HomeMy WebLinkAboutBOE_2020_1016_Notice_Agenda-Packet_1An 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, October 16, 2020
1:00 p.m. or shortly thereafter
Microsoft Teams Audio: +1 469-848-0234, Conference ID: 942 205 562#
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 September 18, 2020
PUBLIC TESTIMONY
COMMUNICATION
BOE 2020-30 Memorandum from Councilmember Felicia Cowden dated October 7, 2020
relating to her recusal from Resolution No. 2020-44 (Mayoral Reappointment
of Dean A. Toyofuku to the Board of Ethics).
REQUEST FOR AN ADVISORY OPINION
RAO 2020-03 Request for an Advisory Opinion from Adam Roversi dated September 23, 2020
relating to no Code of Ethics issue arising from working in a limited part-time
position with the Fifth Circuit Court.
RAO 2020-04 Request for an Advisory Opinion from Russell Izumo dated October 6, 2020
relating to being offered the position of Automotive Superintendent for the
County of Kauai and the owner of Nex Gen Diesel, an authorized provider of
warranty services to the County of Kauai Auto Shop
.
BUSINESS
BOE 2020-31 Discussion and possible action regarding revisions made to the disclosure
statement.
Board of Ethics – October 16, 2020
2 | Page
DISCLOSURES
Employees:
1. Aaron Larrimore, Office of the County Attorney
2. Luke Evslin, Councilmember
Candidates:
3. Felicia Cowden, Candidate for County Council
4. Mason Chock, Candidate for County Council
5. Kipukai Kuali`i, 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-030: BOE 2020-32 Anonymous letter dated September 22, 2020 requesting the Board of Ethics
initiate an investigation into an allegation relating to an employee(s) or officer(s)
of the County.
ES-031 Executive Session Minutes of September 18, 2020
ES-032: BOE 2020-33 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 formal hearing for Complaint No. 20-001 referred to an independent
hearings officer on September 25, 2020.
RETURN TO OPEN SESSION
Ratify on Board actions taken in Executive Session.
ANNOUNCEMENTS
Next Meeting: Friday, November 20, 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.
cc: Charles Foster, Deputy County Attorney
Board of Ethics – October 16, 2020
3 | Page
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 September 18, 2020
Location Teleconference Start of Meeting: 1:01 p.m. End of Meeting: 2:46 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: Nicholas Courson
Excused
Absent
SUBJECT DISCUSSION ACTION
Call To Order Chair Shiraishi called the meeting
to order at 1:01 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 August 10, 2020
Mary stated that she called Administrative Specialist to make two typos which
were corrected and reposted.
Vice Chair Burriss noted that on page 7, “mute” should be “moot”.
Chair Shiraishi noted that on page 3, “question” should be “caution”.
Chair Shiraishi entertained a motion to approve the minutes of August 10,
2020 as amended.
Member Latkiewicz moved to
approve the minutes of August
10, 2020 as amended. Member
Toyofuku seconded.
Voice vote: 6 ayes, 0 nays
Motion carried 6:0
Board of Ethics
Open Session
September 18, 2020
Page 2
SUBJECT DISCUSSION ACTION
Testimony None No action
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.
Chair Shiraishi entertained a motion to receive.
Secretary Tudela moved to
receive BOE 2020-25. Member
Toyofuku seconded.
Voice Vote: 6 ayes, 0 nays
Motion carried 6:0
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.
Charles Foster, Deputy County Attorney, addressed concerns that there may be a conflict
on some of the board members sitting on this matter. His legal opinion is that they do not
have a conflict in rendering an opinion to Nick’s request. He asked if anyone had any
legal reason to think they have a conflict.
Chair Shiraishi clarified that Mr. Courson had been assigned to the Board of Ethics as the
Deputy County Attorney and also former administrator for Boards and Commissions for
some of the members and now he is before some of the people he used to advise.
Question is to see if that in and of itself is in issue.
Mr. Foster confirmed that it is not an issue.
Chair Shiraishi confirmed that all members could be fair and impartial. Hearing no one
with a potential conflict she called for the motion.
Mr. Foster suggested that the motion be more specific. He would suggest a motion that
the Board is finding no conflict with considering the request.
