clause shall
survive the termination or expiration of this Agreement and shall thereafter
remain in full force and effect.
7.5 Licensing of Intellectual Property. This Agreement creates a non-
exclusive and perpetual license for City to copy, use, modify, reuse, or
sublicense any and all copyrights, designs, rights of reproduction, and other
intellectual property embodied in the Documents and Materials. Contracting
Party shall require all subcontractors, if any, to agree in writing that City is
granted a non-exclusive and perpetual license for the Documents and
Materials the subcontractor prepares under this Agreement. Contracting Party
represents and warrants that Contracting Party has the legal right to license
any and all of the Documents and Materials. Contracting Party makes no such
representation and warranty in regard to the Documents and Materials which
were prepared by design professionals other than Contracting Party or
provided to Contracting Party by City. City shall not be limited in any way in
its use of the Documents and Materials at any time, provided that any such
use not within the purposes intended by this Agreement shall be at City’s sole
risk.
7.6 Release of Documents. The Documents and Materials shall not be
released publicly without the prior written approval of the Contract Officer, or
assigned designee, or as required by law. Contracting Party shall not
disclose to any other entity or person any information regarding the activities
of City, except as required by law or as authorized by City.
7.7 Confidential or Personal Identifying Information. Contracting
Party covenants that all City data, data lists, trade secrets, documents with
-11-
personal identifying information, documents that are not public records, draft
documents, discussion notes, or other information, if any, developed or
received by Contracting Party or provided for performance of this Agreement
are deemed confidential and shall not be disclosed by Contracting Party to any
person or entity without prior written authorization by City or unless required
by law. City shall grant authorization for disclosure if required by any lawful
administrative or legal proceeding, court order, or similar directive with the
force of law. All City data, data lists, trade secrets, documents with personal
identifying information, documents that are not public records, draft
documents, discussions, or other information shall be returned to City upon
the termination or expiration of this Agreement. Contracting Party’s covenant
under this section shall survive the termination or expiration of this
Agreement.
8. ENFORCEMENT OF AGREEMENT.
8.1 California Law. This Agreement shall be interpreted, construed,
and governed both as to validity and to performance of the parties in
accordance with the laws of the State of California. Legal actions concerning
any dispute, claim, or matter arising out of or in relation to this Agreement
shall be instituted in the Superior Court of the County of Riverside, State of
California, or any other appropriate court in such county, and Contracting
Party covenants and agrees to submit to the personal jurisdiction of such court
in the event of such action.
8.2 Disputes. In the event of any dispute arising under this
Agreement, the injured party shall notify the injuring party in writing of its
contentions by submitting a claim therefore. The injured party shall continue
performing its obligations hereunder so long as the injuring party commences
to cure such default within ten (10) days of service of such notice and
completes the cure of such default within forty-five (45) days after service of
the notice, or such longer period as may be permitted by the Contract Officer,
or assigned designee; provided that if the default is an immediate danger to
the health, safety, or general welfare, City may take such immediate action
as City deems warranted. Compliance with the provisions of this Section shall
be a condition precedent to termination of this Agreement for cause and to
any legal action, and such compliance shall not be a waiver of any party’s right
to take legal action in the event that the dispute is not cured, provided that
nothing herein shall limit City’s right to terminate this Agreement without
cause pursuant to this Article 8.0. During the period of time that Contracting
Party is in default, City shall hold all invoices and shall, when the default is
cured, proceed with payment on the invoices. In the alternative, City may, in
its sole discretion, elect to pay some or all of the outstanding invoices during
any period of default.
-12-
8.3 Retention of Funds. City may withhold from any monies payable
to Contracting Party sufficient funds to compensate City for any losses, costs,
liabilities, or damages it reasonably believes were suffered by City due to the
default of Contracting Party in the performance of the Services required by
this Agreement.
8.4 Waiver. No delay or omission in the exercise of any right or
remedy of a non-defaulting party on any default shall impair such right or
remedy or be construed as a waiver. City’s consent or approval of any act by
Contracting Party requiring City’s consent or approval shall not be deemed to
waive or render unnecessary City’s consent to or approval of any subsequent
act of Contracting Party. Any waiver by either party of any default must be in
writing and shall not be a waiver of any other default concerning the same or
any other provision of this Agreement.
8.5 Rights and Remedies are Cumulative. Except with respect to
rights and remedies expressly declared to be exclusive in this Agreement, the
rights and remedies of the parties are cumulative and the exercise by either
party of one or more of such rights or remedies shall not preclude the exercise
by it, at the same or different times, of any other rights or remedies for the
same default or any other default by the other party.
8.6 Legal Action. In addition to any other rights or remedies, either
party may take legal action, at law or at equity, to cure, correct, or remedy
any default, to recover damages for any default, to compel specific
performance of this Agreement, to obtain declaratory or injunctive relief, or
to obtain any other remedy consistent with the purposes of this Agreement.
8.7 Termination Prior To Expiration of Term. This Section shall govern
any termination of this Agreement, except as specifically provided in the
following Section for termination for cause. City reserves the right to
terminate this Agreement at any time, with or without cause, upon thirty
(30) days’ written notice to Contracting Party. Upon receipt of any notice of
termination, Contracting Party shall immediately cease all Services hereunder
except such as may be specifically approved by the Contract Officer, or
assigned designee. Contracting Party shall be entitled to compensation for
all Services rendered prior to receipt of the notice of termination and for any
Services authorized by the Contract Officer, or assigned designee, thereafter
in accordance with the Schedule of Compensation or such as may be approved
by the Contract Officer, or assigned designee, except amounts held as a
retention pursuant to this Agreement.
8.8 Termination for Default of Contracting Party. If termination is due
to the failure of Contracting Party to fulfill its obligations under this Agreement,
Contracting Party shall vacate any City-owned property which Contracting
-13-
Party is permitted to occupy hereunder and City may, after compliance with
the provisions of Section 8.2, take over the Services and prosecute the same
to completion by contract or otherwise, and Contracting Party shall be liable
to the extent that the total cost for completion of the Services required
hereunder exceeds the compensation herein stipulated (provided that City
shall use reasonable efforts to mitigate such damages), and City may withhold
any payments to Contracting Party for the purpose of setoff or partial payment
of the amounts owed City.
8.9 Attorneys’ Fees. If either party to this Agreement is required to
initiate or defend or made a party to any action or proceeding in any way
connected with this Agreement, the prevailing party in such action or
proceeding, in addition to any other relief which may be granted, whether
legal or equitable, shall be entitled to reasonable attorneys’ fees; provided,
however, that the attorneys’ fees awarded pursuant to this Section shall not
exceed the hourly rate paid by City for legal services multiplied by the
reasonable number of hours spent by the prevailing party in the conduct of
the litigation. Attorneys’ fees shall include attorneys’ fees on any appeal, and
in addition a party entitled to attorneys’ fees shall be entitled to all other
reasonable costs for investigating such action, taking depositions and
discovery, and all other necessary costs the court allows which are incurred in
such litigation. All such fees shall be deemed to have accrued on
commencement of such action and shall be enforceable whether or not such
action is prosecuted to judgment. The court may set such fees in the same
action or in a separate action brought for that purpose.
9. CITY OFFICERS AND EMPLOYEES; NONDISCRIMINATION.
9.1 Non-liability of City Officers and Employees. No officer, official,
employee, agent, representative, or volunteer of City shall be personally liable
to Contracting Party, or any successor in interest, in the event or any default
or breach by City or for any amount which may become due to Contracting
Party or to its successor, or for breach of any obligation of the terms of this
Agreement.
9.2 Conflict of Interest. Contracting Party covenants that neither it,
nor any officer or principal of it, has or shall acquire any interest, directly or
indirectly, which would conflict in any manner with the interests of City or
which would in any way hinder Contracting Party’s performance of the
Services under this Agreement. Contracting Party further covenants that in
the performance of this Agreement, no person having any such interest shall
be employed by it as an officer, employee, agent, or subcontractor without
the express written consent of the Contract Officer, or assigned designee.
Contracting Party agrees to at all times avoid conflicts of interest or the
-14-
appearance of any conflicts of interest with the interests of City in the
performance of this Agreement.
No officer or employee of City shall have any financial interest, direct
or indirect, in this Agreement nor shall any such officer or employee
participate in any decision relating to this Agreement which effects his financial
interest or the financial interest of any corporation, partnership or association
in which he is, directly or indirectly, interested, in violation of any State statute
or regulation. Contracting Party warrants that it has not paid or given and will
not pay or give any third party any money or other consideration for obtaining
this Agreement.
9.3 Covenant against Discrimination. Contracting Party covenants
that, by and for itself, its heirs, executors, assigns, and all persons claiming
under or through them, that there shall be no discrimination against or
segregation of, any person or group of persons on account of any
impermissible classification including, but not limited to, race, color, creed,
religion, sex, marital status, sexual orientation, national origin, or ancestry in
the performance of this Agreement. Contracting Party shall take affirmative
action to ensure that applicants are employed and that employees are treated
during employment without regard to their race, color, creed, religion, sex,
marital status, sexual orientation, national origin, or ancestry.
10. MISCELLANEOUS PROVISIONS.
10.1 Notice. Any notice, demand, request, consent, approval, or
communication either party desires or is required to give the other party or
any other person shall be in writing and either served personally or sent by
prepaid, first-class mail to the address set forth below. Either party may
change its address by notifying the other party of the change of address in
writing. Notice shall be deemed communicated forty-eight (48) hours from
the time of mailing if mailed as provided in this Section.
To City:
CITY OF LA QUINTA
Attention: Insert Contract Officer
78495 Calle Tampico
La Quinta, California 92253
To Contracting Party:
VENDORS COMPANY NAME
VENDORS CONTACT
VENDORS STREET ADDRESS
VENDORS CITY, STATE, ZIP
10.2 Interpretation. The terms of this Agreement shall be construed in
accordance with the meaning of the language used and shall not be construed
-15-
for or against either party by reason of the authorship of this Agreement or
any other rule of construction which might otherwise apply.
10.3 Section Headings and Subheadings. The section headings and
subheadings contained in this Agreement are included for convenience only
and shall not limit or otherwise affect the terms of this Agreement.
10.4 Counterparts. This Agreement may be executed in counterparts,
each of which shall be deemed to be an original, and such counterparts shall
constitute one and the same instrument
10.5 Integrated Agreement. This Agreement including the exhibits
hereto is the entire, complete, and exclusive expression of the understanding
of the parties. It is understood that there are no oral agreements between
the parties hereto affecting this Agreement and this Agreement supersedes
and cancels any and all previous negotiations, arrangements, agreements,
and understandings, if any, between the parties, and none shall be used to
interpret this Agreement.
10.6 Amendment. No amendment to or modification of this Agreement
shall be valid unless made in writing and approved by Contracting Party and
by the City Council of City. The parties agree that this requirement for written
modifications cannot be waived and that any attempted waiver shall be void.
10.7 Severability. In the event that any one or more of the articles,
phrases, sentences, clauses, paragraphs, or sections contained in this
Agreement shall be declared invalid or unenforceable, such invalidity or
unenforceability shall not affect any of the remaining articles, phrases,
sentences, clauses, paragraphs, or sections of this Agreement which are
hereby declared as severable and shall be interpreted to carry out the intent
of the parties hereunder unless the invalid provision is so material that its
invalidity deprives either party of the basic benefit of their bargain or renders
this Agreement meaningless.
10.8 Unfair Business Practices Claims. In entering into this Agreement,
Contracting Party offers and agrees to assign to City all rights, title, and
interest in and to all causes of action it may have under Section 4 of the
Clayton Act (15 U.S.C. § 15) or under the Cartwright Act (Chapter 2,
(commencing with Section 16700) of Part 2 of Division 7 of the Business and
Professions Code), arising from purchases of goods, services, or materials
related to this Agreement. This assignment shall be made and become
effective at the time City renders final payment to Contracting Party without
further acknowledgment of the parties.
-16-
10.9 No Third-Party Beneficiaries. With the exception of the specific
provisions set forth in this Agreement, there are no intended third-party
beneficiaries under this Agreement and no such other third parties shall have
any rights or obligations hereunder.
10.10 Authority. The persons executing this Agreement on behalf of
each of the parties hereto represent and warrant that (i) such party is duly
organized and existing, (ii) they are duly authorized to execute and deliver
this Agreement on behalf of said party, (iii) by so executing this Agreement,
such party is formally bound to the provisions of this Agreement, and (iv) that
entering into this Agreement does not violate any provision of any other
Agreement to which said party is bound. This Agreement shall be binding
upon the heirs, executors, administrators, successors, and assigns of the
parties.
[SIGNATURES ON FOLLOWING PAGE]
-17-
IN WITNESS WHEREOF, the parties have executed this Agreement as of
the dates stated below.
CITY OF LA QUINTA,
a California Municipal Corporation
FRANK J. SPEVACEK, City Manager
City of La Quinta, California
Dated:
CONTRACTING PARTY:
By:
Name:
Title:
ATTEST:
MONIKA RADEVA, City Clerk
La Quinta, California
By:
Name:
Title:
APPROVED AS TO FORM:
WILLIAM H. IHRKE, City Attorney
City of La Quinta, California
Exhibit A
Page 1 of 1
Exhibit A
Scope of Services
1. Services to be Provided:
[TO BE PROVIDED BY STAFF (include location of work)]
2. Performance Standards:
[TO BE PROVIDED BY STAFF]
OR
[See Attached]
a03/21/19
Exhibit B
Page 1 of 1
Exhibit B
Schedule of Compensation
With the exception of compensation for Additional Services, provided for
in Section 2.3 of this Agreement, the maximum total compensation to be paid
to Contracting Party under this Agreement is not to exceed
______________________ ($ __________) (“Contract Sum”). The Contract
Sum shall be paid to Contracting Party in installment payments made on a
monthly basis and in an amount identified in Contracting Party’s schedule of
compensation attached hereto for the work tasks performed and properly
invoiced by Contracting Party in conformance with Section 2.2 of this
Agreement.
