3-Supporting Documents 3 Campaign Contributions Disclosure Form.pdf
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- Delaware County, Pennsylvania
About this file
The document is a Campaign Contributions Disclosure Form from Chester City Hall, located at 1 East 4th Street in Chester, Pennsylvania. The form is designed to capture comprehensive information about potential campaign contributions from bidders and their affiliates, including officers, directors, shareholders, and partners. The form requires respondents to disclose whether their firm or associated entities have made contributions, solicited contributions, served as intermediaries, or reimbursed contributions to the City of Chester. Notably, the document emphasizes that legally disclosed campaign contributions do not automatically disqualify a bidder from participating in the procurement process.
The form consists of 11 yes/no questions that probe various potential contribution scenarios, followed by a detailed table where bidders must provide specifics about any disclosed contributions, including the name of the contributor, their relationship to the firm, the recipient of the contribution, the date, and the amount. Additional fields require bidders to provide their company information, contact details, and a signature. The purpose of this form appears to be ensuring transparency in the bidding process by requiring full disclosure of potential financial interactions with the city's political ecosystem.
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Text version
Chester City Hall, Municipal Building, 1 East 4th Street, Chester, Pennsylvania, 19013
Campaign Contributions Disclosure Form
Please note that legally disclosed campaign contributions do not automatically disqualify a bidder from participating as a contractor. The City of Chester must obtain this information as part of its procurement process.
1. Has your firm made any contributions to the City of Chester? Yes ___ No ___
2. Has your firm solicited or served as an intermediary for any contributions? Yes ___ No ___
3. Has an officer, director, controlling shareholder, or partner of your firm solicited or served as an intermediary for any contributions?
Yes ___ No ___
4. Has an affiliate of your firm made any contributions? Yes ___ No ___
5. Has an affiliate of your firm solicited or served as an intermediary for any contributions?
Yes ___ No ___
6. Has an officer, director, controlling shareholder, or partner of a for-profit affiliate of your firm made any contributions?
Yes ___ No ___
7.
Has an officer, director, controlling shareholder, or partner of a for-profit affiliate of your firm solicited or served as an intermediary for any contributions?
Yes ___ No ___
8.
Has your firm or an affiliate of your firm business reimbursed another individual or business for a contribution that the individual or business has made?
Yes ___ No ___
9.
Has an officer, director, controlling shareholder, or partner of a for-profit business, or of a for-profit affiliate of your firm, reimbursed another individual or business for a contribution that the individual or business has made?
Yes ___ No ___
10. Has a political committee controlled by your firm or by an affiliate of your firm, made any contributions?
Yes ___ No ___
11.
Has a political committee controlled by an officer, director, controlling shareholder, or partner of the for-profit business, or of a for-profit affiliate of your firm, made any contributions?
Yes ___ No ___
Chester City Hall, Municipal Building, 1 East 4th Street, Chester, Pennsylvania, 19013
Campaign Contributions Disclosure Form
For any “Yes” answers on the previous page, please provide the following details:
Name of Contributor
Relationship to Your firm
Recipient of the Contribution Date Amount ($)
City of Chester Bid Number
City of Chester Project Name
Bidder Company Name
Bidder Company Contact Name
Title
Signature
Today’s Date
Phone
File details come from the government source that posted it. Updated .