Campaign_Contribution_Disclosure_Form.docx
DOCX document 33 KB Posted
- Attached to
- ARCHITECT-ENGINEER SERVICES FOR CONTRACT ADMINISTRATION-PROJECT MANAGEMENT SUPPORT SERVICES
- Solicitation number
- 060-2730-RFQ-CAPM-JC
- Issued by
- Orange County, California
About this file
This is a Campaign Contribution Disclosure Form required by the County of Orange for applicants and solicitation respondents. The form applies to the Orange County Sheriff-Coroner Department's request for qualifications from architect-engineer firms to provide contract administration and project management support services for various County projects on a usage contract basis. Respondents must disclose any campaign contributions made within the last 12 months to members of the Orange County Board of Supervisors or County Agency Officers by the applicant, proposed subcontractors, agents, or lobbyists, regardless of dollar amount. Statements of Qualifications must be received by October 23, 2026, at 2:00 P.M. Pacific Daylight Time, with all questions and requests for interpretation due by October 9, 2026, at 3:30 P.M. Pacific Daylight Time. Questions must be submitted through the County's OpenGov online bidding system; direct contact with County personnel regarding the RFQ is prohibited.
The disclosure form requires applicants to certify the accuracy of all statements provided and commits them to disclose any future contributions made to Board Members or County Agency Officers by the applicant, subcontractors, or agents within 12 months following approval, renewal, or extension of the contract. The form identifies the five Orange County Board of Supervisors members (Janet Nguyen, Vicente Sarmiento, Donald P. Wagner, Doug Chaffee, and Katrina Foley) and eight County Agency Officers (Assessor, Auditor-Controller, Clerk-Recorder, District Attorney-Public Administrator, Sheriff-Coroner, and Treasurer-Tax Collector) subject to this disclosure requirement. Failure to accurately complete this form or subsequent disclosure violations may impact contract award or continuation eligibility.
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Text version
COUNTY OF ORANGE
CAMPAIGN CONTRIBUTION DISCLOSURE FORM
Application or Solicitation Number:
Application or Solicitation Title:
Was a campaign contribution, regardless of the dollar amount, made to any member of the Orange County Board of Supervisors or to any County Agency Officer within the last 12 months by the applicant, or, if applicable, any of the applicant’s proposed subcontractors or the applicant’s agent or lobbyist?
Yes ____ No_____
If no, please sign and date below.
If yes, please provide the following information:
Applicant’s Name:
Contributor or Contributor Firm’s Name:
Contributor or Contributor Firm’s Address:
Is the Contributor:
| o | The Applicant | Yes___ | No ___ | |
| o | Subcontractor | Yes___ | No ___ | |
| o | The Applicant’s agent/ or lobbyist | Yes___ | No ___ |
Identify the Board of Supervisors Member(s) and County Agency Officer(s) to whom you, your subcontractors, and/or agent/lobbyist made campaign contributions within the last 12 months, the name of the contributor, the dates of contribution(s) and dollar amount of the contribution. Each date must include the exact month, day, and year of the contribution.
Name of Board of Supervisors Member or County Agency Officer:
Name of Contributor:
Date(s) of Contribution(s):
Amount(s):
(Please add an additional sheet(s) to identify additional Board Members or County Agency Officer to whom you, your subconsultants, and/or agent/lobbyist made campaign contributions)
By signing below, I certify that the statements made herein are true and correct. I also agree to disclose to the County any future contributions made to Board Members or County Agency Officers by the applicant, or, if applicable, any of the applicant’s proposed subcontractors or the applicant’s agent or lobbyist after the date of signing this disclosure form, and within 12 months following the approval, renewal, or extension of the requested license, permit, or entitlement to use.
Date Signature of Applicant
| _______________________________________ | ________________________________ | |
| Print Firm Name, if applicable | Print Name of Applicant |
ORANGE COUNTY BOARD OF SUPERVISORS
AND COUNTY AGENCY OFFICERS
Board of Supervisors
Janet Nguyen, First District
Vicente Sarmiento, Second District
Donald P. Wagner, Third District
Doug Chaffee, Fourth District
Katrina Foley, Fifth District
County Agency Officers
Claude Parrish, Assessor
Andrew Hamilton, Auditor-Controller
Hugh Nguyen, Clerk-Recorder
Todd Spitzer, District Attorney-Public Administrator
Don Barnes, Sheriff-Coroner
Shari L. Freidenrich, Treasurer-Tax Collector
File details come from the government source that posted it. Updated .