Ms. Ching suggested that though Nicholas Courson has previously served as the Deputy
County Attorney for the Board of Ethics and previously Administrator for Boards and
Commissions the members find that they have no legal conflict in considering RAO
2020-02.
Vice Chair Burriss moved that all
though Nicholas Courson had
previously served as the Deputy
County Attorney for the Board of
Ethics and Administrator for Boards
and Commissions the members find
that they have no legal conflict in
considering RAO 2020-02.
Secretary Tudela seconded.
Voice vote: 6 ayes, 0 nays
Motion carried 6:0
Board of Ethics
Open Session
September 18, 2020
Page 3
SUBJECT DISCUSSION ACTION
Chair Shiraishi opened the meeting up for discussion.
Secretary Tudela asked Mr. Courson if he could share any example of when his
transactional work with non-County potential clients would ever overlap with his current
duties as County Project Manager and Compliance Officer.
Mr. Courson did persee it as a possibility and request is a surplus of caution and to be
transparent. If the occasion arose he would disclose it to the KEMA administrator and
appropriately handle it.
Member Toyofuku asked Mr. Courson to specify transactional work in addition to estate
planning.
Mr. Courson stated that he has been asked in the past to do 1031 exchanges and lease
work. He is busy and it would be limited. It would be things that would be after work or
weekend so would not include work to go to court or before administrative agencies.
Maybe basic consulting work.
Vice Chair Burris got disconnected, she was connected by computer but could not
unmute. She rejoined the meeting, but could not be heard. She reconnected and
confirmed that she could hear the meeting, but could not unmute.
Chair Shiraishi asked what he means by consulting work.
Mr. Courson did not have any examples, but has been asked to draw trust and do 1031
exchanges, but would not want to limit himself unduly provided that he stayed within
what he outlined in his letter. He confirmed that he would come back to the Board if
something came up outside of his letter.
Chair Shiraishi asked him to explain the bulk of his current work, specifically if the buck
stops with him.
Mr. Courson said it does not and he explained how the CARES Act grant operates. He is
a resource and tracks the money overall per US Treasury guidelines, but no final
determinations on who receives money and what it is used for except for being within the
guidelines. He will also be involved in the County’s ACT 35 monies project to fix up a
levy on the west side. He explained his role in the Small Business grants.
Board of Ethics
Open Session
September 18, 2020
Page 4
SUBJECT DISCUSSION ACTION
Chair Shiraishi asked who he anticipates his clients to be.
Mr. Courson stated that it would be work for family members as well as clients for a
friend who is a financial planner who has asked, and possibly some estate planning. He
emphasized that he does not have a lot of time for extra work.
Chair Shiraishi stated that she wants to be sure it is an appearance of a conflict versus a
conflict.
Mr. Courson does not see it as either. He stated that many in the County have second
jobs and he does not have the ability to directly influence and the handful that he does he
would stay far from that. He is disclosing far above and beyond HR policy.
Chair Shiraishi stated her concern being if someone whom receives money becomes a
client.
Member Toyofuku stated that he is assuming that Mr. Courson would know that County
employees or any entities that got CARES Act money could potentially be an appearance
of conflict.
Mr. Courson stated that he would commit to that, but was not in control of anyone that
received CARES Act money, and in response to County employees the County Code is
specific. He stated he could commit to not engage in work with anyone that got CARES
Act monies or any County employees if that makes the Board more comfortable.
Secretary Tudela clarified that she hears that Mr. Courson does not intend to market
himself and that he will adhere to County codes and is concerned that the Board would
not be consistent and restrict him in a way that they would not restrict another employee.
Deputy County Attorney Foster stated that the request is for an opinion about whether the
proposal violates conflict of interest and that the Board needs to focus on section 3.17 of
the code and make that determination. He is uncomfortable with the Board making ad
hoc conditions, the question is, is there a conflict or is there not a conflict? This is his
opinion as their attorney.
Board members discussed their thoughts on what they believe Mr. Courson was saying.
Vice Chair Burriss moved that there
is no conflict provided that Mr.
Courson conducts business as stated
in his request. Secretary Tudela
seconded.
