HomeMy WebLinkAboutBOE_2019_1220_Notice_Agenda-PacketAn Equal Opportunity Employer
Dean Toyofuku Members:
Chair Ryan de la Pena
Maureen Tabura
Mia Shiraishi Mary Tudela
Vice Chair
Susan Burriss
Secretary
COUNTY OF KAUA'I BOARD OF ETHICS
NOTICE OF MEETING AND AGENDA
Friday, December 20, 2019
1:00 p.m. or shortly thereafter
Mo‘ikeha Building, Liquor Conference Room 3
4444 Rice Street, Līhu'e, HI 96766
CALL TO ORDER
APPROVAL OF MINUTES
Open Session Minutes of November 15, 2019
COMMUNICATION
None
REQUEST FOR AN ADVISORY OPINION
None
BUSINESS
BOE 2018-17 Discussion and possible action by the Board of Ethics to provide
explicit recommendation(s) on how to improve the existing
countywide disclosure requirement and to discuss and propose a
fine schedule for non-compliance. Review and discuss HRS
section 46-1.5(24), County of Honolulu Chapter 6 Ethics Board
Sec. 3-8.5, Chapter 14 Ethics Board of Appeals.
BOE 2019-22 Discussion and possible action by the Board to provide notice to
County employees regarding ethics requirements for former
employees.
BOE 2019-33 Discussion and possible action by the Board of Ethics to provide
ethics training for County employees.
Board of Ethics – December 20, 2019 2 | Page
BOE 2019-29 Discussion, review and possible action by the Board of Ethics on
proposed language to Amend Charter Section 20.04 A. Disclosure
to submit to Charter Review Commission for review.
BOE 2019-30 Discussion and decision-making on establishing a Permitted
Interaction Group (PIG). The purpose of establishing a PIG would
be to establishing an ordinance to require annual gift disclosures
and that the Board will define the scope of the PIG and each
individual’s authority to establish an ordinance requiring annual
gift disclosures .
BOE 2019-31 Discussion, review and possible action by the Board of Ethics on
draft of proposed language to amend Charter 20.05.D.2 and delete
“an opinion within 45 days is deemed a finding of no breach of the
Code of Ethics.”
BOE 2019-32 Discussion, review and possible action by the Board of Ethics to
approve the revised Disclosure Form which does not require a
notary, added a sworn statement under penalty of perjury, and
added a date to the signature line.
DISCLOSURES
Volunteer
1. Katherine Lewi Otsuji-Board of Review
EXECUTIVE SESSION
Pursuant to Hawai’i Revised Statutes §92-4, §92-5 (a) (2) and (4), §92-6 (a) (b), the purpose of
this Executive Session is to consult with the Board’s legal counsel on issues pertaining to
Resolution 2019-1 to consider the evaluation, dismissal or discipline of an employee or officer of
the County in which charges have been alleged against an employee or officer where
consideration of matters affecting privacy will be involved; provided that if the individual
concerned requests an open meeting, an open meeting shall be held;, the Board’s and the
County’s powers, duties, privileges, immunities, and /or liabilities as they may relate to this item,
deliberate and take such action as appropriate.
ES-009 Executive Session Minutes of November 15, 2019
ES-007: BOE 2019-24 Review of Resolution 2019-1 for initiating an investigation under
Rule 6.2 into an allegation that an employee or officer of the
County has breached the Code of Ethics as set forth in the Kaua'i
County Charter section 20.02 A and E, the Kaua'i County Code
1987, as amended by June 2019 Code Supplement, Article 1,
Section 3-1.4 and 3-1.6.
Board of Ethics – December 20, 2019 3 | Page
No officer or employee of the county shall:
a. Solicit, accept, or receive, directly or indirectly, any gift,
whether in the form of money, service, loan, travel,
entertainment, hospitality, thing, or promise, or in any other
form, under circumstances in which it can reasonably be
inferred that the gift is intended to influence the officer or
employee in the performance of the officer or employee’s
official duties or is intended as a reward for any official action
on the officer or employee’s part.
b. Use county property for other than public activity or purpose.
