Participating Addendumfor Tires, Tubes and Services between City of Thousand Oaks and The Goodyear Tire and Rubber Company This Participating Addendum is entered into by City of Thousand OaksParticipating Entityand the following Contractor (for the purpose of participating in NASPO ValuePoint Master Agreement Number 24155, executed by Contractor and the State of Iowa for Tires, Tubes and Services : The Goodyear Tire and Rubber Company200 Innovation WayAkron, OH 44316I. PARTICIPATING ADDENDUM CONTACTS.this ParticipatingAddendum is:Kenny MillerGovernment Sales Contract [email protected](330) 796-4352contact for this Participating Addendum is:Chris MeskeSenior Purchasing [email protected](805) 376-5090II. TERM.This Participating Addendum is effective as of the date of the last signature below or August 27, 2024,whichever is later, and will terminate upon termination of the Master Agreement, as amended, unless theParticipating Addendum is terminated sooner in accordance with the terms set forth herein.III. PARTICIPATION AND USAGE.This Participating Addendum may be used only by the Participating Entity.Participating Entity has sole authority to determine which entities are eligible to use this Participating Addendum.If Contractor becomes aware that ause of this Participating Addendum is not authorized, Contractorwill notify NASPO ValuePoint to initiate outreach to the appropriate parties.IV. GOVERNING LAW. The construction and effect of this Participating Addendum and any Orders placedV. SCOPE. Except as otherwise stated herein, this Participating Addendum incorporates the scope, pricing, terms,and conditions of the Master Agreement and the rights and obligations set forth therein as applied to Contractorand Participating Entity and Purchasing Entities.a. Products.All products available through the Master Agreement may be offered and sold byContractor to Purchasing Entities.b. Services.All services available through the Master Agreement may be offered and sold byContractor to Purchasing Entities.c. Contractor Partners. All subcontractors, dealers, distributors, resellers, and other partners identifiedParticipating Entity may provide Products and Services to users of this Participating Addendum.resellers, and other partners is in accordance with the terms and conditions set forth in the MasterAgreement and in this Participating Addendum.Any amendment to the Master Agreement shall be deemed incorporated into this Participating Addendum.
Participating AddendumforTires, Tubes and Services Between City of Thousand Oaks and The Goodyear Tire and Rubber Company_________________________________________________________________________________________________________________ Any conflict between this Participating Addendum and the Master Agreement will be resolved in favor of the Participating Addendum.The terms of this Participating Addendum, including those modifying or adding to the terms of the Master Agreement, apply only to the Parties and shall have no effect on participating addenda with other participating entities or Master Agreement with the Lead State.VI. ORDERS.Purchasing Entities may place orders under this Participating Addendum by referencing ordersnumbers for each order placed. Each Order placed under this Participating Addendum is subject to the pricingand terms set forth herein and in the Master Agreement, including applicable discounts, reporting requirements,and payment of administrative fees to NASPO ValuePoint and Participating Entity, if applicable.VII. FEDERAL FUNDING REQUIREMENTS. Orders funded with federal funds may have additional contractualrequirements or certifications that must be satisfied at the time the Order is placed or upon delivery. Whenapplicable, a Purchasing Entity will identify in the Order any alternative or additional requirements related to theuse of federal funds. By accepting the Order, Contractor agrees to comply with the requirements set forththerein.VIII. NOTICE.Any notice required herein shall be sent to the following:For Contractor:Kenny MillerGovernment Sales Contract [email protected](330) 796-4352For Participating Entity:Chris MeskeSenior Purchasing [email protected](805) 376-5090IX. SUBMISSION OF PARTICIPATING ADDENDUM TO NASPO VALUEPOINT.Upon execution, Contractorshall promptly email a copy of this Participating Addendum and any amendments hereto to NASPO [email protected]. The Parties acknowledge and agree that the Participating Addendum, asamended, may be published on the NASPO ValuePoint website.SIGNATUREThe undersigned for each Party represents and warrants that this Participating Addendum is a valid and legal agreement binding on the Party and enforceable in accordance with theterms and thatthe undersigned is duly authorized and has legal capacity to execute and deliver this Participating Addendum andbind the Party hereto.Scanned Signatures. In the event that any signature is delivered by facsimile transmission or submitted electronically as a scanned image (i.e. files with .pdf, .tiff or .jpeg extensions), such signature shall create a valid and binding obligation of the party executing (or on whose behalf such signature is executed) with the same force and effect as if such facsimile or scanned signature page were an original thereof.Digital/Electronic Signatures. This Agreement may be executed through the use of digital or electronic signaturesprovided they meet the requirements of the Electronic Signatures in Global and National Commerce (ESIGN) Actand the California Uniform Electronic Transactions Act (UETA) and are produced using a City-approved method.The presence of an electronic signature on this document shall be construed as theconsent to do businesselectronically.