Exhibit C
Page 1 of 1
Exhibit C
Schedule of Performance
Contracting Party shall complete all services identified in the Scope of
Services, Exhibit A of this Agreement, in accordance with the Project
Schedule, attached hereto and incorporated herein by this reference.
Exhibit D
Page 1 of 1
Exhibit D
Special Requirements
[insert Special Requirements or indicate “None” if there are none]
Exhibit E
Page 1 of 6
Exhibit E
Insurance Requirements
E.1 Insurance. Prior to the beginning of and throughout the duration of
this Agreement, the following policies shall be maintained and kept in full force
and effect providing insurance with minimum limits as indicated below and
issued by insurers with A.M. Best ratings of no less than A-VI:
Commercial General Liability (at least as broad as ISO CG 0001)
$1,000,000 (per occurrence)
$2,000,000 (general aggregate)
Must include the following endorsements:
General Liability Additional Insured
General Liability Primary and Non-contributory
Errors and Omissions Liability
$1,000,000 (per claim and aggregate)
Workers’ Compensation
(per statutory requirements)
Must include the following endorsements:
Workers Compensation with Waiver of Subrogation
Workers Compensation Declaration of Sole Proprietor if applicable
Contracting Party shall procure and maintain, at its cost, and submit
concurrently with its execution of this Agreement, Commercial General
Liability insurance against all claims for injuries against persons or damages
to property resulting from Contracting Party’s acts or omissions rising out of
or related to Contracting Party’s performance under this Agreement. The
insurance policy shall contain a severability of interest clause providing that
the coverage shall be primary for losses arising out of Contracting Party’s
performance hereunder and neither City nor its insurers shall be required to
contribute to any such loss. An endorsement evidencing the foregoing and
naming the City and its officers and employees as additional insured (on the
Commercial General Liability policy only) must be submitted concurrently with
the execution of this Agreement and approved by City prior to commencement
of the services hereunder.
Professional Liability or Errors and Omissions Insurance as
appropriate shall be written on a policy form coverage specifically designed to
protect against acts, errors or omissions of the Contracting Party and “Covered
Professional Services” as designated in the policy must specifically include
work performed under this agreement. The policy limit shall be no less than
Exhibit E
Page 2 of 6
$1,000,000 per claim and in the aggregate. The policy must “pay on behalf
of” the insured and must include a provision establishing the insurer’s duty to
defend. The policy retroactive date shall be on or before the effective date of
this agreement.
Contracting Party shall carry Workers’ Compensation Insurance in
accordance with State Worker’s Compensation laws with employer’s liability
limits no less than $1,000,000 per accident or disease.
Contracting Party shall provide written notice to City within ten
(10) working days if: (1) any of the required insurance policies is terminated;
(2) the limits of any of the required polices are reduced; or (3) the deductible
or self-insured retention is increased. In the event any of said policies of
insurance are cancelled, Contracting Party shall, prior to the cancellation date,
submit new evidence of insurance in conformance with this Exhibit to the
Contract Officer. The procuring of such insurance or the delivery of policies
or certificates evidencing the same shall not be construed as a limitation of
Contracting Party’s obligation to indemnify City, its officers, employees,
contractors, subcontractors, or agents.
E.2 Remedies. In addition to any other remedies City may have if
Contracting Party fails to provide or maintain any insurance policies or policy
endorsements to the extent and within the time herein required, City may, at
its sole option:
a. Obtain such insurance and deduct and retain the amount of the
premiums for such insurance from any sums due under this Agreement.
b. Order Contracting Party to stop work under this Agreement
and/or withhold any payment(s) which become due to Contracting Party
hereunder until Contracting Party demonstrates compliance with the
requirements hereof.
c. Terminate this Agreement.
Exercise of any of the above remedies, however, is an alternative to
any other remedies City may have. The above remedies are not the exclusive
remedies for Contracting Party’s failure to maintain or secure appropriate
policies or endorsements. Nothing herein contained shall be construed as
limiting in any way the extent to which Contracting Party may be held
responsible for payments of damages to persons or property resulting from
Contracting Party’s or its subcontractors’ performance of work under this
Agreement.
Exhibit E
Page 3 of 6
E.3 General Conditions Pertaining to Provisions of Insurance Coverage
by Contracting Party. Contracting Party and City agree to the following with
respect to insurance provided by Contracting Party:
1. Contracting Party agrees to have its insurer endorse the third
party general liability coverage required herein to include as additional
insureds City, its officials, employees, and agents, using standard ISO
endorsement No. CG 2010 with an edition prior to 1992. Contracting Party
also agrees to require all contractors, and subcontractors to do likewise.
2. No liability insurance coverage provided to comply with this
Agreement shall prohibit Contracting Party, or Contracting Party’s employees,
or agents, from waiving the right of subrogation prior to a loss. Contracting
Party agrees to waive subrogation rights against City regardless of the
applicability of any insurance proceeds, and to require all contractors and
subcontractors to do likewise.
3. All insurance coverage and limits provided by Contracting Party
and available or applicable to this Agreement are intended to apply to the full
extent of the policies. Nothing contained in this Agreement or any other
agreement relating to City or its operations limits the application of such
insurance coverage.
4. None of the coverages required herein will be in compliance with
these requirements if they include any limiting endorsement of any kind that
has not been first submitted to City and approved of in writing.
5. No liability policy shall contain any provision or definition that
would serve to eliminate so-called “third party action over” claims, including
any exclusion for bodily injury to an employee of the insured or of any
contractor or subcontractor.
6. All coverage types and limits required are subject to approval,
modification and additional requirements by the City, as the need arises.
Contracting Party shall not make any reductions in scope of coverage (e.g.
elimination of contractual liability or reduction of discovery period) that may
affect City’s protection without City’s prior written consent.
7. Proof of compliance with these insurance requirements, consisting
of certificates of insurance evidencing all the coverages required and an
additional insured endorsement to Contracting Party’s general liability policy,
shall be delivered to City at or prior to the execution of this Agreement. In
the event such proof of any insurance is not delivered as required, or in the
event such insurance is canceled at any time and no replacement coverage is
provided, City has the right, but not the duty, to obtain any insurance it deems
Exhibit E
Page 4 of 6
necessary to protect its interests under this or any other agreement and to
pay the premium. Any premium so paid by City shall be charged to and
promptly paid by Contracting Party or deducted from sums due Contracting
Party, at City option.
8. It is acknowledged by the parties of this agreement that all
insurance coverage required to be provided by Contracting Party or any
subcontractor, is intended to apply first and on a primary, non-contributing
basis in relation to any other insurance or self-insurance available to City.
9. Contracting Party agrees to ensure that subcontractors, and any
other party involved with the project that is brought onto or involved in the
project by Contracting Party, provide the same minimum insurance coverage
required of Contracting Party. Contracting Party agrees to monitor and review
all such coverage and assumes all responsibility for ensuring that such
coverage is provided in conformity with the requirements of this section.
Contracting Party agrees that upon request, all agreements with
subcontractors and others engaged in the project will be submitted to City for
review.
10. Contracting Party agrees not to self-insure or to use any self-
insured retentions or deductibles on any portion of the insurance required
herein (with the exception of professional liability coverage, if required) and
further agrees that it will not allow any contractor, subcontractor, Architect,
Engineer or other entity or person in any way involved in the performance of
work on the project contemplated by this agreement to self-insure its
obligations to City. If Contracting Party’s existing coverage includes a
deductible or self-insured retention, the deductible or self-insured retention
must be declared to the City. At that time the City shall review options with
the Contracting Party, which may include reduction or elimination of the
deductible or self-insured retention, substitution of other coverage, or other
solutions.
11. The City reserves the right at any time during the term of this
Agreement to change the amounts and types of insurance required by giving
the Contracting Party ninety (90) days advance written notice of such change.
If such change results in substantial additional cost to the Contracting Party,
the City will negotiate additional compensation proportional to the increased
benefit to City.
12. For purposes of applying insurance coverage only, this Agreement
will be deemed to have been executed immediately upon any party hereto
taking any steps that can be deemed to be in furtherance of or towards
performance of this Agreement.
Exhibit E
Page 5 of 6
13. Contracting Party acknowledges and agrees that any actual or
alleged failure on the part of City to inform Contracting Party of non-
compliance with any insurance requirement in no way imposes any additional
obligations on City nor does it waive any rights hereunder in this or any other
regard.
14. Contracting Party will renew the required coverage annually as
long as City, or its employees or agents face an exposure from operations of
any type pursuant to this agreement. This obligation applies whether the
agreement is canceled or terminated for any reason. Termination of this
obligation is not effective until City executes a written statement to that effect.
15. Contracting Party shall provide proof that policies of insurance
required herein expiring during the term of this Agreement have been renewed
or replaced with other policies providing at least the same coverage. Proof
that such coverage has been ordered shall be submitted prior to expiration.
A coverage binder or letter from Contracting Party’s insurance agent to this
effect is acceptable. A certificate of insurance and an additional insured
endorsement is required in these specifications applicable to the renewing or
new coverage must be provided to City within five (5) days of the expiration
of coverages.
16. The provisions of any workers’ compensation or similar act will not
limit the obligations of Contracting Party under this agreement. Contracting
Party expressly agrees not to use any statutory immunity defenses under such
laws with respect to City, its employees, officials, and agents.
17. Requirements of specific coverage features, or limits contained in
this section are not intended as limitations on coverage, limits or other
requirements nor as a waiver of any coverage normally provided by any given
policy. Specific reference to a given coverage feature is for purposes of
clarification only as it pertains to a given issue and is not intended by any
party or insured to be limiting or all-inclusive.
18. These insurance requirements are intended to be separate and
distinct from any other provision in this Agreement and are intended by the
parties here to be interpreted as such.
19. The requirements in this Exhibit supersede all other sections and
provisions of this Agreement to the extent that any other section or provision
conflicts with or impairs the provisions of this Exhibit.
20. Contracting Party agrees to be responsible for ensuring that no
contract used by any party involved in any way with the project reserves the
right to charge City or Contracting Party for the cost of additional insurance
Exhibit E
Page 6 of 6
coverage required by this agreement. Any such provisions are to be deleted
with reference to City. It is not the intent of City to reimburse any third party
for the cost of complying with these requirements. There shall be no recourse
against City for payment of premiums or other amounts with respect thereto.
21. Contracting Party agrees to provide immediate notice to City of
any claim or loss against Contracting Party arising out of the work performed
under this agreement. City assumes no obligation or liability by such notice,
but has the right (but not the duty) to monitor the handling of any such claim
or claims if they are likely to involve City.
Exhibit F
Page 1 of 3
Exhibit F
Indemnification
F.1 Indemnity for the Benefit of City.
a. Indemnification for Professional Liability. When the law
establishes a professional standard of care for Contracting Party’s Services, to
the fullest extent permitted by law, Contracting Party shall indemnify, protect,
defend (with counsel selected by City), and hold harmless City and any and
all of its officials, employees, and agents (“Indemnified Parties”) from and
against any and all claims, losses, liabilities of every kind, nature, and
description, damages, injury (including, without limitation, injury to or death
of an employee of Contracting Party or of any subcontractor), costs and
expenses of any kind, whether actual, alleged or threatened, including,
without limitation, incidental and consequential damages, court costs,
attorneys’ fees, litigation expenses, and fees of expert consultants or expert
witnesses incurred in connection therewith and costs of investigation, to the
extent same are caused in whole or in part by any negligent or wrongful act,
error or omission of Contracting Party, its officers, agents, employees or
subcontractors (or any entity or individual that Contracting Party shall bear
the legal liability thereof) in the performance of professional services under
this agreement. With respect to the design of public improvements, the
Contracting Party shall not be liable for any injuries or property damage
resulting from the reuse of the design at a location other than that specified
in Exhibit A without the written consent of the Contracting Party.
b. Indemnification for Other Than Professional Liability. Other
than in the performance of professional services and to the full extent
permitted by law, Contracting Party shall indemnify, defend (with counsel
selected by City), and hold harmless the Indemnified Parties from and against
any liability (including liability for claims, suits, actions, arbitration
proceedings, administrative proceedings, regulatory proceedings, losses,
expenses or costs of any kind, whether actual, alleged or threatened,
including, without limitation, incidental and consequential damages, court
costs, attorneys’ fees, litigation expenses, and fees of expert consultants or
expert witnesses) incurred in connection therewith and costs of investigation,
where the same arise out of, are a consequence of, or are in any way
attributable to, in whole or in part, the performance of this Agreement by
Contracting Party or by any individual or entity for which Contracting Party is
legally liable, including but not limited to officers, agents, employees, or
subcontractors of Contracting Party.
c. Indemnity Provisions for Contracts Related to Construction
(Limitation on Indemnity). Without affecting the rights of City under any
Exhibit F
Page 2 of 3
provision of this agreement, Contracting Party shall not be required to
indemnify and hold harmless City for liability attributable to the active
negligence of City, provided such active negligence is determined by
agreement between the parties or by the findings of a court of competent
jurisdiction. In instances where City is shown to have been actively negligent
and where City’s active negligence accounts for only a percentage of the
liability involved, the obligation of Contracting Party will be for that entire
portion or percentage of liability not attributable to the active negligence of
City.
d. Indemnification Provision for Design Professionals.
