I certify the following:

• 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. 
• This contribution does not cause me to exceed my contribution limit of $1500. 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 a United States citizen or a lawfully admitted permanent resident (i.e., green card holder). 
• My individual contribution was made with personal funds.
• I am not a lobbyist or lobbying firm that is prohibited from contributing under Los Angeles City Charter §470(c)(11). 
• I have not applied for a significant entitlement with the Los Angeles City Planning Department within the past 12 months. 
• 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). 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 above is true and correct.
• 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.