RETURN TO OPEN SESSION
Ratify on Board actions taken in Executive Session.
ANNOUNCEMENTS
Next Meeting: Friday, January 17, 2020 – 1:00 p.m., Mo‘ikeha Building, Liquor Conference
Room 3
ADJOURNMENT
NOTICE OF EXECUTIVE SESSION
Pursuant to Hawaii Revised Statutes §92-7(a), the Board 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 HRS §92-5(a). Discussions held in Executive
Session are closed to the public.
cc: Office of the County Attorney
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
Board of Ethics – December 20, 2019 4 | Page
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
Office of Boards & Commissions
4444 Rice Street, Suite 150
Līhu‘e, HI 96766
Phone: (808) 241-4917 Fax: (808) 241-5127
SPECIAL ASSISTANCE
IF YOU NEED AN AUXILIARY AID/SERVICE, OTHER ACCOMODATION DUE TO A
DISABILITY, OR AN INTERPRETER FOR NON-ENGLISH SPEAKING PERSONS,
PLEASE CONTACT THE OFFICE OF BOARDS & COMMISSIONS AT (808) 241-4917 OR
ASEGRETI@KAUAI.GOV AS SOON AS POSSIBLE. REQUESTS MADE AS EARLY AS
POSSIBLE WILL ALLOW ADEQUATE TIME TO FULFILL YOUR REQUEST.
UPON REQUEST, THIS NOTICE IS AVAILABLE IN ALTERNATE FORMATS SUCH AS
LARGE PRINT, BRAILLE, OR ELECTRONIC COPY.
COUNTY OF KAUAI
Minutes of Meeting
OPEN SESSION
Board/Commission: BOARD OF ETHICS Meeting Date November 15, 2019
Location Mo‘ikeha Building, Liquor Conference Room 3 Start of Meeting: 1:05 p.m. End of Meeting: 3:28 p.m.
Present Chair Dean Toyofuku, Vice Chair Mia Shiraishi, Secretary Susan Burriss. Members: Ryan de la Pena, Maureen Tabura, Mary Tudela
Also: Deputy County Attorney Todd Jenson. Boards & Commissions Office Staff: Administrator Ellen Ching and Administrative
Specialist Anela Segreti.
Excused
Absent
SUBJECT DISCUSSION ACTION
Call To Order Chair Toyofuku called the meeting
to order at 1:05 p.m. with six
members present which constituted
a quorum.
Approval of
Minutes
Open Session Minutes of October 18, 2019 Mr. de la Pena moved to approve
the minutes of October 18, 2019
as circulated. Ms. Burriss
seconded. Motion carried 6:0.
Communication None
Board of Ethics
Open Session
November 15, 2019 Page 2
SUBJECT DISCUSSION ACTION
Request for
Advisory Opinion
RAO 2019-07 Request for an Advisory Opinion from Julie Simonton dated October 10,
2019 relating to a possible conflict of ethics to her nomination for appointment to the
Board of Water.
Request Withdrawn by requester.
Business BOE 2018-17 Discussion and possible action by the Board of Ethics to provide explicit
recommendation(s) on how to improve the existing countywide disclosure requirement
and to discuss and propose a fine schedule for non-compliance. Review and discuss HRS
section 46-1.5(24), County of Honlulu Chapter 6 Ehics Board Sec. 3-8.5, Chapter 14
Ethics Board of Appeals.
Ellen Ching, Administrator, explained that the Board received a brief with
recommendations from former Deputy County Attorney. Chair and Vice Chair attended
the State Ethics Conference and realized that the Board needed to comply with State law.
Requested that current Deputy County Attorney look at the brief along with the
information from the State Conference.
Todd Jenson, Deputy County Attorney, shared materials (on file) on different fine
schedules collected from the different counties.
Chair Toyofuku stated that greatest question was regarding an Ethics Board of Appeals to
be in compliance with HRS. What would be required, how would Board handle appeals.
Ms. Ching recommended the Contested Case Hearing process similar to the Planning
Commission as an appeal process.