1. Applicability of this Section F.1(d). Notwithstanding
Section F.1(a) hereinabove, the following indemnification provision shall apply
to a Contracting Party who constitutes a “design professional” as the term is
defined in paragraph 3 below.
2. Scope of Indemnification. When the law establishes a
professional standard of care for Contracting Party’s Services, to the fullest
extent permitted by law, Contracting Party shall indemnify and hold harmless
City and any and all of its officials, employees, and agents (“Indemnified
Parties”) from and against any and all losses, liabilities of every kind, nature,
and description, damages, injury (including, without limitation, injury to or
death of an employee of Contracting Party or of any subcontractor), costs and
expenses, including, without limitation, incidental and consequential
damages, court costs, reimbursement of attorneys’ fees, litigation expenses,
and fees of expert consultants or expert witnesses incurred in connection
therewith and costs of investigation, to the extent same are caused by any
negligent or wrongful act, error or omission of Contracting Party, its officers,
agents, employees or subcontractors (or any entity or individual that
Contracting Party shall bear the legal liability thereof) in the performance of
professional services under this agreement. With respect to the design of
public improvements, the Contracting Party shall not be liable for any injuries
or property damage resulting from the reuse of the design at a location other
than that specified in Exhibit A without the written consent of the Contracting
Party.
3. Design Professional Defined. As used in this
Section F.1(d), the term “design professional” shall be limited to licensed
architects, registered professional engineers, licensed professional land
surveyors and landscape architects, all as defined under current law, and as
may be amended from time to time by Civil Code § 2782.8.
F.2 Obligation to Secure Indemnification Provisions. Contracting
Party agrees to obtain executed indemnity agreements with provisions
Exhibit F
Page 3 of 3
identical to those set forth herein this Exhibit F, as applicable to the
Contracting Party, from each and every subcontractor or any other person or
entity involved by, for, with or on behalf of Contracting Party in the
performance of this Agreement. In the event Contracting Party fails to obtain
such indemnity obligations from others as required herein, Contracting Party
agrees to be fully responsible according to the terms of this Exhibit. Failure
of City to monitor compliance with these requirements imposes no additional
obligations on City and will in no way act as a waiver of any rights hereunder.
This obligation to indemnify and defend City as set forth in this Agreement are
binding on the successors, assigns or heirs of Contracting Party and shall
survive the termination of this Agreement.
December 2018
2018/2019
Statement of
Economic Interests
Form 700
California Fair Political Practices Commission
1102 Q Street, Suite 3000 • Sacramento, CA 95811
Email Advice: advice@fppc.ca.gov
Toll-free advice line: 1 (866) ASK-FPPC • 1 (866) 275-3772
Telephone: (916)322-5660 • Website: www.fppc.ca.gov
A Public Document
Table of Contents
Quick Start Guide .....................................................p.2
Who? Where? How? When? ....................................p.3
Types of Statements .................................................p.4
Cover Page and Schedules
Cover Page ........................................................p.5
Schedule A-1 (Investments) ...............................p.7
Schedule A-2 (Business Entities/Trusts) ............p.9
Schedule B (Real Property) ...............................p.11
Schedule C (Income) .........................................p.13
Schedule D (Gifts) ..............................................p.15
Schedule E (Travel Payments) ...........................p.17
Restrictions and Prohibitions ....................................p.19
Q & A ........................................................................p.20
Helpful Resources
• Video Tutorials
• Reference Pamphlet
• Excel Version
• FAQs
• Gift and Travel Fact
Sheet for State and
Local Officials
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 2
Quick Start Guide
Detailed instructions begin on page 3.
WHEN IS THE ANNUAL STATEMENT DUE?
• March 1 – Elected State Officers, Judges and Court Commissioners, State Board and Commission
members listed in Government Code Section 87200
• April 2 – Most other filers
WHERE DO I FILE?
Most people file the Form 700 with their agency. If you’re not sure where to file your Form 700, contact your
filing officer or the person who asked you to complete it.
ITEMS TO NOTE!
• The Form 700 is a public document.
• Only filers serving in active military duty may receive an extension on the filing deadline.
• You must also report interests held by your spouse or registered domestic partner.
• Your agency’s conflict of interest code will help you to complete the Form 700. You are encouraged to get
your conflict of interest code from the person who asked you to complete the Form 700.
NOTHING TO REPORT?
Mark the “No reportable interests” box on Part 4 of the Cover Page, and submit only the signed Cover Page.
Be sure to review each schedule carefully!
Schedule
Common
Reportable Interests
Common
Non-Reportable Interests
A-1:
Investments
Stocks, including those held in an IRA
or 401K. Each stock must be listed.
Insurance policies, government bonds, diversified
mutual funds, funds similar to diversified mutual
funds.
A-2:
Business
Entitites/Trusts
Business entities, sole proprietorships,
partnerships, LLCs, corporations and
trusts. (e.g., Form 1099 filers).
Savings and checking accounts, and annuities.
B:
Real Property
Rental property in filer’s jurisdiction, or
within two miles of the boundaries of
the jurisdiction.
A residence used exclusively as a personal
residence (such as a home or vacation property).
C:
Income
Non-governmental salaries. Note that
filers are required to report only half of
their spouse’s or partner’s salary.
Governmental salary (from school district, for
example).
D:
Gifts
Gifts from businesses, vendors, or
other contractors (meals, tickets, etc.).
Gifts from family members.
E:
Travel
Payments
Travel payments from third parties (not
your employer).
Travel paid by your government agency.
Note: Like reportable interests, non-reportable interests may also create conflicts of interest and could be
grounds for disqualification from certain decisions.
QUESTIONS?
• advice@fppc.ca.gov
• (866) 275-3772 Mon-Thurs, 9-11:30 a.m.
E-FILING ISSUES?
• If using your agency’s system, please contact technical support at your agency.
• If using FPPC’s e-filing system, write to form700@fppc.ca.gov.
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 3
What’s New
Gift Limit Increase
The gift limit increased to $500 for calendar years 2019
and 2020. The gift limit in 2018 was $470.
Who must file:
• Elected and appointed officials and candidates listed in
Government Code Section 87200
• Employees, appointed officials, and consultants filing
pursuant to a conflict of interest code (“code filers”).
Obtain your disclosure categories, which describe
the interests you must report, from your agency;
they are not part of the Form 700
• Candidates running for local elective offices that are
designated in a conflict of interest code (e.g., county
sheriffs, city clerks, school board trustees, and water
board members)
Exception: Candidates for a county central
committee are not required to file the Form 700.
• Members of newly created boards and
commissions not yet covered under a conflict of
interest code
• Employees in newly created positions of existing
agencies
See Reference Pamphlet, page 3, at www.fppc.ca.gov.
Where to file:
87200 Filers
State offices Your agency
Judicial offices The clerk of your court
Retired Judges Directly with FPPC
County offices Your county filing official
City offices Your city clerk
Multi-County offices Your agency
Code Filers — State and Local Officials, Employees,
and Consultants Designated in a Conflict of Interest
Code: File with your agency, board, or commission unless
otherwise specified in your agency’s code (e.g., Legislative
staff files directly with FPPC). In most cases, the agency,
board, or commission will retain the statements.
Members of Boards and Commissions of Newly
Created Agencies: File with your newly created agency
or with your agency’s code reviewing body.
Employees in Newly Created Positions of Existing
Agencies: File with your agency or with your agency’s
code reviewing body. (See Reference Pamphlet, page 3.)
Candidates: File with your local elections office.
How to file:
The Form 700 is available at www.fppc.ca.gov. Form
700 schedules are also available in Excel format. All
statements must have an original “wet” signature or be
duly authorized by your filing officer to file electronically
under Government Code Section 87500.2.
When to file:
Annual Statements
March 1, 2019
-Elected State Officers
-Judges and Court Commissioners
-State Board and State Commission Members listed
in Government Code Section 87200
April 2, 2019
-Most other filers
Individuals filing under conflict of interest codes in city and
county jurisdictions should verify the annual filing date with
their local filing officers.
Statements postmarked by the filing deadline are
considered filed on time.
Statements of 30 pages or less may be emailed or faxed
by the deadline as long as the originally signed paper
version is sent by first class mail to the filing official within
24 hours.
Assuming Office and Leaving Office Statements
Most filers file within 30 days of assuming or leaving office
or within 30 days of the effective date of a newly adopted
or amended conflict of interest code.
Exception:
If you assumed office between October 1,2018, and
December 31, 2018, and filed an assuming office
statement, you are not required to file an annual
statement until March 2, 2020, or April 1, 2020,
whichever is applicable. In that case, the annual
statement will cover the day after you assumed
office through December 31, 2019. (See Reference
Pamphlet, page 6, for additional exceptions.)
Candidate Statements
File no later than the final filing date for the declaration
of candidacy or nomination documents. A candidate
statement is not required if you filed an assuming office or
annual statement for the same jurisdiction within 60 days
before filing a declaration of candidacy or other nomination
documents.
Late Statements
There is no provision for filing deadline extensions unless
the filer is serving in active military duty. (See page 19 for
information on penalties and fines.)
Amendments
Statements may be amended at any time. You are only
required to amend the schedule that needs to be revised.
It is not necessary to amend the entire filed form. Obtain
amendment schedules at www.fppc.ca.gov.
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 4
Types of Statements
Assuming Office Statement:
If you are a newly appointed official or are newly employed
in a position designated, or that will be designated, in
a state or local agency’s conflict of interest code, your
assuming office date is the date you were sworn in or
otherwise authorized to serve in the position. If you are a
newly elected official, your assuming office date is the date
you were sworn in.
• Investments, interests in real property, and business
positions held on the date you assumed the office
or position must be reported. In addition, income
(including loans, gifts, and travel payments) received
during the 12 months prior to the date you assumed the
office or position is reportable.
For positions subject to confirmation by the State Senate
or the Commission on Judicial Performance, your
assuming office date is the date you were appointed or
nominated to the position.
Example:
Maria Lopez was nominated by the Governor to serve
on a state agency board that is subject to state Senate
confirmation. The assuming office date is the date Maria’s
nomination is submitted to the Senate. Maria must report
investments, interests in real property, and business
positions she holds on that date, and income (including
loans, gifts, and travel payments) received during the 12
months prior to that date.
If your office or position has been added to a newly
adopted or newly amended conflict of interest code, use
the effective date of the code or amendment, whichever is
applicable.
• Investments, interests in real property, and business
positions held on the effective date of the code or
amendment must be reported. In addition, income
(including loans, gifts, and travel payments) received
during the 12 months prior to the effective date of the
code or amendment is reportable.
Annual Statement:
Generally, the period covered is January 1, 2018,
through December 31, 2018. If the period covered by
the statement is different than January 1, 2018, through
December 31, 2018, (for example, you assumed office
between October 1, 2017, and December 31, 2017 or you
are combining statements), you must specify the period
covered.
• Investments, interests in real property, business
positions held, and income (including loans, gifts, and
travel payments) received during the period covered
by the statement must be reported. Do not change the
preprinted dates on Schedules A-1, A-2, and B unless
you are required to report the acquisition or disposition
of an interest that did not occur in 2018.
• If your disclosure category changes during a reporting
period, disclose under the old category until the
effective date of the conflict of interest code amendment
and disclose under the new disclosure category through
the end of the reporting period.
Leaving Office Statement:
Generally, the period covered is January 1, 2018,
through the date you stopped performing the duties of
your position. If the period covered differs from January
1, 2018, through the date you stopped performing the
duties of your position (for example, you assumed office
between October 1, 2017, and December 31, 2017, or
you are combining statements), the period covered must
be specified. The reporting period can cover parts of two
calendar years.
• Investments, interests in real property, business
positions held, and income (including loans, gifts, and
travel payments) received during the period covered
by the statement must be reported. Do not change the
preprinted dates on Schedules A-1, A-2, and B unless
you are required to report the acquisition or disposition
of an interest that did not occur in 2018.
Candidate Statement:
If you are filing a statement in connection with your
candidacy for state or local office, investments, interests
in real property, and business positions held on the date
of filing your declaration of candidacy must be reported.
In addition, income (including loans, gifts, and travel
payments) received during the 12 months prior to the date
of filing your declaration of candidacy is reportable. Do not
change the preprinted dates on Schedules A-1, A-2, and B.
Candidates running for local elective offices (e.g., county
sheriffs, city clerks, school board trustees, or water
district board members) must file candidate statements,
as required by the conflict of interest code for the elected
position. The code may be obtained from the agency of
the elected position.
Amendments:
If you discover errors or omissions on any statement, file
an amendment as soon as possible. You are only required
to amend the schedule that needs to be revised; it is not
necessary to refile the entire form. Obtain amendment
schedules from the FPPC website at www.fppc.ca.gov.
Note that once you file your statement, you may not
withdraw it. All changes must be noted on amendment
schedules.
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 5
Leaving Office: Date Left //
(Check one circle.)
The period covered is January 1, 2018, through the date of
leaving office.
The period covered is //, through
the date of leaving office.
