LEVINE ACT DISCLOSURE FORM
1 CAO:650-90/tmn/Legal Files\Levine Act - Applications
California Government Code section 84308 (Levi ne Act) prohibits any Thousand Oaks City Council member from participating in any action related to a contract, agreement, or franchise agreement (excluding labor or competitively bid contracts) if the Council member receives a campaign contribution totaling more than $250 (aggregated) from the party to the contract, agreement or franchise agreement, their agents, or any financially interested participant who actively supports or opposes the matter within the previous twelve (12) months. Council members must also disclose any eligible campaign contribution received on the record of the proceeding.
Council members are prohibited from accepting, soliciting, or directing a campaign contribution of more than $250 (aggregated) from a party, their agent/representative, or a financially interested participant during a proceeding and for 12 months following the date a final decision is made. In addition, a party, their agent/representative, or a financially interested participant is prohibited from contributing more than $250 (aggregated) to a Council member during a proceeding and for 12 months following the date a final decision is made.
The Levine Act also requires parties to certain contracts, agreements, or franchise agreements to disclose any campaign contribution over $250 (aggregated) within the preceding twelve (12) months by the party to the agreement, contract, or franchise agreement and their agents. The Levine Act does not apply to competitively bid, labor, or personal employment contracts.
The Levine Act (Gov Code § 84308) DOES NOT apply to this proposal/application The Levine Act (Gov Code § 84308) DOES apply to this proposal/application and the required disclosure is set forth below:
1. Have you or your company, or any agent on behalf of you or your company, made campaign contributions totaling more than $250 (aggregated) to any council member in the 12 months preceding the date you submitted your proposal/application, the date you completed this form, or the anticipated date of any Council action related to this proposal/application? YES
NO
Council Member Name Payee Na me Payment Date Payment Amount CDD:440-10/H:/COMMON/City Council/CC Agenda Items/2024/06182024/ Professional Services Agreements for Arborist and Landscape Architect Consultant Services/Attachment 2 Levine Act Disclosure Forms 2 CAO:650-90/tmn/Legal Files\Levine Act - Applications
2. Do you or your organization, or any agency or representative on behalf of you or your organizat
ion, anticipate or plan to make any cam paign
cont
ributions of more than $250 (aggregated) to any City Council member in the 12 months following any City Council action related to this proposal/application? ** There may be legal restrictions on maki ng cont
ributions during the 12 months following City Council Action. It is recommended that you consult with your own legal counse l regarding
the requirements of law.
YES
NO
Council Member Name Payee Name Payment Date Payment Amount Answer
ing “YES” to either question above does not preclude the City of Thousand Oaks from entering into or taking any subsequent action related to this proposal/application. However, it may preclude the identified Council member(s) from part icipating in any actions/decisions related to this proposal/application.
____________ ______________________________ _______________________ Date Printed Name/Title of Authorized Name of Business/Legal Repr
esentative Ent
ity
____________________________________________________________________________ Signature
*** You must submit a supplemental form if y ou make any new reportable contribution(s) while the proposal/application is being considered ***
** “Aggregated” contributions, as described in FPPC Regulation §18438.5, include the following types of contributions made during a 12-month period: (1) all contributions made by the party or participant; (2) all contributions made by an a gent of the party or participant; and (3) all contributions made by an individual or entity required to be aggregated with the party or participant, and any agent of the party or participant.
Joseph Monaco, AICP, President & CEO
5/17/2024
Dudek
CDD:440-10/H:/COMMON/City Council/CC Agenda Items/2024/06182024/ Professional Services Agreements for Arborist and Landscape Architect Consultant Services/Attachment 2 Levine Act Disclosure Forms
LEVINE ACT DISCLOSURE FORM
1 CAO:650-90/tmn/Legal Files\Levine Act - Applications
California Government Code section 84308 (Levi
ne Act) prohibits any Thousand Oaks City
Council member from participating in any action related to a contract, agreement, or franchise agreement (excluding labor or competitively bid
contracts) if the Council member receives a
campaign contribution totaling more than $250 (aggregated) from the party to the contract, agreement or franchise agreement, their agents, or
any financially interested participant who
actively supports or opposes the matter within the previous twelve (12) months. Council members must also disclose any eligible campaign contri
bution received on the record of the proceeding.
Council members are prohibited from accepting, solic
iting, or directing a campaign contribution of
more than $250 (aggregated) from a party, their agent/representative, or a financially interested participant during a proceeding and for 12 months following the date a final decision is made. In addition, a party, their agent/representative, or a financially interested participant is prohibited from contributing more than $250 (aggregated) to a Council member during a proceeding and for 12 months following the date a final decision is made.
The Levine Act also requires parties to certain contracts, agreements, or franchise agreements to disclose any campaign contribution over $250
(aggregated) within the preceding twelve (12)
months by the party to the agreement, contract, or franchise agreement and their agents. The Levine Act does not apply to competitively bi
d, labor, or personal employment contracts.
The Levine Act (Gov Code § 84308) DOES NOT apply to this proposal/application The Levine Act (Gov Code § 84308) DOES
apply to this proposal/application and
the required disclosure is set forth below:
1. Have you or your company, or any agent on behalf of you or your company, made campaign contributions totaling more than $250 (aggregated) to any council member in the 12 months preceding the date you submitted your proposal/application, the date you completed this form, or the anticipated date of any Council action related to this proposal/application? YES
NO
Council Member Name Payee Na
me Payment Date Payment Amount
X
X
CDD:440-10/H:/COMMON/City Council/CC Agenda Items/2024/06182024/ Professional Services Agreements for Arborist and Landscape Architect Consultant Services/Attachment 2 Levine Act Disclosure Forms 2 CAO:650-90/tmn/Legal Files\Le
vine Act - Applications
2. Do you or your organization, or any agency or representative on behalf of you or your organization, anticipate
or plan to make any campaign
contributions of more than $250 (aggregated) to any City Council member in the 12 months following any City Council action related to this proposal/application?
