Fill - Free fillable Quarterly Report And Schedules 2018 (City of Oakland) PDF form

CITY OF OAKLAND

PUBLIC ETHICS COMMISSION

Date Received

RESERVED FOR PUBLIC ETHICS USE

Name__________________________

Page ____ of ____

2018 LOBBYIST QUARTERLY REPORT

(Attach disclosure schedules as necessary)

Full Name:

List all clients or employers:

Name of Lobbyist Firm or Employer:

Lobbyist Firm/Employer Business Address:

Work Phone:

Reporting Period:

Q1: January 1 – March 31, 2018 (Due April 30)

Q2: April 1 – June 30, 2018 (Due July 30)

Q3: July 1 – Sept. 30, 2018 (Due October 30)

Q4: October 1 – Dec. 31, 2018 (Due Jan 30, 2019)

Work Email:

Please check one.

No, I did not engage in any reportable lobbying activity during the reporting period.

Yes, I did engage in reportable lobbying activity during the reporting period, and I am including the

pertinent disclosure documents.

Schedule A – Statement of Lobbying Activities

Schedule B – Employment Relationships Arranged By A Lobbyist or A Registered Client at the

Lobbyist's Behest

Schedule C – Employment Relationships between a Lobbyist And An Elected City Officeholder

or a Candidate for City Office

Schedule D – Statement of Solicitations for Campaign Contributions

(If applicable, disclosure schedules must be attached to your quarterly report and be filed no later

than 30 days after the end of each calendar quarter.)

DECLARATION OF LOCAL GOVERNMENTAL LOBBYIST

I have used all reasonable diligence in completing this form and attachments. I have reviewed the form and

any attachments and to the best of my knowledge the information contained herein is true and complete. I

declare under penalty of perjury under the laws of the State of California that the information I provided

above and on the attached Disclosure Schedules is true and correct.

Date: __________________________ Signature: ___________________________________________

Please return via email to ethicscommission@oaklandnet.com

Filings sent by mail or fax are also accepted. Send to:

Public Ethics Commission

1 Frank H. Ogawa Plaza, 1st Floor, Room 104

Oakland, CA 94612

Fax: (510) 238-3315

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CITY OF OAKLAND

PUBLIC ETHICS COMMISSION

Name____________________________

Page _____ of _____

2018 LOBBYIST DISCLOSURE FORM

SCHEDULE A -- Statement of Lobbying Activities

If applicable, Schedule A must be attached to your Quarterly Report and be filed no later than 30 days after

the end of each calendar quarter.

Please provide the following information for each client or employer on whose behalf you lobbied during the period

of time covered by this report. If you lobbied on more than one item of governmental action for any individual client

or employer, please complete a separate Schedule A for each item of governmental action lobbied on behalf of

that individual client or employer.

(A) Name and address of the client or employer on whose behalf I lobbied:

__________________________________________________________________________________

(B) Item of governmental action on which I lobbied for the above-named client:

__________________________________________________________________________________

the name and title of each city boardmember or commissioner you lobbied, and the job title and office or

department of each city employee you lobbied (do not provide the city employee's name):

__________________________________________________________________________________

(D) Please check the box indicating the position advocated on behalf of the client or employer identified in (A)

above and provide a brief narrative description (no longer than 3 sentences):

Support Oppose Policy Development Informational Briefing

__________________________________________________________________________________

_____________________________________________________________ __________________

(E) Total amount of economic consideration received, or entitled to receive, from client or employer for

lobbying activity during the reporting period:

Amount: _________________________

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CITY OF OAKLAND

PUBLIC ETHICS COMMISSION

Name____________________________

Page _____ of _____

2018 LOBBYIST DISCLOSURE FORM

SCHEDULE B -- Employment Relationships Arranged By a Lobbyist or a

Registered Client at the Lobbyist's Behest

If applicable, Schedule B must be attached to your Quarterly Report and be filed no later than 30 days after

the end of each calendar quarter.

Please provide the information below for each elected city officeholder, candidate for elected city office,

designated employee, or member of the immediate family of one of the foregoing persons, who you -- or a

registered client at your behest -- employed or hired during the period of time covered by this report.

If you or a registered client employed or hired more than one city officer, candidate, designated employee or one

of their immediate family members, please complete a separate Disclosure Form/Schedule B for each person

you employed or hired.

(A) Name of elected city officeholder, candidate for elected city office, designated employee, or member of

the immediate family of one of the foregoing persons you or your registered client employed or hired:

__________________________________________________________________________________

(B) A description of the services actually performed by the employed or hired person:

__________________________________________________________________________________

than $250; between $250 and $1,000; between $1,001 and $10,000; greater than $10,000.

Enter amount category: _____________

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CITY OF OAKLAND

PUBLIC ETHICS COMMISSION

Name____________________________

Page _____ of _____

2018 LOBBYIST DISCLOSURE FORM

SCHEDULE C -- Employment Relationships between a Lobbyist and an

Elected City Officeholder or a Candidate for City Office

If applicable, Schedule C must be attached to your Quarterly Report and be filed no later than 30 days after

the end of each calendar quarter.

Please provide the following information for each elected city officeholder or candidate for elected city office who

employed or hired you to provide compensated services during the period of time covered by this report.

If you were employed or hired by more than one elected city officeholder or candidate for city office, please

complete a separate Disclosure Form/Schedule C for each officeholder or candidate who employed or hired

you.

(A) Name of elected city officeholder or candidate for elected city office who employed or hired you:

__________________________________________________________________________________

(B) A description of the services you actually performed:

__________________________________________________________________________________

less than $250; between $250 and $1,000; between $1,001 and $10,000; greater than $10,000.

Enter amount category: ____________

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CITY OF OAKLAND

PUBLIC ETHICS COMMISSION

Name____________________________

Page _____ of _____

2018 LOBBYIST DISCLOSURE FORM

SCHEDULE D -- Statement of Solicitations for Campaign Contributions

If applicable, Schedule D must be attached to your Quarterly Report and filed no later than 30 days

after the end of each calendar quarter.

Please provide the following information for campaign contributions you solicited for the benefit of a City

officeholder, candidate for City office, or committee or fund controlled by such officeholder or candidate, during

the period of time covered by this report.

Contributions Solicited by Lobbyist

Date of

Solicitation

Elective City Officer, Candidate, or

Controlled Committee

Person/Contributor Solicited

Amount Solicited

Total Amount Solicited

Note: A solicitation does not include a request for a contribution made (1) in a mass mailing sent to members of

the public, (2) in response to a specific request for a recommendation, (3) to a gathering which members of the

public may attend, or (4) in a newspaper, on radio or television, or in any other mass media.

If a lobbyist solicits more than fifty (50) individual members or employees of a corporation, union or other

association that is a registered client of the lobbyist -- or all of the individual members or employees of a

corporation, union or other association that is a registered client of the lobbyist -- the lobbyist may choose to

disclose the name of the registered client instead of the names of the persons whom the lobbyist actually

solicited. (See OMC Section 3.20.110(F)).

$ 0.00

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