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<br /> <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 />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 /> <br /> <br /> <br /> <br /> <br />8-27-2026 <br />Owner/OperatorVincent T Clear <br />Clear Em Out Pest Control <br />Docusign Envelope ID: 12D38450-126F-85C2-806D-B77CACC97D2B