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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 17-6894 <br />EUCLID STREET AT HAZARD AVENUE SIGNAL MODIFICATION <br />FEDERAL PROJECT NO: HSIPL 5063 (171) <br />DISCLOSURE OF LOBBYING ACTIVITIES <br />DISCLOSURE OF LOBBYING ACTIVff1ES APFrb o ay c a3 <br />Complete Thisform to disclose lobbying activities phaslat b 31 U.S.C. 1352 ire-si+E <br />(See reverse for public burden d6cbMne.) <br />1. Type of Federal Action: <br />2. Staters of Federal Action: <br />3. Repeat Type. <br />1-1 a contract <br />a. bidfotter/applicabon <br />El a. iael Rinp <br />b. grant <br />bin vai award <br />b. malarial change <br />c. cwoperatrve agreement <br />c. post -award <br />For 11alersal Charge Only: <br />d ban <br />year quaver <br />e. ban guarantee <br />dawn of tam report <br />f. loan insurance <br />4_ Maine and Address of Reporting Entity: <br />5. If Reporting Entity in No. 4 is a Srbaiwa dew, ErM Name <br />❑ Pone ❑ swaw.m.. <br />and Address of Prime: <br />Tier .f, known <br />Congressional District, 0known <br />Corignisisional Dtstrict. if known <br />6. Federal DepartnnenUAgency- <br />T. Federal Program MamelDeseription: <br />CFDA Number. fapphcable. <br />6. Federal Action Number, filmoen: <br />S. Award Amour , fknwnn: <br />S <br />10. a Name and Address of LobbyarV Entity b. Individuals Perfornrsg Services (ircliWng address if <br />ffindividi al, last name. fWsf name. Ml): dfferent kom No 10a) <br />(last name. fist name. Ml). <br />>ilaw c .s.F41LA e I <br />11. Amount of Payeaert (check a4 M& apply): <br />13. Type of Payment (check ae that apply): <br />S ❑ WON ❑ <br />a reYbn <br />❑ a. onHiae M <br />❑ c. cw.r.tah <br />12. Form of Payment (dwok aff "appfyk <br />❑ a fawn <br />❑ it Wahgwrt he <br />❑ a Inatnq apeyr. nature <br />❑ e. clear" <br />value <br />❑ t Mar. specify. <br />14. Brie( Description of Services Performed or to be Performed and Date(s) of Service, eseudig oflicer(s), <br />employee(s), or Mernber(s) contacted, for Payment Indicated in Item <br />/71: <br />iM CbrOSGuon i f.F1LlA l / <br />15. Continwtion S s SFlI1A albcbed: Yee /ae <br />16. <br />sw'ature: <br />ni ft <br />>n rr a.r�. r erree sr e . r� ee�r.� r r <br />Prim Name: nest Brown <br />Tale: President So Cal Div. <br />.ae..ar r r.v.rr w. �� �n✓A .ere. ter. r <br />Telephone No.:(951) 682-2982 Dale: 02/26/20 <br />Federal Use Only: <br />A100AW b testy Ilma�e <br />SOON ftm UL tftv.7 <br />