Participating AddendumforTires, Tubes and Services Between City of Thousand Oaks and The Goodyear Tire and Rubber Company_________________________________________________________________________________________________________________ IN WITNESS WHEREOF, the Parties have executed this Participating Addendum.PARTICIPATING ENTITY:__________________________________________Al Adam, MayorATTEST:CONTRACTOR:____________________________________________________________________________________DateLaura B. Maguire, City ClerkAPPROVED AS TO ADMINISTRATION:Andrew P. Powers, City ManagerAPPROVED BY DEPARTMENT HEADClifford G. Finely, Public Works DirectorAPPROVED AS TO FORMOffice of the City AttorneyTracy Friedl, Assistant City Attorney
GOODYEAR APPROVED DISTRIBUTOR (DEALER) AGREEMENTCITY OF THOUSAND OAKSFOR TIRE RELATED SERVICES RFP0223005113NASPO ValuePoint Master Agreement 24155CITY OF THOUSAND OAKS AGREEMENT #The CITY OF THOUSAND OAKShas executed a Participating Addendum with Goodyear Tire and Rubber Company to provide tires and services to the City under the State of Iowa Request for Proposal 0223005113 (and all extensions thereof) onbehalf of the NASPO ValuePoint Master Agreement 24155 and other participating states,and as permitted by Thousand Oaks Municipal Code section 3-10.203 which permits cooperative purchasing with other agencies. Specific independent Dealers will be authorized by THE GOODYEAR TIRE & RUBBER COMPANY to provide tires and tire related services related to purchasing the tires (mounting tires, rotating tires, etc.).all GOODYEAR TIRE & RUBBER COMPANY authorized dealers.) DANIELS TIRE SERVICE of Santa Fe Springs is hereby designated as the authorized Dealer to provide the services under the Participating Addendum.This Dealer Agreement will identify the responsibilities of the Dealer for the services provided by the Dealer. Dealers will need to sign the Dealer Agreement before the Dealer will be authorized to provide services to the City. This Agreement will be effective on the last signature date below.The Dealer agrees to the following:1. PROFESSIONAL SERVICESDealer warrants that all services shall be performed in a professional and workmanlike manner consistent with standard industry practice, and in accordance with any approved Statement of Work, if applicable. All work shall include the delivery of new tires, recapped tires, installation of new tires and recapped tires, mounting and dismounting of tires onto City vehicles and the removal of old tires from City. Dealer agrees to abide by all applicable laws, regulations, and industry standards when performing services for the City of Thousand Oaks.2. INSURANCE REQUIREMENTSThe Dealer will agree to carry all insurance, as listed in Attachment A, which may be required by federal and state laws, state and city ordinances, charters, regulations, and codes. The Dealer certifies that it has now and will continue to have in full force and effect the certificates of insurance. Copies of the insurance certificates shall be provided to the City within ten (10) days upon request. All Insurance shall be issued by an insurance company authorized by the Insurance Department to transact business in the State. No policy shall expire, be canceled or materially changed to affect coverage available to the City without thirty (30) days written notice to the City.
