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Exhibit 4 <br /> <br /> <br /> <br />DISCLOSURE OF LOBBYING ACTIVITIES <br />Complete this form to disclose activities pursuant to 31 U.S.C 1352 <br />1.Type of Federal Actions:2. Status of Federal Actions: 3. Report Type: <br />a. contract a. bid/offer/application a. initial filing <br />b. grant b. initial award b. material change <br /> c. cooperative agreement c. post-award <br /> d. loan For material change only: <br /> e. loan guarantee Year: Quarter: <br />f. loan insurance Date of last report: <br />4.Name and Address of Reporting Entity 5. If Reporting Entity in No. 4 is a Subawardee: <br />Prime Subawardee Enter Name and Address of Prime: <br /> <br /> Tier if known <br /> <br />Congressional District, if known:Congressional District, if known: <br />6.Federal Department / Agency:7. Federal Program Name/Description <br /> <br /> <br />8.Federal Action Number, if known: 9. Award Amount, if known: <br /> $ <br />10a.Name and Address of Lobbying Entity10b.Individual Performing Services <br /> (if individual, last name, first name, MI): (including address if different from No. 10a) <br /> (last name, first name, MI): <br /> <br /> <br /> <br />(attach Continuation Sheets SF-LLL-A, if necessary) <br />11. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply) <br />$ Actual a. retainer <br />Planned b. one-time free <br /> c. commission <br />12. Form of Payment (check all that apply): <br /> d. contingent fee <br /> a. cash <br /> e. deferred <br /> b. in-kind: specify: <br />f.other specify: <br />nature: <br /> <br />value: <br />14. Enter Description of Services performed or to be Performed and date(s) of Service, including officer(s), employee(s), or Member(s) <br /> contacted, for Payment indicated on item 11: <br />15. Continuation sheet(s) SF-LLL-A attached: Yes No <br />16. Information requested through this form authorized by Title <br />31 U.S.C. Section 1352. This disclosure of lobbying activities is a Signature: <br />material representation of fact upon which reliance was placed by the <br /> <br />tier above when this transaction was made or entered into. This <br />disclosure is required pursuant to 31 U.S.C. 1352. This information <br />will be reported to the Congress semiannually and will be available for <br />Print Name: <br />public inspection. An person who fails to file the required disclosure <br />shall be subject to a civil penalty of not less than $10,000 and not Title: <br />more than $100,000 for each such failure. <br />Telephone No: <br />Date: <br /> <br />