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HomeMy WebLinkAbout2011_0408_Agenda_MeetingPacket_Amended_1 Paul Weil Members: Chair Kurt Akamine Kathy Clark Mark Hubbard Brad Nagano Vice-Chair Warren Perry Secretary COUNTY OF KAUAI BOARD OF ETHICS AMENDED NOTICE OF MEETING AND AGENDA Friday,April 8, 2011 9:00 a.m, or shortly thereafter Mo'ikeha Building,Liquor Conference Room 3 4444 Rice Street,1,111m'e, HI 96766 CALL TO ORDER APPROVAL OF AGENDA APPROVAL OF MINUTES Regular Session Minutes of February 11, 2011 COMMUNICATIONS BOE 2011-06 Memorandum dated February 9, 2011, from Derek S.K.Kawakami, Councilmember, regarding Possible Conflict of Interest with Bill No. 2400, Relating to Plastic Bag Reduction,February 9, 2011 Council Agenda BOE 2011-07 Memorandum dated March 16, 2011, from Nadine K.Nakamura, Councilmember, regarding Possible Conflict of Interest: Resolution No 2011-42 (Filing of an annual Action Plan for the CDBG) REQUEST FOR AN ADVISORY OPINION RAO 11-002 Request dated March 23,2011, from Imaikalani Aiu, Special Assistant to the Housing Director, as to whether there is a conflict for him to subcontract as a planning consultant to write Environmental Assessments for small projects, including those proposed by County Agencies other than the Housing Agency. RAO 11-003 Request from Mauna Kea Trask, Deputy County Attorney, as to whether there is a conflict for him to participate as the narrator/main character in a local documentary about fishing and the fishing industry in Hawaii An Equal Opportunity Etnplqver I A 0/0-01 M BUSINESS BOE 2011-05 Discussion and decision-making on Disclosure Statement, Section III Annual Income to determine if the S 10,000 reporting level needs to be revised (ongoing from 2/I I/11) (a)Article X1V,Code of Ethics,The Constitution of the State of Hawaii (b)Sample Form of State Ethics Disclosure Form DISCLOSURES for review and examination by the Board of Ethics: a. Johanna Ventura(Open Space Commission) b. Dee Crowell(Deputy Planning Director) c. Peter Nakamura(County Clerk) d. John Blalock(Deputy Fire Chief) e. Bernard Carvalho,Jr. (Mayor) f Eugene Jimenez(Housing Director) g. William Eddy(Deputy Manager-Engineer—DONIV) h. David Craddick(Manager&Chief Engineer—DOW) i. Robert Crowell(Salary Commission) j. Andrea Suzuki(Deputy County Attorney) k. Gaylord Fukumoto (Building Board of Appeals) 1. Darnney Proudfoot (Fire Commission) in. John Low(Civil Sei vice Commission) n. Randy Finlay(Salary Commission) o. Dane Oda(Liquor Control Commission) p. Jennifer Winn(Deputy County Attorney) q. Ernest Barreira(Assistant Chief Procurement Officer) r. Tim Bynum (County Council) s. Nancy McMahon(Historic Preservation Review Commission) t. Wayne Katayama(Planning Commission) u. Herman Texeira(Planning Commission) v. Melinda Mendes(Deputy Prosecuting Attorney) ANNOUNCEMENTS Next Meeting: Friday, May 13, 2011 - 9:00 am., Mo*ikeha Building,Liquor Conference Room 3 ADJOURNMENT NOTICE OF EXECUTIVE SESSION Pursuant to Hawaii Revised Statutes §92-7 (a), the Commission may, when deemed necessary, hold an executive session on any agenda item without written public notice if the executive session was not anticipated in advance. Any such executive session shall be held pursuant to HRS §92-4 and shall be limited to those items described in FIRS§92-5(a). c: Mona Clark,Deputy County Attorney Board of Ethics-April 8,2011 ARM 0 0 PUBLIC COMMENTS AND TESTIMONY Persons wishing to offer comments are encouraged to submit written testimony at least 24- hours prior to the meeting indicating: 1. Your name and if applicable, your position/title and organization you are representing, 2. The agenda item that you are providing comments on; and 3. Whether you will be testifying in person or submitting written comments only. 4. If you are unable to submit your testimony at least 24 hours prior to the meeting, please provide 10 copies of your written testimony at the meeting clearly indicating the name of the testifier; and While every effort will be made to copy, organize and collate all testimony received, materials received on the day of the meeting or improperly identified may be distributed to the members after the meeting is concluded. The length of time allocated to persons wishing to present verbal testimony may be limited at the discretion of the chairperson or presiding member. Send written testimony to-, Board of Ethics Attn: Barbara Davis Office of Boards&Commissions 4444 Rice Street, Suite 150 L-1hu'e, 1-11 96766 Email: bdavis etvkauai.gov Fax. 241-5127 Phone: 241-4919 SPECIALASSISTANCE If you need an alternate format or an auxiliary aid to participate, please contact the Boards& Commissions Support Clerk at 241-4919 at least five(5)working days prior to the meeting, 3 Board of Ethics -April 8, 2011 C C € _ 3 t E f I 0 � co U1 g 21 f0 _ _ �3 -Cl u) i ,.� f0 o a) {: cc o S a) tJ T o i C7} (27 m - C ea i � pl { ! 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Cc 0 �w -a !E -t-- — > -0 0 0 a FS 's; o �— .9 17 -C — C: 5 r- 0 3: 4- 8L 0 U) 10 0 a 0 o s E ') - o — — — 0) = c 0 0 m c E 0 -05 00 :5 a r- 0 0 (D 0::' -0 0 E 1-C cu a "M E o ' 0 -a IE o o 0 c m - 0 0 0 m Ito m m w a) W en o m - 0) (D (n a) z Zo w E ED 0 0 Z- = 2 CL 0 0 ,2 0 o E -C cr 0 0 _0 EC} 00 -00 :03 -5 a 00 > Lf c: L 10 > > 46 0 1 0 0 U) Ito -.0 - " -0 C :3 — CL CL 1- 10 a CL 0 < CO L CO 0 si z COUNTY COUNCIL 'd' MINOR ;'N' M FICE OF THE COUNTY CLERK Jay Furfaro,Chair JoAnn A. Yukimura, Vice Chair Peter A. Nakamura, County Clerk Tim Bymum Eduardo Topenio,Jr., Deputy County Clerk Dickie Chang Derek S. K. Kawakami Telephone(808)241 Nadine K.Nakamura OF Fax (808)241 Mel Rapozo Email cokcouncil,,'&l Council Services Division 3371-A Wilcox Road L-1hu'e,Kauai,Hawaii 96766 ii j MEMORANDUM w February 9, 2011 BOARDS Lei COiVWISSIONS TO: Jay Furfaro, Council Chair And Members of the County Council FROM: Derek S. K. Kawakami, Councilmemberff)�-----.