ACT 44 Disclosure Form for Entities Providing Professional Services to the

Transcription

1 ACT44DisclosureFormforEntitiesProviding ProfessionalServicestothe Borough of Somerset spensionsystem CHAPTER 7A OF ACT 44 OF 2009 MANDATES the annual disclosure of certain information by every entity (hereinafter Contractor )whichisapartytoaprofessionalservicescontractwithoneofthepension fundsofthe Borough of Somerset (hereinafter the Requesting Municipality ). Act 44 disclosure requirements apply to Contactors who provide professional pension services and receive paymentofanykindfromtherequestingmunicipality spensionfund.therequestingmunicipality has determined that your company falls under the requirements of Act 44 and must complete this disclosureform.youareexpectedtosubmitthiscompletedform,totherequestingmunicipalitybelow, by 12/17/2018.If,foranyreasonyoubelievethatAct44doesnotrequireyoutocompletethis disclosureform,pleaseprovideawrittenexplanationofyourreason(s)by 12/10/2018. RETURNCOMPLETED DISCLOSURETO: Attention: Borough of Somerset Michelle A. Enos, Manager P.O. Box 71 Somerset, PA REQUIREDUPDATES: Wherenoted,informationinthisformmustbeupdatedinwritingaschangesoccur. 1

2 CONTRACTOR TERM: SUBCONTRACTORORADVISOR AFFILIATEDENTITY CONTRIBUTIONS POLITICALCOMMITTEE EXECUTIVELEVELEMPLOYEE MUNICIPALPENSIONSYSTEM MUNICIPALPENSIONSYSTEM OFFICIALSANDEMPLOYEES; MUNICIPALOFFICIALSAND EMPLOYEES PROFESSIONALSERVICES CONTRACT DefinitionsforDisclosure DEFINITION: Anyperson,company,orotherentitythatreceivespayments,fees,or anyotherformofcompensationfromamunicipalpensionfundin exchangeforrenderingprofessionalservicesforthebenefitofthe municipalpensionfund. Anyonewhoispaidafeeorreceivescompensationfromamunicipal pensionsystem directlyorindirectlyfromorthroughacontractor. Anyofthefollowing: 1. Asubsidiaryorholdingcompanyofalobbyingfirmorother businessentityownedinwholeorinpartbyalobbyingfirm. 2. AnorganizationrecognizedbytheInternalRevenueServiceasa taxexemptorganizationundersection501(c)oftheinternal RevenueCodeof1986(PublicLaw99514,26U.S.C. 501(c)) establishedbyalobbyistorlobbyingfirmoranaffiliatedentity. Asdefinedinsection1621oftheactofJune3 rd,1937(p.l.1333,no. 320),knownasthePennsylvaniaElectionCode Asdefinedinsection1621oftheactofJune3 rd,1937(p.l.1333,no. 320),knownasthePennsylvaniaElectionCode Anyemployeeorpersonortheperson saffiliatedentitywho: 1. Canaffectorinfluencetheoutcomeoftheperson soraffiliated entity sactions,policies,ordecisionsrelatingtopensionsand theconductofbusinesswithamunicipalityoramunicipal pensionsystem;or 2. Isdirectlyinvolvedintheimplementationordevelopment policiesrelatingtopensions,investments,contractsor procurementortheconductofbusinesswithamunicipalityor municipalpensionsystem. Anyqualifyingpensionplan,underPennsylvaniastatelaw,forany municipalitywithinthecommonwealthofpennsylvania;includesthe PennsylvaniaMunicipalRetirementSystem. Example:thePolicePensionPlanfortheBoroughofWinchesterville Specifically,thoselistedinTABLE2titled: ListofPensionSystemand MunicipalOfficialsandEmployees onthenextpage.where applicable,includesanyemployeeoftherequestingmunicipality. Acontracttowhichthemunicipalpensionsystemisapartythatis:(1) forthepurchaseofprofessionalservicesincludinginvestmentservices, legalservices,realestateservices,andotherconsultingservices;and, (2)notsubjecttoarequirementthatthelowestbidbeaccepted. 2

3 ListofMunicipalOfficialsfortheRequestingMunicipality Certainrequestsforinformationinthisformwillrefertoa ListofMunicipalOfficials. Toassistyouin preparing your answers, you should consider the following names to be a complete list of pension systemandmunicipalofficialsandemployees.throughoutthisdisclosureform,thebelownameswill bereferredtoasthe ListofMunicipalOfficials. Ruby W. Miller Pamela Ream Fredric Rosemeyer Judy Pyle Gary Thomas Sue Opp Steve Shaulis Scott Walker Borough Council President Borough Council Vice-President Borough Council President Pro-Tem Council Member Council Member Council Member Council Member Mayor Michele A. Enos Brett B. Peters James R. Cascio, Esq. Solicitor Borough Manager CAO Collective Bargaining Plan, CAO Police Plan CAO Non-Collective Bargaining Plan Director of Finance 3

