HomeMy WebLinkAbout2022-01-06-Hornig-OCPF DISCLOSURE BY S"ECTAL MUNICIPAL EMPLOYEE
OF FINANCIAL INTER EST IN A MUNICIPAL CONTRACT
AS REQUIRE; i BY G. L. c. 268A, § 20(c)
. . .
SPECIAL MUNICIPAL. Ek'': LOYEE INFORMATION
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Name of special
municipal Charles Hornig
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employee: y1C s 0
I am a special municipal employee because:
Put an X
beside one _1 am a selectman in a town with a population of 10,000 or fewer people;
statement.
X_I am not a mayor, alderman or city councilor, and
_X_ I serve in a municipal position for which no compensation is provided, or
I earned compensation for fewer than 800 hours in the preceding 365-day
period, or
By the classification of my position by my municipal agency or by the terms of a
contract or my conditions of employment, I am permitted to have personal or
private employment during normal business hours.
I work for a company or organization which has a contract with a municipal agency,
and I am a "key employee" because the contract identifies me by name or it is
otherwise clear that the municipal is contracting for my services in particular, and the
contract states that I am a special municipal employee or indicates that I meet
one of the three requirements listed above.
Title/ Position Member, Planning Board
If you are a special municipal employee because a municipal agency has contracted with your
Fill in this box company or organization, please provide the name and address of the company or organization.
if it applies to you.
Municipal Agency/ This is"my Municipal Agency."
Department: Town of Lexington Planning Board
Agency Address: 1625 Massachusetts Avenue
Lexington, MA 02420
Office phone: 781-698-4560
Office e-mail: planning@Iexingtonma.gov
Check one: _X_ Elected or Non-elected
Starting date as a March 7, 2005
special municipal
employee.
ELECTED SPECIAL MUNICIPAL EMPLOYEE
BOX#1 I am an elected special municipal employee.
STATEMENT#1: 1 had a financial interest in a contract made by a municipal agency before I
was elected to a compensated special municipal employee position. I will continue to have this
Select either financial interest in a municipal contract.
STATEMENT#1 or
STATEMENT 92. _X_STATEMENT#2: 1 will have a new financial interest in a contract made by a municipal agency.
My financial interest in a contract made by a municipal agency is:
A compensated, non-elected position with a municipal agency.
X A contract between a municipal agency and myself.
Write an X _
by your financial —A financial benefit or obligation because of a contract that a municipal agency has with another
interest. person or with a company or organization,
_Other work because a municipal agency has a contract with my company or organization and
am a"key employee"because the contract identifies me by name or it is otherwise clear that the
municipal is contracting for my services in particular.
BOX#2 NON-ELECTED SPECIAL MUNICIPAL EMPLOYEE
I am a non-elected special municipal employee (compensated or uncompensated).
Select either —STATEMENT#1: I had a financial interest in a contract made by a municipal agency,other
STATEMENT#1 or than an employment contract,before I took a non-elected,compensated special municipal
employee position. 1 will continue to have this financial interest in a municipal contract.
STATEMENT#2.
My financial interest in a contract made by a municipal agency is:
A contract between a municipal agency and myself, but not an employment contract.
Write an X
by your financial A financial benefit or obligation because of a contract that a municipal agency has with another
interest. —person or with a company or organization.
OR
STATEMENT#2: 1 will have a new financial interest in a contract made by a municipal agency.
My financial interest in a contract made by a municipal agency is:
A compensated, non-elected position with a municipal agency.
A contract between a municipal agency and myself.
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_A financial benefit or obligation because of a contract that a municipal agency hath another
person or with a company or organization. c_
X0 l
_Other work because a municipal agency has a contract with my companylrgarifatiort' id I
am a"key employee"because the contract identifies me by name or it is o-40 isefqlear fllydt the
municipal is contracting for my services in particular. 0rr-
FINANCIAL INTEREST IN A MUNICIPAL CONTRACT .e
Name and address This is the"contracting agency."
of municipal agency Town of Lexington Conservation Commission
that made the
contract
Write an X to confirm X In my work as a special municipal employee for my Municipal Agency, I do not participate in
this statement. or have official responsibility for any of the activities of the contracting agency.
ANSWER THE QUESTION IN THIS BOX
FILL IN IF THE CONTRACT IS BETWEEN THE MUNICIPAL AGENCY AND YOU.
THIS BOX 4R - Please explain what the contract is for.
THE NEXT BOX The contract is a license agreement permitting public access across land owned by me as
part of a municipal trail system.
ANSWER THE QUESTIONS IN THIS BOX
IF THE CONTRACT IS BETWEEN THE MUNICIPAL AGENCY
AND ANOTHER PERSON OR ENTITY
- Please identify the person or entity that has the contract with the municipal agency.
- What is your relationship to the person or entity?
- What is the contract for?
What is your - Please explain the financial interest and include the dollar amount if you know it.
financial interest My financial interest is a is nominal consideration ($11year) in consideration of the license.
in the municipal
contract?
Date when you March 26, 2019
acquired the
financial interest
What Is the financial - Please explain the financial interest and include the dollar amount if you know it.
interest of your None
immediate family?
Date when your NIA
immediate family
acquired the
financial interest
Employee signature: —
Date: 6 January 2022
Attach additional pages if necessary.
File your completed,signed Disclosure with the city or town clerk.
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Form revised February,2012 i