Suisun City, CA · Solano County
Levine Act Disclosure Statement
This statement lets a person or company submitting a proposal or seeking city action disclose political contributions involving City officers.
What this form is
The statement records political contributions by you, your company, or a participant or agent in connection with a proposal or anticipated City action involving a contract, license, permit, or entitlement. It asks about contributions over $250 in the preceding 12 months and anticipated contributions in the following 12 months, and provides space to identify officers and contribution details. The signer certifies the information under penalty of perjury.
Who needs it
A person or company submitting a proposal or seeking City action related to a contract, license, permit, or entitlement can use this statement to disclose contributions.
How to submit it
Submit it to the city department named on the form; check the city website for current contact details.
About notarization
This document is signed without a notary; the signer certifies under penalty of perjury that the information is true and correct.
How to submit this form
- 1
Download The Statement
Download the Levine Act Disclosure Statement PDF.
- 2
Complete The Questions
Answer the questions about past and anticipated political contributions and provide the requested contributor and contribution details.
- 3
Add Contribution Details
Add sheets if needed to identify additional Councilmembers or City officers who received contributions.
- 4
Sign And Date
Print your name and title, provide your company, and sign and date the certification.
- 5
Submit To The City
Submit it to the city department named on the form; check the city website for current contact details.
Frequently asked questions
- What does the Levine Act Disclosure Statement ask?
- It asks whether you, your company, or a participant or agent made or anticipate making political contributions over $250 to a City officer, and provides space for contribution details.
- Who fills out this statement?
- A person or company submitting a proposal or seeking City action related to a contract, license, permit, or entitlement can use it to disclose relevant political contributions.
- How do I submit the Levine Act Disclosure Statement?
- The form does not state a submission method. Submit it to the city department named on the form; check the city website for current contact details.
- Do I need a notary for the Levine Act Disclosure Statement?
- No. The document is signed without a notary, but the signer certifies under penalty of perjury that the information is true and correct.