Pasadena_Taxpayer_Protection_Amendment_Disclosure_(2).pdf
PDF 472 KB Posted
- Solicitation number
- 2023-RFP-530
- Issued by
- Los Angeles County, California
About this file
This document is a Disclosure Form pursuant to the City of Pasadena Taxpayer Protection Amendment, specifically under the Pasadena City Charter, Article XVII. The form requires contractors or organizations to disclose detailed information about their organizational structure, including trustees, directors, partners, officers, and individuals with more than 10% equity, participation, or revenue interest. The form provides spaces for entering the contractor/organization name, type of entity (with options for non-government or nonprofit 501(c)(3), (4), or (6)), and listing key personnel and stakeholders.
The form is specifically tied to a contract opportunity for a Nurse Educator and Continuous Quality Improvement (CQI) Program Coordinator for the Pasadena Fire Department's Emergency Medical Services Division. While the disclosure form itself does not contain pricing or funding details, it is part of the transparency and accountability requirements for entities seeking to contract with the City of Pasadena. The form must be completed legibly, with the option to use additional sheets if necessary, and includes fields for the preparer's name, title, phone number, and date of preparation.
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Text version
{project.template.processClassification} - {project.title} Release Date: {project.releaseProjectDate}
Disclosure Pursuant to the City of Pasadena Taxpayer Protection Amendment
Pasadena City Charter, Article XVII
Contractor/Organization hereby discloses its trustees, directors, partners, officers, and those with more than 10% equity, participation, or revenue interest in Contractor/Organization, as follows:
(If printing, please print legibly. Use additional sheets as necessary.)
1. Contractor/Organization Name:
2. Type of Entity:
□ non-government □ nonprofit 501(c)(3), (4), or (6)
3. Name(s) of trustees, directors, partners, officers of Contractor/Organization:
4. Names of those with more than 10% equity, participation or revenue interest in Contractor/Organization:
Prepared by: ________________________________
Title: ______________________________________
Phone:
Date: ______________________________________
File details come from the government source that posted it. Updated .