HomeMy WebLinkAbout1M - Staff CorrespondencePUBLIC INTEGRITY DISCLOSURE
APPLICANT DISCLOSURE FORM
1.
Name of Entity
COLANTUONO, HIGHSMITH & WHATLEY, PC
2.
Address of Entity (Principle Place of Business)
420 Sierra College Drive, Suite 140
Grass Valley, CA 95945-5091
3.
Local or California Address (if different than #2)
4.
State where Entity is Registered with Secretary of State
California
If other than Califomia, is the Entity also registered in Califomia? Yes M No
S.
Type of Entity
Corporation ❑ Limited Liability Company ❑ Partnership ❑ Trust ❑ Other (please specify)
6.
Officers, Directors, Members, Managers, Trustees, Other Fiduciaries (please specify)
Note: /f any response is not a natural person, please identify all officers, directors,
members, managers and other fiduciaries for the member, manager, trust or other entity
Michael G. Colantuono _ Ig Officer ❑ Director [:]Member ❑ Manager
[name]
❑ General Partner ❑ Limited Partner
❑ Other
Teresa L. Highsmith Officer ❑ Director ❑ Member ❑ Manager
[name]
❑ General Partner ❑ Limited Partner
❑Other _-.- _-- —
Holly O. Whatley Kofficer ❑ Director [-]Member ❑ Manager
[name]
❑ General Partner ❑ Limited Partner
❑ Other _
CITY OF PALM SPRINGS — PUBLIC INTEGRITY DISCLOSURE
APPLICANT DISCLOSURE FORM
Page 1 of 4
(Revised 09 13 18)
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1. Name of Entity
2. Address of Entity
3. Local or
PUBLIC INTEGRITY DISCLOSURE
APPLICANT DISCLOSURE FORM
Address (if different than #2)
4. State where Entity Is Register Ith Secretary of State
If other than California, is the Er also registered in C_ ali_fomia? Q Yes LLNo
5_ Type o tity
❑ C oration ❑ Limited Liability Com y ❑ Partnership ❑ Trust ❑ Other (please specify)
6. Officers, Directors, Members, Managers, Trustees, Other Fiduciaries (please specify)
Note: if any response is not a natural person, please identify all officers, directors,
members, managers and other fiduciaries for the member, manager, trust or other entity
Gary B. Bell
[name]
Jeffrey A. Walter _
[name)
David J. Ruderman
[name]
0Officer ❑ Director ❑ Member [:]Manager
❑ General Partner ❑ Limited Partner
❑ Other
'Officer ❑ Director ❑ Member [:]Manager
❑ General Partner ❑ Limited Partner
❑ Other
%Officer ❑ Director ❑ Member ❑ Manager
❑ General Partner ❑ Limited Partner
❑ Other
CITY OF PALM SPRINGS - PUBLIC INTEGRITY DISCLOSURE
APPLICANT DISCLOSURE FORM
Page 2 of 4
(Revised 09 13 18)
PUBLIC INTEGRITY DISCLOSURE
APPLICANT DISCLOSURE FORM
1. Name of Entity
2. Address of Entity (Principle�e of Business)
3. Loca>or ornia Address (if different than #2) f
4' State where Entity is Registered Ith Secretary of State
If other than California rs the Entityalso registered in omia� [I Yes !No
5. Type o tity
❑ C oration ❑ Limited Liabi company ❑ Partnership �rust❑Other (please specify)
s
6. Officers, Directors, Members, Managers, Trustees, Other Fiduciaries (please specify)
Note: if any response is not a natural person, please identify all officers, directors,
members, managers and other fiduciaries for the member, manager, trust or other entity
Matthew T. S ummais
[name]
JXOfficer ❑ Director ❑ Member ❑ Manager
❑ General Partner ❑ Limited Partner
❑ Other _
❑ Officer ❑ Director ❑ Member ❑ Manager
(name]
❑ General Partner ❑ Limited Partner
❑ Other
_ ❑ Officer ❑ Director ❑ Member ❑ Manager
(name]
❑ General Partner ❑ Limited Partner
❑ Other
CITY OF PALM SPRINGS — PUBLIC INTEGRITY DISCLOSURE
APPLICANT DISCLOSURE FORM
Page 3 of 4
(Revised 09 13 18)
7. Owners/Investors with a 5% beneficial interest in the Applicant Entity or a related entity
EXAMPLE
JANE DOE
50% ABC COMPANY, Inc.
[name of owner/investor]
[percentage of beneficial interest in entity
and name of entity
A.
Michael G. Colantuono
greater than 5%
[name of owner/investor]
[percentage of beneficial interest in
entity
and name of entity]
B.
Teresa L. Highsmith
greater than 5%
[name of owner/investor]
[percentage of beneficial interest in
entity
and name of entity]
C.
Holly O. Whatley
greater than 51/6
(name of owner/investor]
[percentage of beneficial interest in
entity
and name of entity]
D.
Gary B. Bell
greater than 5%
[name of owner/investor]
[percentage of beneficial interest in
entity
and name of entity]
E.
Jeffrey A. Walter
greater than 5%
[name of owner/investor]
[percentage of beneficial interest in entity
and name of entity]
I DECLARE UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF
CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT.
Signature of Disclos rt inted Name, Title Date
November 16, 2021
Keelynn B. Beutler, Office Manager
CITY OF PALM SPRINGS — PUBLIC INTEGRITY DISCLOSURE
APPLICANT DISCLOSURE FORM
Page 4 of 4
(Revised 09 13 18)