HomeMy WebLinkAboutBOE_2020_0918_Notice_Agenda-PacketAn Equal Opportunity Employer
Mia Shiraishi Members:
Chair Kelly Gentry
John Latkiewicz
Susan Burriss Dean Toyofuku
Vice Chair
Mary Tudela
Secretary
COUNTY OF KAUA'I BOARD OF ETHICS
NOTICE OF TELECONFERENCE AND AGENDA
Friday, September 18, 2020
1:00 p.m. or shortly thereafter
Microsoft Teams Audio: +1 469-848-0234, Conference ID: 831 659 943#
This meeting will be held via Microsoft Teams conferencing only. Members of the public are invited to
join this meeting by calling the number above with the conference ID information. You may testify
during the video conference or submit written testimony in advance of the meeting via e-mail, fax, or
mail. To avoid excessive noise/feedback, please mute your microphone except to testify.
CALL TO ORDER
ROLL CALL
APPROVAL OF MINUTES
Open Session Minutes of August 10, 2020
PUBLIC TESTIMONY
COMMUNICATION
BOE 2020-25 Possible conflict of interest from Council Chair Arryl Kaneshiro dated June 10,
2020 relating to C 2020-169, right-of-entry agreement on the June 17, 2020
Council Meeting.
REQUEST FOR AN ADVISORY OPINION
RAO 2020-02 Request for an Advisory Opinion from Nicholas Courson dated August 10, 2020
relating to whether it would be a conflict of interest for him to do transactional
legal work while employed on a contract basis by the Kauai Emergency
Management Agency.
BUSINESS
BOE 2020-26 Discussion and possible action regarding Advisory Opinion in response to RAO
2020-01.
BOE 2020-27 Discussion and possible action regarding revising the disclosure statement.
BOE 2020-28 Discussion and possible action on new employee orientation and
acknowledgement on ethics.
Board of Ethics – September 18, 2020
2 | Page
DISCLOSURES
Employees:
1. Hugo Cabrera, Office of the County Attorney
2. Arryl Kaneshiro, Councilmember
Volunteers:
3. Kelly Gentry, Board of Ethics
4.Jennifer Carter, Civil Service Commission
Candidates:
5. Richard Fukushima, Candidate for County Council
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-028 Executive Session Minutes of August 10, 2020
ES-029: BOE 2020-29 Pursuant to Hawai‘i Revised Statutes §92-4 and §92-5 (a) and (2) and (4), the
purpose of this Executive Session is for the Board to discuss and make decisions
regarding any response to the Complaint No. 20-001 served on August 24, 2020,
in accordance with the Preliminary Opinion served on August 18, 2020 that may
be received prior to the meeting (formal Answer to Complaint due on September
14, 2020).
RETURN TO OPEN SESSION
Ratify on Board actions taken in Executive Session.
ANNOUNCEMENTS
Next Meeting: Friday, October 16, 2020 – 1:00 p.m., Teleconference
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.
Board of Ethics – September 18, 2020
3 | Page
cc: Charles Foster, Deputy County Attorney
PUBLIC COMMENTS and TESTIMONY
SPEAKER REGISTRATION
Prior to the Day of the Meeting: Persons wishing to testify are requested to register their name, phone
number, and agenda item via email at asegreti@kauai.gov; or by calling 808-241-4917.
On the Day of the Meeting: Persons who have not registered to testify by the time the Commission
meeting begins will be given the opportunity to speak on an item following oral testimonies of
registered speakers.
Each speaker is limited to a three-minute presentation on each item.
WRITTEN TESTIMONY
Prior to the Day of the Meeting: Testimony may be emailed: asegreti@kauai.gov faxed: 808-241-5127,
or mailed: County of Kauai, Office of Boards and Commissions, Board of Ethics, 4444 Rice St., Ste.
300, Lihue, HI 96766.
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 Aug 10, 2020
Location Teleconference Start of Meeting: 1:00 p.m. End of Meeting: 2:55 p.m.
Present Chair Mia Shiraishi, Vice Chair Susan Burriss, Secretary Mary Tudela. Members: Kelly Gentry, John Latkiewicz, Dean Toyofuku.
Also: Deputy County Attorney Charles Foster. Boards & Commissions Office Staff: Administrator Ellen Ching and
Administrative Specialist Anela Segreti. Testifier: Ed Renaud
Excused
Absent
SUBJECT DISCUSSION ACTION
Call To Order Prior to the start of the meeting the Board welcomed Kelly Gentry as their newest Board
Member.
Chair Shiraishi called the meeting
to order at 1:00 p.m.
Roll call:
Member Gentry: present
Member Latkiewicz: present
Member Toyofuku: present
Secretary Tudela: present
Vice Chair Burriss: present
Chair Shiraishi: present
Six members present, which
constituted a quorum.