3. HOLD HARMLESS AND INDEMNITY(a) Hold Harmless for Dealer's Damages.The Dealer holds the City, its electedrequired under this Agreement, or occur while Dealer is in a City building or on City property, or which are any activity or work required under this Agreement.(b) Defense and Indemnity of Third-Party Claims/Liability. Dealer shall investigate, defend, and indemnify the City, its elected officials, officers and employees, from any claims, lawsuits, demands, judgments and all liability including, but not limited to, monetary or property damage, lost profit, personal injury, wrongful death, general liability, automobile, infringement of copyright/patent/trademark, professional errors and omissions arising out of, directly or indirectly, an error, a negligent act or negligent nts/subconsultants, or subcontractors or the in performing the services described in, or normally associated with, this type of contracted work. The duty to defend shall include any suits or actions in law or equity concerning any activity, product or work required under this Agreement, and also include the payment of all court costs, attorney fees, expert witness costs, investigation costs, claims adjusting costs and any other costs required for and related to such litigation. (c) Nonwaiver. The City does not waive, nor shall be deemed to have waived,any indemnity, defense or hold harmless rights under this section because of the acceptance by the City, or the deposit with the City, of any insurance certificates or policies.4. CONTRACT WITH THE GOODYEAR TIRE & RUBBER COMPANYThe Dealer agrees to abide by all the terms and conditions of the Participating Addendumbetween THE GOODYEAR TIRE & RUBBER COMPANY and the CITY OF THOUSAND OAKS resulting from State of Iowa Request for Proposal 0223005113, in addition to all agreed upon terms and conditions referenced in (and all extensions thereof) on behalf of the NASPO ValuePoint Master Agreement 24155.5. NON-APPROPRIATION OF FUNDSPayments due and payable to Dealer for current services are within the current budget and within an available, unexhausted and unencumbered appropriation of City funds. In the event City has not appropriated sufficient funds for payment of Dealer services beyond the current fiscal year, this Agreement shall cover only those costs incurred up to the conclusion of the current fiscal year.
DEALER INFORMATIONLegal Status (Circle One): Partnership Sole Proprietor Dealer Name: Daniels Tire ServiceAddress: 11850 E Slauson AvenueCity, State, Zip: Santa Fe Springs CA 90670Phone: (805) 487-0453Fax: (805) 483-7266Contact Name: Raul MartinezEmail Address: [email protected] Tax ID #: 952548015 ATTACHMENT ACITY OF THOUSAND OAKS STANDARD TERMS AND CONDITIONS1.TERMS OF PERFORMANCENon-Exclusivity.This Agreement is non-exclusive. City reserves the rights to retain,employ, or contract with other qualified services providers during the term of thisAgreement on such occasions and in such circumstances as City shall determine areappropriate.Ability to Perform.Dealer warrants that it possesses, or has arranged throughsubcontracts, all capital and other equipment, labor, materials, and licensesnecessary to carry out and complete the work hereunder in compliance with any andall federal, state, county, city, and special district laws, ordinances, and regulations.Laws to be Observed.Dealer shall keep itself fully informed of and shall observeand comply with all applicable state and federal laws as well as with Ventura Countyand City of Thousand Oaks ordinances, regulations and adopted codes during itsperformance of the work.Payment of Taxes.The contract prices shall include provision for all taxes thatDealer is required to pay. Dealer is responsible for all taxes required to be paid underthis Agreement.Permits and Licenses.Dealer shall procure all permits and licenses, pay all chargesand fees, and give all necessary or legally required notices.Safety Provisions.Dealer shall conform to the rules and regulations pertaining tosafety established by Occupational Safety & Health Administration (OSHA) and theCalifornia Division of Industrial Safety.Preservation of City Property.Dealer shall provide and install suitable safeguards,approved by City, to protect City property from injury or damage. If City property isinjured or damaged as a result of Dealer's operations, it shall be replaced or restoredwithin a reasonable time at Dealer's expense. The facilities shall be replaced orrestored to a condition as good as when Dealer began work.Subcontractors.Dealer shall be solely responsible for ensuring that anysubcontractors used in completing tasks under the Agreement comply with allpertinent laws and regulations as well as the relevant terms of this Agreement. Cityshall have no obligation to monitor or oversee subcontractors.Immigration Act of 1986.Dealer warrants on behalf of itself and all subcontractorsengaged for the performance of this work that only persons authorized to work in the United States pursuant to the Immigration Reform and Control Act of 1986 and otherapplicable laws shall be employed in the performance of the work hereunder.Dealer Non-Discrimination.In the performance of this work, Dealer agrees that itwill not engage in, nor permit such subcontractors as it may employ, to engage indiscrimination in employment of persons because of age, race, color, sex, nationalorigin or ancestry, sexual orientation, or religion of such persons.Work Delays. Should Dealer be obstructed or delayed in the work required to bedone hereunder by changes in the work or by any default, act, or omission of City, orby strikes, fire, earthquake, or any other Act of God, or by the inability