COUNTY_OF_ORANGE_CAMPAIGN_CONTRIBUTION_DISCLOSURE_FORM.pdf
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- Attached to
- Library Materials Lending Machine(s)
- Solicitation number
- RFP 012-2421201-DV
- Issued by
- Orange County, San Francisco City, California
About this file
The document is a Campaign Contribution Disclosure Form from the County of Orange, California, which requires applicants to disclose any campaign contributions made to Orange County Board of Supervisors members or County Agency Officers on or after January 1, 2023. The form is specifically tied to a solicitation for Library Materials Lending Machine(s), with proposal submissions due by October 23, 2023 at 2:00 P.M. PDT. Questions were required to be submitted through OpenGov by October 16, 2023.
The form outlines specific disclosure requirements, including identifying any campaign contributions made to the five Board of Supervisors members (Donald P. Wagner, Andrew Do, Vicente Sarmiento, Doug Chaffee, Katrina Foley) and six County Agency Officers (Claude Parrish, Andrew Hamilton, Hugh Nguyen, Todd Spitzer, Don Barnes, Shari L. Freidenrich). Applicants must provide detailed information about contributions, including the contributor's name, date, and amount. The form emphasizes that campaign contributions from the applicant, subcontractors, and agents/lobbyists must be aggregated, and requires ongoing disclosure of contributions within 12 months following approval or extension of the requested license, permit, or entitlement.
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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 on or after January 1, 2023, 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 ___
Note: Under California law as implemented by the Fair Political Practices Commission, campaign contributions made by the Applicant and the Applicant’s agent/lobbyist who is representing the Applicant in this application or solicitation must be aggregated together to determine the total campaign contribution made by the Applicant.
Identify the Board of Supervisors Member(s) and County Agency Officer(s) to whom you, your subcontractors, and/or agent/lobbyist made campaign contributions on or after January 1, 2023, 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
COUNTY OF ORANGE
CAMPAIGN CONTRIBUTION DISCLOSURE FORM
ORANGE COUNTY BOARD OF SUPERVISORS
AND COUNTY AGENCY OFFICERS
Board of Supervisors
Donald P. Wagner, Chairman, Third District
Andrew Do, Vice Chairman, First District
Vicente Sarmiento, Second 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 .