Exhibit No.
The followingdisclosureand statementapplytotheBidder/Proposer/Contractor/Consultant/Vendor/Supplieror Company:
1. submittinga bidor proposalinresponsetoa solicitationby CityofVisalia;or
2. as Awardee of a contract/purchaseorderwhich issubjecttoapprovalbytheVisaliaCityCouncil.
OWNERSHIP DISCLOSURE
E M Tharp Inc doing business as Golden State Peterbilt,American Truck Parts.Golden State Peterbilt PacLease and Golden State TRP
Name ofBidder/Proposer/Contractor/ConsultantAi'endor/SupplierorCompany 15243 Road 192 Porterville. CA93257
Address
Listthe names of allprincipals,partners,and/ortrustees.Forcorporations,providenames ofofficers,directors and allstockholdersowning more than 10% equityinterestincorporation:MorrisA Tharpand Casey O Tharp
CALIFORNIA LEVINE ACT STATEMENT
California Government Code Section 84308, also know as the “LevineAct,"can prohibitmembers of theVisalia CityCouncilfrom participatinginany actionrelatedtoa contractifhe orshereceivesany politicalcontributions totalingmore than $250 withinthe previoustwelve(12)months,and fortwelve(12)monthsfollowingthedatea finaldecisionconcerningthe contracthas been made, fromthepersonorcompany awarded thecontract.The LevineAct alsorequiresdisclosureofsuch contribution(s)by a partytobe awarded a specificcontract The followingwebsitecontainsa listofcurrentVisaliaCityCouncilMembers, https://www.visalia.citv/qovernment/citvcouncil/default.asp.You are responsiblefor reviewingthe names of VisaliaCityCouncilMembers priorto making thefollowingdisclosure;
1. Have you oryourcompany, or any agenton behalfofyouoryourcompany,made any politicalcontributions of more than $250 to a VisaliaCityCouncil Member inthetwelve(12)months precedingthedateofthe submission of your proposals or the anticipateddate ofany CityCouncilactionrelatedtothiscontract? Ifyes, please identifythe CityCouncil Member(s) and date(s)ofcontributionNO: X ■YES:
in the space below:
Date of Contribution(s)Council Member(s) Name
Answering YES, does not precludethe CityofVisaliafromawardinga contracttoyourfirmorfromtakingany subsequent actionrelatedtothe contract.Itdoes, however,precludetheidentifiedVisaliaCityCouncil Member(s) from participatinginany actionsrelatedto thiscontract.
NOTICE: The disclosureduty under state law continues fortwelve(12)months afterthe award. Ifthe above informationregarding contributionschanges during thistimeaftertheaward, then the awardee isrequiredto update thisdisclosureform.
E IVlTharp
PrintOfTypeyarrfe9f^klder/Proposer/Conlractor/Consultant/SupplierA/endor/Company Ginnie Sterling
SignatureofCompanyAuthorizedIndivid^f Printor Type Name ofAuthorized Individual