Board of Ethics
Open Session
September 18, 2020
Page 5
SUBJECT DISCUSSION ACTION
Chair Shiraishi summarized that Mr. Courson is saying that he would not do any
transactional work on County time and will not appear before any County agencies then
that would be fine, and he will come before Board if there is anything that comes up he
will come before Board again for guidance.
Mr. Courson stated he would comply with the Code of Ethics, Charter and Code, and
Board of Ethics Rules and Regulations.
Chair Shiraishi called for roll call vote.
Roll call vote:
Member Gentry: aye
Member Latkiewicz: aye
Member Toyofuku: aye
Secretary Tudela: aye
Vice Chair Burriss: aye
Chair Shiraishi: aye
Motion carried 6:0
BUSINESS BOE 2020-26 Discussion and possible action regarding Advisory Opinion in response to
RAO 2020-01.
Board discussed the finished advisory opinion and forwarding it to Mr. Renaud and
question if it should be sent to his supervisor. Clarified that it needs to be sent to address
furnished by the requester per rules.
No action.
BOE 2020-27 Discussion and possible action regarding revising the disclosure
statement.
Ms. Ching explained that based on previous discussions this item was placed on the
agenda regarding Section IV of disclosures and adding type of business for more
information and clarification.
Ms. Ching clarified that can add acronym statement under employment but looking at
adding type of business under section IV.
Chair Shiraishi suggested changing type of business and type of organization to nature of
business and nature of organization.
Ms. Ching suggested description of business. Board discussed which to use.
Secretary Tudela moved that change
disclosure form to specify under
employment to ask for a description
of the type of business and if
acronyms are used to spell out the
meaning of the acronym.
Secretary Tudela amended motion
to under 4 description of business
interest and under type of
employment to spell out the
acronyms.
Secretary Tudela amended her
motion to under #2 Employment to
add identifying acronyms as
appropriate and amend type of
business to description of business
activity, under #4 Business Interest
description to add description of
Board of Ethics
Open Session
September 18, 2020
Page 6
SUBJECT DISCUSSION ACTION
business activity and under #5
Position Held in Business or
Organization to add description of
organization activity. Vice Chair
Burriss seconded.
Voice vote: 6 ayes, 0 nays
Motion carried 6:0
BOE 2020-28 Discussion and possible action on new employee orientation and
acknowledgement on ethics.
Ms. Ching reported that she has been in conversation with HR and there is an
acknowledgement signed by employees when first hired. She asked about a reminder to
employees, and HR suggested putting it in a newsletter. She last discussed with them
putting it in their newsletter twice a year as an update.
No action.
Chair Shiraishi asked to amend the agenda to go into executive session to accommodate
Nadine Ando, Special Counsel’s schedule.
Member Latkiewicz moved to
amend the agenda to go into
executive session. Member
Toyofuku 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-028 Executive Session Minutes of August 10, 2020
Board of Ethics
Open Session
September 18, 2020
Page 7
SUBJECT DISCUSSION ACTION
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).
The Board moved into Executive Session at 2:02 pm
Vice Chair Burris moved to go into
executive session at 2:02pm.
Secretary Tudela seconded.
Voice vote: 6 ayes, 0 nays
Motion carried 6:0
Return to Open
Session
Ratify on Board actions taken in Executive Session. The Board resumed in Open
Session at 2:43 p.m.
Secretary Tudela moved to
ratify decisions made in
Executive Session. Member
Latkiewicz seconded.
Voice vote 6 ayes, 0 nays.
Motion carried 6:0
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
Secretary Tudela moved to approve
disclosures Cabrera, Kaneshiro,
Carter & Fukushima. Vice Chair
Burriss seconded.
Voice vote: 6 ayes, 0 nays
Motion carried 6:0
Secretary Tudela moved to approve
disclosure Gentry. Vice Chair
Burriss seconded.
Voice vote: 5 ayes, 1 abstain, 0
nays
Motion carried 5:1:0
Board of Ethics
Open Session
September 18, 2020
Page 8
SUBJECT DISCUSSION ACTION
Announcements Next Meeting: Friday, October 16, 2020 – 1:00 p.m., Teleconference
Adjournment Without objection the meeting
was adjourned at 2:46 p.m.
Submitted by: Reviewed and Approved by:
Anela Segreti, Administrative Specialist Mia Shiraishi, Chair
( ) Approved as circulated.