Annual: The period covered is January 1, 2018, through
December 31, 2018.
The period covered is //, through
December 31, 2018.
Statement of economic intereStS
cover Page
A PubliC DoCument
I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained
herein and in any attached schedules is true and complete. I acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.
Date Signed
(month, day, year)
3. Type of Statement (Check at least one box)
State Judge or Court Commissioner (Statewide Jurisdiction)
Multi-County County of
City of Other
2. Jurisdiction of Office (Check at least one box)
Candidate: Date of Election and office sought, if different than Part 1:
Assuming Office: Date assumed //
Date Initial Filing Received
Official Use Only
Please type or print in ink.
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
Agency Name (Do not use acronyms)
Division, board, Department, District, if applicable Your Position
1. Office, Agency, or Court
name of filer (laSt) (firSt) (middle)
MaIlIng aDDreSS Street CItY State ZIP CoDe
( )
DaYtIMe telePhone nuMber EMAiL ADDrESS
(business or Agency Address Recommended - Public Document)
Signature
(File the originally signed paper statement with your filing official.)
5. Verification
► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
agency: Position:
-or-
-or-
None - no reportable interests on any schedule
4. Schedule Summary (must complete)
Schedules attached
Schedule A-1 - investments – schedule attached
Schedule A-2 - investments – schedule attached
Schedule B - Real Property – schedule attached
► Total number of pages including this cover page:
-or-
Schedule C - income, loans, & business Positions – schedule attached
Schedule D - Income – Gifts – schedule attached
Schedule E - Income – Gifts – Travel Payments – schedule attached
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 6
• If your agency is a multi-county office, list each county in
which your agency has jurisdiction.
• If your agency is not a state office, court, county office, city
office, or multi-county office (e.g., school districts, special
districts and JPAs), check the “other” box and enter the
county or city in which the agency has jurisdiction.
Example:
This filer is a member of a water district board with jurisdiction
in portions of Yuba and Sutter Counties.
Part 3. Type of Statement
Check at least one box. The period covered by a statement
is determined by the type of statement you are filing. If you
are completing a 2018 annual statement, do not change the
pre-printed dates to reflect 2019. Your annual statement is
used for reporting the previous year’s economic interests.
Economic interests for your annual filing covering January 1,
2019, through December 31, 2019, will be disclosed on your
statement filed in 2020. See Reference Pamphlet, page 4.
Combining Statements: Certain types of statements may be
combined. For example, if you leave office after January 1,
but before the deadline for filing your annual statement, you
may combine your annual and leaving office statements. File
by the earliest deadline. Consult your filing officer or the
FPPC.
Part 4. Schedule Summary
• Complete the Schedule Summary after you have reviewed
each schedule to determine if you have reportable
interests.
• Enter the total number of completed pages including the
cover page and either check the box for each schedule you
use to disclose interests; or if you have nothing to disclose
on any schedule, check the “No reportable interests” box.
Please do not attach any blank schedules.
Part 5. Verification
Complete the verification by signing the statement and
entering the date signed. All statements must have an original
“wet” signature or be duly authorized by your filing officer to
file electronically under Government Code Section 87500.2.
When you sign your statement, you are stating, under
penalty of perjury, that it is true and correct. Only the filer
has authority to sign the statement. An unsigned statement
is not considered filed and you may be subject to late filing
penalties.
Instructions
Cover Page
Enter your name, mailing address, and daytime telephone
number in the spaces provided. Because the Form 700 is
a public document, you may list your business/office
address instead of your home address.
Part 1. Office, Agency, or Court
• Enter the name of the office sought or held, or the agency
or court. Consultants must enter the public agency name
rather than their private firm’s name. (Examples: State
Assembly; Board of Supervisors; Office of the Mayor;
Department of Finance; Hope County Superior Court)
• Indicate the name of your division, board, or district, if
applicable. (Examples: Division of Waste Management;
Board of Accountancy; District 45). Do not use acronyms.
• Enter your position title. (Examples: Director; Chief
Counsel; City Council Member; Staff Services Analyst)
• If you hold multiple positions (i.e., a city council member
who also is a member of a county board or commission),
you may be required to file statements with each agency.
To simplify your filing obligations, you may complete an
expanded statement.
• To do this, enter the name of the other agency(ies) with
which you are required to file and your position title(s) in
the space provided. Do not use acronyms. Attach an
additional sheet if necessary. Complete one statement
covering the disclosure requirements for all positions.
Each copy must contain an original signature. Therefore,
before signing the statement, make a copy for each
agency. Sign each copy with an original signature and file
with each agency.
If you assume or leave a position after a filing deadline,
you must complete a separate statement. For example, a
city council member who assumes a position with a county
special district after the April annual filing deadline must file
a separate assuming office statement. In subsequent years,
the city council member may expand his or her annual filing to
include both positions.
Example:
Brian Bourne is a city council member for the City of Lincoln
and a board member for the Camp Far West Irrigation
District – a multi-county agency that covers Placer and
Yuba counties. Brian will complete one Form 700 using full
disclosure (as required for the city position) and covering
interests in both Placer and Yuba counties (as required for
the multi-county position) and list both positions on the Cover
Page. Before signing the statement, Brian will make a copy
and sign both statements. One statement will be filed with
City of Lincoln and the other will be filed with Camp Far West
Irrigation District. Both will contain an original signature.
Part 2. Jurisdiction of Office
• Check the box indicating the jurisdiction of your agency
and, if applicable, identify the jurisdiction. Judges, judicial
candidates, and court commissioners have statewide
jurisdiction. All other filers should review the Reference
Pamphlet, page 13, to determine their jurisdiction.
State Judge or Court Commissioner (Statewide Jurisdiction)
Multi-County County of
City of Other
2. Jurisdiction of Office (Check at least one box)
Agency Name (Do not use acronyms)
Division, board, Department, District, if applicable Your Position
1. Office, Agency, or Court
► If filing for multiple positions, list below or on an attachment. (Do not use acronyms)
agency: Position:
x Yuba & Sutter Counties
Board MemberN/A
N/A
Feather River Irrigation District
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 7
IF APPLICABLE, LIST DATE:
// //
ACquIRED DISPOSED
IF APPLICABLE, LIST DATE:
// //
ACquIRED DISPOSED
IF APPLICABLE, LIST DATE:
// //
ACquIRED DISPOSED
IF APPLICABLE, LIST DATE:
// //
ACquIRED DISPOSED
IF APPLICABLE, LIST DATE:
// //
ACquIRED DISPOSED
IF APPLICABLE, LIST DATE:
// //
ACquIRED DISPOSED
18 18 18 18
1818
181818
Name
► NAME OF BuSINESS ENTITY
GENERAL DESCRIPTION OF THIS BuSINESS
► NAME OF BuSINESS ENTITY
GENERAL DESCRIPTION OF THIS BuSINESS
► NAME OF BuSINESS ENTITY
GENERAL DESCRIPTION OF THIS BuSINESS
► NAME OF BuSINESS ENTITY
GENERAL DESCRIPTION OF THIS BuSINESS
► NAME OF BuSINESS ENTITY
GENERAL DESCRIPTION OF THIS BuSINESS
► NAME OF BuSINESS ENTITY
GENERAL DESCRIPTION OF THIS BuSINESS
Comments:
SCHEDULE A-1
Investments
Stocks, Bonds, and Other Interests
(Ownership Interest is Less Than 10%)
Investments must be itemized.
Do not attach brokerage or financial statements.
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
FAIR MARkET vALuE
$2,000 - $10,000 $10,001 - $100,000
$100,001 - $1,000,000 Over $1,000,000
FAIR MARkET vALuE
$2,000 - $10,000 $10,001 - $100,000
$100,001 - $1,000,000 Over $1,000,000
FAIR MARkET vALuE
$2,000 - $10,000 $10,001 - $100,000
$100,001 - $1,000,000 Over $1,000,000
FAIR MARkET vALuE
$2,000 - $10,000 $10,001 - $100,000
$100,001 - $1,000,000 Over $1,000,000
FAIR MARkET vALuE
$2,000 - $10,000 $10,001 - $100,000
$100,001 - $1,000,000 Over $1,000,000
FAIR MARkET vALuE
$2,000 - $10,000 $10,001 - $100,000
$100,001 - $1,000,000 Over $1,000,000
18
NATuRE OF INvESTMENT
Stock Other (Describe)
Partnership Income Received of $0 - $499
Income Received of $500 or More (Report on Schedule C)
NATuRE OF INvESTMENT
Stock Other (Describe)
Partnership Income Received of $0 - $499
Income Received of $500 or More (Report on Schedule C)
NATuRE OF INvESTMENT
Stock Other (Describe)
Partnership Income Received of $0 - $499
Income Received of $500 or More (Report on Schedule C)
NATuRE OF INvESTMENT
Stock Other (Describe)
Partnership Income Received of $0 - $499
Income Received of $500 or More (Report on Schedule C)
NATuRE OF INvESTMENT
Stock Other (Describe)
Partnership Income Received of $0 - $499
Income Received of $500 or More (Report on Schedule C)
NATuRE OF INvESTMENT
Stock Other (Describe)
Partnership Income Received of $0 - $499
Income Received of $500 or More (Report on Schedule C)
1818
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 8
Instructions – Schedules A-1 and A-2
Investments
“Investment” means a financial interest in any business
entity (including a consulting business or other independent
contracting business) that is located in, doing business in,
planning to do business in, or that has done business during
the previous two years in your agency’s jurisdiction in which
you, your spouse or registered domestic partner, or your
dependent children had a direct, indirect, or beneficial interest
totaling $2,000 or more at any time during the reporting
period. (See Reference Pamphlet, page 13.)
Reportable investments include:
• Stocks, bonds, warrants, and options, including those held
in margin or brokerage accounts and managed investment
funds (See Reference Pamphlet, page 13.)
• Sole proprietorships
• Your own business or your spouse’s or registered
domestic partner’s business (See Reference Pamphlet,
page 8, for the definition of “business entity.”)
• Your spouse’s or registered domestic partner’s
investments even if they are legally separate property
• Partnerships (e.g., a law firm or family farm)
• Investments in reportable business entities held in a
retirement account (See Reference Pamphlet, page 15.)
• If you, your spouse or registered domestic partner,
and dependent children together had a 10% or greater
ownership interest in a business entity or trust (including
a living trust), you must disclose investments held by the
business entity or trust. (See Reference Pamphlet, page
16, for more information on disclosing trusts.)
• Business trusts
You are not required to disclose:
• Government bonds, diversified mutual funds, certain
funds similar to diversified mutual funds (such as
exchange traded funds) and investments held in certain
retirement accounts. (See Reference Pamphlet, page 13.)
(Regulation 18237)
• Bank accounts, savings accounts, money market accounts
and certificates of deposits
• Insurance policies
• Annuities
• Commodities
• Shares in a credit union
• Government bonds (including municipal bonds)
• Retirement accounts invested in non-reportable interests
(e.g., insurance policies, mutual funds, or government
bonds) (See Reference Pamphlet, page 15.)
• Government defined-benefit pension plans (such as
CalPERS and CalSTRS plans)
• Certain interests held in a blind trust (See Reference
Pamphlet, page 16.)
Use Schedule A-1 to report ownership of less than 10%
(e.g., stock). Schedule C (Income) may also be required if
the investment is not a stock or corporate bond. (See second
example below.)
Use Schedule A-2 to report ownership of 10% or greater
(e.g., a sole proprietorship).
To Complete Schedule A-1:
Do not attach brokerage or financial statements.
• Disclose the name of the business entity.
• Provide a general description of the business activity of
the entity (e.g., pharmaceuticals, computers, automobile
manufacturing, or communications).
• Check the box indicating the highest fair market value of
your investment during the reporting period. If you are
filing a candidate or an assuming office statement, indicate
the fair market value on the filing date or the date you took
office, respectively. (See page 20 for more information.)
• Identify the nature of your investment (e.g., stocks,
warrants, options, or bonds).
• An acquired or disposed of date is only required if you
initially acquired or entirely disposed of the investment
interest during the reporting period. The date of a stock
dividend reinvestment or partial disposal is not required.
Generally, these dates will not apply if you are filing a
candidate or an assuming office statement.
Examples:
Frank Byrd holds a state agency position. His conflict of
interest code requires full disclosure of investments. Frank
must disclose his stock holdings of $2,000 or more in any
company that is located in or does business in California,
as well as those stocks held by his spouse or registered
domestic partner and dependent children.
Alice Lance is a city council member. She has a 4% interest,
worth $5,000, in a limited partnership located in the city. Alice
must disclose the partnership on Schedule A-1 and income of
$500 or more received from the partnership on Schedule C.
Reminders
• Do you know your agency’s jurisdiction?
• Did you hold investments at any time during the period
covered by this statement?
• Code filers – your disclosure categories may only
require disclosure of specific investments.
