The Levine Act (Gov Code § 84308) DOES NOT apply to this Agreement/ContractThe 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 $0 (aggregated) to anycouncil member in the 12 months preceding the date you submitted yourproposal, the date you completed this form, or the anticipated date of anyCouncil action related to this Agreement/Contract?YESNO
LEVINE ACT DISCLOSURE FORM
2. Do you or your organization, or any agency or representative on behalf ofyou or your organization, anticipate or plan to make any campaigncontributions of more than $0 (aggregated) to any City Council memberin the 12 months following any City Council action related to thisAgreement/Contract? ** There may be legal restrictions on makingcontributions during the 12 months following City Council Action. Itis recommended that you consult with your own legal counselregarding the requirements of law.YESNOCouncil Member Name Payee Name Payment Date Payment A mountAnswering “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.____________ ______________________________ _______________________Date Printed Name/Title of Authorized Name of Business/Legal Representative Entity____________________________________________________________________________ Signature*** 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; (2) all contributions made by an agent of the party or participant; and (3) all contributions made by an individual or entity required to be aggregated with the party or participant, and any agent of the party or participant.
May 27, 2026 Ryan Erickson, Vice PresidentTrillium USA Company, LLC dba Love's Alternative Energy