Approval of
Minutes
Open Session Minutes of July 14, 2020
Open Session Minutes of July 21, 2020
Chair Shiraishi entertained a motion to approve the minutes of July 14, 2020
and July 21, 2020 with no edits.
Member Latkiewicz moved to
approve the minutes of July 14,
2020 and July 21, 2020. Vice
Chair Burriss seconded.
Chair Shiraishi approved the
minutes as read with no
corrections.
Board of Ethics
Open Session
August 10, 2020
Page 2
SUBJECT DISCUSSION ACTION
Testimony None No action
Communication BOE 2020-24 Possible conflict of interest from Council Chair Arryl Kaneshiro dated July
31, 2020 relating to C 2020-196 relating to a donation of gift certificates from Grove
Farm Foundation, valued at $10,000.00 to help Kaua`i’s Kūpuna in need of assistance.
Chair Shiraishi entertained a motion to receive.
Vice Chair Burriss moved to
receive BOE 2020-24. Member
Toyofuku seconded.
Voice Vote: 6 ayes, 0 nays
Motion carried 6:0
Request for an
Advisory Opinion
RAO 2020-01 Request for an Advisory Opinion from Edmond Renaud dated July 27,
2020 relating to a possible conflict of interest relating to his marriage to an inactivated
licensed contractor and his positions as Chief of Field Operations and Maintenance.
Chair Shiraishi acknowledged that the board received that request and position
description and asked Mr. Renaud if he wanted to add anything else.
Mr. Renaud replied that was it.
Chair Shiraishi entertained a motion.
Board moved into discussion.
Secretary Tudela questioned where is the potential conflict.
Mr. Renaud replied that when this happened at a meeting, it was suggested by his
supervisor, Troy Tanigawa, that he submit a request for an advisory opinion. He clarified
that there was no complaint against him. He later found out that his wife was the
licensed contractor for a company that was doing work at the hotel and they needed a
contractor license and she was helping out. He testified that he is aware that in his
position he should not be involved in any of this and that he was not, but he wanted to
inform the board of the situation.
Secretary Tudela clarified that his wife no longer has an ABC license for General
Engineering, Independent, and other.
Board of Ethics
Open Session
August 10, 2020
Page 3
Mr. Renaud clarified that his job is to review contracts after the engineer and project
assistant has worked on them to make sure that everything is legal within the County. He
also clarified that he approves within the division, than it is moved up and his is not the
final approval. The contractor, D&K, used his wife’s license so they could do work and
the County’s road division has contracts with them. He continued to clarify that he
reviewed contracts by this contractor and they were the low bidder and everything was in
line and allowed it to move forward for approval.
Secretary Tudela asked him to clarify being asked to write a request for an advisory
opinion.
Mr. Renaud explained that when COVID-19 happened the local Contractors General
Association of Hawaii was looking for contractors and they made a list available to the
community of General Contractors and RMEs in case they needed assistance. His wife’s
name was on the list and that’s how it came forward.
Vice Chair Burriss asked if his wife planned to reactivate her contractor’s license.
Mr. Renaud replied that he does not believe she will, but has told her that if she does get
involved in something she cannot get involved in anything with the County as long as he
is working.
Chair Shiraishi asked Deputy County Attorney Charles Foster that they do not look at
past behavior for a violation. They are only to advise on actions that have not yet
happened.
Mr. Foster stated that request can be made to assist officers and employees in the proper
performance of their official duties and responsibilities in accordance with the Code of
Ethics.
It was clarified that Request for an Advisory Opinion is not to review actions that
happened in the past, that would be a complaint.
Chair Shiraishi is satisfied that Mr. Renaud’s wife’s license is inactivated and they have
been told that she has no plans to reactivate at this time. She would question that if she
does that he would contact the board with the issue.
Member Toyofuku asked if the company that she had her license with have any current
Vice Chair Burriss moved to find no
conflict Member Toyofuku
seconded.
Roll call vote:
Member Gentry: no conflict
Member Latkiewicz: no
conflict
Member Toyofuku: no
conflict
Secretary Tudela: aye
Vice Chair Burriss: aye, no
conflict
Chair Shiraishi: aye, no conflict
Motion carried 6:0
Board of Ethics
Open Session
August 10, 2020
Page 4
contracts with the County.
Mr. Renaud explained that she inactivated her license he believes on April 1. He doesn’t
know why, she said she retired already and she wasn’t getting paid, she was just helping
out and with the list that came out on the 20th with the Contractors Association she was
already out. When he found out he checked all the accounts and there wasn’t anything
with him. The company is finishing a contract with the County, but cannot apply for
anymore until they get a licensed contractor. He also clarified that she was not getting
payed and not an employee. The company has 90 days to obtain a licensed contractor.
