EXHIBIT "B-5"
Ownership Disclosure and California Levine Act Statement The following disclosure and statement apply to the Bidder/Proposer/Contractor/Consultant/ Vendor/Supplier or Company:
1. submitting a bid or proposal in response to a solicitation by City of Visalia; or
2. as Awardee of a contract/purchase order which is subject to approval by the Visalia City Council.
I OWNERSHIP DISCLOSURE
Name of B1dder/Proposer/Contractor/ConsultanWendor/Supplier or Company Ca
Address
List the names of all principals. partners, and/or trustees. For corporations. provide names of officers, directors and all stockholders owning more than 10% equity interest in corporation:
A11:t u.,w 1 -s
I CALIFORNIA LEVINE ACT STATEMENT
California Government Code Section 84308. also know as the ''Levine Act," can prohibit members of the Visalia City Council from participating in any action related to a contract if he or she receives any political contributions totaling more than $250 within the previous twelve (12) months. and for twelve (12) months following the date a final decision concerning the contract has been made, from the person or company awarded the contract. The Levine Act also requires disclosure of such contribution(s) by a party to be awarded a specific contract.
The following website contains a list of current Visalia City Council Members. https://www visalta.city/government/c1ty council/default asp. You are responsible for reviewing the names of V1sal1a City Council Members prior to making the following disclosure:
1. Have you or your company, or any agent on behalf of you or your company, made any political contributions of more than $250 to a Visalia City Council Member in the twelve (12) months preceding the date of the submission of your proposals °'t!>e anticipated date of any City Council action related to this contract? YES:__ NO:�. If yes. please identify the City Council Member(s) and date(s) of contribution in the space below:
Council Member(sl Name Date of Contribution(s)
Answering YES. does not preclude the City of Visalia from awarding a contract to your firm or from taking any subsequent action related to t contract. It does, however, preclude the identified Visalia City Council Member(s) from participating in a acti s related to this contract.
NOTICE: der state law continues for twelve (12) months after the award. If the above infor • ns changes during this time after the award, then the awardee is required to u
RFB No. 23-24-45
Annual Contract for Evidence Towing & Storage Services