3-Appendix D - Campaign Contribution Form.pdf

January 18, 2022

CAMPAIGN CONTRIBUTION DISCLOSURE FORM

Pursuant to the Procurement Ordinance, Chapter 2, Article V, Division 1-3, Section 2-390 (b), any prospective contractor seeking to enter into a contract with the Bernalillo County (“County”), when submitting a Proposal in response to a Request for Proposal, for Sole Source procurements, or small purchase contract for Professional Services, must complete and submit this Campaign Contribution Form (“Form”). The prospective contractor must disclose whether they, a family member or a representative of the prospective contractor has made a campaign contribution to an applicable public official of the state or a local public body during the two years prior to the date on which the contractor submits a Request for Proposals or, in the case of a sole source or small purchase contract, the two years prior to the date the contractor signs the contract, if the aggregate total of contributions given by the prospective contractor, a family member or a representative of the prospective contractor to the public official exceeds two hundred and fifty dollars ($250) over the two year period. The disclosure shall indicate the date, the amount, the nature and the purpose of the contribution.

Furthermore, the state agency or local public body may cancel a solicitation or proposed award for a proposed contract pursuant to Procurement Ordinance, Section 2-390, or a contract that is executed may be ratified or terminated pursuant to Section 2-390, of the Procurement Ordinance if: 1) a Prospective Contractor or a Family Member or Representative of the Prospective Contractor shall not give a campaign contribution or other thing of value to an Applicable Public Official or the Applicable Public Official's employees during the Pendency of the Procurement Process or during the pendency of negotiations for a sole source or small purchase contract, or 2) a prospective contractor fails to submit a fully completed disclosure statement pursuant to the law.

The County’s Campaign Contribution Disclosure Form, shall indicate the name or names of every applicable public official, if any, for which disclosure is required by a Prospective Contractor.

THIS FORM MUST BE FILED BY ANY PROSPECTIVE CONTRACTOR WHETHER

OR NOT THEY, THEIR FAMILY MEMBER, OR THEIR REPRESENTATIVE HAS

MADE ANY CONTRIBUTIONS SUBJECT TO DISCLOSURE.

The following definitions apply:

“Applicable Public Official” means a person elected to an office or a person appointed to complete a term of an elected office, who has the authority to award or influence the award of the contract for which the prospective contractor is submitting a competitive sealed proposal or who has the authority to negotiate a sole source or small purchase contract that may be awarded without submission of a sealed competitive proposal.

“Family member” means spouse, father, mother, child, father-in-law, mother-in-law, daughter-in-law or son-in-law of (a) a prospective contractor, if the prospective contractor is a natural person; or (b) an owner of a prospective contractor.

“Pendency of the procurement process” means the time period commencing with the public notice of the request for proposals and ending with the award of the contract or the cancellation of the request for proposals.

“Prospective contractor” means a person or business that is subject to the competitive sealed proposal process set forth in the Procurement Code or is not required to submit a competitive sealed proposal because that person or business qualifies for a sole source or a small purchase contract.

“Representative of a prospective contractor” means an officer or director of a corporation, a member or manager of a limited liability corporation, a partner of a partnership or a trustee of a trust of the prospective contractor.

Name(s) of Applicable Public Official(s):

Board of County Commissioners:

Barbara Baca, Chair Eric C. Olivas, Vice-Chair Walt Benson, Member Steven Michael Quezada, Member Adriann Barboa, Member

Elected Public Officials:

Damian R. Lara, Assessor Linda Stover, County Clerk Cristy J. Carbon-Gaul, Probate Judge John D. Allen, Sheriff Nancy M. Bearce, Treasurer

DISCLOSURE OF CONTRIBUTIONS BY PROSPECTIVE CONTRACTOR:

Name of Company (Prospective Contractor) __________________________________________ Contribution Made By: __________________________________________ Relation to Prospective Contractor: __________________________________________ Name of Applicable Public Official __________________________________________ Date Contribution(s) Made: __________________________________________ Amount(s) of Contribution(s) __________________________________________ Nature of Contribution(s) __________________________________________ Purpose of Contribution(s) __________________________________________

(Attach extra pages if necessary)

Signature Date Title (position)

--OR—

NO CONTRIBUTIONS IN THE AGGREGATE TOTAL OVER TWO HUNDRED FIFTY

DOLLARS ($250) WERE MADE to an applicable public official by me, a family member or representative.

Name of Company:

Signature Date

Title (Position)