I certify the following:

• This contribution does not cause me to exceed my contribution limit of $1000. I understand that all contributions I make to this candidate or committee must be cumulated. I understand that a contribution from another individual or entity whose contribution activity I control, such as a business that I own or control, must be aggregated with this contribution, and both contributions will be treated as a single contribution from me.

• I am not a bidder, sub-contractor, principal, or underwriting firm that is prohibited from contributing under Los Angeles City Charter § 470(c)(12) or 609(e).

• The information regarding my address, occupation, and employer is correct.

• This contribution is not being made under a false name, is not being made under another person’s name, and has not been and will not be reimbursed.

• I am not a lobbyist or lobbying firm that is prohibited from contributing under Los Angeles City Charter § 470(c)(11).

• I am a U.S. citizen or lawfully admitted permanent resident (i.e., green card holder).

• The address provided is my residence address.

• This contribution is from my personal funds.

• I am not a planning applicant, owner, or principal that is prohibited from contributing under Los Angeles Municipal Code Section 49.7.37.

• I am at least eighteen years old.

• This contribution is made from my own funds, and funds are not being provided to me by another person or entity for the purpose of making this contribution.

• I certify under penalty of perjury under the laws of the City of Los Angeles and the state of California that all of the information I have provided on this contribution form is true and correct.