** There may be legal restrictions on making
contributions during the 12 months following City Council Action. It is recommended that you consult with your own legal counsel regarding the requirements of law.
YES
NO
Council Member Name Payee Name
Payment Date Payment Amount
Answering “YES” to either question above does not preclude the City of Thousand Oaks from entering into or taking any subsequent action related to this proposal/application. However, it may preclude the identified Council member(s) from part
icipating in any actions/decisions related to
this proposal/application.
____________ ______________________________ _______________________ Date Printed Name/Title of Authorized Name of Business/Legal Representative Entity
____________________________________________________________________________ Signature
*** You must submit a supplemental form if y
ou make any new reportable contribution(s)
while the proposal/application is being considered ***
** “Aggregated” contributions, as described in
FPPC Regulation §18438.5, include the following
types of contributions made during a 12-month peri
od: (1) all contributions made by the party or
participant; (2) all contributions made by an a
gent of the party or participant; and (3) all
contributions made by an individual or entity
required to be aggregated with the party or
participant, and any agent of the party or participant.
X
05/17/2024
Greg Ainsworth/Director
Rincon Consultants, Inc
CDD:440-10/H:/COMMON/City Council/CC Agenda Items/2024/06182024/ Professional Services Agreements for Arborist and Landscape Architect Consultant Services/Attachment 2 Levine Act Disclosure Forms
LEVINE ACT DISCLOSURE FORM
1 CAO:650-90/tmn/Legal Files\Levine Act - Applications
California Government Code section 84308 (Levi ne Act) prohibits any Thousand Oaks City Council member from participating in any action related to a contract, agreement, or franchise agreement (excluding labor or competitively bid contracts) if the Council member receives a campaign contribution totaling more than $250 (aggregated) from the party to the contract, agreement or franchise agreement, their agents, or any financially interested participant who actively supports or opposes the matter within the previous twelve (12) months. Council members must also disclose any eligible campaign contribution received on the record of the proceeding.
Council members are prohibited from accepting, soliciting, or directing a campaign contribution of more than $250 (aggregated) from a party, their agent/representative, or a financially interested participant during a proceeding and for 12 months following the date a final decision is made. In addition, a party, their agent/representative, or a financially interested participant is prohibited from contributing more than $250 (aggregated) to a Council member during a proceeding and for 12 months following the date a final decision is made.
The Levine Act also requires parties to certain contracts, agreements, or franchise agreements to disclose any campaign contribution over $250 (aggregated) within the preceding twelve (12) months by the party to the agreement, contract, or franchise agreement and their agents. The Levine Act does not apply to competitively bid, labor, or personal employment contracts.
The Levine Act (Gov Code § 84308) DOES NOT apply to this proposal/application The Levine Act (Gov Code § 84308) DOES apply to this proposal/application and the required disclosure is set forth below:
1. Have you or your company, or any agent on behalf of you or your company, made campaign contributions totaling more than $250 (aggregated) to any council member in the 12 months preceding the date you submitted your proposal/application, the date you completed this form, or the anticipated date of any Council action related to this proposal/application? YES
NO
Council Member Name Payee Na me Payment Date Payment Amount X
X
CDD:440-10/H:/COMMON/City Council/CC Agenda Items/2024/06182024/ Professional Services Agreements for Arborist and Landscape Architect Consultant Services/Attachment 2 Levine Act Disclosure Forms 2 CAO:650-90/tmn/Legal Files\Levine Act - Applications
2. Do you or your organization, or any agency or representative on behalf of you or your organization, anticipate or plan to make any campaign contributions of more than $250 (aggregated) to any City Council member in the 12 months following any City Council action related to this proposal/application? ** There may be legal restrictions on making contributions during the 12 months following City Council Action. It is recommended that you consult with your own legal counsel regarding the requirements of law.
YES
NO
Council Member Name Payee Name Payment Date Payment Amount
Answering “YES” to either question above does not preclude the City of Thousand Oaks from entering into or taking any subsequent action related to this proposal/application. However, it may preclude the identified Council member(s) from part icipating in any actions/decisions related to this proposal/application.
____________ ______________________________ _______________________ Date Printed Name/Title of Authorized Name of Business/Legal Representative Entity
____________________________________________________________________________ Signature
*** You must submit a supplemental form if y ou make any new reportable contribution(s) while the proposal/application is being considered ***
** “Aggregated” contributions, as described in FPPC Regulation §18438.5, include the following types of contributions made during a 12-month period: (1) all contributions made by the party or participant; (2) all contributions made by an a gent of the party or participant; and (3) all contributions made by an individual or entity required to be aggregated with the party or participant, and any agent of the party or participant.
X
Amanda Gibbs
Wildscape Restoration
5/15/2024
, Chief Bus.Dev. Officer
CDD:440-10/H:/COMMON/City Council/CC Agenda Items/2024/06182024/ Professional Services Agreements for Arborist and Landscape Architect Consultant Services/Attachment 2 Levine Act Disclosure Forms