to obtainmaterials, equipment, or labor due to federal government restrictions arising out ofdefense or war programs, then the time of completion may, at City's sole option, beextended for such periods as may be agreed upon by City and Dealer.Inspection.Dealer shall furnish City with every reasonable opportunity for City toascertain that the services of Dealer are being performed in accordance with therequirements and intentions of this Agreement. All work done and all materialsfurnished, if any, shall be subject to City's inspection and approval. The inspection ofsuch work shall not relieve Dealer of any of its obligations to fulfill its contractrequirements.Audit.Dealer shall maintain, in accordance with generally accepted accountingprinciples, complete and accurate records of all activities and operations relating tothis Agreement. Records, including but not limited to, timecards, employmentrecords, work progress reports, reimbursements, invoices, project records,proprietary data and information, as well as licensed software and any electronicrecords shall be kept for a period of four years beyond the termination or expirationof this Agreement. Dealer agrees that City, or its authorized representative, shallhave the right to examine, audit, excerpt, copy or transcribe any of the recordspertaining to this Agreement at any time during normal business hours. Dealer shallreimburse City for all reasonable costs of the audit, including travel time and auditorcosts, should such audit reveal an overcharge of five (5) percent or more. Anyovercharge will be considered a breach of this Agreement and could be cause fortermination. The obligations of this section shall be explicitly included in anysubcontracts or other agreements entered into by Dealer with respect to thisAgreement, if allowed by this Agreement.Levine Act Compliance. California Government Code section 84308 (Levine Act)prohibits any Thousand Oaks City Council member from participating in any actionrelated to a contract, agreement, or franchise agreement (excluding labor orcompetitively bid contracts) if the Council member receives a campaign contributiontotaling more than $250 (aggregated) from the party to the contract, agreement orfranchise agreement, their agents, or any financially interested participant whoactively 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) froma party, their agent/representative, or a financially interested participant during aproceeding 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 prohibitedfrom contributing more than $250 (aggregated) to a Council member during aproceeding and for 12 months following the date a final decision is made.The Levine Act also requires parties to certain contracts, agreements, or franchiseagreements to disclose any campaign contribution over $250 (aggregated) within thepreceding twelve (12) months by the party to the agreement, contract, or franchiseagreement and their agents. The Levine Act does not apply to competitively bid,labor, or personal employment contracts.2.MINIMUM SCOPE AND LIMIT OF INSURANCEWithout limiting Dealerindemnification of City, and prior to commencement ofWork, Dealer shall obtain, provide, and maintain at its own expense during theterm of this Agreement, and any extension thereof, policies of insurance of the typeand amounts described below and in a form that is satisfactory to City.Coverage shall be at least as broad as:(a).Commercial General Liability(CGL): Dealer shall, at Dealersolecost and expense and throughout the term of this Agreement, and any extensionsthereof, carry General Liability insurance coverage at least as broad as InsuranceServices form CG 00 01 in an amount not less than $2,000,000 per occurrence,$4,000,000 general aggregate for bodily injury, personal and advertising injury andproperty damage, including with limitation, blanket contractual liability.(b).Automobile Liability:Dealer shall, at Dealersole cost andexpense and throughout the term of this Agreement, and any extensions thereof,carry Automobile Liability insurance coverage at least as broad as InsuranceServices form CA 00 01 or the exact equivalent covering bodily injury and propertydamage for all activities of Dealer arising out of or in connection with the work tobe performed under this Agreement, including coverage of any owned, hired, non-owned, or rented vehicles, in an amount not less than $1,000,000 combined singlelimit for each accident.(c).s Compensation:Dealer shall, at Dealersole cost andexpense and throughout the term of this Agreement, and any extensions thereof,carrycompensation statutory benefits as required by law withliability limits no less than $1,000,000 per accident for bodily injury or disease.Dealer shall submit to City, along with the certificate of insurance, a Waiver ofSubrogation endorsement in favor of City, its officers, agents, employees and volunteers for all work performed by Dealer, its employees, agents andsubcontractors.If the Dealer maintains higher limits than the minimum shown above, City requires and shall be entitled to coverage for the higher limits maintained by Dealer. Any available insurance proceeds in excess of the specified minimum limits of insurance and coverage shall be available to City.Other Insurance ProvisionsThe insurance policies are to contain, or be endorsed to contain, the followingprovisions:Additional Insured StatusCity, its officers, officials, employees and volunteers are to be covered as additional insureds on the CGL policy with respect to liability arising out of work or operations performed by or on behalf of the Dealer including materials, parts, or equipment furnished in connection