--- RE: Possible Conflict of Interest Bill No. 2400, Relating to Plastic Bag Reduction February 9, 2011 Council Agenda Pursuant to Section 20.04(8), Charter, Sec. 3-1.9, Kauai County Code 1987, and Council Rule No. 8, this memo is to provide written disclosure on the record, of a possible conflict of interest on the following because of my employment position and family involvement in retail and food service establishments: • Proposed Draft Bill (No. 2400)—A BILL FOR AN ORDINANCE AMENDING ARTICLE 19, CHAPTER 22, Kaua'i COUNTY CODE 1987, AS AMENDED, RELATING TO PLASTIC BAG REDUCTION. For reasons stated above, I will recuse myself from any discussion and deliberation on this item (Bill No. 2400). Thank you for your attention in this matter. cc: Board of Ethics 2-23-11 Council Meeting Agenda SI.'V:\,MichaINakashima\dk 2010-2012\confliet of intrest 2011-952,dotx ME 2011-06 AN EQUAL OPPORTUNITY EMPLOYER COUNTY COUNCIL 'q &FICE OF THE COUNTY CLERK Jay Furfaro,Chair JoAnn A. Yukimura,Vice Chair Peter A.Nakamura,County Clerk Tim Bynum Eduardo Topenio,Jr.,Deputy County Clerk Dickie Chang Derek S.K.Kawakami Telephone(808)241-4188 Nadine K.Nakamura OF Fax (808)241-6349 Mel Rapozo Email cokco nci1(&kauai,gQy Council Services Division 3371-A Wilcox Road L1hu'e,Kaua'i,Hawaii 96766 L MAR MEMORANDUM 1W W BOARDS March 16, 2011 To: Jay Furfaro, Council Chair and Members of the Kaua'i County Council From: Nadine K. Nakamura, Councilmember �IVO� Re: POSSIBLE CONFLICT OF INTEREST: RESOLUTION NO. 2011-42 (FILING OF AN ANNUAL ACTION PLAN FOR THE CDBG ALLOCATION) Pursuant to Section 20.04(B) of the Kaua'i County Charter, Section 3-1.9 of the Kaua'i County Code, and Rule 8 of the Rules of the Kaua'i County Council, I hereby provide written disclosure on the record of a possible conflict of interest relating to Resolution No. 2011-42, because I am a Board Member of the Hawaii Community Reinvestment Corporation, which is designated to receive CDBG funding. For this reason, I am recusing myself from discussing or participating in the decision making regarding Resolution No. 2011-42. If you have any questions, please contact me. Thank you for your attention to this matter. cc: April 6, 2011 Council Meeting Agenda Ethics Commission CNT/wa2011-1045 BOE 2011-07 AN EQUAL OPPORTUNITY EMPLOYER March 23, 2011 Members of the Board of Ethics c/o Office of Boards and Commissions 4444 Rice Street, Suite 150 Uhu'e, HI 96766 Dear Members of the Board of Ethics: I am writing to request an Advisory Opinion on whether it is appropriate for me to engage in private consulting business: My current position is Special Assistant the Housing Director. As such I am involved in project development, grant funding and legislative efforts for the County Housing Agency. My proposed business would be a planning consultant service primarily writing Environmental Assessments for small projects, including those proposed by County Agencies other than the Housing Agency. I would not contract directly with the County but rather as a sub contractor to parties already contracted with the County. With regard to Section 3-1.7 of the Kauai County Code: (a) No employee shall take any official action directly affecting: (1) A business or other undertaking in which he has a substantial financial interest; or (2) A private undertaking in which he is engaged as legal counsel, advisor, consultant, representative, or other agency capacity, The Housing agency has limited official actions with regard to proposed project requiring an Environmental Assessment. The Housing Agency can require or exempt affordable housing requirements for certain developments and can engage in the building of affordable units. RAO 11-002 VIVO OF I would not be contracting on any development proposed by the Housing Agency nor any development which may have an affordable housing requirement, despite the fact that my financial interest would not be in the completion of the development but in its assessment. (b) No councilman or employee shall acquire financial interests in any business or other undertaking which he has reason to believe may be directly involved in official action to be taken by him. Similar to 3-13(a), I would avoid all projects with which the Housing Agency may have authority to require an affordable housing exaction. (c) No councilman or employee shall assist any person or business or act in a representative capacity before any County agency far a contingent compensation in any transaction involving the County. As mentioned I would act only as a subcontractor providing the environmental assessment and not in any capacity to gain approval before any County Agency. Any representation before the County would be handled by the applicant or their lead consultant. (d) No councilman or employee shall assist any person or business or act in a representative capacity for afee or other compensation to secure passage of a bill or to obtain a contract, claim, or other transaction or proposal in which he has participated or will participate as a councilman or employee, nor shall he assist any person or business or act in a representative capacity for a fee or other compensation on a bill, contract, claim or other transaction or proposal before the Council or agency of which he is an employee or councilman. I would not be contracting on any development proposed by the Housing Agency and any services for Environmental Assessments would be contracted after a contract with the County was executed, (e) No employee shall assist any person or business or act in a representative capacity before a County agency for ofee or other consideration on any bill, contract, claim, or other transaction or proposal involving official action by the agency if he has official authority over that County agency unless he has by the agency if he has official authority over that County agency unless he has complied with the disclosure requirements of Section 3-1.9. (Sec. 