( ) Approved with amendments. See minutes of .
COUNTY COUNCIL
Arryl Kaneshiro, Chair
Ross Kagawa, vice Chair
Arthur Brun
Mason K. Chock
Felicia Cowden
Luke A. Evslin
KipuKai Koat'i
' ,j
RECEIVED
OFFICE OF THE COUNTY CLERX
Jade K. Fountain-Taaigawa, County Clerk
Scott K. Sato, Deputy County Clerk
Council Services Division
4396 Rice Street, Suite 209
Lihu'e, Kaua'i, Hawar'r 96766
REEHt\,rEtunc,@kauai
? GI-? A8TI
)f i,:[ 0F
TH['.'CUHTY CLERX
iouxtv or i{AUA'l
gov
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0 d 2020
TO
BOARDS &,COMMISSIONS October 7,2O2O
ArryI Kaneshiro, Council Chair
and Members of the Kaua'i County Council
FROM: FeliciaCowden, Councilmember
RE:RECUSAL FROM RESOLUTION NO. 2O2O-44 (MAYORAL
REAPPOINTMENT OF DEAN A. TOYOFUKU TO THE BOARD OF
ETHICS)
€ra"- (,*"4"n
This is to inform you that pursuant to the provisions of the Kaua'i County
Charter and RuIe No. 8 of the Rules of the Council of the County of Kaua'i, I hereby
provide written disclosure on tlre record of a- possible conflict of interest relating to
ihe Mayoral Reappointment of Dean A. Toyofuku to the Board of Ethics, as I have an
interest in a matter before the Board of Ethics.
Should you have any questions, please feel free to contact me. Thank you for
your attention to this matter.
cc: October 21, 2020 Council Meeting Agenda
County of Kaua'i Board of Ethics
Council Services Staff
AN EQUAI OPPORTL]NITY EMPLOYER
Telephone:
Facsimile:
(808) 24 r 4188
(808) 241-6349
MEN4OEANDUU
BOE 2020-30
www.kauai.gov
4444 Rice Street Suite 330 • Līhu‘e, Hawai‘i 96766 • (808) 241-4444 (b) • (808) 241-5118 (f)
An Equal Opportunity Employer
KAUA‘I COUNTY HOUSING AGENCY
THE COUNTY OF KAUA‘I
DEREK S. K. KAWAKAMI, MAYOR
MICHAEL A. DAHILIG, MANAGING DIRECTOR
ADAM P. ROVERSI
HOUSING DIRECTOR
September 23, 2020
Chair Mia Shiraishi
Kaua‘i Board of Ethics
c/o Office of Boards and Commissions
4444 Rice Street, Suite 300
Līhu‘e, Hawai‘i 96766
Re: Request for advisory opinion that there is no Code of Ethics issue arising from
working in a limited part-time position with the Fifth Circuit Court
Aloha Chair Shiraishi,
I am presently serving as the Director of the Kaua‘i County Housing Agency and am
interested in applying for a 1-year appointment as grand jury council with the Fifth
Circuit Court. The grand jury council position is a part-time one-year contract, which
requires at most one day of work per month; a total of twelve days during the one-year
contract.
The grand jury hearing dates are set at the beginning of the year for the following 12
months. Accordingly, hearing dates are known far in advance and can be easily planned
for. If selected to serve as grand jury council, it would be my intention to utilize accrued
vacation time on any day I appeared in court. Accordingly, no work for the court would
occur on “county time.”
In substance the grand jury reviews potential criminal charges that may be brought for
crimes that take place on Kaua‘i. My work as Housing Director is not involved
whatsoever with criminal court matters. Accordingly, there should be no conflict of
interest arising between the two positions.
If it would be beneficial, I would be happy to appear at the next Board hearing to answer
any questions.
Sincerely,
Adam P. Roversi
Director
RAO 2020-03
RAO 2020-04
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 Pi`ikoi Building
4444 Rice Street, Suite 300
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 2020-31
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 Description of Business Activity 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).
Please identify acronyms appropriately.
Business Name Description of Business Activity Percent Ownership Interest Check here if
business
contracts with
the County
Organization Name Description of Organization Activity 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