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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 17-6875 <br />CITYWIDE TRAFFIC SIGNAL VEHICLE HEAD UPGRADES <br />FEDERAL PROJECT NO: HSIPL 5063(188) <br />DISCLOSURE OF LOBBYING ACTIVITIES <br />DISCLOSURE OF LOBBYING ACTIVITIES APPbved by OlB <br />Complete this form to disobse lobbying activities pursuant to 31 U.S.C. 1352 o3444)0e6 <br />1. Type o1 Federal Action: 2. Status of Federal Action: 3. Report Type: <br />a granted �a- bid/otlerlapplicabon ❑ a. initial filing <br />b. grant b. iilbal award b. material change <br />c. cooperative agreement c. post -award For Material Change Only: <br />d ban year quarter <br />e. ban guarantee date of last report <br />1 loan insurance <br />a. Name and Address of Reporting Entity: 5, If Reporting Entity in No A is a Subawardee. Enter Name <br />❑ Pure ❑ SlCawa iee <br />Tier r,, known <br />Federal <br />g. a_ Name and Address of Lobbyip Entil <br />(ifklaWidual. lastname. Fastname. AM): <br />Form of Payment (check aY that apply) <br />❑ a rash <br />❑ b. '"Ma apmW navure <br />vakm <br />and Address of Prime: <br />CFDA Number. if applicable: <br />S <br />b. Individuals Performing Services (ndudng address if <br />drfixent ham No. 10a ) <br />(last name, test name. MI). <br />❑ a. retanu <br />❑ a aralrtr nee <br />❑ c dommmm <br />❑ a conttignit ive <br />❑ a. defened <br />❑ t other, peday. <br />u i,,er uesmpnon or Services PMormed or to be Performed and Date(s) <br />employee(s), or Memberisl contacted, for Payment Indicated in Rem 11: <br />w r )i J SG . <br />Signature: <br />.P rtl w pee is ire. rr e.� wra <br />r nCt llr <br />Print NarlF <br />•a Y �ierb <br />new . N eA� Ye YY Y a. e. r r r <br />Title:si <br />N.rr.r <br />�s.tr.wsrr r1.wr rr ewem ram. w.. ee,em t. <br />n M <br />..uetr.. <br />TMwiMna <br />Federal Use Only- <br />— Darw:1 <br />AVtbaad Er Ua <br />9Q4T>34 <br />