Levine_Act_Disclosure_Form.pdf

ISSUED FOR RFP Rev. 4-25 LEVINE ACT PARTY DISCLOSURE STATEMENT

Page 1 of 2 DOCUMENT 00 42 53

3322838.1

DOCUMENT 00 42 53A

LEVINE ACT STATEMENT — PARTY DISCLOSURE FORM

1. The Levine Act. California Government Code § 84308, commonly referred to as the “Levine Act,” precludes an elected officer of a local government agency from participating in a proceeding involving a license, permit, or other entitlement for use if the official receives political contributions totaling more than $500.00 in the twelve (12) months preceding the pendency of the matter, and for twelve (12) months following the final decision, from a party or a participant in the proceeding.

2. Who is Covered. These prohibitions also apply to the party and participant’s agents, and if the party or participant is a closely held corporation, partnership, sole proprietorship, or other entity, to the majority shareholder or majority investor.

For the City of Pasadena (“City”), the directly elected and appointed officers as well as any alternates to elected or appointed officers and any candidates for elective office are subject to the Levine Act, which officers include, but are not limited to, the Mayor and members of the City Council, the City Manager, the City Attorney/City Prosecutor, the City Clerk, and members of each City Commission and Board. The list of individuals currently holding these offices is available on the City website at https://www.cityofpasadena.net/city-organizational-chart and https://www.cityofpasadena.net/commissions.

3. Definitions. A “party” is defined in the Levine Act as any person who files an application for, or is the subject of, a proceeding involving a license, permit, or other entitlement for use. (Gov’t Code § 84308(a)(1).)

A “license, permit, or other entitlement for use” means all business, professional, trade, and land use licenses and permits and all other entitlements for use, including all entitlements for land use, all contracts (other than competitively bid, labor, or personal employment contracts), and all franchises. (Gov’t Code § 84308(a)(5).)

A “participant” is defined by the Levine Act as a person who is not a party but who actively supports or opposes a particular decision in a proceeding involving a license, permit, or other entitlement for use and who has a financial interest in the decision. A person actively supports or opposes a decision in a proceeding if they lobby in person the officer or employees of an agency, testify in person before the agency, or otherwise act to influence the officers of the agency. (Gov’t Code § 84308(a)(2).)

4. The Levine Act applies to this Qualifications and Proposal procurement and the resulting Contract with the City Submitting a Qualifications and Proposal for this procurement triggers your obligation (as a party) to disclose political contributions made to City officers.

5. Disclosure. The Levine Act requires a party to a proceeding to disclose on the record of the proceeding any contributions totaling more than $500.00 within the preceding 12-months they or their agent made to an officer. (Gov’t Code § 84308(e)(1).) The party must also make a disclosure at the time the application is filed, or the proceeding otherwise commenced, and no later than thirty (30) days after a contribution is made at any stage in the proceeding. (2 CCR § 18438.8(b).) The Levine Act prohibits a party, or the agent of a party, to a proceeding from contributing more than $500.00 to any officer of the local agency during the preceding and for twelve (12) months after the date a final decision is rendered by the agency. (Gov’t Code Section 84308(e)(2).)

[Continued on next page.]

ISSUED FOR RFP Rev. 4-25 LEVINE ACT PARTY DISCLOSURE STATEMENT

Page 2 of 2 DOCUMENT 00 42 53

3322838.1

With this general information, please respond to the following question:

Have you or your company, or an agent on behalf of you or your company, made political contributions of more than $500.00 to any City officer in the twelve (12) months preceding the date you submitted your Qualifications and Proposal for this procurement?

Yes __________ No ______________

If you answered yes, for each contribution you must provide the name the party or other person making the contribution, if any, the name of each recipient of the contribution, the amount of the contribution, and the date the contribution was made. Attach additional pages if necessary.

As noted above, you must refresh this disclosure statement no later than thirty (30) days after a contribution is made and on the record of the proceeding.

This form and refreshed versions of this form must be filed with your Qualifications and Proposal Package.

For each subsequent contribution send by email to Antonio Watson at awatson@cityofpasadena.net

Authorized Signature Date

Name Title

Company Name

Party or Company Address