Chair Toyofuku asked to clafiry that if a fine schedule is imposed or enforce what is
currently in the rules and regulations in areas that a fine could be imposed according to
the HRS there would be a violation if an appeal process is not provided for.
Mr. Jenson discussed that currently the current Board of Ethics Rules & Regulations has
a limited procedure for what looks like an appeal. For a contested case under Rule 8.4 it
sets forth a hearing format and after a decision is made, they can make a request for
reconsideration. So there is a due process, but it is heard by the same body. The County
Board of Ethics
Open Session
November 15, 2019 Page 3
SUBJECT DISCUSSION ACTION
Code does set forth some penalties and specifically the Board of Ethics ability to assess
administrative penalties. In subsection 3, it limits to $1000, between $1-$1000 it should
be fine. He gave them an example from the Liquor Commission.
Ms. Tudela discussed having a standard that had categories for a range of fine amount to
be consistent. Alternative would be to track them all.
Ms. Ching asked if the article only relate to a Lobbyist as there is mention of revoking
the registration of a Lobbyist.
Chair Toyofuku stated that it is similarly stated under the Disclosure Statement.
Ms. Shiraishi reminded the Board that they had previously decided on a fine schedule
and table
BOE 2019-22 Discussion and possible action by the Board to provide notice to County
employees regarding ethics requirements for former employees.
Ms. Ching requested a deferral.
Ms. Burriss moved to defer BOE
2019-22. Mr. de la Pena seconded.
Motion carried 4:0
BOE 2019-29 Discussion and possible action by the Board of Ethics to draft language
to Amend Charter Section 20.04 A. Disclosure to submit to Charter Review
Commission for review.
Chair Toyofuku clarified that this was to amend the section on who is required to file a
disclosure. Chair went over his memo (on file) of his appearance before the Charter
Review Commission he submitted to the Board and research done by staff comparing
counties. Informed Board that they must come up with the proposed language for the
Charter amendment.
Board of Ethics
Open Session
November 15, 2019 Page 4
SUBJECT DISCUSSION ACTION
Ms. Tudela presumes that the process for approving procurement varies by
department.
Ms. Ching explained the procurement process.
Board had a lengthy discussion whether required filers should be stated more in
generic terms with guidance as to what type of duties of an employee would require
them to file a disclosure rather than specific job titles. They reviewed requirements of
other counties.
Chair Toyofuku reminded the members that the Charter Review Commission will
consider this and that they need to convince the Commission to add the amendment to
the ballot. The Board will also need to write the language and submit.
Ms. Tudela stated that the language is in legal terms and she is uncomfortable in
drafting the language. She suggested that the Board should agree on what they want to
accomplish and ask legal counsel to draft something that they would review.
Mr. Jenson explained that Board would decide on direction, come up with proposed
language and then the Office of the County Attorney would review for legality and
make sure it complies.
Ms. Burriss asked if they could put it on the department heads to identify the
employees in their departments that should file disclosure statements.
Ms. Tudela asked if each department could come in to talk to the Board.
Board discussed to send an email or survey to each department that would say, “we’re
looking to expand the people who are required to fill out a disclosure without putting a
burden on each department, do you have suggestions for how we should be proceeding
for your department.
Mr. Jenson suggested that Ernie Barreira may be able to identify who in each
department will be making the final call on procurement.
Board of Ethics
Open Session
November 15, 2019 Page 5
SUBJECT DISCUSSION ACTION
Chair Toyofuku asked if there was any language from the other counties that stood out
as one they could possibly use for guidance.
The Board discussed the County of Hawaii’s language. Looking at the term
“regulatory employees” and possibly introducing and defining it.
Ms. Ching recommended that with a Charter amendment the Board should go broad
and keep changes minimal. When there are too many changes and too much to
language it is too complicated and people forget it. The initial proposal started off
with, with the suggestion of the Charter Review Commission to add Managing
Director and Agency Heads. In addition if want to expand further like County of
Hawaii, could add “regulatory employees” and leave it at that. On the education side
define “regulatory employees”.