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 9
IF APPLICABLE, LIST DATE:
// //
ACquIRED DISPOSED
IF APPLICABLE, LIST DATE:
// //
ACquIRED DISPOSED
IF APPLICABLE, LIST DATE:
// //
ACquIRED DISPOSED
IF APPLICABLE, LIST DATE:
// //
ACquIRED DISPOSED
18 18
18 1818 18
SCHEDULE A-2
Investments, Income, and Assets
of Business Entities/Trusts
(Ownership Interest is 10% or Greater)
Comments:
Name
Address (Business Address Acceptable)
Name
Address (Business Address Acceptable)
FAIR MARkET vALuE
$0 - $1,999
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
Over $1,000,000
FAIR MARkET vALuE
$0 - $1,999
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
Over $1,000,000
GENERAL DESCRIPTION OF THIS BuSINESS
GENERAL DESCRIPTION OF THIS BuSINESS
INvESTMENT REAL PROPERTY
Name of Business Entity, if Investment, or Assessor’s Parcel Number or Street Address of Real Property
Description of Business Activity or
City or Other Precise Location of Real Property
INvESTMENT REAL PROPERTY
Name of Business Entity, if Investment, or Assessor’s Parcel Number or Street Address of Real Property
Description of Business Activity or
City or Other Precise Location of Real Property
► 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR
LEASED BY THE BUSINESS ENTITY OR TRUST
► 4. INVESTMENTS AND INTERESTS IN REAL PROPERTY HELD OR
LEASED BY THE BUSINESS ENTITY OR TRUST
Check one
Trust, go to 2 Business Entity, complete the box, then go to 2
Check one
Trust, go to 2 Business Entity, complete the box, then go to 2
► 2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA
SHARE OF THE GROSS INCOME TO THE ENTITY/TRUST)
► 2. IDENTIFY THE GROSS INCOME RECEIVED (INCLUDE YOUR PRO RATA
SHARE OF THE GROSS INCOME TO THE ENTITY/TRUST)
Name
700
Check one box:Check one box:
YOuR BuSINESS POSITION YOuR BuSINESS POSITION
FAIR MARkET vALuE
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
Over $1,000,000
FAIR MARkET vALuE
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
Over $1,000,000
$0 - $499
$500 - $1,000
$1,001 - $10,000
$0 - $499
$500 - $1,000
$1,001 - $10,000
$10,001 - $100,000
OvER $100,000
$10,001 - $100,000
OvER $100,000
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
► 1. BUSINESS ENTITY OR TRUST ► 1. BUSINESS ENTITY OR TRUST
NATuRE OF INTEREST
Property Ownership/Deed of Trust Stock Partnership
Leasehold Other
Check box if additional schedules reporting investments or real property
are attached
Yrs. remaining
NATuRE OF INTEREST
Property Ownership/Deed of Trust Stock Partnership
Leasehold Other
Check box if additional schedules reporting investments or real property
are attached
Yrs. remaining
18 18
Other
NATuRE OF INvESTMENT
Partnership Sole Proprietorship Other
NATuRE OF INvESTMENT
Partnership Sole Proprietorship
None Noneor or Names listed below Names listed below
► 3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF
INCOME OF $10,000 OR MORE (Attach a separate sheet if necessary.)
► 3. LIST THE NAME OF EACH REPORTABLE SINGLE SOURCE OF
INCOME OF $10,000 OR MORE (Attach a separate sheet if necessary.)
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 10
Instructions – Schedule A-2
Investments, Income, and Assets of Business Entities/Trusts
Use Schedule A-2 to report investments in a business
entity (including a consulting business or other independent
contracting business) or trust (including a living trust) in
which you, your spouse or registered domestic partner,
and your dependent children, together or separately, had a
10% or greater interest, totaling $2,000 or more, during the
reporting period and which is located in, doing business in,
planning to do business in, or which has done business during
the previous two years in your agency’s jurisdiction. (See
Reference Pamphlet, page 13.) A trust located outside your
agency’s jurisdiction is reportable if it holds assets that are
located in or doing business in the jurisdiction. Do not report
a trust that contains non-reportable interests. For example,
a trust containing only your personal residence not used in
whole or in part as a business, your savings account, and
some municipal bonds, is not reportable.
Also report on Schedule A-2 investments and real property
held by that entity or trust if your pro rata share of the
investment or real property interest was $2,000 or more
during the reporting period.
To Complete Schedule A-2:
Part 1. Disclose the name and address of the business entity
or trust. If you are reporting an interest in a business entity,
check “Business Entity” and complete the box as follows:
• Provide a general description of the business activity of the
entity.
• Check the box indicating the highest fair market value of
your investment during the reporting period.
• If you initially acquired or entirely disposed of this interest
during the reporting period, enter the date acquired or
disposed.
• Identify the nature of your investment.
• Disclose the job title or business position you held with the
entity, if any (i.e., if you were a director, officer, partner,
trustee, employee, or held any position of management). A
business position held by your spouse is not reportable.
Part 2. Check the box indicating your pro rata share of the
gross income received by the business entity or trust. This
amount includes your pro rata share of the gross income
from the business entity or trust, as well as your community
property interest in your spouse’s or registered domestic
partner’s share. Gross income is the total amount of income
before deducting expenses, losses, or taxes.
Part 3. Disclose the name of each source of income that is
located in, doing business in, planning to do business in, or
that has done business during the previous two years in your
agency’s jurisdiction, as follows:
• Disclose each source of income and outstanding loan
to the business entity or trust identified in Part 1 if
your pro rata share of the gross income (including your
community property interest in your spouse’s or registered
domestic partner’s share) to the business entity or trust
from that source was $10,000 or more during the reporting
period. (See Reference Pamphlet, page 11, for examples.)
Income from governmental sources may be reportable
if not considered salary. See Regulation 18232. Loans
from commercial lending institutions made in the lender’s
regular course of business on terms available to members
of the public without regard to your official status are not
reportable.
• Disclose each individual or entity that was a source
of commission income of $10,000 or more during the
reporting period through the business entity identified in
Part 1. (See Reference Pamphlet, page 8.)
You may be required to disclose sources of income located
outside your jurisdiction. For example, you may have a client
who resides outside your jurisdiction who does business on a
regular basis with you. Such a client, if a reportable source of
$10,000 or more, must be disclosed.
Mark “None” if you do not have any reportable $10,000
sources of income to disclose. Phrases such as “various
clients” or “not disclosing sources pursuant to attorney-client
privilege” are not adequate disclosure. (See Reference
Pamphlet, page 14, for information on procedures to request
an exemption from disclosing privileged information.)
Part 4. Report any investments or interests in real property
held or leased by the entity or trust identified in Part 1 if your
pro rata share of the interest held was $2,000 or more during
the reporting period. Attach additional schedules or use
FPPC’s Form 700 Excel spreadsheet if needed.
• Check the applicable box identifying the interest held as
real property or an investment.
• If investment, provide the name and description of the
business entity.
• If real property, report the precise location (e.g., an
assessor’s parcel number or address).
• Check the box indicating the highest fair market value
of your interest in the real property or investment during
the reporting period. (Report the fair market value of the
portion of your residence claimed as a tax deduction if you
are utilizing your residence for business purposes.)
• Identify the nature of your interest.
• Enter the date acquired or disposed only if you initially
acquired or entirely disposed of your interest in the
property or investment during the reporting period.
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 11
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BuSINESS ACTIvITY, IF ANY, OF LENDER
IF APPLICABLE, LIST DATE:
// //
ACquIRED DISPOSED
IF APPLICABLE, LIST DATE:
// //
ACquIRED DISPOSED
18 1818 18
SCHEDULE B
Interests in Real Property
(Including Rental Income)
Name
► ASSESSOR’S PARCEL NuMBER OR STREET ADDRESS
► ASSESSOR’S PARCEL NuMBER OR STREET ADDRESS
CITY CITY
INTEREST RATE TERM (Months/Years)
% None
SOuRCES OF RENTAL INCOME: If you own a 10% or greater
interest, list the name of each tenant that is a single source of
income of $10,000 or more.
SOuRCES OF RENTAL INCOME: If you own a 10% or greater
interest, list the name of each tenant that is a single source of
income of $10,000 or more.
NATuRE OF INTEREST
Ownership/Deed of Trust Easement
Leasehold
Yrs. remaining Other
NATuRE OF INTEREST
Ownership/Deed of Trust Easement
Leasehold
Yrs. remaining Other
Comments:
FAIR MARkET vALuE
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
Over $1,000,000
FAIR MARkET vALuE
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
Over $1,000,000
IF RENTAL PROPERTY, GROSS INCOME RECEIvED
OvER $100,000
$500 - $1,000 $0 - $499 $1,001 - $10,000
$10,001 - $100,000
IF RENTAL PROPERTY, GROSS INCOME RECEIvED
OvER $100,000
$500 - $1,000 $0 - $499 $1,001 - $10,000
$10,001 - $100,000
HIGHEST BALANCE DuRING REPORTING PERIOD
Guarantor, if applicable
OvER $100,000
$500 - $1,000 $1,001 - $10,000
$10,001 - $100,000
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BuSINESS ACTIvITY, IF ANY, OF LENDER
INTEREST RATE TERM (Months/Years)
% None
Guarantor, if applicable
HIGHEST BALANCE DuRING REPORTING PERIOD
OvER $100,000
$500 - $1,000 $1,001 - $10,000
$10,001 - $100,000
* You are not required to report loans from a commercial lending institution made in the lender’s regular course of
business on terms available to members of the public without regard to your official status. Personal loans and
loans received not in a lender’s regular course of business must be disclosed as follows:
None None
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 12
• If you received rental income, check the box indicating the
gross amount you received.
• If you had a 10% or greater interest in real property and
received rental income, list the name of the source(s) if
your pro rata share of the gross income from any single
tenant was $10,000 or more during the reporting period. If
you received a total of $10,000 or more from two or more
tenants acting in concert (in most cases, this will apply
to married couples), disclose the name of each tenant.
Otherwise, mark “None.”
• Loans from a private lender that total $500 or more and
are secured by real property may be reportable. Loans
from commercial lending institutions made in the
lender’s regular course of business on terms available
to members of the public without regard to your official
status are not reportable.
When reporting a loan:
-Provide the name and address of the lender.
-Describe the lender’s business activity.
-Disclose the interest rate and term of the loan. For
variable interest rate loans, disclose the conditions
of the loan (e.g., Prime + 2) or the average interest
rate paid during the reporting period. The term of
a loan is the total number of months or years given
for repayment of the loan at the time the loan was
established.
-Check the box indicating the highest balance of the
loan during the reporting period.
-Identify a guarantor, if applicable.
If you have more than one
reportable loan on a single
piece of real property, report
the additional loan(s) on
Schedule C.
Example:
Allison Gande is a city
planning commissioner.
During the reporting period,
she received rental income of
$12,000, from a single tenant
who rented property she
owned in the city’s jurisdiction.
If Allison received $6,000
each from two tenants, the
tenants’ names would not be
required because no single
tenant paid her $10,000 or
more. A married couple is
considered a single tenant.
Instructions – Schedule B
Interests in Real Property
Reminders
• Income and loans already reported on Schedule B are
not also required to be reported on Schedule C.
• Real property already reported on Schedule A-2, Part 4
is not also required to be reported on Schedule B.
• Code filers – do your disclosure categories require
disclosure of real property?
Report interests in real property located in your agency’s
jurisdiction in which you, your spouse or registered domestic
partner, or your dependent children had a direct, indirect, or
beneficial interest totaling $2,000 or more any time during
the reporting period. Real property is also considered to be
“within the jurisdiction” of a local government agency if the
property or any part of it is located within two miles outside
the boundaries of the jurisdiction or within two miles of any
land owned or used by the local government agency. (See
Reference Pamphlet, page 13.)
Interests in real property include:
• An ownership interest (including a beneficial ownership
interest)
• A deed of trust, easement, or option to acquire property
• A leasehold interest (See Reference Pamphlet, page 14.)
• A mining lease
• An interest in real property held in a retirement account
(See Reference Pamphlet, page 15.)
• An interest in real property held by a business entity or
trust in which you, your spouse or registered domestic
partner, and your dependent children together had a 10%
or greater ownership interest (Report on Schedule A-2.)
• Your spouse’s or registered domestic partner’s interests in
real property that are legally held separately by him or her
You are not required to report:
• A residence, such as a home or vacation cabin, used
exclusively as a personal residence (However, a residence
in which you rent out a room or for which you claim a
business deduction may be reportable. If reportable,
report the fair market value of the portion claimed as a tax
deduction.)
Please note: A non-reportable residence can still be
grounds for a conflict of interest and may be disqualifying.
• Interests in real property held through a blind trust (See
Reference Pamphlet, page 16.)
To Complete Schedule B:
• Report the precise location (e.g., an assessor’s parcel
number or address) of the real property.
• Check the box indicating the fair market value of your
interest in the property (regardless of what you owe on the
property).
• Enter the date acquired or disposed only if you initially
acquired or entirely disposed of your interest in the
property during the reporting period.