4 IdentificationofContractors&RelatedPersonnel CONTRACTORS(See Definitions Page2):Anyentitywhocurrentlyprovidesservice(s)bymeansofa ProfessionalServicesContracttotheMunicipalPensionSystemoftheRequestingMunicipality,pleasecomplete allofthefollowing: IdentifytheMunicipalPensionSystem(s)forwhichyouareprovidinginformation: Indicateallthatapplywithan X : NonUniformPlan PolicePlan FirePlan NOTE: Forallthatfollow,youmayanswerthequestions/itemsonaseparatesheetofpaperandattachitto thisdisclosureifthespaceprovidedisnotsufficient.pleasereferenceeachquestion/itemyouare respondingtobytheappropriatenumber(example:reference Item#1). 1. Please provide the names and titles of all individuals providing professional services to the Requesting Municipality s pension plan(s) identified above.also include the names and titles of any advisors and subcontractorsofthecontractor,identifyingthemassuch.aftereachnameprovideadescriptionofthe responsibilitiesofthatpersonwithregardtotheprofessionalservicesbeingprovidedtoeachdesignated pensionplan. See Attached 2. Please list the name and title of any Affiliated Entity and their Executivelevel Employee(s) that require disclosure;aftereachname,includeabriefdescriptionoftheirduties.(see:definitions) None 3. AreanyoftheindividualsnamedinItem1orItem2above,acurrentorformerofficialoremployeeofthe RequestingMunicipality? YES NO IF YES,p 4

5 4. AreanyoftheindividualsnamedinItem1orItem2aboveacurrentorformerregisteredFederalorState lobbyist? YES NO IF YES,providethenameoftheindividual,specifywhethertheyareastateorfederallobbyist,and thedateoftheirmostrecentregistration/renewal. NOT:Allinformationprovidedforitems14abovemustbeupdatedaschangesoccur. 5. SinceDecember17 th 2009,hastheContractororanAffiliatedEntitypaidcompensationtooremployed anythirdpartyintermediary,agent,orlobbyistthatistodirectlyorindirectlycommunicatewithanofficial oremployeeofthemunicipalpensionsystemoftherequestingmunicipality(or),anymunicipalofficialor employeeoftherequestingmunicipalityinconnectionwithanytransactionorinvestmentinvolvingthe ContractorandtheMunicipalPensionSystemoftheRequestingMunicipality? ThisquestiondoesnotapplytoanofficeroremployeeoftheContractorwhoisactingwithinthescopeof the firm s standard professional duties on behalf of the firm, including the actual provision of legal, accounting, engineering, real estate, or other professional advice, services, or assistance pursuant to the professionalservicescontactwithmunicipality spensionsystem. YES NO IF YES, identify: (1) whom (the third party intermediary, agent, or lobbyist) was paid the compensationoremployedbythecontractororaffiliatedentity,(2)theirspecificdutiestodirectlyor indirectly communicate with an official or employee of the Municipal Pension System of the RequestingMunicipality(OR),anymunicipalofficialoremployeeoftheRequestingMunicipality,(3) theofficialtheycommunicatedwith,and(4)thedatesofthisservice. 6. SinceDecember17 th 2009,hastheContractor,oranyagent,officer,directororemployeeoftheContractor solicited a contribution to any municipal officer or candidate for municipal office in the Requesting Municipality,ortothepoliticalpartyorpoliticalactioncommitteeofthatofficialorcandidate? YES NO IF YES,identifytheagent,officer,directororemployeewhomadethesolicitationandthemunicipal officials,candidates,politicalpartyorpoliticalcommitteewhoweresolicited(towhomthesolicitation wasmade). 5

6 7. Since December 17 th, 2009:Has the Contractor or an Affiliated Entity made any contributions to a municipalofficialoranycandidateformunicipalofficeintherequestingmunicipality? YES NO IF YES,providethenameandaddressofthe person(s) makingthecontribution,thecontributor s relationship to the Contractor, The name and office or position of the person receiving the contribution,thedateofthecontribution,andtheamountofthecontribution. 8. DoestheContractororanAffiliatedEntityhaveanydirectfinancial,commercialorbusinessrelationship withanyofficialidentifiedonthelistofmunicipalofficials,oftherequestingmunicipality? YES NO IF YES,identifytheindividualwithwhomtherelationshipexistsandgiveadetaileddescriptionof thatrelationship. A written letter is required from the Requesting Municipality acknowledging the relationship and consenting to its existence. The letter must be attached to this disclosure.contact therequestingmunicipality toobtain thisletterandattachitto thisdisclosurebeforesubmission. 9. HastheContractororanAffiliatedEntitygivenanygiftshavingmorethananominalvaluetoanyofficial, employeeorfiduciary specifically,thoseonthelistofmunicipalofficialsoftherequestingmunicipality? YES NO 6

