Campaign_Contribution_Disclosure_Form.docx
DOCX document 33 KB Posted
- Attached to
- ARCHITECT/ENGINEER (A/E) ARCHITECTURAL SERVICES
- Solicitation number
- 060-2730-RFQ- AE-JC
- Issued by
- Orange County, California
About this file
This is a Campaign Contribution Disclosure Form required by the County of Orange, California, for use in conjunction with a Request for Qualifications (RFQ) solicitation issued by the Orange County Sheriff-Coroner Department (OCSD) for Architect/Engineer (A/E) Architectural Services. The form requires applicants and their proposed subcontractors, agents, or lobbyists to disclose any campaign contributions made within the last 12 months to members of the Orange County Board of Supervisors or County Agency Officers, regardless of dollar amount. Statements of Qualifications must be submitted by 2:00 P.M. PDT on October 23, 2026, with all questions and requests for interpretation due by October 9, 2026, at 3:30 P.M. Pacific Daylight Time. The awarded contract will establish a usage contract between the County of Orange and selected Respondents for various architectural services projects as detailed in the Scope of Work (Attachment A). Questions must be submitted through the County's online bidding system at https://opengov.com/products/procurement/suppliers/ under SOQ 060-2730-RFQ-AE-JC.
By signing the disclosure form, applicants certify that all statements are true and correct and agree to notify the County of any future contributions made to Board Members or County Agency Officers by the applicant, subcontractors, or agent/lobbyist within 12 months following the approval, renewal, or extension of the requested contract. The form identifies five Board of Supervisors Members (Janet Nguyen, Vicente Sarmiento, Donald P. Wagner, Doug Chaffee, and Katrina Foley) and eight County Agency Officers (Claude Parrish, Andrew Hamilton, Hugh Nguyen, Todd Spitzer, Don Barnes, Shari L. Freidenrich, and others) as individuals subject to the disclosure requirement. The form serves as a mandatory compliance document to ensure transparency and prevent conflicts of interest in the procurement process.
View the file
Other files
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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 .