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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 ACTIVITIES Aappred by OLE <br />Complete this torn to disclose lobbying activities pursuant to 31 U.S.C. 1352 DUMM46 <br />See reverse for public burden disclosure. <br />1 _ Type of Federal Action: <br />2. Status of Federal Action: <br />3. Report Type: <br />a. contract <br />a- bidfoffenapplicabon <br />a. initial filing <br />b. grant <br />b. initial award <br />b_ material change <br />a cooperative agreement <br />c. post -award <br />For Material Change Only: <br />d. ban <br />Year quarter <br />e. ban guarantee <br />date oflaw report <br />f. loan insurance <br />4. Name and Address of Reporting Entity: <br />5_ C Reporting Entity in No_ 4 is a Subawardee, Enter Name <br />❑ Pram Cl abowwwow, <br />and Address of Priume: <br />Tier . it known: <br />C sional District. iflrnown: <br />congressional District. ifknown: <br />6. Federal DeparfinentlAgency: <br />y. Federal Program Name/Description: <br />CFDA Number, ifappTocable: <br />S_ Federal Action Humber, iknown: <br />9. Award Amount, if known: <br />S <br />10. a. Name and Address of Lobbying Entity b. Individuals Perforw ng SsrNees (kncbd W address if <br />(if individual. last name. frrst name. Mf): dMemnikom No. f0a) <br />(last name. fist name, M11: <br />Conl'niJ>mrl r SF411AF <br />11. AmodM of Payment (check aA Curt apply): <br />13. Type of Payment (check all that apply): <br />S ❑ Paso ❑ poetic -a <br />❑ a re aanr <br />❑ b. arr4ePe an <br />❑ a cummimon <br />12. Form of Payment (dmecle ay that apply). <br />❑ a reran <br />❑ a caeMgrd be <br />❑ G sNcpG spay: nature <br />❑ a. dwerred <br />value <br />❑ t. athK apeery: <br />U. Brief Description of Services Performed or to be Performed and Dates) of Service, including offreer(s), <br />employee(s), a Mernber(s) contacted, for Payment Indicated in Ream 17: <br />/ 1 <br />atad+Cpm MINdr, r 5F411A At <br />.! <br />15. Continuation S s SF41 LA attached: Lj Ys <br />m•«w� Mawr e.yn r. Mn ..Mnd M F er U a e <br />C:� ature: .i.. -- <br />Print Nan,.: EaYnest Brown <br />cow. +r rev... wwr.a w... n u e c pax ry <br />Title: President So Cal Div. <br />•bwwwy b web N �v w1 N «e.welw b <br />r•Y1c Nee0m ..,.........r N..w.e Pwm�e vr« <br />��w....,w....aa•>or.....�....naas« <br />Telephone No.:(951)682-2982 Date: 02/26/20 <br />Federal Use Only: <br />AYICnHd b lad Rlprpelrlld+ <br />"San %,b Fbnn 111 . 7471 <br />P-24 of P-39 <br />