LEVINE ACT DISCLOSURE STATEMENT
California Government Code Section 84308, commonly referred to as the "Levine Act," prohibits City Officers from participating in any action concerning a license, permit, other entitlement for use, franchise, or contract (collectively “license, permit, or contract”) if they receive political contribution(s) from a party totaling more than $500 within the twelve (12) months before the proceeding, while a proceeding is pending, and for twelve (12) months following the date of a final decision in a proceeding. Agents are prohibited from making any political contributions to City Officers during this time.
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.longbeach.gov/officials/ (excluding City Attorney) • Board and Commissioners - https://www.longbeach.gov/mayor/administration/commissions-boardscommittees/ • Candidates for elected City office - https://www.longbeach.gov/cityclerk/elections/candidates-home/ Parties and their Agents are responsible for reviewing and disclosing their applicable contributions to City Officers on the record of a proceeding.
As a party to a proceeding, you are also required to provide information below about contributions made by you, your agents on behalf of youor your organization, your organization subject to the proceeding with the City, and any organization you direct or control pursuant to the aggregation rules at FPPC Reg. § 18438.5, except for uncompensated officers of a nonprofit organization. This form is to be submitted to the City of Long Beach and is a public record. If you have any questions about this form, please contact your City representative for assistance.
1. Have you or your organization, or any organization you direct or control made any political contributions of more than $500 to any City Officer in the 12 months preceding the date of the submission of your proposals or the anticipated date of any City Council, Board, or Commission action related to this license, permit, or contract?
YES NO
If yes, please complete the table on the following page. If needed, please continue on additional pages.
Officer Name Payee Name Payment Date Payment Amount
✔
Levine Act Disclosure Form v3
2. Has any Agent on behalf of you or your organization made any political contributions to any City Officer in the twelve (12) months preceding the date of the submission of your proposals or the anticipated date of any City Council Board, or Commission action related to this license, permit, or contract?
YES NO
If yes, please identify the City Officer(s):
Officer Name Payee Name Payment Date Payment Amount
3. Do you or your organization anticipate or plan to make any political contribution of more than $500 to any City Officer in the 12 months following any City Council, Board, or Commission action related to this license, permit, or contract?
YES NO
If yes, please identify the City Officer(s):
Officer Name Payee Name Payment Date Payment Amount
✔
✔
Levine Act Disclosure Form v3
4. Does any Agent on behalf of you or your organization anticipate or plan to make any political contribution to any City Officer in the 12 months following any City Council, Board, or Commission action related to this license, permit, or contract?
YES NO
If yes, please identify the City Officer(s):
Officer Name Payee Name Payment Date Payment Amount
Answering yes to any of the questions above does not preclude the City of Long Beach from awarding a license, permit, or contract to your organization or any taking any subsequent action related to the said license, permit, or contract. It does, however, preclude the identified City Officers from participating in any actions related to this license, permit, or contract.
_______________________________________________________________________________________ (Date) (Printed Name/Title of Authorized Representative) (Name of business/legal entity) ___________________________________
(Signature)
You must submit a supplemental form if you make any new reportable contribution(s) while the contract, license, permit, or other entitlement is being considered. 9/3/26 Shawna Evans, Sr. Finance Operations Manager LeadsOnline, LLC Shawna Evans Digitally signed by Shawna Evans Date: 2026.09.03 15:31:32 -05'00' ✔
Levine Act Disclosure Form v3
LEVINE ACT DISCLOSURE STATEMENT
DEFINITIONS
Term Definition Law
Covered
"proceedings"
A proceeding to grant, deny, revoke, restrict, or
modify a license, permit or other entitlement for
use, that does 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
a franchisee granted by the agency to the party,
other than a contract that is competitively bid, a
labor contract, or a personal employment
contract.
FPPC Reg 18438.2(a)
Party
Any person who files an application for, or is the
subject of, a proceeding involving a license, permit,
or other entitlement for use.
Gov. Code 84308(a)(1)
Participant
Any person who is not a party but who actively
supports or opposes a particular decision in a
proceeding involving a license, permit, or other
entitlement for use and who has a financial interest
in the decision. A person actively supports or
opposes a particular decision in a proceeding if that
person lobbies in person the officers or employees
of the agency, testifies in person before the agency,
or otherwise acts to influence officers of the
agency.
Gov. Code 84308(a)(2)
FPPC Reg 18438.4
Agent
A person who represents a party or participant for
compensation and appears before or otherwise
communicates with the governmental agency for
the purpose of influencing the pending proceeding.
See FPPC Reg 18438.3 for exceptions for certain
consultants.
FPPC Reg 18438.3
Competitively Bid
A contract required by law to be awarded to the
lowest or highest responsible bidder with a
responsive bid, or, if the successful bidder refuses
or fails to execute the contract, to the next lowest
bidder with a responsive bid.
SB 1243
Labor Contract
A 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 agreement
entered under Public Contract Code Section 2500.
FPPC Reg
18438.2(a)(3)(B)
Personal
Employment
Contract
A contract for employment, including the terms and
conditions of employment, between the agency and
an agency employee. A contract with an
independent contractor is NOT a personal
employment contract.
FPPC Reg
18438.2(a)(3)(C)-(D)