Ellen Ching, Administrator, stated that she heard discussion that if circumstances should
change he should come before the board. She asked if a clarifying statement should be
included in the letter.
Chair Shiraishi confirmed she would like a statement regarding that in the letter.
Board discussed that they should not place any judgement on what happened in the past
already, that would be a complaint and not what they were to do today.
Ms. Ching asked for a motion from the board to work with the Chair to draft a letter with
guidance on moving forward.
Member Toyofuku agreed with Ms. Ching and that this is something they have
experienced before and believes that inserting the conditions moving forward that in
whatever way possible that should his wife ever reactivate her license again they would
recommend that he come forward for an advisory opinion. Making decision is based on
today and moving forward. He acknowledged that the company was awarded a contract
prior to knowing the facts, and for example if a complaint came in they would look over
all those facts. He remembered that she was the RME and any permits or contracts that
went through his office would have needed to be signed by her. He clarified for this
opinion it is moving forward and doesn’t matter what happened before.
Secretary Tudela stated that a question on this could come before the board and the
decision they made today has no bearing on that.
Vice Chair Burriss asked if they should reach out to the licensing bureau and perhaps
they could put a cautionary message.
Secretary Tudela moved that the
Board of Ethics allow
administration to confer with the
Chair about added comments on the
response to this request. Vice Chair
Burriss seconded.
Voice vote: 6 ayes, 0 nays
Motion carried 6:0
Board of Ethics
Open Session
August 10, 2020
Page 5
Secretary Tudela suggested that it should be made to the County.
Ms. Ching clarified that the contractor’s license is a State body and she could give a call
to them. She stated that this is limited to County employees, similar to the previous one
and if you’re an employee and work for the department giving the license that becomes
problematic.
Member Toyofuku suggested a FYI memo from the Board of Ethics.
Ms. Ching offered to discuss this with HR and the Board agreed.
Business BOE 2020-20 Discussion and possible action on returning to conducting Board of
Ethics meetings on the third Friday of the Month beginning September 18, 2020.
Sue thanked the Board for being flexible as she preferred Fridays.
Secretary Tudela moved to return
the Board of Ethics meeting to the
third Friday of every month
beginning September 18, 2020. Vice
Chair Burriss seconded.
Voice vote: 6 ayes, 0 nays
Motion carried 6:0
Disclosures Candidates:
1. Justin Kollar, Candidate for Prosecuting Attorney
2. Addison Bulosan, Candidate for County Council
3. Victoria Franks, Candidate for County Council
4. Debralynn Carveiro, Candidate for County Council
5. Shirley Simbre-Medeiros, Candidate for County Council
6. Michael Dandurand, Candidate for County Council
7. Donovan Cabebe, Candidate for County Council
8. Clint Yago, Candidate for County Council
Board of Ethics
Open Session
August 10, 2020
Page 6
SUBJECT DISCUSSION ACTION
Chair Shiraishi asked how it works now that the primary is done and some of the
candidates are out.
Ms. Ching believes they are still obligated to file disclosures regardless of the results.
She asked for follow-up as to whether all the candidates filed.
Anela Segreti, Administrative Specialist, confirmed that not all candidates filed, none of
the Council incumbents filed.
Discussion that incumbents are assuming since they already have one on file that they do
not need submit one as a candidate.
Mr. Foster confirmed that they clearly have to file the disclosure, the question regarding
once it becomes mute, does the body still need to act on them. He suggested that since
they have filed they should act on them.
Ms. Segreti stated that she did inquire with Council Services as to whether the
incumbents needed to file and was told yes. Justin Kollar filed as a candidate.
Vice Chair Burriss stated that #3, Victoria Franks, #4, and #7 used acronyms in section
IV and should be returned for more information. Also #8, Clint Yago, there are blanks
on sections VI, VIII, and IX.
Ms. Segreti confirmed that for #8, Clint Yago, the incorrect form was sent to members to
review. The correct form was uploaded for the board to review and he completed blank
sections with an N/A.
Members discussed the acronyms used by candidates #3, #4, and #7, to be clear to
describe the acronyms so they can be clear as to a conflict. Discussion continued to
whether the Board should pursue the disclosures for candidates that will not be moving
forward.
Mr. Foster clarified that the board can decide how to handle the disclosures of those
candidates not moving forward. He stated that while there is a legal requirement to look
at them, there’s no legal requirement that you send them back to anyone, there’s no legal
requirement that you follow up on every one. The board can decide among themselves
how to proceed.
Board of Ethics
Open Session
August 10, 2020
Page 7
Ms. Ching suggested that the board may want to not approve as mute and that also not
all information was submitted as requested for future reference.