• Identify the nature of your interest. If it is a leasehold,
disclose the number of years remaining on the lease.
name of lender*
address (Business Address Acceptable)
business activity, if any, of lender
if applicable, list date:
// //
acquired disposed
if applicable, list date:
// //
acquired disposed
18 1818 18
Schedule B
Interests in Real Property
(including rental income)
name
► ASSESSOR’S PARCEL NUMBER OR street address
► ASSESSOR’S PARCEL NUMBER OR street address
city city
interest rate term (months/years)
% none
sources of rental income: if you own a 10% or greater
interest, list the name of each tenant that is a single source of
income of $10,000 or more.
sources of rental income: if you own a 10% or greater
interest, list the name of each tenant that is a single source of
income of $10,000 or more.
nature of interest
ownership/deed of trust easement
leasehold
yrs. remaining other
nature of interest
ownership/deed of trust easement
leasehold
yrs. remaining other
comments:
fair market value
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
over $1,000,000
fair market value
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
over $1,000,000
if rental property, gross income received
over $100,000
$500 - $1,000 $0 - $499 $1,001 - $10,000
$10,001 - $100,000
if rental property, gross income received
over $100,000
$500 - $1,000 $0 - $499 $1,001 - $10,000
$10,001 - $100,000
highest balance during reporting period
guarantor, if applicable
over $100,000
$500 - $1,000 $1,001 - $10,000
$10,001 - $100,000
FPPC Form 700 (2017/2018) Sch. B
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
700
FaIR PolItIcal PRactIceS commISSIon
calIFoRnIa FoRm
name of lender*
address (Business Address Acceptable)
business activity, if any, of lender
interest rate term (months/years)
% none
guarantor, if applicable
highest balance during reporting period
over $100,000
$500 - $1,000 $1,001 - $10,000
$10,001 - $100,000
* You are not required to report loans from commercial lending institutions made in the lender’s regular course of
business on terms available to members of the public without regard to your official status. Personal loans and
loans received not in a lender’s regular course of business must be disclosed as follows:
none none
4600 24th Street
Sacramento
Henry Wells
Sophia Petroillo
2121 Blue Sky Parkway,Sacramento
Restaurant Owner
8 15 Years
name of lender*
address (Business Address Acceptable)
business activity, if any, of lender
if applicable, list date:
// //
acquired disposed
if applicable, list date:
// //
acquired disposed
18 1818 18
Schedule B
Interests in Real Property
(including rental income)
name
► ASSESSOR’S PARCEL NUMBER OR street address
► ASSESSOR’S PARCEL NUMBER OR street address
city city
interest rate term (months/years)
% none
sources of rental income: if you own a 10% or greater
interest, list the name of each tenant that is a single source of
income of $10,000 or more.
sources of rental income: if you own a 10% or greater
interest, list the name of each tenant that is a single source of
income of $10,000 or more.
nature of interest
ownership/deed of trust easement
leasehold
yrs. remaining other
nature of interest
ownership/deed of trust easement
leasehold
yrs. remaining other
comments:
fair market value
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
over $1,000,000
fair market value
$2,000 - $10,000
$10,001 - $100,000
$100,001 - $1,000,000
over $1,000,000
if rental property, gross income received
over $100,000
$500 - $1,000 $0 - $499 $1,001 - $10,000
$10,001 - $100,000
if rental property, gross income received
over $100,000
$500 - $1,000 $0 - $499 $1,001 - $10,000
$10,001 - $100,000
highest balance during reporting period
guarantor, if applicable
over $100,000
$500 - $1,000 $1,001 - $10,000
$10,001 - $100,000
FPPC Form 700 (2017/2018) Sch. B
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
700
FaIR PolItIcal PRactIceS commISSIon
calIFoRnIa FoRm
name of lender*
address (Business Address Acceptable)
business activity, if any, of lender
interest rate term (months/years)
% none
guarantor, if applicable
highest balance during reporting period
over $100,000
$500 - $1,000 $1,001 - $10,000
$10,001 - $100,000
* You are not required to report loans from commercial lending institutions made in the lender’s regular course of
business on terms available to members of the public without regard to your official status. Personal loans and
loans received not in a lender’s regular course of business must be disclosed as follows:
none none
4600 24th Street
Sacramento
Henry Wells
Sophia Petroillo
2121 Blue Sky Parkway,Sacramento
Restaurant Owner
8 15 Years
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 13
(Real property, car, boat, etc.)(Real property, car, boat, etc.)
SCHEDULE C
Income, Loans, & Business
Positions
(Other than Gifts and Travel Payments)
GROSS INCOME RECEIvED No Income - Business Position Only No Income - Business Position OnlyGROSS INCOME RECEIvED
Name
OvER $100,000 OvER $100,000
$500 - $1,000 $500 - $1,000 $1,001 - $10,000 $1,001 - $10,000
$10,001 - $100,000 $10,001 - $100,000
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
► 1. INCOME RECEIVED
NAME OF SOuRCE OF INCOME
ADDRESS (Business Address Acceptable)
BuSINESS ACTIvITY, IF ANY, OF SOuRCE
YOuR BuSINESS POSITION
► 1. INCOME RECEIVED
NAME OF SOuRCE OF INCOME
ADDRESS (Business Address Acceptable)
BuSINESS ACTIvITY, IF ANY, OF SOuRCE
YOuR BuSINESS POSITION
NAME OF LENDER*
ADDRESS (Business Address Acceptable)
BuSINESS ACTIvITY, IF ANY, OF LENDER
INTEREST RATE TERM (Months/Years)
% None
HIGHEST BALANCE DuRING REPORTING PERIOD
$500 - $1,000
$1,001 - $10,000
$10,001 - $100,000
OvER $100,000
Comments:
► 2. LOANS RECEIVED OR OUTSTANDING DURING THE REPORTING PERIOD
* You are not required to report loans from a commercial lending institution, or any indebtedness created as part of
a retail installment or credit card transaction, made in the lender’s regular course of business on terms available to
members of the public without regard to your official status. Personal loans and loans received not in a lender’s
regular course of business must be disclosed as follows:
SECuRITY FOR LOAN
None Personal residence
Real Property
Guarantor
Other
Street address
City
(Describe)
CONSIDERATION FOR WHICH INCOME WAS RECEIvED
Salary Spouse’s or registered domestic partner’s income
(For self-employed use Schedule A-2.)
Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
Sale of
Other
CONSIDERATION FOR WHICH INCOME WAS RECEIvED
Salary Spouse’s or registered domestic partner’s income
(For self-employed use Schedule A-2.)
Partnership (Less than 10% ownership. For 10% or greater use
Schedule A-2.)
Sale of
Other
(Describe)(Describe)
(Describe)(Describe)
Rental Income, list each source of $10,000 or more Rental Income, list each source of $10,000 or moreCommission or Commission or
Loan repayment Loan repayment
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 14
Instructions – Schedule C
Income, Loans, & Business Positions
(Income Other Than Gifts and Travel Payments)
Reporting Income:
Report the source and amount of gross income of $500 or
more you received during the reporting period. Gross income
is the total amount of income before deducting expenses,
losses, or taxes and includes loans other than loans from a
commercial lending institution. (See Reference Pamphlet,
page 11.) You must also report the source of income to your
spouse or registered domestic partner if your community
property share was $500 or more during the reporting period.
The source and income must be reported only if the source
is located in, doing business in, planning to do business in,
or has done business during the previous two years in your
agency’s jurisdiction. (See Reference Pamphlet, page 13.)
Reportable sources of income may be further limited by
your disclosure category located in your agency’s conflict of
interest code.
Reporting Business Positions:
You must report your job title with each reportable business
entity even if you received no income during the reporting
period. Use the comments section to indicate that no income
was received.
Commonly reportable income and loans include:
• Salary/wages, per diem, and reimbursement for expenses
including travel payments provided by your employer
• Community property interest (50%) in your spouse’s
or registered domestic partner’s income - report the
employer’s name and all other required information
• Income from investment interests, such as partnerships,
reported on Schedule A-1
• Commission income not required to be reported on
Schedule A-2 (See Reference Pamphlet, page 8.)
• Gross income from any sale, including the sale of a house
or car (Report your pro rata share of the total sale price.)
• Rental income not required to be reported on Schedule B
• Prizes or awards not disclosed as gifts
• Payments received on loans you made to others
• An honorarium received prior to becoming a public official
(See Reference Pamphlet, page 10.)
• Incentive compensation (See Reference Pamphlet, page
12.)
You are not required to report:
• Salary, reimbursement for expenses or per diem, or
social security, disability, or other similar benefit payments
received by you or your spouse or registered domestic
partner from a federal, state, or local government agency.
• Stock dividends and income from the sale of stock unless
the source can be identified.
• Income from a PERS retirement account.
(See Reference Pamphlet, page 12.)
To Complete Schedule C:
Part 1. Income Received/Business Position Disclosure
• Disclose the name and address of each source of income
or each business entity with which you held a business
position.
• Provide a general description of the business activity if the
source is a business entity.
• Check the box indicating the amount of gross income
received.
• Identify the consideration for which the income was
received.
• For income from commission sales, check the box
indicating the gross income received and list the name of
each source of commission income of $10,000 or more.
(See Reference Pamphlet, page 8.) Note: If you receive
commission income on a regular basis or have an
ownership interest of 10% or more, you must disclose
the business entity and the income on Schedule A-2.
• Disclose the job title or business position, if any, that you
held with the business entity, even if you did not receive
income during the reporting period.
Part 2. Loans Received or Outstanding During the
Reporting Period
• Provide the name and address of the lender.
• Provide a general description of the business activity if the
lender is a business entity.
• Check the box indicating the highest balance of the loan
during the reporting period.
• Disclose the interest rate and the term of the loan.
-For variable interest rate loans, disclose the conditions
of the loan (e.g., Prime + 2) or the average interest rate
paid during the reporting period.
-The term of the loan is the total number of months or
years given for repayment of the loan at the time the
loan was entered into.
• Identify the security, if any, for the loan.Reminders
• Code filers – your disclosure categories may not require
disclosure of all sources of income.
• If you or your spouse or registered domestic partner are
self-employed, report the business entity on Schedule A-2.
• Do not disclose on Schedule C income, loans, or business
positions already reported on Schedules A-2 or B.
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 15
SCHEDULE D
Income – Gifts
Comments:
Name
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
► NAME OF SOuRCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
BuSINESS ACTIvITY, IF ANY, OF SOuRCE
DATE (mm/dd/yy) vALuE DESCRIPTION OF GIFT(S)
// $
// $
// $
► NAME OF SOuRCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
BuSINESS ACTIvITY, IF ANY, OF SOuRCE
DATE (mm/dd/yy) vALuE DESCRIPTION OF GIFT(S)
// $
// $
// $
► NAME OF SOuRCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
BuSINESS ACTIvITY, IF ANY, OF SOuRCE
DATE (mm/dd/yy) vALuE DESCRIPTION OF GIFT(S)
// $
// $
// $
► NAME OF SOuRCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
BuSINESS ACTIvITY, IF ANY, OF SOuRCE
DATE (mm/dd/yy) vALuE DESCRIPTION OF GIFT(S)
// $
// $
// $
► NAME OF SOuRCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
BuSINESS ACTIvITY, IF ANY, OF SOuRCE
DATE (mm/dd/yy) vALuE DESCRIPTION OF GIFT(S)
// $
// $
// $
► NAME OF SOuRCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
BuSINESS ACTIvITY, IF ANY, OF SOuRCE
DATE (mm/dd/yy) vALuE DESCRIPTION OF GIFT(S)
// $
// $
// $
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 16
Instructions – Schedule D
Income – Gifts
Reminders
• Gifts from a single source are subject to a $500 limit in
2019. (See Reference Pamphlet, page 10.)
• Code filers – you only need to report gifts from
reportable sources.
Gift Tracking Mobile Application
• FPPC has created a gift tracking app for mobile
devices that helps filers track gifts and provides a quick
and easy way to upload the information to the Form
700. visit FPPC’s website to download the app.
A gift is anything of value for which you have not provided
equal or greater consideration to the donor. A gift is
reportable if its fair market value is $50 or more. In addition,
multiple gifts totaling $50 or more received during the
reporting period from a single source must be reported.
It is the acceptance of a gift, not the ultimate use to which it is
put, that imposes your reporting obligation. Except as noted
below, you must report a gift even if you never used it or if you
gave it away to another person.
If the exact amount of a gift is unknown, you must make a
good faith estimate of the item’s fair market value. Listing
the value of a gift as “over $50” or “value unknown” is not
adequate disclosure. In addition, if you received a gift through
an intermediary, you must disclose the name, address, and
business activity of both the donor and the intermediary. You
may indicate an intermediary either in the “source” field
after the name or in the “comments” section at the bottom
of Schedule D.
Commonly reportable gifts include:
• Tickets/passes to sporting or entertainment events
• Tickets/passes to amusement parks
• Parking passes not used for official agency business
• Food, beverages, and accommodations, including those
provided in direct connection with your attendance at a
convention, conference, meeting, social event, meal, or like
gathering
• Rebates/discounts not made in the regular course of
business to members of the public without regard to official
status
• Wedding gifts (See Reference Pamphlet, page 16)
• An honorarium received prior to assuming office (You may
report an honorarium as income on Schedule C, rather
than as a gift on Schedule D, if you provided services of
equal or greater value than the payment received. See
Reference Pamphlet, page 10.)
• Transportation and lodging (See Schedule E.)
• Forgiveness of a loan received by you
You are not required to disclose:
• Gifts that were not used and that, within 30 days after
receipt, were returned to the donor or delivered to a
charitable organization or government agency without
being claimed by you as a charitable contribution for tax
purposes
• Gifts from your spouse or registered domestic partner,
child, parent, grandparent, grandchild, brother, sister, and
certain other famly members (See Regulation 18942 for a
complete list.). The exception does not apply if the donor
was acting as an agent or intermediary for a reportable
source who was the true donor.
• Gifts of similar value exchanged between you and an
individual, other than a lobbyist registered to lobby your
state agency, on holidays, birthdays, or similar occasions
• Gifts of informational material provided to assist you in the
performance of your official duties (e.g., books, pamphlets,
reports, calendars, periodicals, or educational seminars)
• A monetary bequest or inheritance (However, inherited
investments or real property may be reportable on other
schedules.)
