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DISCLOSURE OF LOBBYING ACTIVITIES <br />Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352 OMB Number: 4040-0013 <br />Expiration Date: 02/28/2022 <br />1. * Type of Federal Action: <br />2. * Status of Federal Action: <br />3. * Report Type: <br />❑ a. contract <br />a. bid/offer/application <br />® a. initial filing <br />® b. grant <br />® b. initial award <br />❑ b. material change <br />❑ c. cooperative agreement <br />❑ c. post -award <br />❑ d.loan <br />❑ e.loan guarantee <br />f. loan insurance <br />4. Name and Address of Reporting Entity: <br />®Prime F—]SubAwardee <br />Name <br />City of Santa Ana <br />Street 1 Street 2 <br />220 S. Daisy Ave <br />City State zip <br />Santa Ana CA: California 92703-9000 <br />Congressional District, If known: CA-1 <br />5. If Reporting Entity in No.4 is Subawardee, Enter Name and Address of Prime: <br />6. * Federal Department/Agency: <br />7. * Federal Program Name/Description: <br />Bureau of Reclamation <br />WaterSMART (Sustain and Manage America's Resources for Tomorrow) <br />CFDA Number, ifapplicable: 15.507 <br />8. Federal Action Number, ifknown: <br />9. Award Amount, ifknown: <br />$ <br />10. a. Name and Address of Lobbying Registrant: <br />Prefix First Name N/A Middle Name <br />"Last Name N/A Suffix <br />Street 1 N/A Street 2 <br />city N/A State zip <br />b. Individual Performing Services (including address ifdifferentfrom No. 10a) <br />Prefix * First Name N/A Middle Name <br />* Last Name N/A Suffix <br />Street 1 N/A Street 2 <br />City N/A State zip <br />11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which <br />reliance was placed by the tier above when the transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to <br />the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than <br />$10,000 and not more than $100,000 for each such failure. <br />` Signature: Completed on submission to Grants.gov <br />*Name: Prefix "First Name Middle Name <br />Rudy <br />"Last Name Suffix <br />Rosas <br />Title: Principal Civil Engineer Telephone No.: F Date: Completed on submission to Grants.gov <br />Federal Use QDI : <br />y <br />Authorized for Local Reproduction <br />Standard Form - LLL (Rev. 7-97) <br />PREVIEW Date: Nov 03, 2021 Workspace ID: WS00800354 Funding Opportunity Number: R22AS00023 <br />