Gabrielle Vieira-Summer Employment Disclosure — File 24-1056

Name of municipal employee: Title/ Position Fill in this box if it applies to you. Agency/ Department Agency Address Office phone: Office e-mail: Starting date as a municipal employee. BOX#1 Select either STATEMENT #1 or STATEMENT #2. Write an X beside your financial interest. BOX#2 Select either STATEMENT #1 or STATEMENT #2. DISCLOSURE BY MUNICIPAL EMPLOYEE OF FINANCIAL INTEREST IN A MUNICIPAL CONTRACT AS REQUIRED BY G. L. c. 268A, § 20(b) MUNICIPAL EMPLOYEE INFORMATION Gu~br: (I /e_ vie; (C"- f-us; s +-c\.V' +- 1\thh;,hc -- I ro...\ner If you are a municipal employee because a municipal agency has contracted with your company or organization, please provide the name and address of the company or organization. :Sor.,..,< ( v .· II<- PubLc_fi ScJwa Is '61 H~hlrmi A V'e_ .. J'()°Mt'( v ! I le: . ~tv\~ Od l43 jV:c:rt, e lC/9-· )0 1-.e..-v.1/c • VV! t~ ,<..) 5 Check one: -- Elected or x Non-elected i/~/JD'JJ- ELECTED MUNICIPAL EMPLOYEE I am an elected municipal employee. - STATEMENT #1 : I had one of the following financial interests in a contract made by a municipal agency before I was elected to my municipal employee position. I will continue to have this financial interest in a municipal contract. OR _ STATEMENT #2: I will have a new financial interest in a contract made by a municipal agency. My financial interest in a municipal contract is: __ I have a non-elected, compensated municipal employee position. __ A municipal agency has a contract with me. __ I have a financial benefit or obligation because of a contract that a municipal agency has with another person or an entity, such as a company or organization . .____ I work for a company or organization that 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 city or town has contracted for my services in particular. NON-ELECTED, COMPENSATED MUNICIPAL EMPLOYEE I am a non-elected municipal employee. ~STATEMENT# 1: I had one of the following financial interests in a contract made by a municipal agency before I took a position as a non-elected municipal employee. I will continue to have this financial interest in a municipal contract. My financial interest in a municipal contract is: 7;1z1i ~v ."i .JUL - 1 p I: 23 i_:/i ·r CL ERK 'S 0 FF IC [ SOMER l/IL LE. Mt,

Write an X beside your _A municipal agency has a contract with me, but not an employment contract. financial interest. Name and address of municipal agency that made the contract Please put in an x to confirm these facts. FILLIN THIS BOX OR THE BOX BELOW FILLIN THIS BOX OR THE BOX ABOVE _ I have a financial benefit or obligation because of a contract that a municipal agency has with another person or an entity, such as a company or organization. --OR-- i sTATEMENT # 2: agency. I will have a new financial interest in a contract made·by a municipal My financial interest in a municipal contract is: i I have a non-elected, compensated municipal employee position. _A municipal agency has a contract with me. __ I have a financial benefit or obligation because of a-contract that a municipal agency has with another person or an entity, such as a company or organization. _ I work for a company or organization that 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 city or town has contracted for my" services in particular. FINANCIAL INTEREST IN A MUNICIPAL CONTRACT S01\,\_u .,;; 11.e ~::<c._,f:::S rAY\.J ·f2.eoreu...-\-:ot"i I ~ 7 J-lo I ( °' n d J' ~ . u2.ooM do) OJIWL/ "My Municipal Agency" is the municipal agency that I serve as a municipal employee. The "contracting agency" is the municipal agency that made the contract. :/) My Municipal Agency is not the contracting agency. --./J · My Municipal Agency does not regulate the activities of the contracting agency. -r-. . / ' In my work for my Municipal Agency, I do not participate in or have official responsibility for any of the activities of the contracting agency. '/' The contract was made after public notice or through competitive bidding. ANSWER THE QUESTION IN THIS BOX IF THE CONTRACT IS BETWEEN THE CITY OR TOWN AND YOU. - Please explain what the contract is for. 5'.:c'5oNLi eVVl(Jf dyl/!t€-f\+- ?-\S A f 0-.'(1- - -J--i ~ f rv_:r-o..vvi 5f ec. lo. I :5.J--, IN. 5dtool ckftL<+rvten J- Job 15 {,\.._ I' 0 - IMo rd· h C.c.nttl\Ch:) Job +iic1.\- he( ) ho ov-er (c.p w1-H\ +kt SoY111J/JU. ANSWER THE QUESTIONS IN THIS BOX • IF THE CONTRACT IS BETWEEN THE CITY OR TOWN 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 In the municipal contract? Date when you acquired a financial interest

What is the financial interest of your immediate family? Date when your immediate family acquired a financial interest Write an X to confirm each statement. Employee signature: Date: Please explain the financial interest and include the dollar amount if you know it. FOR A CONTRACT FOR PERSONAL SERVICES - Answer the questions in this box ONLY if you will have a contract for personal services with a municipal agency (i.e., you will do work directly for the contracting agency). I will have a contract with a municipal agency to provide personal services. $. The services will be provided outside my normal working hours as a municipal employee. 1 The services are not required as part of my regular duties as a municipal employee. _j_ For these services, I will be compensated for not more than 500 hours during a calendar year. · Attach additional pages if necessary. NOT A PERSONAL SERVICES CONTRACT -- File disclosure with the city or town clerk. SEE CERTIFICATION AND APPROVAL REQUIRED FOR PERSONAL SERVICES CONTRACTS, BELOW. oFOR CONTRACTS FOR PERSONAL SERVICES ONLY: If you are disclosing a financial interest in a contract for personal services with a municipal agency, you must file the Certification below signed by the head of the contracting agency, and you must get approval of the exemption from the city council, board of aldermen, board of selectmen or town council. CERTIFICATION BY HEAD OF CONTRACTING AGENCY INFORMATION ABOUT HEAD OF CONTRACTING AGENCY Name: Su~ fev- "k: e .5 Title/ Position v~\fec.JOy ei{ ·?u.v I( "5 4 Vlei 'Kecre°'-h'o n Municipal So1JVt.erv1 lf-e ?°'v k;; CJJV} 'Keer ea__ +-le n Agency: De..oh.v+-}'\ ~ "' - .+- Agency Address: l<o 7 HD I { ovitl '5-1-. · fZnoVVt ~) SD i/1'1._er vi // .e , /V1 Ac. 0 R-JL-f L/ Office Phone: (;17- GJr:;- r~r()oo d-qto A. CERTIFICATION

Signature: Date: Name: Title/ Position Agency Address: Office Phone: Signature: Date: I have received a disclosure under G.L. c. 268A, § 20(b) from a municipal employee who seeks to provide personal services to my municipal agency, identified above. I certify that no employee of my agency is available to perform th rvi s described above as part of his or her regular duties. APPROVAL BY CITY COUNCIL, BOARD OF ALDERMEN, BOARD OF SELECTMEN OR TOWN COUNCIL INFORMATION ABOUT APPROVING BODY APPROVAL I have received a disclosure under G.L. c. 268A, § 20(b) from a municipal employee who seeks to provide personal services to a municipal agency, identified above. The exemption under§ 20(b) is approved. On behalf of the Council or Board, I sign this approval. Attach additional pages if necessary. File disclosure, Certification and Approval with the city or town clerk. Form revised February, 2012