1 CAO:650-90/tmn/Legal Files\Levine Act - Applications
LEVINE AC
T DISCLOSURE FORM
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 $500 (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 $500
(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
$500 (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 $500 (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 $500 (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 AMAZON CONFIDENTIAL. THE INFORMATION IN THIS DOCUMENT MAY NOT BE DISCLOSED WITHOUT THE PRIOR WRITTEN CONSENT OF AMAZON.
CC STC 00006533 2025 TR
Docusign Envelope ID: F9CD3B40-56E9-47AF-BDC7-E88AF781A2A7
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 $500 (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
NOTE: 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; or (2)
all contributions made by an individual or entity required to be aggregated with the party or
participant. Contributions made by agents of the party are not included in the aggregation.
2 CAO:650-90/tmn/Legal Files\Levine Act - Applications
Oscar Montes, Authorized Signatory Amazon.com Services LLC AMAZON CONFIDENTIAL. THE INFORMATION IN THIS DOCUMENT MAY NOT BE DISCLOSED WITHOUT THE PRIOR WRITTEN CONSENT OF AMAZON.
CC STC 00006533 2025 TR
Docusign Envelope ID: F9CD3B40-56E9-47AF-BDC7-E88AF781A2A7 January 8, 2025