Board discussed possibly forming a PIG (Permitted Interaction Group) to work on the
proposed Charter amendment.
Board discussed using current language, all Department Heads, and adding Agency,
Division and regulatory employees, that it would broaden it quite a bit and not forming
a PIG.
Ms. Tudela moved that the
Boards and Commissions
Administrator draft Charter
language that adds to existing
language Agency Heads,
Division Heads, Regulatory
Employees and Managing
Director. Ms. Burriss
seconded. Motion carried 6:0
BOE 2019-30 Discussion and possible action by the Board of Ethics to require annual
gift disclosures.
Ms. Ching explained that this would be an amendment to the ordinance and suggested
that they form a PIG to look at this.
Board discussed that they would like to look at this requirement for the County.
Ms. Tudela moved to add a
decision for a PIG for BOE 2019-
30 to the next meeting agenda. Mr.
de la Pena seconded. Motion
carried 6:0
Board of Ethics
Open Session
November 15, 2019 Page 6
SUBJECT DISCUSSION ACTION
BOE 2019-31 Discussion and possible action by the Board of Ethics to revise the ethics
rule to state that the Board of Ethics should render an advisory opinion within 45 days of
receipt of the request, but delete the provision that failure to do so within 45 days is
deemed a finding of no breach of the Code of Ethics.
Ms. Ching explained that this would be a Charter Amendment.
Chair Toyofuku explained that this was brought to his attention from the City & County
of Honolulu’s Ethics Board Staff Attorney.
Board discussed the current language and what needs to be amended to remove the
provision of failure to so within 45 days is deemed a finding of a no breach of the Code
of Ethics.
Ms. Tudela moved to defer BOE
2019-31 and ask that Administrator
draft for the next meeting proposed
language to amend Charter
20.05.D.2 and delete “an opinion
rendered by lapse of 45 days”.
Ms.Tabura seconded. Motion
carried 6:0
BOE 2019-32 Discussion and possible action by the Board of Ethics to delete from the
ethics rules the requirement that disclosure forms must be notarized.
Chair Toyofuku explained that Kauai is the only County with this requirement. Staff
and Deputy County Attorney Jenson stated that they could not find this in the rules, it is
only on the form.
Board discussed removing this from the form.
Ms. Burriss suggested adding a sworn statement under penalty of perjury.
Mr. Jenson explained statements are treated differently under the law. With a sworn
statement there is penalty associated with it.
Vice Chair Shiraishi suggested also adding the date of the signature.
Mr. de la Pena moved to remove
the notary requirement from
disclosure statements. Ms. Tabura
seconded. Motion withdrawn by
Mr. de la Pena and Ms. Tabura.
Mr. de la Pena moved to remove
the notary requirement from
disclosure statements form and
add a sworn statement under
penalty of perjury and date of
signature. Ms. Tabura seconded.
Motion carried 6:0
Board of Ethics
Open Session
November 15, 2019 Page 7
SUBJECT DISCUSSION ACTION
BOE 2019-33 Discussion and possible action by the Board of Ethics to provide ethics
training for County employees.
Ms. Tudela moved to defer
BOE 2019-33 to the second
quarter of 2020. Ms. Burriss
seconded. Motion carried 6:0
BOE 2019-34 Discussion and possible action by the Board of Ethics to build a database
of ALL previous opinions and consider reviewing old opinions which may be in
violation of any laws, rules, regulations that may have changed.
Board discussed with staff what’s in place now and staff’s work towards consolidating
files and building a data base.
Ms. Tudela moved to approve. Ms.
Burriss seconded. Motion carried
6:0
BOE 2019-35 Discussion and approval to add a December 2019 meeting.
Board discussed date in December.
Ms. Tabura moved to meet Dec. 20,
2019. Ms. Burriss seconded.
Motion carried 6:0
BOE 2019-36 Review and Possible Approval of Meeting Schedule for 2020.
Board reviewed calendar.