20.01, Art. XX, Charter;Sec. 25, CO. 1971; Sec, 3-1.7, R.C.O. 1976) My position with the County does not carry any authority over the Housing Agency In analyzing the County Code of Ethics against the business I am proposing it would seem that, with careful project selection and the understanding that this would be a venture limited in size that I could carry out this business without a conflict of interest. I hope the board concurs with this conclusion and look forward to discussing this with you. Please let me know if you have any questions. Thank you. Mahalo, I m a i�ka I a nWi AXii 4u: Special Assistant to the Housing Director r Board of Ethics zful c/o Office of Boards & Commissions �f Y 4444 Rice Street, Suite 150 ;. I_ihu`e, Hawaii 96756 Re: Request for Advisory Opinion by Deputy County Attorney Mauna Kea Trask. Aloha Honorable Members of the County of Kauai Board of Ethics, I am requesting and advisory opinion pursuant to Rule 5.1 of the Kauai County Board of Ethics Rules and Regulations. I submit the following information pursuant to the requirements of Rule 5.1 (b). My name is Mauna Kea Trask. I am a Deputy County Attorney and I work within the Office of the County Attorney for the County of Kauai. The nature and duties of my services or employment are detailed in the Charter of the County of Kauai Article VIII. The following is a statement of Facts and Circumstances upon which the Board is to make its determination. I have been recently offered an opportunity to be in a local documentary about fishing and the fishing industry in Hawaii. My understanding is that I will be the narrator/ main character in this documentary and I will be traveling around Hawaii showing the different types of ways of fishing from ancient Hawaiian methods to modern day commercial fishing practices. According to the producer/talent agreement (see attached) my employment will not involve and activity that would run afoul of 20.02 (a)-{f). I have been given permission to participate in this production by my boss County Attorney Alfred Castillo Jr. I have also been advised by the Office of Disciplinary Council that I will not be in violation of any Hawaii Rules of Professional Conduct governing Hawaii state attorneys. The question presented is as follows, is there a violation of the County Code of Ethics if I am involved in this film production? Thank you for your consideration in this matter. Please contact me if you need any supplemental information pursuant to Rule 5.1 (c). Mahalo, Mauna Kea Trask Deputy County Attorney A 11 - 003 Ae PRODUCER/TALENT AGREEMENT This Agreement is entered into as of the—day of 2011. between Kauai Girl Productions, LLC (hereinafter "Producer") and Mauna Kea Trask (hereinafter "Talent"). A. Producer intends to produce a half hour television program for the Public Broadcasting System (PBS) based upon that certain Production Proposal tentatively entitled "Fishing Pono" (hereinafter "Production"). Producer has applied for and been approved to receive production ftmds from PBS for the program. B. Producer wishes to utilize the services of Talent in connection with the Production upon the terms and conditions herein contained. Accordingly, it is agreed as follows: 1. PHOTOPLAY, ROLE, SALARY and GUARANTEE: Producer hereby engages Talent to render services as such in the role of narrator and actor in the Production, at the salary of$500 per work day, and $250 for travel days. If work and travel occur on the same day, the higher rate shall apply. Talent accepts such engagement upon the terms herein specified. Producer guarantees that it will furnish Talent not less than 10 days' employment. 2. TERM. The term of employment hereunder shall begin on or about April 11, 2011 ("Start Date") and continue until October 31, 2011, or until the completion of photography and recordation of said role. 3. TALENT'S ADDRESS: All notices which the producer is required or may desire to give to Talent may be given via email at or such other address as designated by Talent. 4. TALENT'S CELL PHONE: Talent must keep the Producer's office advised as to where Talent may be reached by cell without unreasonable delay. The current cell number of Talent is (808) 5. NON UNION PICTURE: Producer makes the material representation that it is not a signatory to the Screen Actors Guild collective bargaining agreement. Talent warrants that Talent is not a member of any union or guild memberships which would prevent Talent from working in this Production. 6. NAME AND LIKENESS: Producer shall have the exclusive right to use and to I license the use of Talent's name, photograph, likeness, and voice in connection with the Production, including the commercial advertising, publicizing, exhibition and/or other promotions of the Production. 7. TRAVEL EXPENSES: Producer shall be responsible for all travel and lodging expenses in connection with the Production. Producer shall provide meals during principal photography, or a per them allowance of$75 per day, whichever is more convenient to the location of the principal photography. 8. INCLUSIVE PAYMENTS- All payments to Talent hereunder shall be deemed to be equitable and inclusive remuneration for all services rendered by Talent in connection with the program. 