Matters ▸ Attachment
Elyse Best Disclosure Form — File 24-1600
DISCLOSURE BY SPECIAL MUNICIPAL EMPLOYEE
OF FINANCIAL INTEREST IN A MUNICIPAL CONTRACT
AS REQUIRED BY G. L. c. 268A, § 20(d)
SPECIAL MUNICIPAL EMPLOYEE INFORMATION
Name of special
municipal
employee:
Elyse Best
Put an X
beside one
statement.
I am a special municipal employee because:
___ I am a selectman in a town with a population of 10,000 or fewer people;
_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
Commissioner - Somerville Human Rights Commission
Fill in this box
if it applies to you.
If you are a special municipal employee because a municipal agency has contracted with your
company or organization, please provide the name and address of the company or organization.
Municipal Agency/
Department:
This is “my Municipal Agency.”
City of Somerville
Agency Address:
93 Highland Avenue
Office phone:
[phone removed] x 2059
Office e-mail:
lsaulters@somervillema.gov
Check one:
____
Elected
or
_x___
Non-elected
Starting date as a
special municipal
employee.
February 14, 2024
[phone removed]
BOX # 1
Select either
STATEMENT #1 or
STATEMENT #2.
Write an X
by your financial
interest.
ELECTED SPECIAL MUNICIPAL EMPLOYEE
I am an elected special municipal employee.
___ STATEMENT #1: I 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
financial interest in a municipal contract.
___ STATEMENT #2: I 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.
___ A financial benefit or obligation because of a contract that a municipal agency has with another
person or with a company or organization.
___ Other work because a municipal agency has a contract with my company or organization 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.
BOX #2
Select either
STATEMENT #1 or
STATEMENT #2.
Write an X
by your financial
interest.
NON-ELECTED SPECIAL MUNICIPAL EMPLOYEE
I am a non-elected special municipal employee (compensated or uncompensated).
___ STATEMENT #1: I had a financial interest in a contract made by a municipal agency, other than
an employment contract, before I took a non-elected, compensated special municipal employee
position. I will continue to have this financial interest in a municipal contract.
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.
___ A financial benefit or obligation because of a contract that a municipal agency has with another
person or with a company or organization.
OR
_x__ STATEMENT #2: I 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:
_x__ A compensated, non-elected position with a municipal agency.
___ A contract between a municipal agency and myself.
___ A financial benefit or obligation because of a contract that a municipal agency has with another
person or with a company or organization.
___ Other work because a municipal agency has a contract with my company or organization 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.
FINANCIAL INTEREST IN A MUNICIPAL CONTRACT
Name and address
of municipal agency
that made the
contract
This is the “contracting agency.”
City of Somerville
Write an X to confirm
this statement.
_x__
In my work as a special municipal employee for my Municipal Agency, I participate in or
have official responsibility for activities of the contracting agency.
FILL IN
THIS BOX OR
THE NEXT BOX
ANSWER THE QUESTION IN THIS BOX
IF THE CONTRACT IS BETWEEN THE MUNICIPAL AGENCY AND YOU.
- Please explain what the contract is for.
To serve on the ADA ( Americans with Disabilities Act) Transition Plan Task Force and
work with City staff and other stakeholders to formulate recommendations to the ADA
Transition Plan.
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?
N/A
What is your
financial interest
in the municipal
contract?
- Please explain the financial interest and include the dollar amount if you know it.
Compensated member of the ADA Task Force, $2,400.
Date when you
acquired the
financial interest
To be determined.
What is the financial
interest of your
immediate family?
- Please explain the financial interest and include the dollar amount if you know it.
N/A
Date when your
immediate family
acquired the
financial interest
N/A
Employee signature:
Date:
November 8, 2024
SEE NEXT PAGE FOR APPROVAL
BY CITY COUNCIL, BOARD OF ALDERMEN,
BOARD OF SELECTMEN. TOWN COUNCIL,
OR DISTRICT PRUDENTIAL COMMITTEE
Verified by pdfFiller
11/08/2024
APPROVAL OF EXEMPTION
BY THE CITY COUNCIL, BOARD OF ALDERMEN, BOARD OF SELECTMEN,
TOWN COUNCIL OR DISTRICT PRUDENTIAL COMMITTEE
Name:
Name of approving
body:
Write an X
by one selection.
___ City Council
___ Board of Aldermen
___ Board of Selectmen
___ Town Council
___ District Prudential Committee
Title/ Position
Agency Address:
Office phone:
APPROVAL OF § 20(d) EXEMPTION
We have received a disclosure under G.L. c. 268A, § 20(d) from a special municipal
employee who seeks to have a financial interest in a contract made by a municipal agency
of this city or town. We understand that the special municipal employee participates in, or
has official responsibility for, activities of the municipal agency that made the contract. We
approve this exemption under § 20(d) regarding the financial interest identified by the
special municipal employee.
Signature:
On behalf of the Council, Board or Committee identified above, I sign this approval.
Date:
Attach additional pages if necessary.
File your completed, signed, approved Disclosure with the city or town clerk.
Form revised February, 2012