CSG Consultants - Assuming Office (Campidonica)■■ STATEMENT OF ECONOMIC INTERESTS Dateec,eived
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FAIR POLITICAL PRACTICES COMMISSION
A PUBLIC [UUl1LL
DOCUMENT
COVER PAGE ►'CLERKS C
Please type or print in ink.
NAME OF FILER (LAST) (FIRST) (MIDDLE)
CAMPIDONICA JON D
1. Office, Agency, or Court
Agency Name
CITY OF GILROY
Division, Board, Department, District, if applicable
Your Position
BUILDING DEPARTMENT
CONSULTANT /PLAN CHECK ENGINEER
► If fling for multiple positions, list below or on an attachment.
Agency:
Position:
L. Jurisdiction of Office (Check at least one box)
❑ State
❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Multi- County
❑ County of
0 City of GILROY
❑ Other
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2011, through
❑ Leaving Office: Date Left
December 31, 2011.
(Check one)
-or-
The period covered is I I through
O The period covered is January 1, 2011, through the date of
December 31, 2011.
leaving office.
❑x Assuming Office: Date assumed 61 29 i 12 O The period covered is through
the date of leaving office.
❑ Candidate: Election Year Office sought, if different than Part 1:
4. Schedule Summary
Check applicable schedules or "None. " P. Total number of pages including this cover page:
❑ Schedule A -1 - Investments - schedule attached ❑ Schedule C - Income, Loans, & Business Positions - schedule attached
❑ Schedule A -2 - Investments - schedule attached ❑ Schedule D - Income - Gifts - schedule attached
❑ Schedule B - Real Proper ; r - schedule attached ❑ Schedule E - Income - Gifts - Travel Payments - schedule attached
-or-
None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(
SAN MATEO CA 94402
DAYTIME TELEPHONE NUMBER E -MAIL ADDRESS (OPTIONAL)
( 650 ) 522 -2500
1 have used all reasonable diligence in preparing this statement. I have reviewed
your bfing official.)
FPPC Form 700 (2011/2012)
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov
1 1 STATEMENT OF ECONOMIC INTERESTS
Da Received
CALIFORNIA • Of 17 use Only
FAIR POLITICAL PRACTICES COMMISSION SIP 2012
DOCUMENT A PUBLIC COVER PAGE r CLERP, r
Please type or print in ink.
NAME OF FILER (LAST) (FIRST) (MIDDLE)
CHAN KEVIN
1. Office, Agency, or Court
Agency Name
CITY OF GILROY
Division, Board, Department, District, if applicable Your Position
BUILDING DEPARTMENT CONSULTANT /PLAN CHECK ENGINEER
► If filing for multiple positions, list below or on an attachment.
Agency: Position:
2. Jurisdiction of Office (Check at least one box)
❑ State ❑ Judge or Court Commissioner (Statewide Jurisdiction)
❑ Multi- County ❑ County of
❑x City of GILROY ❑ Other
3. Type of Statement (Check at least one box)
❑ Annual: The period covered is January 1, 2011, through ❑ Leaving Office: Date Left I I
December 31, 2011. (Check one)
-or-
The period covered is I I through O The period covered is January 1, 2011, through the date of
December 31, 2011. leaving office.
❑x Assuming Office: Date assumed 61 29 1 12 O The period covered is I I through
the date of leaving office.
❑ Candidate: Election Year Office sought, if different than Part 1:
4. Schedule Summary
Check applicable schedules or "None. " ► Total number of pages including this cover page:
❑ Schedule A -1 - Investments - schedule attached ❑ Schedule C - Income, Loans, & Business Positions - schedule attached
❑ Schedule A -2 - Investments - schedule attached ❑ Schedule D - Income - Gifts - schedule attached
❑ Schedule B - Rea! Property- schedule attached ❑ Schedule E - Income - Gifts - Travel Payments - schedule attached
-or-
None - No reportable interests on any schedule
5. Verification
MAILING ADDRESS STREET CITY STATE ZIP CODE
(
E -MAIL ADDRESS (OPTIONAL)
( 650 ) 522 -2500
1 have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained
herein and in any attached schedules is true and complete. I acknowledge this is a public document.
I certify under penalty of perjury under the laws of the State of California that the
)
FPPC Form 700 (2011/2012)
FPPC Toll -Free Helpline: 866/275 -3772 www.fppc.ca.gov