9. ARBITRATION: Any controversy or claim arising out of or relating to this agreement shall be settled by arbitration in accordance with the Rules of the American Arbitration Association. IN WITNESS WHEREOF, the parties have executed this agreement on the day and year first above written. AGREED TO AND ACCEPTED: (Talent's signature) (Talent's name) Talent's Employment Identification or Social Security No. AGREED TO AND ACCEPTED: KAUAI GIRL PRODUCTIONS, LLC By Teresa Tico, its President 2 BOARD OF ETHICS COUNTY OF KAUAI DISCLOSURE S TA TEMENT THIS DOCUMENT SHALL BECOME A PUBLIC RECORD AFTER THE BOARD OF ETHICS HAS EXAMINED IT AND DEEMED IT TO BE COMPLETE 1. GENERAL INFORMATION NAME: (First) (Middle) (Last) Name of Spouse: POSITION TITLE: Indicate your elected or appointed County position, Board or Commission, or the public office you are filing for: ❑ 1 am a Candidate for Public Office: ❑ 1 am an Elected or Appointed Official of Kaua'i County: (Name of Public Office) (Position Title) ❑ 1 am an Appointed member of a Board or Commission (Name of Board or Commission) 11. EMPLOYMENT list all employment other than County employment (including part time employment) EMPLOYER POSITION Ill. ANNUAL INCOME - list all sources and amounts of income greater than $10,000 (i.e., wages, income from rental of real estate, loan repayments, stock dividends, interest on savings or bonds, retirement income, social security etc.) including your County of Kaua'i income Source(required: name of company) Annual Income(you may round to nearest$10,000. If more than$100,000, you may list>$1 oo,000) Disclosure Form March 2011 BOE2011-05 AMR-, IV. BUSINESS INTERESTS - list all businesses, partnerships or sole proprietorships and the percentage of interest in which you have an interest (please identify acronyms appropriately). Business Name Percent {ownership Interest Check here if Business contracts With the County 11 H V. POSITION HELD IN BUSINESS OR ORGANIZATION - List in the space below the information requested for all organizations (whether corporations, non-profit corporations, unincorporated organizations, partnerships, etc., and identify acronyms appropriately) in which you are an official of the organization (for example president, vice-president, secretary, treasurer, trustee, agent, board member, etc.) Organization Name Position VI. CREDITORS - List the name of every person, business, organization or corporation (excluding credit cards) to whom you owe money. VII. REAL PROPERTY— list the street address or tax map key number of any real estate in which you have an interest. (pursuant to The Constitution of the State of Hawaii, Article XIV) Address/Location Tax Map Key Number Disclosure Form March 2011 80E 2011-05 A a 09 VIII. REPRESENTATION BEFORE GOVERNMENT AGENCIES - List the names of all persons, corporations, organizations, partnerships, etc., that you have represented before any government agency (Federal, State or County), board or commission in the last five years: Name of Person, company, etc. Board/Commission/Agency Year IX. CREDITOR INTEREST IN INSOLVENT BUSINESSES - List the name of any insolvent business which owes money to you. X. CERTIFICATION — MUST BE SIGNED IN FRONT OF A NOTARY PUBLIC I hereby certify that the above statements made by me are true, complete and accurate to the best of my knowledge and belief. I further understand that if I acquire or possess an interest that might reasonably tend to create a conflict of interest with my duties or authority, or I or a member of my immediate family, which includes parents, siblings, spouse or children, is an owner, officer, executive director or director of an organization in any matter pending before me, I shall make full disclosure of the conflict of interest and shall not participate in said matter. Signature Doc. Date: # Pages:— Doc. Description: Notary Name: Circuit Subscribed and sworn to before me this dap of 20 Notary Public, State of Hawail My commission expires: Disclosure Form March 2011 HE 2011-05 Hawai'i State Constitution - Article page I of j_ a t pUbtications } reference desk I [ibrary rata€og ( state directory ; iC hps i ,side to trb �y THE CONSTITUTION OF THE STATE OF HAWAII ARTICLE XlV MrerlCe bureau CODE OF ETHICS • • The people of Hawaii believe that public officers and employees must exhibit the highest standards of ethical conduct and that these standards come from the personal integrity of each individual in government. To keep faith with this belief, the legislature, each political section titles subdivision and the constitutional convention shall adopt a code of ethics which shalt apply preamble to appointed and elected officers and employees of the State or the political subdivision, article € € respectively, including members of the boards, commissions and other bodies. article If 1 article €€€ Each code of ethics shalt be administered by a separate ethics commission, except the code article €V of ethics adopted by the constitutional convention which shalt be administered by the state article V ethics commission. The members of ethics commissions shalt be prohibited from taking an article V€ active part in political management or in political campaigns. Ethics commissioners shall be article V11 ! selected in a manner which assures their independence and impartiality. artic€e V€ll I article IX I Each code of ethics shall include, but not be limited to, provisions on gifts, confidential article X i information, use of position, contracts with government agencies, post•employment, article X€ financial disclosure and lobbyist registration and restriction. The financial disclosure artic€e X€€ j provisions shalt require all elected officers, all candidates for elective office and such article X€€€ article X€V Code of Ethics appointed officers and employees as provided by taw to make public financial - I disclosures. Other public officials having significant discretionary or fiscal powers as 1. Code of Ethics I provided by taw shalt make confidential financial disclosures. AU financial disclosure article XV I statements shalt include, but not be Limited to, sources and amounts of income, business article XV€ ; ownership, officer and director positions, ownership of real property, debts, creditor article XV€€ I interests in insolvent businesses and the names of persons represented before government article XV€€i I agencies. [Add Const Con 1978 and election Nov 7, 14781 index (pdf, 45K) disclaimer ! Updated 01.01,07 E —home OOE 2011-05 al http://hawaii.gov/Irb/con/conart I4.html 2/28/2011 ~ 4AWAII STATE ETHICS C@MMISS1���= Disclosure