Levine_Act.pdf
PDF 369 KB Posted
- Solicitation number
- 060-3118801-MB
- Issued by
- Orange County, San Francisco City, California
About this file
This is a Campaign Contribution Disclosure Form issued by the County of Orange, California, in conjunction with a Request for Proposals for Testing, Insulation and Repair of Boilers & Water Heaters solicited by the Orange County Sheriff-Coroner Department. 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. Respondents must indicate whether contributions were made and, if so, provide detailed information including the contributor's name and address, the recipient's name and title, the specific dates of contributions, and the dollar amounts. The form lists all five Board of Supervisors members (Janet Nguyen, Vicente Sarmiento, Donald P. Wagner, Doug Chaffee, and Katrina Foley) and eight County Agency Officers including the Assessor, Auditor-Controller, Clerk-Recorder, District Attorney-Public Administrator, Sheriff-Coroner, and Treasurer-Tax Collector. The RFP deadline for questions and clarifications is Thursday, September 10, 2026, at 5:00 p.m., and all proposals must be submitted electronically through the County's eProcurement Portal.
Applicants must certify the accuracy of their disclosure statements and agree to notify the County of any future contributions made to Board Members or County Agency Officers within 12 months following approval, renewal, or extension of the contract. Failure to disclose campaign contributions or providing false information may result in disqualification from consideration. Under California law as implemented by the Fair Political Practices Commission, campaign contributions made by the applicant and the applicant's agent or lobbyist representing the applicant in this solicitation must be aggregated to determine total campaign contributions. No pricing terms, set-asides, funding amounts, or contract duration information is specified in this disclosure form document.
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 ___
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 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 .