CITY OF
LONG BEACH
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-boards- committees/
• 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
2. Has any Agent on behalf of you or your organization made any political contributions to any City or Commission action related to this license, permit, or contract?
YES NO
If yes, please identify the City Officers):
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 Officers):
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 Officers):
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.
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(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.
Levine Act Disclosure Form v3