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James Kosluchar, Director of Public Works City of Fridley Public Disclosure Statement By Top Level City Employees Name Date Position Title: Pursuant to Section 5.06 of the Fridley City Code, I hereby make the following declarations regarding my financial and personal interests: 1.Names of all business corporations, partnerships, other business enterprises, or governmental agencies doing business with the City of Fridley or located within the City of Fridley. a)With which I have a financial interest As used in Chapter 5, the term financial interest shall be deemed to include ownership of more than 10% of: the outstanding stock in a corporation, an interest in a partnership, proprietorship, or other business entity, or an interest in real property. Financial interest shall apply to real or personal properties owned by one person making the disclosure and by said person’s spouse. b)With which I have a personal interest As used in Chapter 5, the term personal interest shall be deemed to apply whenever a person required to make a disclosure under this code of ethics shall be associated with a business as an employee, officer, director, trustee, partner, advisor or consultant. Name of Business, AddressFinancial Interest Personal Interest Partnership, Etc. (use additional paper if necessary) 2.A list of the non-homestead real property located within the City of Fridley in which I currently have a financial interest: Non-Homestead Real Property Address (use additional paper if necessary) 3.A list of names and nature of business of all corporations, partnerships, or other business enterprises with which I have a financial interest and in which I know one or more other persons covered by this code of ethics also having a financial interest in said enterprise. This list shall indicate the name or names of such persons or persons having such interest in said enterprise. Nature of Business –of All Corporations, NamesPartnerships, or Other Business Enterprises (Use additional paper if necessary) I do swear (or affirm) that this report is a full and true statement pursuant to Section 5.06 of the Fridley City Ejhjubmmz!tjhofe!cz! Code. Kbnft! Kbnft!Lptmvdibs! Ebuf;!3132/12/18! Lptmvdibs 19;29;31!.17(11( _____________________________________________ ___________________________ Signature Date This statement must be filed upon appointment or reappointment to an advisory committee or material changes in financial interest while on an advisory committee. Please submit a signed Public Disclosure Form to the City Clerk’s Office. Thank you.