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Kenneth RukavinaRECEtl3 CALIFORNIA FORm 700 STATEMENT OF ECONOMIC INTEREST CITY OF Rq"T"YAD FAIR POLITICAL PRACTICES COMMISSION COVER PAGE APR 0 3 2006 Please type or print in ink A Public Document CITY CLERK'S OFFICE NAME (LAST) (FIRST) (MIDDLE) DAYTIME TELEPHONE NUMBER RUKAVINA KENNETH Schedule B ( 562 ) 908 -6200 MAILING ADDRESS STREET CITY STATE ZIP CODE OPTIONAL FAX I E -MAIL ADDRESS (May use business address) 6 Business Positions (Income Other than Gins and Travel Payments) 13191 CROSSROADS PKWY N #405 INDUSTRY CA 91746 krukavina @willdan.com 1 . Office, Agency, or Court Name of Office, Agency, or Court: CITY OF ROSEMEAD Division, Board, District, if applicable: Your Position: CONSULTANT- CITY ENGINEER If filing for multiple positions, list additional agency(ies)/ position(s): (Attach a separate sheet if necessary.) Agency: Position: 2. Jurisdiction of Office (Check at /east one box) ❑ State ❑ County of ❑X City of ROSEMEAD ❑ Multi- County ❑ Other 3. Type of Statement (Check at least one box) ❑ Assuming Office /Initial Date:__J__J ❑X Annual: The period covered is January 1, 2005, through December 31, 2005. -or- 0 The period covered is — I through December 31. 2005. ❑ Leaving Office Date Left: (Check one) O The period covered is January 1, 2005, through the date of leaving office. -or- 0 The period covered is through the date of leaving office. ❑ C 4. Schedule Summary Total number of pages Including this cover page: 2 +Check applicable schedules or "No reportable interests." I have disclosed interests on one or more of the attached schedules: Schedule A -1 ❑ Yes - schedule attached investments (Less than fe% Ownership) Schedule A -2 ❑ Yes - schedule attached investments (10% or greater Ownership) Schedule B ❑ Yes - schedule attached Real Property Schedule C -Yes - schedule attached Income, Loans, 6 Business Positions (Income Other than Gins and Travel Payments) Schedule D ❑ Yes - schedule attached Income - Gifts Schedule E ❑ Yes - schedule attached Income - Travel Payments -or- ❑ No reportable interests on any schedule 5. Verification I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained herein and in any attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date Signed MARCH 17, 2006 month, day, year) Signature A�W A 4� '. (Fde me origirilby signed statement wilh your Wing official.) FPPC Form 700 (200612006) FPPC Toll -Free Helaine: 866 1ASK -FPPC SCHEDULE C . Income, Loans & Business Positions Name (Other than Gifts and Travel Payments) KENNETH RUKAVINA NAME OF SOURCE OF INCOME KENNETH RUKAVINA - WILLDAN NAME OF SOURCE OF INCOME ADDRESS ADDRESS 13191 CROSSROADS PKWY N. #405 INDUSTRY BUSINESS ACTIVITY, IF ANY, OF SOURCE BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION YOUR BUSINESS POSITION CONSULTANT- CITY ENGINEER ❑ $500 - $1,000 GROSS INCOME RECEIVED GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑X $10,001 - $100,000 ❑ OVER $100,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED CONSIDERATION FOR WHICH INCOME WAS RECEIVED Q Salary ❑ Spouse's income ❑ Loan repayment ❑ Salary ❑ Spouse's income ❑ Loan repayment ❑ Sale of ❑ Sale of (Property; car, boar, e1c.) - (Property, car; boat, etc) ❑ Commission or [ Income, Ilsteachsourceol$10,000ormum ❑ Commission or ❑ Rental Income, Bsleaoh source of110,000 ormore ❑ Other ❑ Other (Describe) (Describe) LOAN RECEIVED You are not required to report loans from commercial lending institutions, or any indebtedness created as part of a retail installment or credit card transaction, made in the lender's regular course of business on terms available to members of the public without regard to your official status. Personal loans and loans received not in a lender's regular course of business must be disclosed as follows: NAME OF LENDER INTEREST RATE TERM (Months/Years) k ❑ None ADDRESS SECURITY FOR LOAN BUSINESS ACTIVITY, IF ANY, OF LENDER ❑ None ❑ Personal residence ❑ Real Property HIGHEST BALANCE DURING REPORTING PERIOD tree add.. ❑ $500 - $1,000 city ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ Guarantor ❑ OVER $100,000 ❑ Other (Describe) Comments: FPPC Form 700 (200512006) Sch. C FPPC Toll -Free Helpline: 866 1ASK -FPPC STATEMENT OF ECONOMIC INTERESTS Please type or print in ink COVER PAGE A Public Document CITY i E't L 1 ;LA!D Ivl A l� o ;70.F CITY CLERK'S NAME (LAST) (FIRST) (MIDDLE) DAYTIME TELEPHONE NUMBER Rozell, Kenneth D. 310 450 -9582 MAILING ADDRESS STREET CITY STATE ZIP CODE OPTIONAL: FAX / E -MAIL ADDRESS (May use business address) 2800 28th Street, Suite 315 Santa Monica CA 90405 1 . Office, Agency, or Court Name of Office, Agency, or Court: City of Rosemead Division, Board, District, if applicable: Your Position: Assistant City Attorney • If filing for multiple positions, list additional agency(ies)/ position(s): (Attach a separate sheet if necessary.) Agency: Position: 2. Jurisdiction of Office (Check at least one box) ❑ State ❑ County of ® City of Rosemead ❑ Multi- County ❑ Other 3. Type of Statement (Check at least one box) ❑ Assuming Office /Initial Date:_ /___J ❑x Annual: The period covered is January 1, 2005, through December 31, 2005. -or- 0 The