Laserfiche WebLink
DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB <br />Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046 <br />Action: <br />a. contract <br />b. grant <br />c. cooperative agreement <br />d. loan <br />e. loan guarantee <br />f. loan insurance <br />4. Name and Address of Repoi <br />❑ Prime <br />Be reverse Tor DUDuc Duraen disc <br />Status of Federal Action: <br />�a. bid/offer/application <br />b. initial award <br />c. post -award <br />❑ Subawardee <br />Tier . if known: <br />Congressional District, if known: <br />6. Federal DepartmentlAgency: <br />3. Report Type: <br />a. initial filing <br />b. material change <br />For Material Change Only: <br />year _ quarter <br />date of last report <br />If Reporting Entity in No. 4 is a Subawardee, Enter Name <br />and Address of Prime: <br />CFDA Number, if applicable: <br />8. Federal Action Number, if known: <br />9. Award Amount, if known: <br />10. a. Name and Address of Lobbying Entity <br />b. Individuals Performing Services (including address if <br />(if individual, last name, first name, Ml): <br />different from No. 10a) <br />(last name, first name, Ml): <br />(attach Continuation Sheets) SF-LLLA, ifnacessary) <br />11. Amount of Payment (check all that apply): <br />13. Type of Payment (check all that apply): <br />$ —__—_ ❑ actual ❑ planned <br />❑ a. retainer <br />❑ b. one-time fee <br />12. Form of Payment (check all that apply): <br />❑ c. commission <br />❑ a. cash <br />❑ d. contingent fee <br />❑ b. in -kind; specify: nature <br />❑ e. deferred <br />value <br />❑ f. other; specify: <br />14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), <br />employee(s), or Member(s) contacted, for Payment Indicated in Item 11: <br />(attach Continuation Sheet(s) SF-LLLA, if necessary) <br />15. Continuation Sheet(s) SF-LLLA attached: ❑ yea <br />❑ No <br />reque <br />sted <br />ested Mrough this loon auModre is d by titlesecti 31 U.S.C. on <br />15. 1352. This disdosure a lobbying sr it es is a male N] repeserNiion of fad <br />upon whloh reW. wan Placed by the Ear above when this irsr tips ws. made <br />or emend MM. This disdosure is hs,i d pursuant W 31 U.S.C. 1352. This <br />nlamnEon will be repo fed lo IN, Congress semi -.ally end will bs evalebb,, <br />public inspxtlon. My person who fan. W Ill. Ise regiired dsdosure chars bs <br />subject lo a dvr penny of rot k.. that $I0.0g0 srM rwt mare Man $IKO 10 tar <br />each suds forum. <br />Name: <br />No.: __ Date: <br />I Authorized for Local Reproduction <br />