(Submit with Bid/Application)THIS FORM IS A PUBLIC RECORDLEVINE ACT DISCLOSURECalifornia Government Code § 84308, commonly referred to as the "Levine Act," prohibits City Officers from participating in any proceeding concerning a license, permit, other entitlement for contribution(s) from a party to the proceeding, or their agent, totaling more than $500 in the preceding 12 months. The Levine Act also prohibits City Officers from accepting, soliciting, or directing campaign contributions over $500 from parties to a proceeding, or in anyamount by their agents, while a proceeding is pending and for 12 months following the final decision in a proceeding.The Levine Act requirements apply only when the City Officer or the body of which they are a member has the authority to make any decision or recommendation in the proceeding. City Officers include City elected or appointed officers, their alternates, and any candidate for elective office. City Officers are listed at the following sites:City elected officers-https://www.fresno.gov/cityofficials/Board and Commissioners-https://www.fresno.gov/cityclerk/#boards-&-commission-applicationParties are responsible for reviewing and disclosing on the record of a proceeding their applicant as well as the subject of the proceeding. As a bidder/proposer you are a party to a proceeding under the Levine Act, and required to provide information about campaign contributions to City Officers made by you, your agents on behalf of you or your organization, your organization subject to the proceeding with the City, and any organization you direct or control pursuant to the aggregation rules set forth by FPPC Reg. §18438.5, except for uncompensated officers of a nonprofit organization. When a closed corporation is a party to or a participant to a proceeding subject to the Levine Act, the majority shareholder is subject to the disclosure and prohibition requirements of the Levine Act. (Gov. Code 84308(e)(4).)DISCLOSURESBidders/proposers are responsible for reviewing the names of the City Officers at the links aboveprior to making the following disclosure:Have you or your organization/company, or any Agent on behalf of you or your organization/company, or any organization/company you direct or control, made campaign contributions of more than $500 to a City Officer in the 12 months preceding the date of the submission of your bid or proposal, or the anticipated date of any action by a City Officer related to this proceeding?YES: NO:If yes, please identify the City Officer(s), Contributing Entity and if they are a Party or an Agent,and date(s) of contribution(s) in the spaces below: City Officer(s) Name(s) Contributing Entity Date(s) of Contribution(s)_____________________________________________________________________________________________________________________________________________________________________274302.4 (Submit with Bid/Application)__________________________________________________________________________________________Answering yes to the question above does not preclude the City of Fresno from awarding alicense, permit, or contract to your entity or taking any subsequent action related to thelicense, permit, or contract.OWNERSHIPTo facilitate compliance with the Levine Act, the City of Fresno requests bidders/proposersvoluntarily disclose information about the ownership of their companies. Bidders will not be found non-responsive if they do not provide this information, but the disclosure above is legally required.Name of Bidder/ProposerAddressList the names of all principals, partners, and/or trustees. For corporations, provide names of officers, directors, and all stockholders owning more than 10% equity interest in corporation.For closed corporations, list the name of the majority shareholder:SIGNATUREI hereby certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct.Name of Business/Legal EntityPrint Name and Title of Authorized RepresentativeSignatureDate274302.4
(Submit with Bid/Application)LEVINE ACT DISCLOSURE STATEMENTDEFINITIONSTermDefinitionLawCovered "proceedings"A license, permit, or other entitlement for use, meaning all business, professional, trade, and land use licenses and permits and all other entitlements for use, including all entitlements for land use, all contracts, and all franchises. Including a proceeding to grant, deny, revoke, restrict, or modify a license, permit or other entitlement for use, thatdoes not solely involve purely ministerial decisions and is:(1) Applied for by the party;(2) Formally or informally requested by the party; or(3) A contract between the agency and the party or afranchisee granted by the agency to the party, other thanthosecompetitively bid, labor contract, personalemployment contract, valued under $50,000, between twoor more agencies, where no party receives financialcompensation, periodic review of or renewal of adevelopment agreement with no material changes; or aperiodic review or renewal of competitively bid contracts(unless material modifications or amendments valued at>10% value of the contract $50,000, whichever is less).FPPC Reg18438.2(a)PartyAny person who files an application for, or is thesubject of, a proceeding involving a license, permit, or other entitlement for use.Gov. Code84308(a)(1)AgentA person who represents a party or participant for compensation and appears before or otherwise communicates with the governmental agency for thepurpose of influencing the pending proceeding.See FPPC Reg 18438.3 for exceptions for certain consultants.FPPC Reg 18438.3Competitively BidCompetitively bid contracts are required by law, agency policy, or agency rule to be awarded pursuant to a competitive process. A contract required by law to be awarded to the lowest responsible bidder with aresponsive bid, or, if the successful bidder refuses or fails to execute the contract, to the next lowest bidder with aresponsive bid.Gov. Code 84308(a)(5)(B);FPPC Reg 18438.2(a)(3)(A)Labor ContractA contract or agreement reached through collective bargaining or with a representative group regarding the salary, benefits, or terms and conditions under an employment or retirement policy for employees or retirees, including a project labor agreemententered under Public Contract Code Section 2500.FPPC Reg 18438.2(a)(3)(B)Personal Employment ContractA contract for employment, including the terms and conditions of employment, between the agency and an agency employee. A contract with anindependent contractor is NOT a personal employment contract.FPPC Reg 18438.2(a)(3)(C)-(D)Additional information on the Levine Act:https://www.fppc.ca.gov/content/dam/fppc/NS-Documents/TAD/Campaign%20Documents/84308/Section%2084308%20and%20Parties%20and%20Participants%20Guide.pdf274302.4