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Page 8 of 8 <br /> <br /> <br />Answering YES does not preclude the City of Pleasanton from awarding a contract or taking <br />subsequent action related to the item. It does, however, preclude the identified City officer from <br />participating in any actions related to such an item. <br /> <br />By signing below, you certify you also agree to disclose to the City any future contributions <br />made to a City officer by you or your agent(s) after the date of signing this disclosure form, and <br />within 12 months following the approval, renewal, or extension of the requested contract. <br /> <br />I HEREBY CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE <br />STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT. <br /> <br />Signed: __________________________ Date: ________________ <br /> <br />Print Name: __________________________ Title: ________________ <br /> <br />Company: __________________________ <br /> <br />American Integrated Services, Inc. <br />Project Manager <br />06/05/2026 <br />LaVonne Acosta <br />Docusign Envelope ID: 454B37BC-E736-8121-8335-9195AC5F2386