period covered is ___J ___J, through December 31, 2005. ❑ Leaving Office Date Left: I I (Check one) • The period covered is January 1, 2005, through the date of leaving office. -or- • The period covered is ___J ___J, through the date of leaving office. ❑ Candidate 4. Schedule Summary — Total number of pages including this cover page: 3 r Check applicable schedules or "No reportable interests." I have disclosed interests on one or more of the attached schedules: Schedule A -1 ❑ Yes - schedule attached Investments (Less Than 10 OWnershlp) Schedule A -2 ® Yes - schedule attached Investments (10% or greater Ownership) Schedule B ❑ Yes - schedule attached Real Property Schedule C ® Yes - schedule attached Income, Loans, 8 Business Positions (Income OTher than Gins and Travel Paymends) Schedule D ❑ Yes - schedule attached Income - Gifts Schedule E ❑ Yes - schedule attached Income - Travel Payments -or- ❑ No reportable interests on any schedule 5. Verification I have used all reasonable diligence in preparing this statement. I have reviewed this statement and to the best of my knowledge the information contained herein and in any attached schedules is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Date Signed March 7, 2006 (month, day,, year) Signature /( D° (File the originally signed stalemenl your {ling official.) FPPC Form 700 (200512006) FPPC Toll -Free Helpline: 866 /ASK -FPPC SCHEDULE A -2 Investments, Income, and Assets of Business Entities /Trusts (Ownership Interest is 10% or Greater) Wallin, Kress, Reisman & Kranitz, LLP Name 2800 28th Street, Suite 315, Santa Monica, CA 90405 Address Check one ❑ Trust, go to 2 ❑ Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ® $10,001 - $100.000 _JJ 05 ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INVESTMENT ❑ Sole Proprietorship ® Partnership YOUR BUSINESS POSITION 0 Oher ❑ $0 - $490 ❑ $10,001 - $100,000 ❑ $500 - $1,000 ❑K OVER $100.000 ❑ $1,001 - $10.000 Check one box: ❑ INVESTMENT ❑ REAL PROPERTY Name of Business Entity gt Street Address or Assessor's Parcel Number of Real Property Description of Business Activity of City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 __/_J 05 _j___J 05 ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ❑ Property Ownership /Deed of Trust ❑ Stock ❑ Partnership ❑ Leasehold ❑ Other Y.. remaining ❑ Check box if additional schedules reporting investments or real property are attached Name Kenneth D. Rozell k one ❑ Trust, go to 2 ❑ Business Entity, complete the box, then go to 2 GENERAL DESCRIPTION OF BUSINESS ACTIVITY FAIR MARKETVALUE IF APPLICABLE, LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,o0o ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INVESTMENT ❑ Sole Proprietorship ❑ Partnership ❑ YOUR BUSINESS POSITION Other ❑ $0-$499 ❑ $10,001- $100,000 ❑ $500 - $1,000 ❑ OVER $100,000 ❑ $1.001 - $10.000 Check one box: — ]INVESTMENT ❑ REAL PROPERTY of Business Entity g Address or Assessor's Parcel Number of Real Property Description of Business Activity Of City or Other Precise Location of Real Property FAIR MARKET VALUE IF APPLICABLE. LIST DATE: ❑ $2,000 - $10,000 ❑ $10,001 - $100,000 ___J 1, ❑ $100,001 - $1,000,000 ACQUIRED DISPOSED ❑ Over $1,000,000 NATURE OF INTEREST ❑ Property Ownership /Deed of Trust ❑ Stock ❑ Partnership ❑ Leasehold ❑ Other Yrs, remaining ❑ Check box if additional schedules reporting investments or real property are attached FPPC Form 700 (2005/2006) Sch. A -2 FPPC Toll -Free Helpline: 866/ASK-FPPC SCHEDULE C . Income, Loans & Business Positions Name (Other than Gifts and Travel Payments) Kenneth D. Rozell NAME OF SOURCE OF INCOME Wallin, Kress, Reisman & Kranitz, LLP ADDRESS 2800 28th Street, Suite 315, Santa Monica 90405 BUSINESS ACTIVITY, IF ANY, OF SOURCE Law firm YOUR BUSINESS POSITION Partner GROSS INCOME RECEIVED ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑X OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's income ❑ Loan repayment ❑ Sale of (Property, car, boas, elc.) ❑ Commission or ❑ Rental Income, asfeachsomceas NAME OF SOURCE OF INCOME ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME RECEIVED ❑ $500 $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑ Salary ❑ Spouse's income ❑ Loan repayment ❑ Sale of (Property, car, boat, etc.) ❑ Commission or ❑ Rental Income, list each source or$10,000 ormore (Describe ) ❑ Other I I ❑ Other sc (Deribe ) RECEIVED 2. LOAN You are not required to report loans from commercial lending institutions, or any indebtedness created as part of a retail installment or credit card transaction, made in the lender's regular course of business on terms available to members of the public without regard to your official status. Personal loans and loans received not in a lender's regular course of business must be disclosed as follows: NAME OF LENDER INTEREST RATE TERM (Months/Years) % ❑ None ADDRESS SECURITY FOR LOAN BUSINESS ACTIVITY, IF ANY, OF LENDER ❑ None ❑ Personal residence n ce_i o.,...o.«, HIGHEST BALANCE DURING REPORTING PERIOD ❑ $500 - $1,000 ❑ $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 Comments: ❑ Guarantor ❑ Other FPPC Form 700 (2005/2006) Sch. C FPPC Toll -Free Helpline: 666 /ASK -FPPC