ORANGE, COUNTY OF A-2020-069 - Laserfiche WebLink

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DocuSign Envelope ID: 26A1 FOD6-5970-4421 -B5CB-2891848ECB74 Exhibit 4 DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose activities pursuant to 31 U.S.0 1352 1. Type of Federal Actions: 2. Status of Federal Actions: 3. Report Type: a. contract a, bid/offer/application a. initial filing b. grant b, initial award b. material change C. cooperative agreement C. post -award d. loan For material change only: e. loan guarantee Year: Quarter: f. loan insurance Date of last report: 4. Name and Address of Reporting Entity 5. If Reporting Entity in No. 4 is a Subawardee: Prime Subawardee Enter Name and Address of Prime: Tier if known Congressional District, if known: Con ressional District, if known: 6. Federal Department/ Agency: 7. Federal Program NamelDescription 8. Federal Action Number, if known: 9. Award Amount, if known: 10a. Name and Address of Lobbying Entity 110b. Individual Performing Services (if individual, last name, first name, MI): (including address if different from No. 10a) (last name, first name, Ml): attach Continuation Sheets SF-LLL-A, if necessary) 11. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply) $ Actual a. retainer Planned b. one-time free C. commission 12. Form of Payment (check all that apply): a. cash d. contingent fee b, in -kind: specify: e. deferred nature: f. other specify: value: 14. Enter Description of Services performed or to be Performed and date(s) of Service, including officer(s), employee(s), or Member(s) contacted, for Payment indicated on item 11: 15. Continuation sheets SF-LLL-A attached: ❑ Yes ❑ No 16. Information requested through this form authorized by Title 31 U.S.C. Section 1352. This disclosure of lobbying activities is a Signature: material representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semiannually and will be available for Print Name: public inspection. An person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not Title: more than $100,000 for each such failure. Telephone No: Date: I County of Orange Page 2 of 3 City of Santa Ana OC Community Resources Contract # 19-28-0070-RWS