E
XHIBIT _____
LEVINE ACT DISCLOSURE FORM
1 C
AO:650-90/tmn/Legal Files\Levine Act - Contracts
California Government Code section 84308 (Levine 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.
C
ouncil 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 Lev
ine 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 Lev ine Act (Gov Code § 84308) DOES NOT apply to this Agreement/Contract The Levine Act (Gov Code § 84308) DOES apply to this Agreement/Contract and the required disclosure is set forth below:
1. H
ave 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, the date you completed this form, or the anticipated date of any Council action related to this Agreement/Contract?
YES
NO
Counci l M ember Name Pay ee Name Pay ment Date Payment A mount C
X
X
DocuSign Envelope ID: 29B9244D-2829-4773-8955-F83EB65AC0DB ATTACHMENT #3
FIN:350-10\mc\H:\Common\Council\2024\Administration\061824 HDL Sales-Property Tax Agreements Levine Act Disclosure.pdf 2 CAO:650-90/tmn/Legal Files\Levine Act - Contracts
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 Agreement/Contract? ** 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
Counci l M ember Name Pay ee Name Pay ment Date Payment A mount Answ
ering “YES” to either question above does not preclude the City of Thousand Oaks from entering into or taking any subsequent action related to this Agreement/Contract. However, it may preclude the identified Council member(s) from participating in any actions/decisions related to this Agreement/Contract.
____________ ______________________________
Da
te Printed Name/Title of Authorized
Representative
____________________________________________________________________________ S
ignature
***
You must submit a supplemental form if you make any new reportable contribution(s) while the Agreement/Contract 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 agent 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
6/12/24
Robert Gray
Vice President, HDL
_______________________
Name of Business/Legal
Entity
DocuSign Envelope ID: 29B9244D-2829-4773-8955-F83EB65AC0DB FIN:350-10\mc\H:\Common\Council\2024\Administration\061824 HDL Sales-Property Tax Agreements Levine Act Disclosure.pdf EXHIBIT _____
LEVINE ACT DISCLOSURE FORM
1 CAO:650-90/tmn/Legal Files\Levine Act - Contracts
California Government Code section 84308 (Levine Act) prohibits any Thousand Oaks City Council member from participating in any action related to a co ntract, agreement, or franchise agreement (excluding labor or competitively bid contracts) if t he 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 financia lly 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/represent ative, 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, agre ements, or franchise agreements to disclose any campaign contribution over $250 (aggregated) wi thin the preceding twelve (12) months by the party to the agreement, contract, or franchise ag reement 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 Agreement/Contract The Levine Act (Gov Code § 84308) DOES apply to this Agreement /Contract and the required disclosure is set forth below:
1. Have you or your company, or any agent on behalf of you or y our company, made campaign contributions totaling more than $250 (aggregated) to any council member in the 12 months preceding the date you submitte d your proposal, the date you completed this form, or the anticipated date of any Council action related to this Agreement/Contract?
YES
N O
Counci l M ember Name Pay ee Name Pay ment Date Pay ment A mount
C
X
X
2 CAO:650-90/tmn/Legal Files\Levine Act - Contracts
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 Agreement/Contract? ** 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
Counci l M ember Name Pay ee Name Pay ment Date Payment A mount Ans
wering “YES” to either question above does not preclude the City of Thousand Oaks from entering into or taking any subsequent action related to this Agreement/Contract. However, it may preclude the identified Council member(s) from participating in any actions/decisions related to this Agreement/Contract.
____________ ______________________________
_______________________
Date Printed Name/Title of Authorized Name of Business/Legal Representative Entity
____________________________________________________________________________
Signature
**
* You must submit a supplemental form if you make any new reportable contribution(s) while the Agreement/Contract 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 agent 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.
FIN:350-10\mc\H:\Common\Council\2024\Administration\061824 HDL Sales-Property Tax Agreements Levine Act Disclosure.pdf