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OAK071358 (City of Oakland)

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Public Ethics Commission 2018 Election
Page 1 of 1
LPF Candidate Information Form
Candidate Name (as appears on ballot):
Home Address: District
Age: How many times have you ran for office?
18-24 45-54 First time 1 2 3 4 or more
25-34 50-64 Are you legally disabled? Yes No
35-49 65+
Gender: Household Income:
Male <$30,000 $75-100k
Female $30-60k $100-150k
Prefer not to answer $60-75k $150k+
Prefer to self-describe ________________
Race/Ethnicity:
Black/African-American American Indian/Alaska native
Asian Native Hawaiian/other Pacific Islander
Hispanic/Latino/Latina Other
White/Caucasian Two or more races
This form must be filed with the Office of the Public Ethics Commission at:
Oakland Public Ethics Commission
One Frank H. Ogawa Plaza, Room 104
Oakland, CA 94612
(510) 238-3593
(510) 238-3315 (fax)
www.oaklandnet.com/pec
ethicscommission@oaklandnet.com
RESET FORM
Public Ethics Commission Limited Public Financing Program - 2018 Election
13
LPF FORM 2 Initial Application for Public Financing
Please type or print clearly in ink.
Candidate Name:
District Office Being Sought:
Date of Election:
Tuesday, November 6, 2018
Campaign Mailing Address:
Phone:
(Number at which candidate can be reached
during business hours)
Fax:
Candidate’s Campaign Email:
Name of Controlled Committee
Campaign ID Number:
Campaign EIN No.
Name of Campaign Treasurer:
Treasurer Phone:
Treasurer Email:
Name and Address of Financial Institution
Campaign Bank Account Number
This form continues on the next two pages.
Public Ethics Commission Limited Public Financing Program - 2018 Election
14
I hereby apply for public financing and certify that the following information is true and correct:
1. I have executed and timely filed OCRA Form No. 301 accepting voluntary expenditure ceilings.
2. I have executed and timely filed a “Statement of Acceptance or Rejection of Public Financing” (LPF
Form 1) and have agreed to accept public financing for the November 6, 2018, election.
3. I am certified to appear on the ballot for the election for which public matching funds are sought.
4. I have received campaign contributions from donors located within the City of Oakland totaling at
least 5% of the voluntary expenditure ceiling for the office being sought, exclusive of any loans or
contributions from my personal funds. Copies of the checks received to meet this 5% threshold
are attached.
5. I have made qualified campaign expenditures in an aggregate amount of at least 5% of the
voluntary expenditure ceiling for the office being sought. Copies of the invoices and/or checks
evidencing proof of meeting this 5% expenditure threshold are attached.
6. I have not made any contribution or loan to my campaign from any personal funds in an amount
exceeding 10% of the voluntary expenditure ceiling for the office being sought.
7. I or my campaign treasurer or designee has attended a training program conducted or sponsored
by the Public Ethics Commission.
I understand and agree that to receive public financing I must be opposed by a candidate for the same
office.
I understand and agree that as a condition of receiving public financing I must timely file, and completely
and accurately execute, all pre-election campaign statements that are due at the time public financing is
payable as well as timely file, and completely and accurately execute, all post-election campaign
statements for the election in which I receive public financing.
I understand and agree that I must return surplus funds to the Public Ethics Commission no later than
January 31 of year following the election.
I understand and agree to all conditions of and requirements for the use of public financing set forth in
this Application, the Act and any regulations adopted thereunder. I understand and agree to submit to
reasonable audits deemed necessary by the Oakland Public Ethics Commission or other civil authorities as
specified by the Limited Public Financing Act.
By my signature below, I certify that:
1. I have read and understand the requirements and conditions set forth in this Application
and the Oakland Limited Public Financing Act and understand that those requirements
and conditions must be satisfied before, during and after I receive public financing.
Public Ethics Commission Limited Public Financing Program - 2018 Election
2. I have not made and I agree to not make any expenditures in excess of the voluntary
expenditure limits of Oakland Municipal Code Section 3.12.200. (This requirement shall
not apply if the voluntary expenditure ceilings have been lifted pursuant to Oakland
Municipal Code Section 3.12.220.)
3. The attached copies of documents are true and accurate copies of the original. I
understand that they will be used by Public Ethics Commission staff to determine my
eligibility to apply for and receive public financing.
CANDIDATE’S DECLARATION
I declare under penalty of perjury under the laws of the State of California that my campaign committee
and I have complied with all applicable contribution and expenditure limitations under the Oakland
Campaign Reform Act at all times in which those limitations apply to my candidacy for the office in contest
and I further declare that the representations set forth above are true and correct.
Date: ___________________ ________________________________________________
Candidate’s Signature
________________________________________________
Print or Type Candidate’s Name
This form must be submitted to the Public Ethics Commission at:
One Frank H. Ogawa Plaza (City Hall), Room 104
Oakland, CA 94612
(510) 238-3593
(510) 238-3315 (fax)
www.oaklandnet.com/pec
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Completed 18 July 2020

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