Form Instructions |f you have any questions regarding the following instructions, contact the Hawaii State Ethics Commission for assistance, WHO MUST FILE? HRS §84-1 7(c) lists the officers and employees, including board and commission rnernbero, who are required to file disclosures. HRS §84-17(d) identifies the disclosures that are available for public review. WHAT TYPES OF FINANCIAL DISCLOSURE STATEMENTS ARE THERE? WHEN ARE THEY FILED? • Initial Statement: within thirty (30) days of being elected or appointed 1u a state position required to file a financial disclosure. • Annual Statement: between January 1 and May 31 of each year. • Exit Statement: within thirty (30) days of separation from a state position if a prior financial disclosure has not been filed within one hundred and eighty (180) days preceding the dote of separation. WHAT TIME PERIOD DOES THE FINANCIAL DISCLOSURE STATEMENT COVER? WHAT IS THE "DISCLOSURE PERIOD"? The "disclosure period" is the period nf time for which you must disclose all pertinent information. /f further clarification is needed, please contact the Hawaii State Ethics Commission. • Initial Statement: The disclosure period covers January 1 of the preceding calendar year to the date offiling. • Annual Statement: The disclosure period covers the date of the last filing to the date of the current filing. • Exit Statement: The disclosure period covers the date of the last filing to the date of the current filing. WHERE CAN FINANCIAL DISCLOSURE FORMS BE OBTAINED. Forms are available from the Hawaii State Ethics Commission or may be downloaded from the State Ethics Commission's vvebaite at WHERE MUST THE FINANCIAL DISCLOSURE FORM BE FILED? The financial disclosure form must be filed with the Hawaii State Ethics Commission, 1001 Bishop Street, American Savings Bank Tower, Suite 978, Honolulu, Hawaii or rnmUad to the Hawaii State Ethics Commission, P. O. Box 616, Honolulu, Hawaii 96809. WHAT INTERESTS MUST BE DISCLOSED? HRS §84-17(f) Umtm those interests that must be disclosed. These include the source and amount of income of $1 ,000 or more received during the preceding calendar year for services rendered; ownership or beneficial interests in a business having a value of $5,000 or more or equal to tan percent of the ownership of the business; fiduciary relationships held in a business; the name of creditors to vvhorn the value of $3'000 or more was owed; reel property, other than the permunal residence(s) of the filer or the filer's spouse or dependent children, in which an interest is held, acquired, or transferred whose value is $10,000 or rnonm; creditor interests, having Va"-l"' �eof $5'OOOormore, in an inaob sineos; and clients represented before state agencies. Note: The financial disclosure statement shall disclose, in addition to the financial interests of the filer, the financial interests of the filer's spouse and dependent children. IMPORTANT: PENALTIES FOR FAILURE TO FILE OR FILING LATE HRS §84-170) states that failure to file a disclosure of financial interests constitutes a violWtion of chapter 84, HRS. The Hawaii State Ethics Commission may assess monetary penalties against persons who fail to file a financial disclosure statement when due. Failure to file a disclosure by the applicable deadline will result in an initial penalty of $50. The Commission will notify a person by registered mail of the failure to file. Failure to file a disclosure by 4:30 p.m. on the tenth day after the notification has been mailed will result in an additional penalty of $10 for each day a disclosure remains unfiled. The Commission may waive any monetary penalties assessed for good cause shown, The filing of an incomplete or false disclosure also constitutes a violation of chapter 84, HRS. Persons who have filed disclosures but have not reported all financial interests as required by law should immediately contact the Hawaii State Ethics Commission for further instructions. Other penalties for failure to file a disclosure may include (but are not limited to) reprimand, probation, demotion, suspension, or discharge. GENERAL INSTRUCTIONS Step 1 : On page 1 of the financial disclosure form, provide your name; the names of your spouse and any dependent children; your residence and mailing addresses; and your telephone numbers (business and residential); the name of your department, agency, board, or commission; your state position; and your term of office. The information on page 1 |m for office use only by the Hawaii State Ethics Commission. On page 2' complete the heading by providing your name, state position ha/d' state agency/division, and term of office. Stop 2: Complete Items / through 10 of the financial disclosure form (see the item-by-item instructions on the next page). You are required to report your interests and the interests ofyour spouse and any dependent children. In listing information, indicate that a financial interest belongs to you' your spouse, a dependant child, or is jointly held. Do so by marking ^F~ for filer (you) "SP" for spouse, ~0C" for dependent child, or ^JT" for jointly held, in the left-hand column. If you^ have no reportable interests in any item, check the appropriate space on the form. /fnmoreapaceis - edod to answer any item, attach an additional sheet and check the space under the appropriate item number. P|euoa refer by number to the item or items that are being completed on additional '-oatm. Step O: Sign the certification at the bottom of the form and fill in the date on which you sign the forrn The filing is not vaUd without an original signature. . ' Step 4: Make sure you retain a copy for your records and keep it for reference for future filings. Step 5: File your completed /mrrn with the Hawaii State Ethics Commission. DEFINITIONS The following definitions, set forth in HHS §84-3, must be adhered to as you complete the form: ^Bus/nmms~ includes a corporation, partnership, a sole proprietorship, m trust orfoundation or any other individual ororganizabon carrying on e business, v*hetherornot operated for profit. ' "Compensation" means any money, thing of value, or economic benefit conferred on or received by any person in return for services rendered or to be rendered by oneself oranother. ^ErnV|oyrnent~ rnemnm any rendering of services for compensation. "Financial interest" means an interest held by an individual, the individual's spouse, r dependent children which is; ' 1 . An ownership interest inmbusiness. 