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Home My WebLink About1979 06 26 Regular FORM 4 MEMORANDUM OF VOTING CONFLICT .. DATE ON WHICH VOTE OCCURRED: 26 JUN ,19-19 i"-it~ ../ Name: PELLERIN (LAST) 116 Moss (STREET) Laurent (FIRST) Alfred (MIDDLE) aY'. Telephone: "W5-~27-' 300 (A/C) (NUMBER) SEJfI.OLE (ZIP CODE) (COUNTY) Address: Road. Winter S'Driu-g8, FL :12107 (CITY) PART B Agency is a unit of [check one] : ) State of Florida; (IJl County, City or other Political Subdivision Name of Agency: City of Winter Spril1.Cs. FL Position held in Agency: Council.an PART C MEMORANDUM OF CONFLICT OF INTEREST IN A VOTING SITUATION [Required by Florida Statutes ~ 112.3143 (1975)] If you have voted in your official capacity upon any measure in which you had a personal, private, or professional interest which inures to your special private gain or the special private gain of any principal by whom you are retained, please disclose the nature of your interest below. 1. Description of the matter upon which you voted in your official cap acity: P'I"nl'",...i:y 1{1l0wtl a. tlJe> "Old Borth Orlando Water &; Sewer Plant" loeated on MORS ROAd yi ni:~r 6pri ~gtll t Ft. ,,- 2. Description of the personal, private, or professional interest you have in the above matter which inures to your special private gain or the special private gain of any principal by whom you are retained: My hnm~ iR 'n~atpa oppo~tt the property whish V&'$ te be rc zaaed C 1. I vnt~a RgRinf:l+. i:np t'E'zolJing d'le to the oppoaition by the peer-Ie 1a the n~i ghhnrhnnil T ~p]t t~.t it was Dot to tae best latereet of the heme avneI8 in ~hp ~rpa and was ill cOllfligt with the ettie.fa land U$e plan. ~~mq ~ OTY of WINTER SPRINGS on HALL r---..~ Person or principal to whom the special gain described above will inure: a. (X)XYourself b. ( ) Principal by whom you are retained: (NAME) PART D ~ .rNG INSTRUCTIONS This memorandum must be filed within fifteen (15) days following the meeting during which the voting conflict occurred with the person responsible for recording the minutes of the meeting, who shall incorporate the memorandum in the meeting minutes. This form need not be filed merely to indicate the absence of a voting conflict. Florida law permits but does not require you to abstain from voting when a conflict of interest arises; if you vote, however, the conflict must be disclosed pursuant to the requirements described above. PART E ~~~ ~. 2IJUN79 SIGNATURE PERSO DISCLOSING DATE SIGNED NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES ~112.317 (1975), A FAILURE TO MAKE ANY REQUIRED DISCLOSURE CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWING: IMPEACHMENT, REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION, REDUCTION IN SALARY, REPRIMAND, OR A CIVIL PENALTY NOT TO EXCEED $5,000. CE FORM 4- EFF. 1/1177 ,FORM 4A, DISCLOSURE OF BUSINESS TRANSACTION, RELATIONSHIP, OR INTEREST ~ PART A ~~~ .~-....- ~at;,~: i '. T Sf - c Of (LAST) Address: LlNnt&B (STREET) .'IB flft"'.t~LA j'nfl'tuaw. (FIRST) (MIDDLE) lO"~E .!~ .a~..t'tq:2 ,..;)01 (CITY) Telephone: (A/C) (NUMBER (ZIP CODE) (COUNTY) Agency is a unit of [check one]: State of Florida: . U ( ) Advisory Board Member a' @Q..l~~' ~8tal~ County, City or other Political Subdivision ....Lb tIif PART B Filing as a: ( .) Public Officer; ( ) Public Employee; Name of Agency: Position held in agency: Date on which term of office or employment began: PART C J'''!ol1 hlO DISCLOSURE OF TRANSACTION OR RELATIONSHIP CONCERNING ADVISORY BOARD MEMBER ~iIi$" Jt1Je.. ~tm~"'Y1s112.313(12), Florida Statutes (1977)] WHOMUSTtCl1pt~''fl-ftgt~~T.Ht'niW .flBO'1 1HIO;.1 .lI0 b..t..IIO.1: ':;;_i"i '!s Sections 112.313(3) and 112.313(7), Florida Statutes, prohibit certain business relationships on nie part of public officers and employees, including persons servinp o~n.. advisory boards. See Part III, Chapter 112, Florida Statutes and/or,the brochure entitled' A Guide to the Sunshine Amendment and Code of Ethics for Public OffiC' Candidates and Employees" for more details on these prohibitions. However, Section 112.313(12), Florida Statutes (1977) permits the appointing official or bodl' ; waive these requirements in a particular instance provided: (a) waiver by the appointing body must be upon a two-thirds affirmative vote of that body; or (b) waiv~ the appointing person may be effected after a p'ublic hearing; and (c) in either case the advisory board member must fully disclose the transaction or relationship which would otherwise be prohibited by Subsections (3) or (7) of Section 112.313, Florida Statutes.