Docusign Envelope ID: 89D1E6BC-D676-412C-94DB-FD9BE82D1EDA
LEVINE ACT DISCLOSURE
General Form
California Government Code Section 84308, commonly referred to as the "Levine Act," prohibits any Lancaster official from participating in any action related to a contract or application if he or she receives any political contributions totaling more than $250 within the previous twelve months, and for twelve months following the date a final decision is rendered. The Levine Act also requires a Lancaster City official who has received such a contribution to disclose the contribution on the record of the proceeding. • Current Lancaster City Council Members are listed at:
https://www.cityoflancasterca.org/government/city-officials/city-council-copy • Current Planning Commissioners are listed at:
https://www.cityoflancasterca.org/government/commissions-appointments/planning Proposers are responsible for accessing the above links to review the names priorto answering the following questions:
Have you or your company, or any agent/board member on behalf of you or your company/entity, made any political contributions of more than $250 to any Lancaster City Council Member or other City official in the 12 months preceding the date of the submission of your proposal or application, or the anticipated date of any Council action?
NO
YES If yes, please identify the Council Member (s)/City official(s):
2. Do you or your company/entity, or any agency on behalf of you or your company/entity, anticipate or plan to make any political contribution of more than $250 to any Lancaster City Council Member or other city official in the 12 months following any Council action related to your proposal or application?
NO
YES If yes, please identify the Council Member(s)/City official(s):
Answering yes to either of the two questions above does not preclude the Lancaster City Council from awarding a contract or approving an application or any subsequent action. It does, however, preclude the identified Council Members) from participating in any actions related to your proposal or application.
— DocuSigned by:
John Smelzer
09-30-24 - 3A3273457F80457...
DATE SIGNATURE OF AUTHORIZED INDIVIDUAL
Antelope Valley Soccer LLC
COMPANY / APPLICANT NAME