2. A creditor interest in an insolvent business, 2 3. An ernp /rnent' or prospective ennp|oyrnent-70� which negotiations have begun. 4. An ownership interest in real or personal property. 5. A loan or other debtor interest G� 4 directorship orofficerahip in e business. "State agency" includes the State, the legislature and its committees, all executive departments, boards' commissions, committees, bureaus, offices, the University of Hawaii, and all independent commissions and other establishments of the state government but excluding the courts. ITEM BY ITEM INSTRUCTIONS These instructions explain the information required by each of the specific items noted in the fornm. Where an item oaUa for the stating of dollar amount, you may indicate the value of the interest by using the appropriate letter from the following code: Financial Amount Code A Less than $1 '000 B At least $1 '000 but less than $10'000 C At least $1O'OOO but less than $25'000 Q At least $25,000 but less than $50'000 E At least $5O,OOO but less than $100'000 F At least $100.000 but less than $150'000 G At least $150.00U but less than $250'000 H At least $250,000 but less than $500,000 | At least $GOQ'OOO but less than $750'000 J At least 875O,O0O but less than $1'000'000 N At least $1 ,0O0,000ormore For example, for Item 1 of the disclosure form, if your income from an employment source is $45'080 per year, you may indicate your compensation by using the letter "ID" from the financial amount code in place of stating the exact dollar amount of your income. Year:Item 1 . Income For Services Rendered For Preceding Calendar You must report the source and amount of all income of $1 000 or more, for services rendered, received during the preceding calendar year by you, your spouse, or any dependent children. The term °aouroe" includes any state orother government agency. You must report the name of the source of the income, the amount of income received, and the nature of the services provided. For example, if you are employed by business, then report the name of the business, the amount ofincome received during the preceding calendar year, and the nature of the services you provided to the business. When disclosing the source, provide the complete name (not acronyms), and the address ofthe business or source from which the income was derived, The interests of your spouse and any dependent children must also be reported. Note: Rental income received ia also reportable, Businesses:Item 2. Ownership or Beneficial Interests in You must report the amount and identity of every ownership or beneficial interest held during the disclosure period by you, your spouse, or any dependent children in any business in or outside of the State where that interest has a value of $5'800 or more or is equal to 1096 or more of the ownership of the business, including, but not limited to, stock, Report the complete name (not acronyms) and address of the business, the kind of activity the business is engaged in, and the nature of your, your spouse's, or any dependent children's interest in the business, If you, your spouse, or any oyyour dependent children is a shareholder of stock or mutual fund(s), you must report the number of shares owned or the approximate value ofthe stock mr mutual fund(m). Note: You need not report interests in the form of accounts in a federal orstate-regulated financial institution (e.g., checking or savings accounts), mutual insurance policies, or individual items in a mutual fund or blind trust if the mutual fund or blind trust has been otherwise disclosed under this item. A/uo, you need not report retirement accounts such au4O1 (K)sand IRAs, or accounts held under the deferred compensation plan for state employees. 3 9 10111 ^ Item 3. Transfer of Owner or Beneficial Interest in Businesses n ownership or beneficial interest reported in .,~.. . was transferred" "u."'g the disclosure period, indicate the date of the transfer. Item 4. Creditors: You must report the name of each creditor to whom $3,000 or more was owed during the disclosure period by you, your spouse, mr any dependent children. You are required tu report the original amount owed and the present amount owed. Accounts of a business entity payable in the ordinary course of business need not bereported. Debts arising out of retail installment transactions for the purchase of consumer goods (e.g., credit card purchases) also need not be reported. Item 5. Officerships, Directorships, Trusteeships: You are required to disclose every m#k:mrohip' directorship,, ^..""