-This Part of Form 4A haS been prescribed by the Commission on Ethics for such disclosure, if and when applicable to an advisory board member. '., Please complete the following only if required to do so in light of the above: 1. The partnership, directorship, proprietorship, ownership of a material interest, position of officer, employment, or contractual relationship which would otherwise violate Subsection (3) or (7) of Section 112.313, Florida Statutes is held by: ( ) The reporting person; Pursuant to Section 112.313(3), Florida Statutes: ( ) Spouse of reporting person whose name is or ( ) Child of the reporting person whose name is ,--:i ~."~.l()~-"'''f 44f.O$ .."1# tl~i~1l: 1$'!~e"'f. edit ;t $eqqc 2. The particular transaction for which this waiver is to be granted involves: a. S~~yYngMe~Ollr~'~aljt~gO~cPs~nd/lr~er~?s~:tJ;~Q~qo gilt oct aull ,&D!aOIf)-r s 8'X':i*Ohe-..ilt tides _ wIIIe__l1'bdomdl",:-4:t c:t .tail ~ 3'} 3'a.nj J ,- "'. c. The relationship of the undersigned advisory board member or spouse or child of such advisory board member to the person or business entity transacting this business is [chec~ U!ll!,i€~: bu.J: e t ..t ~ l ~ 84" lii 11:w j- ~ 1 I't so ~ Ell 2; ( ) Officer; ( ) Partner; ( ) Associate; ( ) Employee; ( ) Sole Proprietor; ( ) 'Stockholder; ( ) Director; ( ) Owner of in excess of 5% of the assets or capital stock in such business entity; ( ) Public Officer or employee holding a contractual relationship with such business entity; ( ) Other, please describe; PART 0 DISCLOSURE -OF INTEREST IN SOLE SOURCE OF SUPPLY [Required by 9112.313(12)(e), Florida Statutes (1977)] WHO MUST COMPLETE THIS PART Sections 112.313(3) and 112.313(7), 'Florida'Statutes prohibit certain business relationships on the part of public officers and employees. See Part III, Chapter 112, Florida Statutes and/or the brochure entitled "A Guide to the Sunshine Amendment and Code of Ethics for Public Officers, Candidates and Employees" for more details on these prohibitions. However, Section 112 .313(12)(e), Florida Statutes (1977) provides an exemption from the above-mentioned restrictions in the event that the business entity involved IS the only.source of supply within the political subdivision of the officer or employee. In such cases the officer's or employee's mterestm the business entity must be fully disclosed to the governing body of the political subdivision. This Part of Form 4A has been prescribed by the CommiSSIOn on Ethics tor,.. such disclosure, if and when applicable. - ' ' 4., ., Please complete the following only if required to do so in light of the above: 1. The goOds or services being supplied by a business entity with which the undersigned public officer or employee or spouse or child of such officer or employee is involved include(s) 2. The business entity which is the only source of supply of the above goods or services within the political subdivision is: (NAME OF ENTITY) (ADDRESS) - ,C"", 3. The interest of the undersigned public officer or employee or spouse or child of such officer or employee in the business entity named in Item 2 above is [cheCK ,f applicable spaces]: ( ) Officer; ( ) Partner; ( ) Associate: ( ) Employee; ( ) Sole Proprietor; ( ) StockhOlder; ( ) Director; ( ) Owner of in excess of 5% of the assets or capital stock in such business entity; ( ) Public Officer or Employee holding a contractual relationship with such business entity; ( ) Other, please describe: PART E SIGNATURE SIGNATURE OF PUBLIC OFFICER OR EMPLOYEE DATE SIGNED ~ ~ LJ T# 1-- PART F FILING INSTRUCTIONS Part C of this Form must be filed, if applicable, with the appointing body or person waiving the restrictions of Section 112.313(3) or (7), Florida Statutes prior to such waiver. Part D must be filed, if applicable, with the governing body of the political subdivision in which the reporting person is serving. It is suggested that this disclosure be made prior to the subject transaction. NOTICE: UNDER PROVISIONS OF FLORIDA STATUTES 9112.317(1977), A FAILURE TO MAKE AtolY REQUIRED DISCLOSURE CONSTITUTES GROUNDS FOR AND MAY BE PUNISHED BY ONE OR MORE OF THE FOLLOWING: IMPEACHMENT, REMOVAL OR SUSPENSION FROM OFFICE OR EMPLOYMENT, DEMOTION, REDUCTION IN SALARY, REPRIMAND, OR A CIVIL PENALTY NOnO EXCEED $5,000. CE FORM 4A - EFF 2125/79