Exhibit_C_-_CAMPAIGN_CONTRIBUTION_DISCLOSURE.pdf
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- Solicitation number
- IFB-080-2331001-JM2
- Issued by
- Orange County, San Francisco City, California
About this file
This is a Campaign Contribution Disclosure Form issued by Orange County, California, required for applicants and bidders on county contract opportunities, including the Crawford Canyon Park and Sidewalk Extension Project. The form requires disclosure of any campaign contributions made on or after January 1, 2023, to members of the Orange County Board of Supervisors or County Agency Officers by the applicant, subcontractors, agents, or lobbyists. Applicants must provide detailed information including the contributor's name and address, the recipient official's name, contribution dates with exact month, day, and year, and contribution amounts. The form applies to the Crawford Canyon Park and Sidewalk Extension Project, a $5,635,000 infrastructure development project located in Orange County that includes park construction, sidewalk extensions, parking facilities, playgrounds, pedestrian bridges, landscaping, irrigation systems, electrical improvements, and drainage construction along Crawford Canyon Road and Newport Avenue/Boulevard, with bids due January 23, 2024, at 2:00 PM through the OpenGov electronic system.
The form serves as a mandatory disclosure and certification document, requiring applicants to attest under penalty of perjury that all statements are true and correct. Applicants must commit to disclosing any future contributions to Board Members or County Agency Officers made within twelve months following contract approval, renewal, or extension. The disclosure identifies all five Orange County Board of Supervisors members (Donald P. Wagner, Andrew Do, Vicente Sarmiento, 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) as relevant recipients. Under California law as implemented by the Fair Political Practices Commission, contributions by the applicant and the applicant's agent or lobbyist representing the applicant must be aggregated to determine total campaign contributions, establishing transparency requirements for this $5.635 million public works project restricted to six pre-qualified contractors.
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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
EXHIBIT 9
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
| ORANGE COUNTY BOARD OF SUPERVISORS |
| AND COUNTY AGENCY OFFICERS |
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