CDD:480-10\ H:\COMMON\Housing & Redevelopment\2025 CDBG\2025 CITY COUNCIL\2025 ACTION PLAN - RCP AI CPP\
LEVINE ACT DISCLOSURE FORMS
x Many Mansions
x Habitat for Humanity of Ventura County
x Senior Alliance for Empowerment (SAFE)
ATTACHMENT #3
1 CDD:480-10\ H:\COMMON\Housing & Redevelopment\2025 CDBG\2025 CITY COUNCIL \2025 ACTION PLAN - RCP AI CPP\
EXHIBIT _____
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 $ (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 $ (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 $ (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 $ (aggregated) within the preceding twelve (12) months by the party to the agreement, contract, or franchise agreement. The Levine Act does not apply to competitively bid, labor, or personal employment contracts.
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 your company, made campaign contributions totaling more than $ (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 Pay ment A mount x
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 $ (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 Pay ment 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 part icipating in any actions/decisions related to this Agreement/Contract.
____________ ______________________________ _______________________ Date Printed Name/Title of Authorized Name of Business/Legal Representative Entity
____________________________________________________________________________ Signature
127(
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; RU (2) all contributions made by an individual or entity required to be aggregated with the party or participanW. &RQWULEXWLRQV PDGHE\ DJHQWV RIWKH SDUW\DUHQRWLQFOXGHGLQWKHDJJUHJDWLRQ
2 CDD:480-10\ H:\COMMON\Housing & Redevelopment\2025 CDBG\2025 CITY COUNCIL \2025 ACTION PLAN - RCP AI CPP\
Represent
____________________
x
04/21/25 Rick Schroeder, President Many Mansions
EXHIBIT
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 $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 agenUrepresentative, 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 agenUrepresentative, 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. The Levine Act does not apply to competitively bid, labor, or personal employment contracts.
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 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, the date you completed this form, or the anticipated date of any Council action related to this AgreemenUContract?
□ YES
� NO
Council Member Name Payee Name
1 CDD:480-10\ H:\COMMON\Housing & Redevelopment\2025 CDBG\2025 CITY COUNCIL\2025 ACTION PLAN - RCP AI CPP\
Payment Date Payment Amount
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 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
(y'No
Coun cil 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 Agreement/Contract. However, it may preclude the identified Council member(s) from participating in any actions/decisions related to this Agreement/Contract.
�H:-g�-t
Representative Entity
NOTE: 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; o r (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 CDD:480-10\ H:\COMMON\Housing & Redevelopment\2025 CDBG\2025 CITY COUNCIL \2025 ACTION PLAN - RCP AI CPP\
1 CDD:480-10\ H:\COMMON\Housing & Redevelopment\2025 CDBG\2025 CITY COUNCIL \2025 ACTION PLAN - RCP AI CPP\
EXHIBIT _____
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 $ (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 $
(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 $
(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 $ (aggregated) within the preceding twelve (12) months by the party to the agreement, contract, or franchise agreement. The Levine Act does not apply to competitively bid, labor, or personal employment contracts.
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 your company, made campaign contributions totaling more than $
(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 Pay ment A mount
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 $ (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 Pay ment 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.
____________________________________________________________________________ Signature
You must submit a supplemental form if you make any new repor table 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 individual or entity required to be aggregated with the party or participan .
2 CDD:480-10\ H:\COMMON\Housing & Redevelopment\2025 CDBG\2025 CITY COUNCIL\2025 ACTION PLAN - RCP AI CPP\