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Ken RukavinaSTATEMENT OF ECONOMIC INTERES Date Received CALIFORNIA FOR m 700 � CE�1 FAIR POLITICAL PRACTICES COMMISSION COVER PAGE CITY OF ROSEMEAD Please type or print in ink A Public Document P'IAR 2 1 2005 NAME (LAST) (FIRST) (MIDDLE) _ER RUKAVINA KENNETH ( 562 ) 908 -6200 MAILING ADDRESS STREET CITY STATE ZIP CODE OPTIONAL: FAX I E -MAIL ADDRESS (May use business address) 13191 CROSSROADS PKWY #405 INDUSTRY CA 91746 krukavina @willdan.com 1 . Office, Agency, or Court Name of Office, Agency, or Court: C ITY O ROSEMEAD Division, Board, District, if applicable: Your Position: CO N SU LTA N T �+ 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 feast one box) ❑ State ❑ County of ® City of ROSEMEAD ❑ Multi- County F ntl,ar 3. Type of Statement (Check at least one box) 4. Schedule Summary (Check applicable schedules or "No reportable interests.') During the reporting period, did you have any reportable interests to disclose on: Schedule A -1 ❑ Yes - schedule attached Investments (Less than 10% Ownership) Schedule A -2 ❑ Yes - schedule attached Investments (to% or greater Ownership) Schedule B ❑ Yes - schedule attached Real Property Schedule C © Yes - schedule attached Income, Loans, & Business Positions (Income other than Gifts and Travel Payments) Schedule D (Eliminated - report loans on Schedule C) Schedule E ❑ Yes - schedule attached Income - Gifts Schedule F ❑ Yes - schedule attached Income - Travel Payments -or- r ❑ No reportable interests on any schedule Total number of pages completed including this cover page: ? ❑ Assuming Office /Initial Date: (] Annual: The period covered is January 1, 2004, through December 31, 2004. -or- 0 The period covered is --- J___J, through December 31. 2004. ❑ Leaving Office Date Left: ---J ---]— (Check one) • The period covered is January 1, 2004, through the date of leaving office. -or- O The period covered is through the dale of leaving office. ❑ Candidate 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 underthe laws of the State of California that the foregoing is true and correct. Date Signed MARCH 8, 2005 / � (month, day, year) Signature ,r��.� (File the originally signed statement with your Filing official.) FPPC Form 700 (200412006) FPPC Toll -Free Helpline: 866 1ASK -FPPC SCHEDULE C _ Income, Loans* & Business Positions Name (Other than Gifts and Travel Payments) KENNETH RUKAVINA KENNETH RUKAVINA - WILLDAN ADDRESS 13191 CROSSROADS PKWY N. #405 BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION CONSULTANT GROSS INCOME RECEIVED /HIGHEST BALANCE DURING REPORTING PERIOD, IF LOAN ❑ $500 - $1,000 ❑x $1,001 - $10,000 ❑ $10,001 - $100,000 ❑ OVER $100,000 CONSIDERATION FOR WHICH INCOME WAS RECEIVED ❑X Salary ❑ Spouse's income ❑ Loan repayment ❑ Sale of (Property, car, boat, etc.) ❑ Commission or ❑ Rental Income, list each source of $10,000 or more ❑ Other (Describe) ❑ LOAN RECEIVED (complete box 2) ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME RECEIVED /HIGHEST BALANCE DURING REPORTING PERIOD, IF LOAN ❑ $50o - $1,0o0 ❑ $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 of $10.00 or mare ❑ Other (Oescnbe) ❑ LOAN RECEIVED (complete box 2) ADDRESS BUSINESS ACTIVITY, IF ANY, OF SOURCE YOUR BUSINESS POSITION GROSS INCOME RECEIVED /HIGHEST BALANCE DURING REPORTING PERIOD, IF LOAN ❑ $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 of $10,000 or more ❑ Other (Describe) ❑ LOAN RECEIVED (complete box 2) INTEREST RATE TERM (Months/Years) h ❑ None SECURITY FOR LOAN ❑ None ❑ Personal residence ❑ Real Property ❑ Guarantor ❑ Other (Describe) * 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. Comments: FPPC Form 700 (2004/2005) Sch. C FPPC Toll -Free Helpline: 866 /ASK -FPPC