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Page 9 of 9 EXHIBIT C LEVINE ACT DISCLOSURE STATEMENT California Government Code § 84308, commonly referred to as the “Levine Act,” prohibits any officer of a local government agency from participating in the consideration or action related to a proceeding, including the award of a contract, if he or she receives political contribution(s) totaling more than $500 within the preceding 12 months while the proceeding is pending, and for 12 months following the date of the final decision in a proceeding or award of a contract. This prohibition applies when an officer accepts, solicits, or directs contributions on the officer’s own behalf, on behalf of another officer, on behalf of any candidate for office, or on behalf of any committee. A list of the members of the City Council can be located at: https://www.cityofpleasantonca.gov/our- government/mayor-city-council/ 1. Have you or your company, or any agent on behalf of you or your company, made any political contributions of more than $500 to any City officer in the 12 months preceding the date of the submission of your proposals or the anticipated date of any Council action related to this contract? □ YES □ NO If YES, please identify the person(s) or agent(s) making the contribution: ____________________________________________________________ If YES, please identify the officer receiving the contribution: ____________________________________________________________ 2. Do you, or your company, or any agent on behalf of you or you company, anticipate or plan to make any political contributions of more than $500 to any City officer in the 12 months following any Council action related to this contract? □ YES □ NO If YES, please identify the person(s) or agent(s) making the contribution: ____________________________________________________________ If YES, please identify the officer receiving the contribution: ____________________________________________________________ Answering YES does not preclude the City of Pleasanton from awarding a contract or taking subsequent action related to the item. It does, however, preclude the identified City officer from participating in any actions related to such an item. By signing below, you certify you also agree to disclose to the City any future contributions made to a City officer by you or your agent(s) after the date of signing this disclosure form, and within 12 months following the approval, renewal, or extension of the requested contract. I HEREBY CERTIFY UNDER PENALTY OF PERJURY UNDER THE LAWS OF THE STATE OF CALIFORNIA THAT THE FOREGOING IS TRUE AND CORRECT. Signed: __________________________ Date: ________________ Print Name: __________________________ Title: ________________ Company: __________________________ Docusign Envelope ID: 51FAFAD2-C432-8610-82B1-8C74A5863E3EDocusign Envelope ID: CF4E9CB2-CD8E-8250-8118-86FF73955901