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 ATTACHMENT #1
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 $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
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
CDD:685-10\lo\H:COMMON\Housing & Redevelopment\Developers & Developments\Emergency Sheter - Navitation Center\ Council\2026-06-2309- F165\Attachment 1 Levine Act.pdf
X
06/18/26
Rick Schroeder, CEO
Many Mansions