with such work or operations. General liability coverage can be provided in the form of an endorsement to Dealerleast as broad as ISO Form CG 20 10 11 85 or if not available, through the addition of both CG 20 10 10 01 and CG 20 37 10 01 if a later edition is used). The provision shall also apply to any excess liability policies. In addition, Dealer shall ensure that the automobile liability policy contains a provision covering City as an additional insured and shall obtain an endorsement to that effect if it does not.Excess InsuranceThe limits of insurance required in this agreement may be satisfied by acombination of primary and umbrella or excess insurance. Umbrella or excesspolicies shall provide coverage at least as broad as specified for underlyingcoverages and covering those insured in the underlying policies. Coverage shallbeonwith defense costs payable in addition to policy limits. Thereshall be no cross liability exclusion of claims or suits by one insured against theother. Any umbrella or excess insurance shall contain or be endorsed to contain aprovision that such coverage shall also apply on a primary and non-contributorybasis for the benefit of City as required in written contract or agreement beforeown insurance or self-insurance shall be called upon to protect it as a namedinsured.Rights of EnforcementIn the event any policy of insurance required under this Agreement does notcomply with these specifications or is cancelled and not replaced, City has the rightbut not the duty to obtain the insurance it deems necessary and any premium paidby City will be promptly reimbursed by Dealer, or City will withhold amounts sufficient to pay premium from Dealerpayments. In the alternative, City maycancel this Agreement.Right to Revise SpecificationsCity reserves the right at any time during the term of the Agreement to change theamounts and types of insurance required by giving the Dealer ninety (90) daysadvance written notice of such change. If such change results in substantialadditional cost to the Dealer, City and Dealer may renegotiate Dealer'scompensation.Primary and Non-Contributory CoverageFor any claims related to this Agreement, Dealer's insurance coverage shall beprimary insurance as respects City, its officers, officials, employees andvolunteers. Any insurance or self-insurance maintained by City, its officers,officials, employees or volunteers shall be excess of Dealer's insurance and shallnot contribute with it and be at least as broad as CG 20 01 04 13.Notice of CancellationEach insurance policy required above shall provide that coverage shall not becanceled, except with notice to City.Deductibles and Self-Insured RetentionsAny deductibles or self-insured retentions must be declared to and approved byCity. City may require Dealer to provide proof of ability to pay losses and relatedinvestigations, claim administration, and defense expenses within the retention.Acceptability of InsurersAll insurance policies shall be issued by an insurance company currentlyauthorized by the Insurance Commissioner to transact business of insurance inthe State of California, with a current A.M.rating of no less than A:VII,(unless otherwise acceptable to City).Waiver of SubrogationAll insurance coverage maintained or procured pursuant to this Agreement shallbe endorsed to waive subrogation against City, its officers, officials, employees orvolunteers or shall specifically allow Dealer, or others providing insuranceevidence in compliance with these specifications, to waive their right of recoveryprior to a loss. Dealer hereby waives his own right of recovery against City andshall require similar written express waivers and insurance clauses from each of its subcontractors. Copies of these waivers shall be submitted to City prior tocommencement of work.Claims Made PoliciesIf any of the required policies provided coverage on a claims-made basis:(a). The Retroactive Date must be shown and must be before the date ofthe Agreement or the beginning of contract work.(b). Insurance must be maintained, and evidence of insurance must beprovided for at least five (5) years after completion of the work requiredunder this Agreement.(c). If coverage is canceled or non-renewed, and not replaced with anotherclaims-made policy form with a Retroactive Date prior to the Agreementeffective date, the Dealer must purchasecoverage fora minimum of five (5) years after completion of Agreement work.Verification of CoverageDealer shall provide City with copies of certificates (on City certificate form or anAccord form as modified per City direction) for all policies, with the appropriatenamed additional insured coverage and an endorsement that they are not subjectto cancellation without 30 days prior written notice to City. All certificates andendorsements are to be received and approved by City before work commences.However, failure to obtain the required documents prior to the work beginning shallnot waive Dealer's obligation to provide them. City reserves the right to requirecomplete, certified copies of all required insurance policies, includingendorsements required by these specifications, at any time.SubcontractorsDealer shall require and verify that all subcontractors maintain insurance meeting all the requirements stated herein, and Dealer shall ensure that City is an additional insured on insurance required from subcontractors. For CGL coverage, subcontractors shall provide coverage with a form at least as broad as CG 20 38 04 13.3.MITIGATION OF DAMAGESIn all situations arising out of this Agreement, the parties shall attempt to avoid andminimize the damages resulting from the conduct of the other party.
