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.YES NO Council Member Name Payee Name Payment Date Payment A mount 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 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. 9/26/2024 Executive DirectorChannel Islands Restoration
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. 09/26/2024 Jesus LopezJAS Landscape LLC
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N/A08/22/24Patrick Mahoney, PresidentWest Coast Arborists, Inc.
1 CAO:650-90/tmn/Legal Files\Levine Act - Applications
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 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 anycouncil member in the 12 months preceding the date you submitted yourproposal/application, the date you completed this form, or the anticipateddate of any Council action related to this proposal/application?YES NO Council Member Name Payee Name Payment Date Payment Amount X
2CAO:650-90/tmn/Legal Files\Levine Act - Applications
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 thisproposal/application?** 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 NamePayee Name Payment Date Payment AmountAnswering “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 participating in any actions/decisions related to this proposal/application.09/03/24 Michael Moraga, President Burns-Pacific Construction, Inc.Date Printed Name/Title of Authorized Name of Business/Legal Representative EntitySignature*** You must submit a supplemental form if you 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 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
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.YES NO Council Member Name Payee Name Payment Date Payment A mount 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 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 Representative____________________________________________________________________________ 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. _______________________ Name of Business/Legal Entity