°=s."p' or other fiduciary relationship ne|u during the disclosure period " by you, your spouau' oranydependentohi|dnan/nmbuainems^' ~"" 'uoorpor�dnna associations,or foundations, and nonprofit buminamuwo and associations. You must also indicate the annual compensation received, if any' and the term of office. Item 6. Interests in Real Property Held: You are required to disclose the street address and the tax map key number (if a tax map key number exists) of any real property in or outside of the State, if the interest has a value of $10,000 or more and was held by you, your spouse, or any dependent children during the disclosure period. The value of the real property interest may be computed in any reasonable manner. You may, for example, compute the value from the property's assessed valuation. You are not required to disclose real property held that is your personal residence or the personal residence of your spouse or dependent children. Note: |f you, your spouse, or any dependent children hold interests in real property placed inatnust you /naybe required to disclose the interests. For darifioabon' contact the HaovohState Ethics Cornnmia' inn. Itern 7. Interests in Real Property Acquired: You are required to disclose any interest in real property /n or outside of the State, if the interest has a value of $1U'OOOormore and was acquired. by you, you r mpousm' or any dependent children during the disclosure period. You must report the amount that was paid for the property and the nature of the consideration paid, ie, whether �h� payment was in caah`nxchenge, agnaenentofaa|e' otc. You must also provide the name of the person from whom the property was acquired (the person receiving the consideration). |n addition, you must report the street address and the tax nap key number (if tax map key number exists) of the meo/ property in which the interest was acquired. You are not required to disclose real property acquired that ia your personal residence or the residence of your spouse or dependent children. Item 8. Interests in Real Property Transferred: For this item, the method of reporting is the same as that indicated for Item 7. Here, however, you must report any interest in real property in or outside of the State, if the interest has a value of $10,000 or more and was transferred by you, your spouse, or any dependent children during the disclosure period. You must report the amount received; the nature of the consideration (cash, exchange, agreement of sale, etc.); and the street address and the tax map key number (if tax map key number exists) of the real property. You must also provide the name of the person to whom the real property was transferred (the person furnishing the consideration), You are not required to disclose real property transferred that was your personal residence or the personal reside—nce of your spouse or dependent children. Item 9. Clients Personal!y Represented Before State Agencies: You are required to report the name of any client you personally represented before state agencies for a fee or compensation during the disclosure period. You must also report the names of the particular state agencies involved. For example, if you represented a client before a particular state board, then report the name of that board. If the representation involved ministerial matters or involved representation of a person in your state capacity where you received no additional compensation (aside from your state salary), the representation need not be disclosed. You need not report clients personally represented before the courts. Item 10. Creditor Interests in Insolvent Businesses: You are required to report the amount and identity of every creditor interest in an insolvent business held by you, your spouse, or any dependent children during the disclosure period. Only interests having a value of $5,000 or more need to be disclosed. An insolvent business is one that is unable to pay debts as they become due. Disclose the name and address of the business, the nature of the business, the nature of the interest held, and the value of the interest IMPORTANT: Rev. 11/07 4 ll HAWAII STATE ETHICS CO MISSION DISCLOSURE OF FINANCIAL INTERESTS (LONG FORM) ij (To be filed by elected officials, state employees, and beard and commission members) This Page Is For Office Use Only HAWAII STATE ETHICS COMMISSION For Office Use Only 1001 Bishop Street, Suite 970 DATE RECD: FILE NO.: Honolulu, Hawaii 96813 (P.O. Box 616, Honolulu, Hawaii 96809) Telephone: (808) 587-0460 Fax: (808) 587-0470 Email: ethics@hawaiiethics.org hawaiiethics.org Web site: www.hawaii.gov/ethics Please read instructions carefully before filling out this form. For this page (page 1), the personal information you provide (e.g., names of spouse and children, residence address, and residence telephone number) is for office use only by the Hawaii State Ethics Commission. FULL NAME (Last, First, Middle) DOE, John SPOUSE'S FULL NAME (Last, First, Middle) DOE, Jane DEPENDENT CHILDREN'S FULL NAMES (Last, First, Middle) DOE, John Jr. RESIDENCE ADDRESS 0000 Mohala Way, Honolulu, HI 96800 MAILING ADDRESS SAME AS ABOVE BUSINESS TELEPHONE STATE DEPARTMENT/DIVISION OR BOARD/COMMISSION (808) 546-0000 Department of Building Maintenance RESIDENCE TELEPHONE STATE POSITION HELD TERM OF OFFICE:(m /dd/yy) (808) 336-0000 Purchasing Agent Begin: 7/1/20XX End: N/A Sample Form FORM©-ao� Page 1 of 5 Addre, H;R All STATE ETHICS COMMIIAN DISCLOSURE OF FINANCIAL INTERESTS (LONG FORM) NAME(Last,First,Middle): DOE, John Date Received: STATE POSITION HELD: Purchasing Agent DEPT/DIVISION or BOARD/COMMISSION: Department of Building Maintenance TERM OF OFFICE(Begin/End): 7/l/20XX / N/A FOR EACH ITEM, EXCEPT ITEM 9, DISCLOSE INTERESTS OF FILER, SPOUSE, AND DEPENDENT CHILDREN. USE THE ABBREVIATIONS: 'F'for filer,"SP'for spouse, "DC"for dependent children,and "JT"for joint interests of the spouse and filer. ITEM 1: INCOME FOR SERVICES RENDERED FOR PRECEDING CALENDAR YEAR List the source (the term "source"also includes any state or other government agencies)and amount of all income of$1,000 or more received during the preceding calendar year, for services rendered, and the nature of the services rendered, F,SP,DC,JT NAME AND ADDRESS OF SOURCE OF INCOME AMOUNT SERVICES RENDERED F State of Hawaii E Purchasing Agent Department of Building Maintenance 0000 Punchbowl Street Honolulu, HI 96800 F John Doe - Income earned under G.E. Tax License a Tax Preparation SP Jane Doe Rentals C Rental of Property 0000 Vineyard Blvd. Honolulu, HI 96800 DC Nonesuch Construction, Inc. B Residential Construction 0000 Puuloa Road Honolulu, HI 96800 ]Check here if entry is None ]Check here if additional sheets are attached ITEM 2: