EXHIBIT C
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 Mrsmber Name Payee Name Payment Date Payment Amount I
I
-
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/applicafi'on. However, it may preclude thci ici3n:ified Council member(s) from participating in any actions/decisions related to this proposal/application.
08/26/20:24
Date
Signature
*** You n1
while the
Pontar,elli, Vice President, Secretary Lisa Wise Consulting, Inc.
Name/Title of Authorized Name 01F Business/Legal
;ontative Entity
supplemental form if you make any new reportable contribut ion(s) UPJ�w.orpplication is; being considered***
** "Aggregated" contributions, as described in FPPC Regulation § 18438.5, indL.de 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. 2 CAO:650-90/tmn/Legal Files\Levine Act - Applications
cdd:460-40\fzm \H:\COMMON\City Council\CC Agenda Items\2024\ 11192024\Contract Zoning Sign Code Lisa Wise\Attachment 2 LWC Levine Act Disclosure Form Signed 082624.pdf I