Board continued to discuss what acronyms versus name of company and initials and how
they will know what the company does and whether there is a potential conflict. That
will be placed on the agenda for another meeting and discussion.
Member Latkiewicz moved to
approve disclosures 1, 2, 5, 6, & 8.
Vice Chair Burriss seconded.
Voice vote: 6 ayes, 0 nays
Motion carried 6:0
Vice Chair Burris moved to approve
3, 4, 7 with a conditional statement
going back to them. Secretary
Tudela seconded.
Voice vote: 6 ayes, 0 nays
Motion carried 6:0
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-026 Executive Session Minutes of July 14, 2020
Executive Session Minutes of July 21, 2020
Board of Ethics
Open Session
August 10, 2020
Page 8
SUBJECT DISCUSSION ACTION
ES-027: BOE 2020-24 Pursuant to Hawai‘i Revised Statutes §92-4 and §92-5 (a) and
(2) and (4), the purpose of this Executive Session is for the Board to discuss and make
decisions regarding the draft of a preliminary opinion regarding Complaint 20-001 under
Rule 6.2 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 E and F, the Kaua’i County Code
1987 as amended by June 2019 Code Supplement, Article 1, Section 3-1.4 and 3-1.6,
No officer or employee of the county shall:
e. Use the officer or employee’s official position to secure
a special benefit, privilege, or exemption for the officer
or employee or others.
f. Use county property for other than public activity or
purpose.
and other related matters where consideration of matters affecting privacy will be
involved, and to consult with its attorney on questions and issues pertaining to the
Board’s powers, duties, privileges, immunities and liabilities as they may relate to this
agenda item.
The Board moved into Executive Session at 2:08 pm
Vice Chair Burriss moved to go
into executive session. Secretary
Tudela seconded.
Voice vote 4 ayes, 0 nays.
Motion carried 4:0
Return to Open
Session
Ratify on Board actions taken in Executive Session. The Board resumed in Open
Session at 2:55 p.m.
Vice Chair Burriss moved to
ratify decisions made in
Executive Session. Member
Latkiewicz seconded.
Voice vote 6 ayes, 0 nays.
Motion carried 6:0
Announcements Next Meeting: Friday, September 18, 2020 – 1:00 p.m., Teleconference
Board of Ethics
Open Session
August 10, 2020
Page 9
SUBJECT DISCUSSION ACTION
Adjournment Without objection the meeting
was adjourned at 2:55 p.m.
Submitted by: Reviewed and Approved by:
Anela Segreti, Administrative Specialist Mia Shiraishi, Chair
( ) Approved as circulated.
( ) Approved with amendments. See minutes of .
COUNryCOUNCIL
Arryl Kaneshiro, Chair
Ross Kagawa, Vice Chair
Arthur Brun
Mason K Chock
Felicia Cowden
Luke A. Evslin
KipuKai Kuali'i
OFFICE OF THE COUN'TY CLERK
Jade K. Fountain-Tanigawa, County Clerk
Scott K. Sato, Deputy County Clerk
Telephone: (808)2414188
Facsimile: (808)24t-6349
E-mail: cokcouncil@kauai.gov
Council Services l)ivision
4396 fuce Street. Suite 209
Lihu'e, Kaua'i, Hawaii 96166
RECEIVED
MEMORANDUM
June 10,2020
BOARDS A COMMISSIONS
TO Members of the Kaua'i County Council
FROM: Arryl Kaneshiro, Council Chair f,[.
RE:
Pursuant to Section 20.04(8) ofthe Kaua'i County Charter, Section 3-1.9 ofthe
Kaua'i County Code 1987, as amended, and RuIe No.8 ofthe Rules ofthe Council of
the County of Kaua'i, I hereby provide written disclosure on the record of a possible
conflict ofinterest relating to C 2020-169, regarding the Right-of-Entry Agreement to
construct ard/or repair portions of Puhi Road for sidewalks and $ading, as well as
for construction related to the Puhi Road drainage system, due to my employment
with Grove Farm Company, Inc.
Should you have any questions, please feel free to contact the OfEce of the
County Clerk, Council Services Division, ar 241-4188. Thank you for your attention
to this matter.
AA:ss
cc:
AN EQUAL OPPORTUNITY EMPLOYER
JUN 15 2020
POSSIBLE CONFLICT OF INTEBEST REGARDING C 2020-169,
RIGHT-OF-ENTRY AGREEMENT ON THE JUNE 17, 2O2O
COUNCIL MEETING
July 8, 2020 Council Meeting Agenda
County of Kaua'i Board of Ethics
Council Services Staff
BOE 2020-25
RAO 2020-02
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 may be filed on-line, or by mail or in person to the
address 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 2020-27
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 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