HomeMy WebLinkAboutDavid Kaskie Filed 1/18/24 FILi . p
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JAN 18 2024
`4UNIFORM CONFLICT OF INTEREST DISCLOSURE STATEMENT
e...t,•,-.. 0Mote Form saxes(R2 r 6•9al l Fenn:zee r
STATE BOARD of ACCOUNTS ,�tr`�' ,�
CLERK LARK CIh'CUlT COURTS
Indiana Code 35-44.1-1.4
A public servant who knowingly or Intentionally has a pecuniary Interest In or derives a profit from
a contract or purchase connected with an action by the governmental entity served by the public servant
commits conflict of interest,a Class D Felony. A public servant has a pecuniary Interest In a contract or
purchase If the contract or purchase will result or is intended to result In an ascertainable increase In the
Income or net worth of the public servant or a dependent of the public servant. "Dependent"means any
of the following: the spouse of a public servant;a child,stepchild,or adoptee(as defined in IC 31-9-2-2)
of a public servant who is unemancipated and less than eighteen(18)years of age;and any Individual
more than one-half(1/2)of whose support Is provided during a year by the public servant.
The foregoing consists only of excerpts from IC 35-44.1-1-4. Care should be taken to review IC
35-44.1-1-4 In its entirety.
1. Name and Address of Public Servant Submitting Statement: David Kaskie, _u
2. Title or Position With Governmental Entity: Captain Fire Department
3. a. Governmental Entity: City of Jeffersonville
b. County: Clark
4. This statement Is submitted(check one):
a._ as a"single transaction"disclosure statement,as to my financial interest in a specific contract or
purchase connected with the governmental entity which I serve. proposed to be made by the
governmental entity with or from a particular contractor or vendor,or
b.✓ as an"annual"disclosure statement,as to my financial Interest connected with any contracts or
purchases of the governmental entity which I servo,which are made on an ongoing basis with or
from particular contractors or vendors.
5. Namo(s)of Contractor(e)or Vendor(s): Koski()Electric,LLC
II. Cescrlption(s) of Contract(s) or Purchases) (Describe the kind of contract involved, and the
effective date and term of the contract or purchase if reasonably determinable. Dates required if 4(a)
Is selected above. If"dependent"Is Involved,provide dependent's name and rnlatlonshlp.):
Maio)nl ocd Communl"a4Ous OPnballor.I wunldt os6aatoe upon=weal tor"foatrkcl and aa,mw lw6ori wash.Tram to not ctandbno=tract for emNoo.
Paso 9 or 3
7. Description of My Financial Interest (Describe to what matador the public servant or°deport-
dent"expects to derive a profit or financial benefit from, or otherwise hos a pecuniary Interest in,
the above contract(s) or purchase(s);If reasonably determinable, state the approximate dollar
value of such profit or benefit.):
..Mwl...... ......liMOestamouos wmika MVINnarroamoa�M.TMtl RbmAR.4M'WraHPA4✓lm �.
(Attach extra pages If additional space Is needed.)
8. Approval of Appointing Officer or Body(To be completed if the public servant was appointed by
en elected public servant or the board of trustees of a state-supported college or university.):
i(We)being the Board of Public Works of
(7dle of c eror ame Qovemiitgr Body)
City of Jeffersonville and having the power to appoint
(Name of Governmental Entity)
the above named public servant to the public position to which he or she holds,hereby approve the
participation to the appointed disclosing public servant in the above described contract(s) or
purchase(s) in which said public servant has a conflict of Interest as defined in Indiana Code 335-
44.1-1-4;howev this approval does not waive any objection to any conflict prohibited by statute,
rule,or rag tt nd is not to be nstrued as a consent to any Illegal act.
Elected Official Office _r
9. Effective Dates((Conflict of Interest statements must be submitted to the governmental entity prior
to final action on the contract or purchase.):
1 - t o- )-4 1-/ r �
Date Submitted(month,day.year) Date of Action on Contractor (marrih,duy,year)
Page 2 or 3
10. Affirmation of Public Servant: This disclosure was submitted to the governmental entity and
accepted by the governmental entity In a public meeting of the governmental entity prior to final
action on the contract or purchase. I efitmi,under penalty of perjury.the truth and completeness of
the statements made above,and that I am the abovo named publics servant.
Signed: •
ni1�7c'SSe nt)
Date: ti t• k a_c,a L1
(month,day,year)
Printed Name: David Kaskie
(Please print legibly.)
Email Address: davkkaskie®gme l.com
Within fifteen (15)days after final action on the contract or purchase,copies of this statement must be
filed with the State Board of Accounts by uploading It hero fairs,// ateway,i(iotrlige.urst/sboa col/which is
the preferred method of filing,or by mailing It to the State Board of Accounts,Indiana Government Center
South,302 West Washington Street, Room E41fi, Indianapolis,Indiana,48204-2 65 and the Clerk of the
Circuit Court of the county where the governmental entity took final action on the contract or purchase.
Paso 3 of 3