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(Name of Volunteer Board) A Utah municipal corporation Office of the Mayor 3330 South 1300 East Millcreek, Utah 84106 (801) 214-2700 ETHICS REVIEW FORM As a member of the _ you must be aware of and abide by a Utah law which prohibits or requires disclosure of certain actual or potential conflicts of interest between public duties and private business interests, if any. The Municipal Officers’ and Employees’ Ethics Act, Utah Code Ann 10-3-1301 et seq. sets forth the following requirements: 1. It is an offense for an elected officer or appointed officer (for purposes of this review appointed officer includes, but is not limited to, persons serving on special, regular, or full-time committees, agencies, or boards whether or not such persons are compensated for their services which includes a member of a Volunteer Board) to: a. Disclose or improperly use private, controlled, or protected information acquired by reason of the officer’s or employee’s official position or in the course of official duties in order to further substantially the officer’s or employee’s personal economic interest or to secure special privileges or exemptions for the officer of employee or for others: b. Use or attempt to use the officer’s or employee’s official position to: i. Further substantially the officer’s or employee’s personal economic interest; or ii. Secure special privileges for the officer of employee or for others’; or c. Knowingly receive, accept, take, seek, or solicit, directly or indirectly, for the officer or employee or for another, a gift of substantial value or a substantial economic benefit tantamount to a gift that: i. Would tend improperly to influence a reasonable person in the person’s position to depart from the faithful and impartial discharge of the person’s public duties; or ii. The person knows or that a reasonable person in that position should know under the circumstances is primarily for the purpose of rewarding the person for official action taken. Subsection does not apply to an occasional ---PAGE BREAK--- nonpecuniary gift having a value of less than $50, an award publicly presented in recognition of public services, any bona fide loan made in the ordinary course of business, or a political campaign contribution. 2. It is an offense for an elected officer or appointed officer who is a member of a public body to receive or agree to receive compensation for assisting any person or business entity in any transaction involving the municipality in which the member is an officer unless the member: a. Files with the mayor a sworn statement giving the information required by this section; and b. Discloses certain information in an open meeting to the members of the body of which the officer is a member immediately before the discussion. 3. It is an offense for an appointed officer who is not a member of a public body or a municipal employee to receive or agree to receive compensation for assisting any person or business entity in any transaction involving the municipality by which the person is employed unless the officer of employee: a. Files with the mayor a sworn statement giving certain information; and b. Disclose the information to: i. The officer or employee’s immediate supervisor; and ii. Any other municipal officer or employee who may rely upon the employee’s representation in evaluating or approving the transaction. 4. Every appointed or elected officer or municipal employee who is an officer, director, agent, or employee or the owner of a substantial interest in any business entity which is subject to the regulation of the municipality in which he/she is an elected or appointed officer or municipal employee shall disclose the position held and the nature and value of his/her interest upon first becoming appointed, elected, or employed by the municipality, and again at any time thereafter if the elected or appointed officer’s or municipal employee’s position in the business entity has changed significantly or if the value of his/her interest in the entity has increased significantly since the last disclosure. The disclosure shall be made in a sworn statement to the mayor. The mayor shall report the substance of all such disclosure statement to the members of the governing body, or may provide to the members of the governing body copies of the disclosure statement within 30 days after the statement is received by him/her. 5. Every appointed or elected officer or municipal employee who is an officer, director, agent, employee, owner of a substantial interest in any business entity which does or anticipates doing business with the municipality in which he/she is an appointed or elected officer or municipal employee, shall publicly disclose to the members of the body of which he/she is a member or by which he/she is employed immediately prior to any discussion by such body concerning matters relating to such business entity, and nature of his/her interest in that business entity. ---PAGE BREAK--- 6. Any personal interest or investment by a municipal employee or by any elected or appointed official of a municipality which creates a conflict between the employee’s or official’s personal interests and his/her public duties shall be disclosed in open meeting to the members of the body. YOUR CONDUCT WILL BE GOVERNED BY THE LAW, NOT THIS REVIEW. Feel free to direct any questions regarding the law’s ethical and disclosure requirements to the City Attorney. I have read and understand the above conditions. Name: Date: _