John Haverty 20(b) disclosure — File 26-0730

,· 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. I 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 dl-· ·6ohT\ ·· ·· H0,vtt-\y •••• s re..0\0\ \ \ ~,+ . ·------- 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. $aM e,rv·, \ \tL QQ~\t.9 Cff'~ 6uc_ f e C\ .--\-"1. er{\ t l,-, l...\o\\tH\O 5-\-". 6Z.oon\ Z,0? So'(l'\trv\ \\('_ M~ o?,,\<'...l,L,{ Colt -,zs-- 0GOG .~,-,C: zqq~ Check one: Elected or ✓ Non-elected -- -- L1 17 I zc 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. jffJ_ A municipal 9gency 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, sue~ as a company or organization. -. _ I work for a company or organization that ha,s 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. • VsTATEMENT # 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.

Write an X beside your 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 FILL IN THIS BOX OR THE BOX ABOVE My financial interest in a municipal contract is: __ A municipal agency has a contract with me, but not an employment contract. __ 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 -- - 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 otherwisacJear that the city or town has contracted for my services in particular. FINANCIAL INTEREST IN A MUNICIPAL CONTRACT S o ~ r,.i,\\Q.__ pa rte 5 er no )< e c, e,; +--( UY'. l ~·7 l--\o\\t,f\() S-t Sv'1-\-( 705 "My Municipal Agency" is the municipal agency that I ~erve as a municipal employee. The "contracting agency" is the municipal agency that made the contract. 'J My Municipal Agency is not the contracting agency. My Municipal Agency does not regulate the activities of the contracting agency. In my work for my Municipal Agency, I do not participate In or have official responsibility for ariy 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. Spec,~q \~ s;-r po S r'-t"LO\f\ (_ 0 Cl C., \"\ \ 'I'\ j ~ --t +h-e_ rh.·\2j:)\e. _scr-o o\ 6a s tc-e e-ht;\\ W e, S :t 5 o '()'\.l,f V\ \ \ e N (\,~ "'-\oo{ h,c, <ZI ~ S,e,, W> 0 \ 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 muriicipal agency. - What is your relationship to the person or entity? - What is the contract for? .~ Cu-r \ e. l"Yf e,\--\: ( e-rt\ r \oy ~<. _ /~ \ ,e.-c.d"{ e, fY\.()to'-( -e..c) \ V\ ~r k ~ S{)ee,,'LOt \ \S+ ~ S~o, t~ Cea0'n C ·1 ---ti a·f We.s·t

Vhat is your • 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 'To C.OCtC-~ C\ -t +~ 6y , Doi \ c1·c Sc.,~ oo\ \ a m a ,rceu f) r u n.S~ <P 25 /fioyf "':f Lf / 7/ 2 b - Please explain the financial interest and include the dollar amoun_t _if you know it Iv I _A .. . . ' • ·• ' ,, . .. •.._ 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 wor.~ directly for the contracting agency). ~. ·,,,., I will have a contract with a municipal agency to provide ,~efs~ al ;~ervices. ~ The services will be provided outside my normal working hours as a municipal employee. '-i::._ The services are not required as part of my regular duties as a municipal employee. ·~ For these services, I w)ll be compensated for not more than 500 hours during a calendar year. (\ "- I ') 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.

FOR 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, boarc;I of afcler'rner'1, boa'rd ofs'electmeh or town-council. Name: Title/ Position Municipal Agency: Agency Address: Office Phone: Signature: Date: Name: Title/ Position Agency Address: Office Phone: Signature: Date: Form revised February, 2012 •·,.1 '. ,: ' CERTIFICATIQ~ 1~Y HEAD. OF CONTRACTING AGENCY ... "'i~,t;. • • '".•""" INFORMATION ABOUT HEAD OF CONTRACTING AGENCY at!(.$ f, c;,, '"? ffel~J s/ s~,:lf; ~s ,,>,. (, io-~ ~ (,,()1) @l<f J,. 8() CERTIFICATION 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 the services 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.