ORANGE COUNTY CRAZIES 4 - 2001 - Laserfiche WebLink

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'-' """ DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 Approved by OMS 0348-0046 ISee reverse for public burden disclosure.) 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: D a. contract Da. bid/offer/application D a. initial filing b. grant b. initial award b. material change c. cooperative agreement c. post-award For Material Change Only: d.loan year _________quarter _________ e. loan guarantee date of last report ___________ f. loan insurance 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No.4 is a Subawardee, Enter Name o Prime o Subawardee and Address of Prime: Tier ______, if known: Conaressional District, if known: Conaressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, if applicable: ___________ 8. Federal Action Number, if known: 9. Award Amount, if known: $ 10. a. Name and Address of Lobbying Entity b. Individuals Performing Services (including address if (if individual, last name, first name, MI): different from No. lOa) (last name, first name, M/): (attach Continuation Sheet(s) SF-LLLA, if necessarY) 11. Amount of Payment (check al/ that apply): 13. Type of Payment (check al/ that apply): $ --------- o actual o planned o a. retainer o b. one~time fee 12. Form of Payment (check all that apply): o c. commission o a. cash D d. contingent fee o b. in.kind; specify: nature ------- o e. deferred value -------- o f. other; specify: 14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or Member(s) contacted, for Payment Indicated in Item 11: (attach Continuation Sheet(s) SF.LLLA, if necessary) 15. Continuation Sheettsl SF-LLLA attached: OYe. ONa 16 Information requested through this form is authorized by \iUs 31 U.S.C. section Signature: . '352. This disdosure of lobbying activities Is a malarial represenlaoon of fact upon which raliancewes placed byUle tier abovawhen this lIansactiOl1 was made Print Name: or entered into. This disdosure is required pursuant to 31 U.S.C. 1352. This informaticn will be reported to the Cool1&se seml-annuaty and will be available for Title: public inspectim. Any person who fails to file the requi'ed disd08UI8 shall be subject to a civil penalty of not Ies8 that $10,000 and not more than $100,000 for Telephone No.: Date: each sud1 failure. Federal Use Only: I Authorized for Local Reproduction Standard Form LLL (Rev. 7-97)