Policies and procedures

Form B:
Principal Authorization for Lobbyist Activity

"*" indicates required fields

Name Of Lobbyist(s)

MM slash DD slash YYYY
Name of Principal
Company Name

do hereby certify that all of the above information provided herein is true and correct and I have not offered to pay, and the Lobbyist has not agreed to receive or accept, in whole or in part, a contingency or success fee

Violation of the Lobbying provisions of the Ethics code may subject a Lobbyist or Principal to a prohibition of lobbying for a period up to twelve months. Repeated offenses of the Ethics Code lobbying provision may result in the suspension of the Lobbyist or Principal from doing business with the City for up to twelve months.

MM slash DD slash YYYY

The above named Lobbyist and/or Principal does hereby agree that any electronic signature appearing on this document is deemed to be the same as a handwritten signature for the purposes of validity, enforceability, and admissibility and shall be deemed to have the same legal effect as delivery of an original executed copy of this document for all purposes.