DocuSign Envelope ID: E3EC32AC-CBE2-4379-BB09-D502E3365EE4
<br />Exhibit 4
<br />INSTRUCTIONS FOR COMPLETION OF
<br />SF-LLL DISCLOSURE OF LOBBYING ACTIVITIES
<br />Tbls disclosure form shall be completed by the reporting entity, whether subawardea or prime Federal reciplent at the initiation or receipt of a
<br />covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C, section 1352. The filing of a form is required for each
<br />a men or agreement to make payment to any lobbying entity for influencing or attempting to Influence an officer or employee of any agency, a
<br />Member of Congress, an officer or employee of Congress. or an employee of a Member of Congress In connection with a covered Federal action.
<br />Use the SF LLL-A Continuation sheet for additional Information if the space on the form Is Inadequate. Complete all items that apply for both the
<br />Initial Sling and material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional
<br />information.
<br />1. Identify the type of covered Federal action for which lobbying Is and has been secured to influence the outcome of a covered action.
<br />2. Identify the status of the covered Federal action.
<br />3. Identify the appropriate classification of this report. If this is a follow up report caused by a material change to the information previously reported,
<br />enter the year and quarter in which the change occurred. Enter the date of the lost previously submitted report by this reporting entity for this
<br />covered Federal action.
<br />4. Enter the full name, address, city, state and zip code of the reporting entity, Include congressional district. if known. Check the appropriate
<br />classification of the reporting entity that designates if it is, or expects to be a prime or subaward recipient
<br />Identify the tier of the subawardee, e. g, the first subawardee of the prime Is the lot tier. Subawards Include but are not limited to subcontracts.
<br />subgrents and contract awards under grants.
<br />5. If the organization filing the report, in item 4 checks "Subawardee", then enter the full name, address, city, state, and zip code of the prime Federal
<br />recipient. Include congressional district, If known.
<br />6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level below agency name, if
<br />known, For example, Department of Transportation, United States Coast Guard.
<br />7. Enter the Federal program name or description for the covered Federal action (Item 1). If known, enter the full Catalog of Federal Domestic
<br />Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments.
<br />8. Enter the most appropriate Federal Identifying number avallabie for the Federal action Identified In Item 1 (a. g, Request for Proposal (RFP)
<br />number; Invitation for Bid (IFS) number; grant announcement number the contract, grant. or loan award number; the application proposal control
<br />number assigned by the Federal agency). Include prefixes, e.g.,'RFP DE 90 09"
<br />9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the
<br />owardlloan.commitment for the primary entity identified In item 4 or S.
<br />10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity Identified in item 4 to
<br />Influence the covered Federal action,
<br />(b) Enter the full names of the individual(s) performing services, and Include full address if different from 10 (a). Enter Last Name, First
<br />Name, and Middle Initial (MI).
<br />11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (Item 4) to the lobbying entity (Item 10),
<br />Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply, If this is a material change report
<br />enter he cumulative amount of payment made or planned to be made.
<br />12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in kind contribution, specify the nature and value of
<br />the In kind payment
<br />13. Check the appropriate box(es), Check all boxes that apply. If other, specify nature,
<br />14. Provide a specific and detailed description of the services that the lobbyist has performed, or will be expected to perform, and the date(s) of any
<br />services rendered. Include all preparatory and related activity, not just time spent in actual contact with Federal officials. Identify the Federal
<br />officlal(s) or employee(s) contacted and the offioer(a), employee(s), or Members) of Congress that were contacted,
<br />15, Check whether or not a SF LLL A Continuation Sheet(s) is attached.
<br />16. The certifying offidal shall sign and date the form, print his/her name, title, and telephone number,
<br />Public reporting burden for this collection of information is estimated to average 30 minutes per response, Including time for reviewing instructions,
<br />searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send
<br />comments regarding the burden estimate or any other aspect of this collection of Information, including suggestions for reducing this burden, to the
<br />Office of Management and Budget, Paperwork Reduction Project (0348 0046) Washington D,C., 20603.
<br />County of Orange Page 1 of 3 City of Santa Ana
<br />OC Community Resources Contract # 19-28-0070-RWS
<br />
|