7 10. DisclosureofcontributionstoanypoliticalentityintheCommonwealthofPennsylvania Applicability: A YES response is required and full disclosure is required ONLY WHEN ALL of the followingapplies: a) Thecontributionwasmadewithinthelast5years(specificallysince:December18 th 2004) b) Thecontributionwasmadebyanofficer,director,executivelevelemployeeorownerofatleast5% ofthecontractororaffiliatedentity. c) Theamountofthecontributionwasatleast$500andintheformof: 1. Asinglecontributionbyapersonin(b.)above,OR 2. Theaggregateofallcontributionsallpersonsin(b.)above; d) Thecontributionwasfor 1. AnycandidateforanypublicofficeoranypersonwhoholdsanofficeintheCommonwealth ofpennsylvania; 2. Thepoliticalcommitteeofacandidateforpublicofficeoranypersonthatholdsanofficein thecommonwealthofpennsylvania. YES NO IF YES,providethenameandaddressoftheperson(s)makingthecontribution,thecontributor s relationshiptothecontractor,thenameandofficeorpositionofthepersonreceivingthe contribution(orthepoliticalentity/partyreceivingthecontribution),thedateofthecontribution,and theamountofthecontribution. 11. WithrespecttoyourprovisionofprofessionalservicestotheMunicipalPensionSystemoftheRequesting Municipality:Areyouawareofanyapparent,potentialoractualconflictsofinterestwithrespecttoany officer,directororemployeeofthecontractorandofficialsoremployeesoftherequestingmunicipality? YES NO If,inthefuture,youbecomeawareofanyapparent,potential,oractualconflictofinterest, youareexpectedtoupdatethisdisclosureformimmediatelyinwritingby: Providingabriefsynopsisoftheconflictofinterest(and); Anexplanationofthestepstakentoaddressthisapparent,potential,oractualconflictofinterest. IF YES,Provideadetailedexplanationofthecircumstanceswhichprovideyouwithabasisto concludethatanapparent,potential,oractualconflictofinterestmayexist. 12. TotheextentthatyoubelievethatChapter7AofAct44of2009requiresyoutodiscloseanyadditional informationbeyondwhathasbeenrequestedabove,pleaseprovidethatinformationbeloworona separatepieceofpaper. 7

8 Please provide the name(s) and position(s) of the person(s) participating in the completion of this Disclosure. One of the individuals identified by the Contractor in Item #1 above must participate in completing this Disclosureandmustsignthebelowverificationattestingtotheparticipationofthoseindividualsnamedbelow. Lori R. Owen Consultant Position Position Position Position Position 11/14/2018 Signature Date Consultant 8

9 Verification I, Lori R. Owen herebystatethatiam Consultant for Position Dunbar, Bender & Zapf, Inc. and I am authorized to make this verification. Contractor I hereby verify that the facts set forth in the foregoing Act 44 Disclosure Form for Entities Providing ProfessionalServicestothe Borough of Somerset s Pension System are true and correcttothebestofmyknowledge,informationandbelief.ialsounderstandthatknowinglymaking material misstatements or omissions in this form could subject the responding Contractor to the penaltiesinsection705a(e)ofact44. Iunderstandthatfalsestatementshereinaremadesubjecttothepenaltiesof18P.A.C.S relatingtounswornfalsificationtoauthorities. 11/14/2018 Signature Date 9

10 Identification of Contractors & Related Personnel Attachment:Item1 JohnS.Mincin,E.A.,C.O.P.A.,F.C.A.,M.A.A.A.,M.S.P.A. JosephSiktar,C.E.B.S. ApprovedActuary SeniorConsultant LoriOwen,Q.P.A. Consultant DescriptionofResponsibilities: ThePlanswillbeassignedtoJohnMincin,JoeSiktarandLoriOwen.Allcalculationsandcorrespondencewill passthroughtheseindividualsbeforepresentationtotheborough.ms.owenandmr.siktarwillpreparethe forms,valuationsandothercalculationssubjecttothereviewofthesigningactuaryandconsultingactuary,mr. Mincin.

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