CITY OF Applicant/Interested Party
NORWALK Campaign Contribution Disclosure Form
A Connected Community
Land use, entitlements, licenses, permits, franchises, contracts (excluding labor and competitively bid contrects)
California Government Code Section 84308, commonly referred to as the Levine Act," prohibits any Norwalk City Council Member or Planning Commissioner (if they are running for City Council) from articipating in any action related to a contract or application if he or she receives any politica ontributions totaling more than $500 within the previous 12 months, and for 12 months following the date a final decision from the business or applicant. The Levine Act also requires a member of the Official who has received such a contribution to disclose the contribution on the record of the Contribution Disclosure
about the contributor's relationship with the recipient.
Contractor
Name/Project: ABC BUS, INC.
Date of Contribution Refunded:
Contribution Recipient Officer/Candidate Amount Yes No Date of Refund No contribution made: I
than 45 days before any agency consideration of an item in which you or your company is engaged with the City.
I declare under penalty of perjury that the information which has been included in this Disclosure Form is true and correct.
Corcy Capps SR. Operations Manager 8/15/2025
Signature of Applicant Title Dato