4.TAXPAYER IDENTIFICATION NUMBERDealer shall provide City with a complete Request for Taxpayer IdentificationNumber and Certification, Form W-9 as most recently issued by the InternalRevenue Service.5.SIGNATURES(a)Counterparts.This Agreement may be executed in two or morecounterparts, each of which together shall be deemed an original, but all of whichtogether shall constitute one and the same instrument.(b)Scanned Signatures.In the event that any signature is delivered byfacsimile transmission or submitted electronically as a scanned image (i.e. fileswith .pdf, .tiff or .jpeg extensions), such signature shall create a valid and bindingobligation of the party executing (or on whose behalf such signature is executed)with the same force and effect as if such facsimile or scanned signature page werean original thereof.(c)Digital/Electronic Signatures.This Agreement may be executed throughthe use of digital or electronic signatures provided they meet the requirements ofthe Electronic Signatures in Global and National Commerce (ESIGN) Act and theCalifornia Uniform Electronic Transactions Act (UETA) and are produced using aCity-approved method. The presence of an electronic signature on this document6.ORDERINGOrders will be placed by the City directly with Dealer. All orders will be shippedpromptly in accordance with the terms of this Contract.7.LARGE VOLUME DISCOUNT PRICINGCity may seek to obtain additional volume discount pricing for large ordersprovided Dealer is willing to offer additional discounts for large volume orders. Noamendment to this Contract is necessary for Dealer to offer discount pricing toCity for large volume purchases.8.CORRECTIONSDealer shall correct, at its expense, all errors in the work which may be disclosedduring City's review of Dealer's work. Should Dealer fail to make such correctionin a reasonably timely manner, such correction shall be made by City, and the costthereof shall be charged to Dealer.9.FEDERAL REQUIREMENTSDealer acknowledges that federal funds may be used for this Agreement and that Dealer is required to comply with all material obligations required by federal orstate law in reporting work completed with said funds, and certifies that Dealer andits subcontractors are eligible to participate in this Federally funded contract,pursuant to thefor Award Managementas maintained by theGeneral Services Administration and required by 2 CFR, part 180.Dealer shall also comply with the federal Americans with Disability Act, Public Law101-336, and observe the disability discrimination prohibitions of such laws in theperformance of the work required under this Agreement.
LEVINE ACT DISCLOSURE FORM 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.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 Agreement/ContractThe 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 your company,made campaign contributions totaling more than $250 (aggregated) to anycouncil member in the 12 months preceding the date you submitted yourproposal, the date you completed this form, or the anticipated date of anyCouncil action related to this Agreement/Contract?YESNOCouncil Member Name Payee Name Payment Date Payment A mount
2. Do you or your organization, or any agency or representative on behalf ofyou or your organization, anticipate or plan to make any campaigncontributions of more than $250 (aggregated) to any City Council memberin the 12 months following any City Council action related to thisAgreement/Contract? ** There may be legal restrictions on makingcontributions during the 12 months following City Council Action. Itis recommended that you consult with your own legal counselregarding the requirements of law.YESNOCouncil Member Name Payee Name Payment Date Payment A mountAnswering “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. 8/21/24 Rob Wood, VPDaniels Tire Service