Attachment 3 Levine Act Signed Forms — Thousand Oaks City Council, May 12, 2026

Cir~ c1f _ It
-r housand 0<:1ks
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.

D 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 Agreement/Contract?
□ YES
0 NO
Council Member Name Payee Name Pa yment Date Payment Amount CAO:650-90/tmn/Legal Files\Levine Act - Contracts
ATTACHMENT #3

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) lo 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.
0 YES
0 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 laking any subsequent action related to this Agreement/Contract. However, ii may preclude the identified Council member(s) from participating in any actions/decisions related to this Agreement/Contract.
4/21/2026 Darcy Taylor, Chief Executive Officer
Printed Name/Title of Authorized
Representative
Habitat for Humanity of Ventura County
Name of Business/Legal
Entity
4 z, Up
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 CAO:650-90/tmn/Legal Files\Levine Act - Contracts
1 CAO:650-9
0/tmn/Legal Files\Levine Act - Contracts
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 partici
pant 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 th
e 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.

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 Agreement/Contract?
YES
NO
Counci l M ember Name Pay ee Name Pay ment Date Payment A mount xxx

YES
NO
Counci l M ember Name Pay ee Name Pay ment Date Payment A mount Answeri
ng “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.
____________ ______________________________ _______________________ Dat
e 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 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; or (2) all contributions made by an individual or entity required to be aggregated with the party or participan t. Contributions made by agents of the party are not included in the aggregation.
2 CAO:650-90/tmn/Legal Files\Levine A ct - Contracts
xx
04/15/2026
Rick Schroeder, President
Many Mansions

II\ of
Thol l ..,<.111d O <-1k~

EXHIBIT

LEVINE ACT DISCLOSURE FORM
California ovemment Code section 84308 (Levine Act) prohibits any Thousand Oaks City Council ember from participating in any action related to a contract, agreement, or franchise agreeme , (excluding labor or competitively bid contracts) if the Council member receives a camp gn contribution totaling more than $500 (aggregated*) from the party to the contract, figreement or franchise agreement, their agents, or any financially interested participa I who actively supports or opposes the matter within the previous twelve (12) months.

Council embers must also disclose any eligible campaign contribution received on the record of the pro eding.

Council mbers are prohibited from accepting, soliciting, or directing a campaign contribution of more tha $500 (aggregated) from a party, their agent/representative, or a financially interested participa during a proceeding and for 12 months following the date a final decision is made. In addition, party, their agent/representative, or a financially interested participant is prohibited from con buting more than $500 (aggregated) to a Council member during a proceeding and for 12 mo ths following the date a final decision is made.

The Levi Act also requires parties to certain contracts, agreements, or franchise agreements to disclo e any campaign contribution over $500 (aggregated) within the preceding twelve (12) mon s by the party to the agreement, contract, or franchise agreement. The Levine Act does not ply 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 Agreement/Contract?
0 YES
(a NO
Counc • :Mem her Name Payee Name Payment Date Payment Amount CA0:65 t o/tmn/Legal Fil~\Levine Act - Cont!acts

Printed Namemtte of Authorized
Senior Alliance for
Empowerment
Date- - -~ - - - Representative
, I< ) f2_ 5;;/_
Name of Business/Legal Entity
Signatun~
NOTE: ~ !u must submit a supplemental form if you make any new reportable contribu~ on(s) while the Agreement/Contract is being considered *"Aggreg~ ted" contributions, as described in FPPC Regulation §18438.5, include the following types of k:ontributions made during a 12-month period: (1) all contributions made by the party or parti<~oant; or (2) all contributions made by an individual or entity required to be a ~gregated with the party or participant. Contributions made by agents of the party are hot included in the aggregation.
2 CAO:650-90/tmn/Legal Files\Levine Act - Contracts
CDD:480-10\H:\COMMON\Housing & Redevelopment\2026 CDBG\2026 CITY COUNCIL\2026 ACTION PLAN\Staff Report Docs \Attachment 3 Levine Act Signed Forms.pdf

Thousand Oaks City CouncilMay 12, 2026

Thousand Oaks City Council
May 12, 2026