Ms. Tabura moved to accept the
2020 Meeting Schedule. Ms.
Burriss seconded. Motion carried
6:0
BOE 2019-37 Election of Chair, Vice Chair and Secretary for Calendar Year 2020.
Ms. Tudela nominated Ms. Shiraishi for the position of Chair for 2020, Ms. Burriss for
the position of Vice Chair for 2020, and Ms. Tudela for Secretary for 2020.
Mr. de la Pena moved to close the
nominations. Ms. Burriss seconded.
Motion carried 6:0
Mr. de la Pena moved to elect Ms.
Shiraishi as Chair, Ms. Burriss as
Vice Chair, and Ms. Tudela as
Secretary. Ms. Tabura seconded.
Motion carried 6:0
Board of Ethics
Open Session
November 15, 2019 Page 8
SUBJECT DISCUSSION ACTION
Board took a break at 3:08pm
Meeting resumed at 3:11pm
Disclosures Volunteer
1. Katherine Otsuji, Board of Review
Under employment, she listed self-employed, but in Section IV, she did not state her
business interest.
Ms. Tabura moved to return Ms.
Otsuji’s Disclosure form to clarify
item IV, Business Interest. Ms.
Burriss seconded. Motion carried
6:0
Executive
Session
Chair Toyofuku entertained a motion to enter into Executive Session pursuant to HRS
§92-4, §92-5 (a) (2) and (4), §92-6 (a) (b), the purpose of this Executive Session is to
consider the evaluation, dismissal or discipline of an employee or officer of the County
in which charges have been alleged against an employee or officer where consideration
of matters affecting privacy will be involved; provided that if the individual concerned
requests an open meeting, an open meeting shall be held; and to consult with the
Board’s legal counsel on issues pertaining to the Board’s and the County’s powers,
duties, privileges, immunities, and /or liabilities as they may relate to this item,
deliberate and take such action as appropriate.
The Board moved into Executive Session at 3:19pm.
Mr. de la Pena moved to go into
executive session. Ms. Tudela
seconded. Motion carried 6:0.
Return to Open
Session
Ratify Board actions taken in Executive Session. The board resumed in Open Session
at 3:26pm
Ms. Burriss moved to ratify
decisions made in Executive
Session. Ms Tabura seconded.
Motion carried 6:0
Board of Ethics
Open Session
November 15, 2019 Page 9
SUBJECT DISCUSSION ACTION
Announcements Next Meeting: Friday, December 20, 2019 – 1:00 p.m., Mo‘ikeha Building, Liquor
Conference Room 3.
Adjournment Mr de la Pena moved to adjourn the
meeting, Vice Chair Shiraishi
seconded. Chair Toyofuku
adjourned the meeting at 3:28pm
Submitted by: Reviewed and Approved by:
Anela Segreti, Administrative Specialist Dean Toyofuku, Chair
( ) Approved as circulated.
( ) Approved with amendments. See minutes of meeting.
Charter 20.04. Disclosure.
A. The mayor, councilpersons, managing director, all department, agency, and division
heads and deputies, members of boards and commissions, the purchasing
administrator, and [any employee delegated or authorized to act on behalf of the
director of finance and the deputy director of finance in their absence] regulatoy
employees shall, within thirty days of assuming office, file with the board a list of all
real property within the county in which such person has any right, title, or interest,
a list of all business firms which contract for county business in which such person
has any interest, and all of such person’s places of employment, including part-time
employment, all sources and amounts of income, business ownership, officer and
director positions, debts, creditor interests in insolvent businesses, and the names of
persons represented before government agencies. Amendments to the list,
including additions, deletions, or changes in title, interest in property or of
employment, shall be made within thirty days of the occurrence of the amendment.
The list shall be a matter of public record. (Amended 2008, 2010)
BOE 2019-29
Section 20.05. Board of Ethics.
