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CITY OF SANTA ANA RE -BID <br />PROPOSAL <br />PROJECT NO.: 17-6876 <br />CROSSWALK UPGRADES PHASE II <br />FEDERAL PROJECT NO: HSIPL 5063(186) <br />DISCLOSURE OF LOBBYING ACTIVITIES <br />DISCLOSURE OF LOBBYING ACTIVITIES nppmtea by OW <br />Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 G�fe-p0<5 <br />I!.nnm ran M nr�FAn A.nrla <br />Type of Federal Action: <br />2- Status of Federal Action.- <br />3. Report Type: <br />a contract <br />❑ a. bid/ ofterfapplica6on <br />a. initial filing <br />. grant <br />b. initial award <br />b. material change <br />c. peralive agreement <br />c- postaward <br />For Material Change Only: <br />d. <br />e. ban arantee <br />y�r quarter <br />date of last report <br />ff, loan in race <br />4- Name and Add s of Reporting Entity: <br />5. If Reporting Entity in No. 4 is a Subawardee er Name <br />❑ Prom Snwwadef <br />and Address of Prime- <br />ifkno.- <br />Congires5ional District, dknown: <br />Conoro.,dcinal District. ifk <br />6- Federal DeparbnentlAgency: <br />Federal Program NZwJcription- <br />\ <br />I-7. <br />CDA Number, if <br />8- Federal Action Number, iflvtown: <br />Award Amou ifknoam- <br />10. a. Name and Address of Lobby -mg Entity b. Ind <br />i - s Performing Services {ir+rJudirg address if(Jindividual, <br />last namQ Fiat name, M!): di from No, i0a) <br />(!a nam first name, MI): <br />ah7d�Cm�muabn s sfitlq Ynere <br />If- Amount of Payment (rheck aft fiat apply): <br />13. Type of Payment ( a8 that apply} <br />S ❑ achmt ❑ p <br />❑ a ra6ber <br />❑ a ane�me be <br />❑ ¢ cwhmwan <br />12 Fonn of Pa yment (cheek ay that apply . <br />❑ e-carn <br />❑ acantaylent eee <br />❑ 4lniinq epedry: nature <br />❑ e. deNied <br />value <br />❑ r-other, "My: <br />14. Brief Description of Ser4des Performed or to be Performed and Dates) of Servtoe, including oiti r(s), <br />employee(s), or Mem s) contacted, for Payment indicated in Rem 11: <br />fatcm Cownaavm sl One SF-LLLq lnr¢ <br />15. Contin n Sheets SF-LLLA attached: Yea AP <br />Is. W b+,rl� N lam ++a�+4M y W al V IIc on <br />vx r roe. ,r mgry ina� r ...rsr .vrew+Signature: <br />ce ++. e.as.. ++etr w•.+.r r of unc lvx ,ti <br />Print Name: O rag <br />ITdie <br />: <br />Vie Pr ident <br />��a..ea a,a r. r�+aeaan .r n+e.w.,nmmea <br />Teiephone No_ 90 - 3-5470 Date: 2/5/2020 <br />Federal Use Only: <br />AundnGglertLEa rtepmoxlen <br />Stai4aN Fmn LLJ. rtee. 79 <br />P-25 of P-42 RE -BID <br />