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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 />Signed: __________________________ Date: ________________ <br />Print Name: __________________________ Title: ________________ <br />Company: __________________________ <br />Docusign Envelope ID: F7F9ED3E-EB07-824E-82A3-2EC213332F32