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CM2018-040 COUNCIL CONFLICT OF INTEREST FORMCM2018-040 DATE: June 14, 2018 MEMORANDUM TO: Honorable Mayor and City Co FROM: Konradt Bartlam, City Man RE: COUNCIL CONFLICT OF INTEJZEST FORM At the June 12, 2018, City Council meeting, Council Member Marquez requested that the City Clerk provide a form to each Council Member prior to each City Council meeting to provide a means for Council Members to identify any items on the agenda which are potential conflicts of interest and would require recusal from the vote. Attached is a sample form used by the San Bernardino County Transportation Authority (SBCTA) that will accomplish that goal. If a Council Member has a Conflict of Interest pursuant to Government Code Section 84308 or 87100, that would preclude them from participating in the discussion of or voting on an item on the agenda, they would complete this form and provide the original to the City Clerk prior to the discussion on the item. As stated in the form, if the item is on the Consent Calendar the Council Member would state the reason for abstention and remain in the room. If the item appears on the Discussion Calendar or as a Public Hearing, they would state the reason for abstention and leave the meeting room until the item is completed. The minutes of the meeting would reflect the abstention due to recusal. The Conflict of Interest form is a public record and would be made a part of the official record. Discussion as to whether or not the Council wishes to make this form a requirement will be brought back before the Council for a vote at the June 26, 2018, City Council meeting. If you have any questions, please contact Cheryl Balz, City Clerk, at extension 2624. KB:CB:ssr cc: Cheryl Balz, City Clerk Attachment Conflict of Interest Form Purpose: If you have a Conflict of Interest pursuant to Gov't. Code sec. 84308 or sec. 87100 et seq., that precludes you from participating in discussion of or voting on an item on the Agenda, or if you wish to avoid the appearance of a conflict of interest by abstaining on an item on the Agenda, please complete this form. Instructions: If the item is on the Consent Calendar: 1) state the reason for your abstention, 2) prior to the vote complete and provide this form to the Clerk of the Board, and 3) you may remain in the meeting room. Ifthe item is on the Discussion Calendar: 1) state the reason for your abstention, 2) prior to discussion of the item complete and provide this form to the Clerk of the Board, and 3 leave the meeting room. I. Board Member Wormation Board Member Name City/County Name Meeting Date II. Campaign Contributions 1. I have a disqualifying campaign contribution of over $250 from , . gdentify the name of the oonpanyand/or ndividuaD and therefore I am abstaining from participation on Agenda Item , Subject: 2. 1 have a disqualifying campaign contribution of over $250 from gdentify the name of the coapanyandtor individual} and therefore I am abstaining from participation on Agenda Item , Subject: 3. 1 have a disqualifying campaign contribution of over $250 from , gdakfy the name of the conparry andlor individual) and therefore I am abstaining from participation on Agenda Item , Subject: 4. 1 have a disqualifying campaign contribution of over $250 from gdenlify the name of the oonpany and/or ndividu40 and therefore I am abstaining from participation on. Agenda Item Subject: III. Financial Interest 1. I have a financial interest of , from/in (Stale income, real property ederest,. investment, orbusiness position) gdentifynarne of oorMany orpropety location) and therefore I am abstaining from participation on Agenda Item , Subject: 2. I have a financial interest of , from/in (3Ueincome,real property mtrinveumeh,orbusinessposLon)(Ideu fynimeofconpanyyorpropetylocation) and therefore I am abstaining from participation on Agenda Item , Subject: IV. Other 1. I do not have a legal conflict of interest but wish to avoid the appearance of a conflict of interest by abstaining from participating in Agenda Item No. , Subject: 2. 1 do not have a legal conflict of interest but wish to avoid the appearance of a conflict of interest by abstaining from participating in Agenda Item No, , Subject: V. Signature Board Member Signature: Date: Please remember to state the reason for your abstention into the public record and tum in the completed form to the Clerk of the Board prior to consideration of the agenda item(s). Form 3, Conflict of Interest Form