D. It shall be the function of the board:
(2) To render advisory opinions or interpretations with respect to application of
the code on request. All requests for advisory opinions shall be answered within forty-five days
of its filing and failure to submit an advisory opinion within said forty-five days shall be deemed
a finding of no breach of the code. Opinions rendered or deemed rendered shall be binding on
the board in any subsequent charges concerning the officer or employee of the county until
said opinion is amended or revoked by the board. (Amended 2010)
BOE 2019-31
KAUA‘I COUNTY BOARD OF ETHICS
DISCLOSURE STATEMENT
INSTRUCTION SHEET
I.WHO MUST FILE. The Mayor, Council persons, Prosecuting Attorney, all department heads and
deputies, members of boards and commissions, the purchasing agent, any employee delegated or
authorized to act on behalf of the director of finance and deputy director of finance in their absence and
all candidates for elective office.
II.WHEN TO FILE. Disclosure forms must be filed within thirty (30) days of taking office or within
seven (7) days of fling nomination paper as a candidate for office, as in the case may be. Section 3-1.9,
Kaua‘i County Code 1987; Section 20.04, Charter of the County of Kaua‘i.
III.WHAT TO FILE. Charter §20.04 says you must file a list of all property in which you have a right, title,
or interest, a list of all business firms which contract for county business in which you have any interest,
all places of your employment including part-time employment, all sources and amounts of income,
business, ownership, officer and director positions, debts, creditor interests in insolvent businesses, and
the names of persons represented before government agencies.
IV.AMENDMENTS. Disclosure forms must be updated within thirty (30) days of any change in
information requiring disclosure.
V.PENALTY FOR FAILURE TO FILE. A violation of any provision of the Code of ethics of the
Charter of the County of Kaua‘i shall be cause for fine, suspension, or removal from office or employment.
VI.WHERE TO FILE. All Disclosure Statements should be filed by mail or in person, addressed as
follows:
Kaua‘i County Board of Ethics
c/o Office of Boards and Commissions
Mo‘ikeha Building
4444 Rice Street, Suite 150
Līhu‘e, Kaua‘i, Hawai‘i 96766
We suggest you make and retain a copy for your personal records.
DISCLOSURE FORMS ARE PUBLIC RECORD
BOE 2019-32
BOARD OF ETHICS
COUNTY OF KAUA‘I
DISCLOSURE STATEMENT
THIS DOCUMENT SHALL BECOME A PUBLIC RECORD WHEN RECEIVED BY THE OFFICE
OF BOARDS AND COMMISSIONS. PLEASE COMPLETE ALL SECTIONS, USE N/A IF YOU
HAVE NOTHING TO REPORT FOR A PARTICULAR SECTION.
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:
I am a Candidate for Public Office:
(Name of Public Office)
I am an Elected or Appointed official or delegated employee for Kaua‘i County: _______________ (Position Title)
I am an Appointed member of a Board or Commission: __________________________________
(Name of Board or Commission)
Employer Type of Business Position
III. CURRENT ANNUAL INCOME – List all sources and amounts of income greater than $1,000 (i.e.
wages, income from rental or 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) Current Annual Income (Round to
the nearest $10,000. If more than
$100,000, you may list > $100,000)
I. GENERAL INFORMATION
II. EMPLOYMENT – List all current employment other than County employment (including part-time)
Business Name Percent Ownership Interest Check here if
business
contracts with
the County
Organization Name Type of Organization Position
Address/Location Tax Map Key Number
IV. BUSINESS INTEREST – List all business, partnerships, or sole proprietorships and the percentage of
interest in which you have an interest (please identify acronyms appropriately).
V. POSITION HELD IN BUSINESS OR ORGANIZATION – List in the space below the information
requested for all organization (whether corporations, non-profit corporations, unincorporated
organization, 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.)
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 Hawai‘i, Article XIV)
Name of person, company, etc. Board/Commission/Agency Year
I hereby certify that the above statement 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.
I hereby swear under oath and certify, under penalty of perjury, and pursuant to HRS § 710-1061, that
all of the information provided in this report is true and correct. I understand that providing false
information may be a violation of Federal and State law. 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 Date
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:
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
Document Date: # Pages:
Document Description:
Notary Name: Circuit
Subscribed and sworn before me this day of , 20
Notary Public, State of Hawai‘i
My Commission Expires: