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CITY OF SANTA ANA <br />PROPOSAL <br />PROJECT NO.: 18-6918 <br />MAIN ST & 15TH ST TRAFFIC SIGNAL INSTALLATION <br />FEDERAL PROJECT NO: HSIPL 5063 (189) <br />DISCLOSURE OF LOBBYING ACTIVITIES <br />DISCLOSURE OF LOBBYING ACTIVITIES <br />COmPlete this form to disclose bbbYlng activities pursuant to 31 U.S.C. 1362 <br />APPmwdM <br />Ria9mJb <br />1- Type o ederal Action <br />2. ns Staiof Federal Action:'V �• <br />V <br />S_ Report Type: <br />❑ a. ct <br />� a. bidlef riappiftc h n <br />a. initial filing <br />b. grant <br />b. Initial award <br />b. material change <br />e. coopera agreement <br />c. Post -award <br />For Material Change On <br />tl_ ban <br />year qu <br />e. ban guard,•It <br />dale rat last report <br />f. loan insurance <br />a. Name and Address of RRporfing Entity: <br />S. N Reporting Entity in No. l is a Sub a rdee, Ender Name <br />Elfiti ❑ a <br />and Address of Prime: <br />Tier ffknevm- <br />C essioeal District, rlkfrown: <br />Co ressional District, frown: <br />7. Federal Program N Descrption: <br />6. Federal DepartrnenURgenoY: <br />CFDA Number. df lira te: <br />e. Federal Action Number, ifknroon: <br />9_ Araao t. dknoan: <br />S <br />10. a. Name and Address of Lobbying Entity b_ Indtvi Is Performing Services (Inrl(MAg address if <br />(ifindividual, fast name, fast aamme. Mf)z dr!/e t r No. 10a) <br />name, 's( name, AN): <br />y <br />laf"c4aurvuWnAff Pi• <br />11. Amount of Payment (crock all Mal apply): <br />13. Type of Payment ( ak dtat apply): <br />S ❑ scrum ❑ PI— <br />❑ a tabwer <br />❑ 0. o11eJ1ala rra <br />❑ c. awmtlwon <br />12l=arm of Payment (check ak Mat apply): <br />a cfen <br />❑ a. conMqud laa <br />b. rnrinc aNcey: nature <br />a. ueninad <br />value <br />r ovuv,- vaelfy: <br />14. Brief Description of Services Flmftnned or to be Performed and Date(%) of Service,. entludog <br />empfoyee(s), or Members) laded, for Payment Indicated in Hem 11: <br />amM Cprraaaalbn SlY a SFiLlt ynam <br />15. Continuation S s SF-LLLA attached: Yee <br />rem..an�re maw ro.n ..mwxx 4ab al uac w, 1g. <br />n!t flw <br />Signature. <br />ram.. eaw•a sErr Y � mmwY +germ w M <br />'•e.a <br />Pdnl Name: J If Wnnal <br />onto . w �..`.d w..mr c ate unn K <br />Vbn�mii IRUWmaw Gle��l.en,reMi4meaY,b <br />Vice P e51 Cnl <br />... �Iram.l�eceawem.alrm.. run uoeemb <br />Tete hone No., 909- -54i0 <br />P Date: 1 U8/2021 <br />Fade the Ody: <br />ma�nnaatartara Rayroarpfun <br />abEaLJ Farrra LLL REV, ]31 <br />P-36 of P-52 <br />