• Personalized plaques or trophies with an individual value of
less than $250
• Campaign contributions
• up to two tickets, for your own use, to attend a fundraiser
for a campaign committee or candidate, or to a fundraiser
for an organization exempt from taxation under Section
501(c)(3) of the Internal Revenue Code. The ticket must
be received from the organization or committee holding the
fundraiser.
• Gifts given to members of your immediate family if the
source has an established relationship with the family
member and there is no evidence to suggest the donor had
a purpose to influence you. (See Regulation 18943.)
• Free admission, food, and nominal items (such as a pen,
pencil, mouse pad, note pad or similar item) available to
all attendees, at the event at which the official makes a
speech (as defined in Regulation 18950(b)(2)), so long as
the admission is provided by the person who organizes the
event.
• Any other payment not identified above, that would
otherwise meet the definition of gift, where the payment is
made by an individual who is not a lobbyist registered to
lobby the official’s state agency, where it is clear that the
gift was made because of an existing personal or business
relationship unrelated to the official’s position and there
is no evidence whatsoever at the time the gift is made to
suggest the donor had a purpose to influence you.
To Complete Schedule D:
• Disclose the full name (not an acronym), address, and, if a
business entity, the business activity of the source.
• Provide the date (month, day, and year) of receipt, and
disclose the fair market value and description of the gift.
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 17
SCHEDULE E
Income – Gifts
Travel Payments, Advances,
and Reimbursements
Name
Comments:
700
FAIR POLITICAL PRACTICES COMMISSION
CALIFORNIA FORM
• Mark either the gift or income box.
• Mark the “501(c)(3)” box for a travel payment received from a nonprofit 501(c)(3) organization
or the “Speech” box if you made a speech or participated in a panel. Per Government Code
Section 89506, these payments may not be subject to the gift limit. However, they may result
in a disqualifying conflict of interest.
• For gifts of travel, provide the travel destination.
DATE(S): // - // AMT: $
(If gift)
DATE(S): // - // AMT: $
(If gift)
► NAME OF SOuRCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
CITY AND STATE
501 (c)(3) or DESCRIBE BuSINESS ACTIvITY, IF ANY, OF SOuRCE
► NAME OF SOuRCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
CITY AND STATE
501 (c)(3) or DESCRIBE BuSINESS ACTIvITY, IF ANY, OF SOuRCE
► NAME OF SOuRCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
CITY AND STATE
501 (c)(3) or DESCRIBE BuSINESS ACTIvITY, IF ANY, OF SOuRCE
► NAME OF SOuRCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
CITY AND STATE
501 (c)(3) or DESCRIBE BuSINESS ACTIvITY, IF ANY, OF SOuRCE
► MuST CHECk ONE:
Made a Speech/Participated in a Panel
Other - Provide Description
Gift -or- Income
► If Gift, Provide Travel Destination
► MuST CHECk ONE:
Made a Speech/Participated in a Panel
Other - Provide Description
Gift -or- Income
► If Gift, Provide Travel Destination
► MuST CHECk ONE:
Made a Speech/Participated in a Panel
Other - Provide Description
Gift -or- Income
► If Gift, Provide Travel Destination
► MuST CHECk ONE:
Made a Speech/Participated in a Panel
Other - Provide Description
Gift -or- Income
► If Gift, Provide Travel Destination
DATE(S): // - // AMT: $
(If gift)
DATE(S): // - // AMT: $
(If gift)
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 18
Travel payments reportable on Schedule E include advances
and reimbursements for travel and related expenses,
including lodging and meals.
Gifts of travel may be subject to the gift limit. In addition,
certain travel payments are reportable gifts, but are not
subject to the gift limit. To avoid possible misinterpretation
or the perception that you have received a gift in excess of
the gift limit, you may wish to provide a specific description of
the purpose of your travel. (See the FPPC fact sheet entitled
“Limitations and Restrictions on Gifts, Honoraria, Travel,
and Loans” to read about travel payments under section
89506(a).)
You are not required to disclose:
• Travel payments received from any state, local, or federal
government agency for which you provided services equal
or greater in value than the payments received, such as
reimbursement for travel on agency business from your
government agency employer.
• A payment for travel from another local, state, or federal
government agency and related per diem expenses when
the travel is for education, training or other inter-agency
programs or purposes.
• Travel payments received from your employer in the
normal course of your employment that are included in the
income reported on Schedule C.
• A travel payment that was received from a nonprofit
entity exempt from taxation under Internal Revenue
Code Section 501(c)(3) for which you provided equal or
greater consideration, such as reimbursement for travel on
business for a 501(c)(3) organization for which you are a
board member.
Note: Certain travel payments may not be reportable
if reported via email on Form 801 by your agency.
To Complete Schedule E:
• Disclose the full name (not an acronym) and address of the
source of the travel payment.
• Identify the business activity if the source is a business
entity.
• Check the box to identify the payment as a gift or income,
report the amount, and disclose the date(s).
-Travel payments are gifts if you did not provide
services that were equal to or greater in value than the
payments received. You must disclose gifts totaling
$50 or more from a single source during the period
covered by the statement.
When reporting travel payments that are gifts, you must
provide a description of the gift, the date(s) received,
and the travel destination.
-Travel payments are income if you provided services
that were equal to or greater in value than the
payments received. You must disclose income totaling
$500 or more from a single source during the period
covered by the statement. You have the burden of
proving the payments are income rather than gifts.
When reporting travel payments as income, you must
describe the services you provided in exchange for the
payment. You are not required to disclose the date(s)
for travel payments that are income.
Example:
City council member MaryClaire Chandler is the chair of a
501(c)(6) trade association, and the association pays for her
travel to attend its meetings. Because MaryClaire is deemed
to be providing equal or
greater consideration for
the travel payment by
virtue of serving on the
board, this payment may
be reported as income.
Payments for MaryClaire
to attend other events for
which she is not providing
services are likely
considered gifts. Note that
the same payment from a
501(c)3 would NOT be reportable.
Example:
Mayor kim travels to China on a trip organized by China
Silicon valley Business Development, a California nonprofit,
501(c)(6) organization. The Chengdu Municipal People’s
Government pays for Mayor kim’s airfare and travel costs,
as well as his meals and
lodging during the trip.
The trip’s agenda shows
that the trip’s purpose is
to promote job creation
and economic activity in
China and in Silicon valley,
so the trip is reasonably
related to a governmental
purpose. Thus, Mayor
Kim must report the gift
of travel, but the gift is
exempt from the gift
limit. In this case, the travel payments are not subject to the
gift limit because the source is a foreign government and
because the travel is reasonably related to a governmental
purpose. (Section 89506(a)(2).) Note that Mayor kim could
be disqualified from participating in or making decisions about
The Chengdu Municipal People’s Government for 12 months.
Also note that if China Silicon Valley Business Development
(a 501(c)(6) organization) paid for the travel costs rather
than the governmental organization, the payments would be
subject to the gift limits. (See the FPPC fact sheet, Limitations
and Restrictions on Gifts, Honoraria, Travel and Loans, at
www.fppc.ca.gov.)
Instructions – Schedule E
Travel Payments, Advances,
and Reimbursements
SChEDuLE E
Income – Gifts
Travel Payments, Advances,
and Reimbursements
Name
Comments:
FPPC Form 700 (2016/2017) Sch. E
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
700
FAIr POLITICAL PrACTICES COMMISSION
CALIFORNIA FORM
• Mark either the gift or income box.
• Mark the “501(c)(3)” box for a travel payment received from a nonprofit 501(c)(3) organization
or the “Speech” box if you made a speech or participated in a panel. These payments are not
subject to the gift limit, but may result in a disqualifying conflict of interest.
• For gifts of travel, provide the travel destination.
DATE(S): // - // AMT: $
(If gift)
DATE(S): // - // AMT: $
(If gift)
► NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
CITY AND STATE
501 (c)(3) or DESCRIBE BuSINESS ACTIvITY, IF ANY, OF SOuRCE
► NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
CITY AND STATE
501 (c)(3) or DESCRIBE BuSINESS ACTIvITY, IF ANY, OF SOuRCE
► NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
CITY AND STATE
501 (c)(3) or DESCRIBE BuSINESS ACTIvITY, IF ANY, OF SOuRCE
► NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
CITY AND STATE
501 (c)(3) or DESCRIBE BuSINESS ACTIvITY, IF ANY, OF SOuRCE
► MuST CHECK ONE:
Made a Speech/Participated in a Panel
Other - Provide Description
Gift -or- Income
► If Gift, Provide Travel Destination
► MuST CHECK ONE:
Made a Speech/Participated in a Panel
Other - Provide Description
Gift -or- Income
► If Gift, Provide Travel Destination
► MuST CHECK ONE:
Made a Speech/Participated in a Panel
Other - Provide Description
Gift -or- Income
► If Gift, Provide Travel Destination
► MuST CHECK ONE:
Made a Speech/Participated in a Panel
Other - Provide Description
Gift -or- Income
► If Gift, Provide Travel Destination
DATE(S): // - // AMT: $
(If gift)
DATE(S): // - // AMT: $
(If gift)
Health Services Trade Association
1230 K Street,Suite 610
Sacramento,CA
Association of Healthcare Workers
150.00
Travel reimbursement for
board meeting.
Chengdu Municipal People's Government
2 Caoshi St,CaoShiJie,Qingyang qu,Chengdu Shi,
Sichuan Sheng,China,610000
09 04 09 08 3,874.38
Travel reimbursement for
trip to China.
Sichuan Sheng,China
XX XX
Clear Page Print
SChEDuLE E
Income – Gifts
Travel Payments, Advances,
and Reimbursements
Name
Comments:
FPPC Form 700 (2016/2017) Sch. E
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
700
FAIr POLITICAL PrACTICES COMMISSION
CALIFORNIA FORM
• Mark either the gift or income box.
• Mark the “501(c)(3)” box for a travel payment received from a nonprofit 501(c)(3) organization
or the “Speech” box if you made a speech or participated in a panel. These payments are not
subject to the gift limit, but may result in a disqualifying conflict of interest.
• For gifts of travel, provide the travel destination.
DATE(S): // - // AMT: $
(If gift)
DATE(S): // - // AMT: $
(If gift)
► NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
CITY AND STATE
501 (c)(3) or DESCRIBE BuSINESS ACTIvITY, IF ANY, OF SOuRCE
► NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
CITY AND STATE
501 (c)(3) or DESCRIBE BuSINESS ACTIvITY, IF ANY, OF SOuRCE
► NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
CITY AND STATE
501 (c)(3) or DESCRIBE BuSINESS ACTIvITY, IF ANY, OF SOuRCE
► NAME OF SOURCE (Not an Acronym)
ADDRESS (Business Address Acceptable)
CITY AND STATE
501 (c)(3) or DESCRIBE BuSINESS ACTIvITY, IF ANY, OF SOuRCE
► MuST CHECK ONE:
Made a Speech/Participated in a Panel
Other - Provide Description
Gift -or- Income
► If Gift, Provide Travel Destination
► MuST CHECK ONE:
Made a Speech/Participated in a Panel
Other - Provide Description
Gift -or- Income
► If Gift, Provide Travel Destination
► MuST CHECK ONE:
Made a Speech/Participated in a Panel
Other - Provide Description
Gift -or- Income
► If Gift, Provide Travel Destination
► MuST CHECK ONE:
Made a Speech/Participated in a Panel
Other - Provide Description
Gift -or- Income
► If Gift, Provide Travel Destination
DATE(S): // - // AMT: $
(If gift)
DATE(S): // - // AMT: $
(If gift)
Health Services Trade Association
1230 K Street,Suite 610
Sacramento,CA
Association of Healthcare Workers
150.00
Travel reimbursement for
board meeting.
Chengdu Municipal People's Government
2 Caoshi St,CaoShiJie,Qingyang qu,Chengdu Shi,
Sichuan Sheng,China,610000
09 04 09 08 3,874.38
Travel reimbursement for
trip to China.
Sichuan Sheng,China
XX XX
Clear Page Print
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 19
Restrictions and Prohibitions
The Political Reform Act (Gov. Code Sections 81000-
91014) requires most state and local government officials
and employees to publicly disclose their personal assets
and income. They also must disqualify themselves
from participating in decisions that may affect their
personal economic interests. The Fair Political Practices
Commission (FPPC) is the state agency responsible for
issuing the attached Statement of Economic Interests,
Form 700, and for interpreting the law’s provisions.
Gift Prohibition
Gifts received by most state and local officials, employees,
and candidates are subject to a limit. In 2017 and 2018,
the gift limit was $470 from a single source during a
calendar year. In 2019-2020, the gift limit increased to
$500 from a single source during a calendar year.
In addition, state officials, state candidates, and certain
state employees are subject to a $10 limit per calendar
month on gifts from lobbyists and lobbying firms registered
with the Secretary of State. See Reference Pamphlet,
page 10.
State and local officials and employees should check with
their agency to determine if other restrictions apply.
Disqualification
Public officials are, under certain circumstances, required
to disqualify themselves from making, participating in, or
attempting to influence governmental decisions that will
affect their economic interests. This may include interests
they are not required to disclose. For example, a personal
residence is often not reportable, but may be grounds for
disqualification. Specific disqualification requirements
apply to 87200 filers (e.g., city councilmembers, members
of boards of supervisors, planning commissioners, etc.).
These officials must publicly identify the economic interest
that creates a conflict of interest and leave the room before
a discussion or vote takes place at a public meeting. For
more information, consult Government Code Section
87105, Regulation 18707, and the Guide to Recognizing
Conflicts of Interest at www.fppc.ca.gov.
