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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 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. The Levine Act does not apply to competitively bid, labor, or personal employment contracts.
Is your grant request $50,000 or greater?
D
YES Levine Act applies. Continue to questions 1 & 2 and certification. � NO Please continue to certification.
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 Agreement/ Contract?
□ YES
� NO
Council Member Name Payee Name Payment Date
1 CAO:650-90/tmn/Legal Files\Levine Act - Contracts
Payment Amount
C
DPW: 850\ev\Council\2026\022426\Electrification and Energy Resiliency Projects at the MSC Att 4 Exh C
2.9.26 ABM | RavenVolt
DPW: 850\ev\Council\2026\022426\Electrification and Energy Resiliency Projects at the MSC Att 4 Exh C