OWNERSHIP OR BENEFICIAL INTERESTS IN BUSINESSES List the amount and identity of every ownership or beneficial interest held during the disclosure period in any business in or outside of the State if the interest has a value of$5,000 or more or is equ I to 10%or more of the ownership of the business, F,SP, BUSINESS NAME AND ADDRESS NATURE OF BUSINESS NATURE OF INTEREST VALUE OR NO. DC,JT OF SNARES F Keyboard Computers, Inc. Computer Sales Stockholder 1,000 shares 0000 Valley Street Cupertino, CA 54321 SP Jane Doe Rentals Property Rentals 100% Ownership of E 0000 Vineyard Blvd. Business Honolulu, HI 96800 JT TPK Mutual Fund Mutual Fund Shareholder C c/o Investors, Inc, 0000 North Avenue Chicago, IL 44444 ]Check here if entry is None ]Check here if additional sheets are attached FORM 0-201 Page 2 of 5 ITEM 3: TRAM OWNERSHIP OR BENEFICIAL IN List any ownership or beneficial interests in businesses transferred during the disclosure eriod and the date of transfer. F,SP, I OWNERSHIP OR BENEFICIAL INTEREST TRANSFERRED DURING THIS DISCLOSURE DATE OF DC,JT PERIOD TRANSFER Transferred 1,000 shares of stock in: 1013012OXX Keyboard Computers, Inc. 0000 Valley Street Cupertino, CA 54321 ]Check here if entry is None ]Check here if additional sheets are attached ITEM 4: CREDITORS List the name of each creditor to whom the value of$3,000 or more was owed during the disclosure period and the original amount and amount outstanding. Exclude debts from retail installment transactions for the purchase of consumer oods. F,SP, I NAME OF CREDITOR ORIGINAL AMOUNT AMOUNT DC,JT ORIGINAL OWED OUTSTANDING V JT Lowest Rate Mortgage Company -1 H H C ISP Everybody's Credit Union 7 ]Check here if entry Is None ]Check here if additional sheets are attached ITEM 5: OFFICERSHIPS, DIRECTORSHIPS, TRUSTEESHIPS List every officership, directorship,trusteeship,or other fiduciary relationship held during the disclosure period in any business or organization, the term of office, and the annual compensation. F,SP, I NAME AND ADDRESS OF BUSINESS TITLE HELD TERM OF OFFICE ANNUAL DC,JT COMPENSATION F Good Works Charities President, Chair 1996-(no end date) 0 President,doe, Board si 0000 Nuuanu Lane Board of Directors Honolulu, HI 96800 SP The Garden and Plant Shop Director 1999-20XX None 00-000 Kamehameha Hwy. Mililani, HI 96700 The Lani Lee Trust Trustee 2000-20XX A 000 Wilder Street Honolulu, Hr 96800 ]Check here if entry is None ]Check here if additional sheets are attached FORM D-201 Page 3 of 5 ANN 0 Aw, so. ITEM 6: INTERESTS AL PROPERTY HELD, EXCLUDING MONAL RESIDENCE(S) C List interests in real property in or outside of the State held during the disclosure period, if the interest has a value of$10,000 or more. Real prop rty that is your personal residence or the personal residence of yours ouse or dependent children need not be listed, F,SP, STREET ADDRESS TAX MAP KEY NUMBER (IF TAX VALUE DC,JT MAP KEY NUMBER EXISTS) SP 0000 Mooheau St- Unit 1600 9-0-0-00-00 E Honolulu, HI 96800 JT 0000 Lark Ave., Apt, 2 Los Vegas, NV 22200 ]Check here if entry is None ]Check here if additional sheets are attached ITEM 7: INTERESTS IN REAL PROPERTY ACQUIRED, EXCLUDING PERSONAL RESIDENCE(S) List interests in real property in or outside of the State acquired during the disclosure period, if the interest has a value of$10,000 or more. Real property that is your personal residence or the personal residence of your spouse or dependent children need not be listed. F,SP, STREET ADDRESS AND TAX MAP KEY NUMBER(IF AMOUNT& NATURE OF NAME OF PERSON DC,JT TAX MAP KEY NUMBER EXISTS) CONSIDERATION PAID RECEIVING THE CONSIDERATION JT 0000 Pebble Lane H, Cash William and Mary Seller Orlando, FL 11100 ]Check here if entry is None ]Check here if additional sheets are attached ITEM 8: INTERESTS IN REAL PROPERTY TRANSFERRED, EXCLUDING PERSONAL RESIDENCE(S) List interests in real property in or outside of the State transferred during the disclosure period, if the interest has a value of$10,000 or more, Real property that was your personal residence or the personal residence of your spouse or dependent children need not be listed, F,SP, STREET ADDRESS AND TAX MAP KEY AMOUNT& NATURE OF NAME OF PERSON DC,JT NUMBER (IF TAX MAP KEY NUMBER EXISTS) CONSIDERATION RECEIVED FURNISHING THE CONSIDERATION JT 0000 Poomau St., Unit 200 F, Cash Robert Buyer Hilo, HI 96700 Tax Map Key No. 8-0-0-00-00 ]check here if entry is None ]Check here if additional sheets are attached FORM D-201 Page 4 of 5 ITEM 9: CLI'a PERSONALLY REPRESENTED BEF!"I .- STATE AGENCIES List the names of clients personally represented by you before state agencies,except in ministerial matters,for a fee or compensation during the disclosure period, excluding clients represented before courts. NAME OF CLIENT NAME OF STATE AGENCY t Clifford Client NAME OF Auditors Board ]Check here if entry Is None ]Check here if additional sheets are attached ITEM 10: CREDITOR INTERESTS IN INSOLVENT BUSINESSES List the amount and identity of every creditor interest in insolvent businesses, held during the disclosure period, if the interest has a value of$5,000 or more. F,SP,DC,JT NAME AND ADDRESS OF BUSINESS NATURE OF BUSINESS NATURE OF VALUE INTEREST F Nola Furniture, Inc. Furniture Sales Unsecured Creditor 0000 Sand Island Road Honolulu, HI 96800 1 ]Check here if entry is None ]Check here if additional sheets are attached CERTIFICATION: I hereby certify that the above is a true, correct, and complete statement to the best of my knowledge and belief. If I have a spouse and/or dependent children, I also hereby certify that I have included their interests on this form to the best of my knowledge and belief. I understand that it is a violation of State law, chapter 84, HIRS, if information is not disclosed as required by chapter 84, HRS. I further understand that there are statutory penalties for noncompliance. hn 3dw 3-15-20XX SIGNATURE DATE FORM D-201 Revised 11/07 Pads 5 of 5