Honorarium Ban
Most state and local officials, employees, and candidates
are prohibited from accepting an honorarium for any
speech given, article published, or attendance at a
conference, convention, meeting, or like gathering. (See
Reference Pamphlet, page 10.)
Loan Restrictions
Certain state and local officials are subject to restrictions
on loans. (See Reference Pamphlet, page 14.)
Post-Governmental Employment
There are restrictions on representing clients or employers
before former agencies. The provisions apply to elected
state officials, most state employees, local elected officials,
county chief administrative officers, city managers,
including the chief administrator of a city, and general
managers or chief administrators of local special districts
and JPAs. The FPPC website has fact sheets explaining
the provisions.
Late Filing
The filing officer who retains originally-signed or
electronically filed statements of economic interests may
impose on an individual a fine for any statement that is filed
late. The fine is $10 per day up to a maximum of $100.
Late filing penalties may be reduced or waived under certain
circumstances.
Persons who fail to timely file their Form 700 may be
referred to the FPPC’s Enforcement Division (and, in some
cases, to the Attorney General or district attorney) for
investigation and possible prosecution. In addition to the
late filing penalties, a fine of up to $5,000 per violation may
be imposed.
For assistance concerning reporting, prohibitions, and
restrictions under the Act:
• Email questions to advice@fppc.ca.gov.
• Call the FPPC toll-free at (866) 275-3772.
Form 700 is a Public Document
Public Access Must Be Provided
Statements of Economic Interests are public
documents. The filing officer must permit any
member of the public to inspect and receive a copy
of any statement.
• Statements must be available as soon as possible
during the agency's regular business hours, but
in any event not later than the second business
day after the statement is received. Access to the
Form 700 is not subject to the Public Records Act
procedures.
• No conditions may be placed on persons seeking
access to the forms.
• No information or identification may be required
from persons seeking access.
• Reproduction fees of no more than 10 cents per
page may be charged.
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 20
Questions and Answers
General
Q. What is the reporting period for disclosing interests
on an assuming office statement or a candidate
statement?
A. On an assuming office statement, disclose all
reportable investments, interests in real property, and
business positions held on the date you assumed
office. In addition, you must disclose income (including
loans, gifts and travel payments) received during the 12
months prior to the date you assumed office.
On a candidate statement, disclose all reportable
investments, interests in real property, and business
positions held on the date you file your declaration of
candidacy. You must also disclose income (including
loans, gifts and travel payments) received during the
12 months prior to the date you file your declaration of
candidacy.
q. I hold two other board positions in addition to my
position with the county. Must I file three statements of
economic interests?
A. Yes, three are required. However, you may complete
one statement listing the county and the two boards on
the Cover Page or an attachment as the agencies for
which you will be filing. Report your economic interests
using the largest jurisdiction and highest disclosure
requirements assigned to you by the three agencies.
Make two copies of the entire statement before
signing it, sign each copy with an original signature,
and distribute one original to the county and to each
of the two boards. Remember to complete separate
statements for positions that you leave or assume
during the year.
q. I am a department head who recently began acting as
city manager. Should I file as the city manager?
A. Yes. File an assuming office statement as city
manager. Persons serving as “acting,” “interim,” or
“alternate” must file as if they hold the position because
they are or may be performing the duties of the
position.
q. My spouse and I are currently separated and in the
process of obtaining a divorce. Must I still report my
spouse’s income, investments, and interests in real
property?
A. Yes. A public official must continue to report a spouse’s
economic interests until such time as dissolution of
marriage proceedings is final. However, if a separate
property agreement has been reached prior to that
time, your estranged spouse’s income may not have to
be reported. Contact the FPPC for more information.
q. As a designated employee, I left one state agency to
work for another state agency. Must I file a leaving
office statement?
A. Yes. You may also need to file an assuming office
statement for the new agency.
Investment Disclosure
q. I have an investment interest in shares of stock in a
company that does not have an office in my jurisdiction.
Must I still disclose my investment interest in this
company?
A. Probably. The definition of “doing business in the
jurisdiction” is not limited to whether the business has
an office or physical location in your jurisdiction. (See
Reference Pamphlet, page 13.)
q. My spouse and I have a living trust. The trust holds
rental property in my jurisdiction, our primary residence,
and investments in diversified mutual funds. I have full
disclosure. How is this trust disclosed?
A. Disclose the name of the trust, the rental property and
its income on Schedule A-2. Your primary residence
and investments in diversified mutual funds registered
with the SEC are not reportable.
q. I am required to report all investments. I have an IRA
that contains stocks through an account managed by
a brokerage firm. Must I disclose these stocks even
though they are held in an IRA and I did not decide
which stocks to purchase?
A. Yes. Disclose on Schedule A-1 or A-2 any stock worth
$2,000 or more in a business entity located in or doing
business in your jurisdiction.
Q. The value of my stock changed during the reporting
period. How do I report the value of the stock?
A. You are required to report the highest value that the
stock reached during the reporting period. You may
use your monthly statements to determine the highest
value. You may also use the entity’s website to
determine the highest value. You are encouraged to
keep a record of where you found the reported value.
Note that for an assuming office statement, you must
report the value of the stock on the date you assumed
office.
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 21
Questions and Answers
Continued
q. I am the sole owner of my business, an S-Corporation.
I believe that the nature of the business is such that it
cannot be said to have any “fair market value” because
it has no assets. I operate the corporation under
an agreement with a large insurance company. My
contract does not have resale value because of its
nature as a personal services contract. Must I report
the fair market value for my business on Schedule A-2
of the Form 700?
A. Yes. Even if there are no tangible assets, intangible
assets, such as relationships with companies and
clients are commonly sold to qualified professionals.
The “fair market value” is often quantified for other
purposes, such as marital dissolutions or estate
planning. In addition, the IRS presumes that “personal
services corporations” have a fair market value. A
professional “book of business” and the associated
goodwill that generates income are not without a
determinable value. The Form 700 does not require a
precise fair market value; it is only necessary to check
a box indicating the broad range within which the value
falls.
q. I own stock in IBM and must report this investment
on Schedule A-1. I initially purchased this stock in
the early 1990s; however, I am constantly buying
and selling shares. Must I note these dates in the
“Acquired” and “Disposed” fields?
A. No. You must only report dates in the “Acquired” or
“Disposed” fields when, during the reporting period, you
initially purchase a reportable investment worth $2,000
or more or when you dispose of the entire investment.
You are not required to track the partial trading of an
investment.
q. On last year’s filing I reported stock in Encoe valued at
$2,000 - $10,000. Late last year the value of this stock
fell below and remains at less than $2,000. How should
this be reported on this year’s statement?
A. You are not required to report an investment if the value
was less than $2,000 during the entire reporting period.
However, because a disposed date is not required for
stocks that fall below $2,000, you may want to report
the stock and note in the “comments” section that the
value fell below $2,000. This would be for informational
purposes only; it is not a requirement.
Q. We have a Section 529 account set up to save money
for our son’s college education. Is this reportable?
A. If the Section 529 account contains reportable interests
(e.g., common stock valued at $2,000 or more), those
interests are reportable (not the actual Section 529
account). If the account contains solely mutual funds,
then nothing is reported.
Income Disclosure
q. I reported a business entity on Schedule A-2. Clients of
my business are located in several states. Must I report
all clients from whom my pro rata share of income is
$10,000 or more on Schedule A-2, Part 3?
A. No, only the clients located in or doing business on a
regular basis in your jurisdiction must be disclosed.
q. I believe I am not required to disclose the names of
clients from whom my pro rata share of income is
$10,000 or more on Schedule A-2 because of their right
to privacy. Is there an exception for reporting clients’
names?
A. Regulation 18740 provides a procedure for requesting
an exemption to allow a client’s name not to be
disclosed if disclosure of the name would violate a
legally recognized privilege under California or Federal
law. This regulation may be obtained from our website
at www.fppc.ca.gov. (See Reference Pamphlet, page
14.)
q. I am sole owner of a private law practice that is not
reportable based on my limited disclosure category.
However, some of the sources of income to my law
practice are from reportable sources. Do I have to
disclose this income?
A. Yes, even though the law practice is not reportable,
reportable sources of income to the law practice of
$10,000 or more must be disclosed. This information
would be disclosed on Schedule C with a note in the
“comments” section indicating that the business entity
is not a reportable investment. The note would be for
informational purposes only; it is not a requirement.
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 22
Questions and Answers
Continued
q. I am the sole owner of my business. Where do I
disclose my income - on Schedule A-2 or Schedule C?
A. Sources of income to a business in which you have an
ownership interest of 10% or greater are disclosed on
Schedule A-2. (See Reference Pamphlet, page 8.)
q. My husband is a partner in a four-person firm where
all of his business is based on his own billings and
collections from various clients. How do I report my
community property interest in this business and the
income generated in this manner?
A. If your husband’s investment in the firm is 10% or
greater, disclose 100% of his share of the business
on Schedule A-2, Part 1 and 50% of his income on
Schedule A-2, Parts 2 and 3. For example, a client of
your husband’s must be a source of at least $20,000
during the reporting period before the client’s name is
reported.
q. How do I disclose my spouse’s or registered domestic
partner’s salary?
A. Report the name of the employer as a source of income
on Schedule C.
q. I am a doctor. For purposes of reporting $10,000
sources of income on Schedule A-2, Part 3, are the
patients or their insurance carriers considered sources
of income?
A. If your patients exercise sufficient control by selecting
you instead of other doctors, then your patients, rather
than their insurance carriers, are sources of income to
you. (See Reference Pamphlet, page 14.)
q. I received a loan from my grandfather to purchase my
home. Is this loan reportable?
A. No. Loans received from family members are not
reportable.
q. Many years ago, I loaned my parents several thousand
dollars, which they paid back this year. Do I need to
report this loan repayment on my Form 700?
A. No. Payments received on a loan made to a family
member are not reportable.
Real Property Disclosure
Q. During this reporting period we switched our principal
place of residence into a rental. I have full disclosure
and the property is located in my agency’s jurisdiction,
so it is now reportable. Because I have not reported
this property before, do I need to show an “acquired”
date?
A. No, you are not required to show an “acquired” date
because you previously owned the property. However,
you may want to note in the “comments” section that
the property was not previously reported because it was
used exclusively as your residence. This would be for
informational purposes only; it is not a requirement.
q. I am a city manager, and I own a rental property located
in an adjacent city, but one mile from the city limit. Do I
need to report this property interest?
A. Yes. You are required to report this property because
it is located within 2 miles of the boundaries of the city
you manage.
q. Must I report a home that I own as a personal residence
for my daughter?
A. You are not required to disclose a home used as a
personal residence for a family member unless you
receive income from it, such as rental income.
q. I am a co-signer on a loan for a rental property owned
by a friend. Since I am listed on the deed of trust, do I
need to report my friend’s property as an interest in real
property on my Form 700?
A. No. Simply being a co-signer on a loan for property
does not create a reportable interest in real property for
you.
Gift Disclosure
Q. If I received a reportable gift of two tickets to a concert
valued at $100 each, but gave the tickets to a friend
because I could not attend the concert, do I have any
reporting obligations?
A. Yes. Since you accepted the gift and exercised
discretion and control of the use of the tickets, you must
disclose the gift on Schedule D.
FPPC Form 700 (2018/2019)
FPPC Advice Email: advice@fppc.ca.gov
FPPC Toll-Free Helpline: 866/275-3772 www.fppc.ca.gov
Page - 23
Q. Julia and Jared Benson, a married couple, want to
give a piece of artwork to a county supervisor. Is each
spouse considered a separate source for purposes of
the gift limit and disclosure?
A. Yes, each spouse may make a gift valued at the gift
limit during a calendar year. For example, during 2018
the gift limit was $470, so the Bensons may have given
the supervisor artwork valued at no more than $940.
The supervisor must identify Jared and Julia Benson as
the sources of the gift.
q. I am a Form 700 filer with full disclosure. Our agency
holds a holiday raffle to raise funds for a local charity.
I bought $10 worth of raffle tickets and won a gift
basket valued at $120. The gift basket was donated by
Doug Brewer, a citizen in our city. At the same event,
I bought raffle tickets for, and won a quilt valued at
$70. The quilt was donated by a coworker. Are these
reportable gifts?
A. Because the gift basket was donated by an outside
source (not an agency employee), you have received a
reportable gift valued at $110 (the value of the basket
less the consideration paid). The source of the gift
is Doug Brewer and the agency is disclosed as the
intermediary. Because the quilt was donated by an
employee of your agency, it is not a reportable gift.
q. My agency is responsible for disbursing grants. An
applicant (501(c)(3) organization) met with agency
employees to present its application. At this meeting,
the applicant provided food and beverages. Would
the food and beverages be considered gifts to the
employees? These employees are designated in our
agency’s conflict of interest code and the applicant is a
reportable source of income under the code.
A. Yes. If the value of the food and beverages consumed
by any one filer, plus any other gifts received from the
same source during the reporting period total $50 or
more, the food and beverages would be reported using
the fair market value and would be subject to the gift
limit.
q. I received free admission to an educational conference
related to my official duties. Part of the conference
fees included a round of golf. Is the value of the golf
considered informational material?
A. No. The value of personal benefits, such as golf,
attendance at a concert, or sporting event, are gifts
subject to reporting and limits.
Questions and Answers
Continued