TALLER SAN JOSE 13 - 2002 - Laserfiche WebLink

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'I. . ".,..~.,...,_'~'..,c-;., . ,-,,"',-.:. '-'~"..-, '-~'w,."""'"""'~""~'""""""~ "_,,,~ .; .. n.._~_, ~,,,_~_.___ . ....... ...." 1. Type of Federal Action: D a. contract b. grant c. cooperative agreement d.loan e. loan guarantee f. loan insurance 4. Name and Address of Reporting Entity: D Prime D Subawardee Tier ____. if known: DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 V.S.C. 1352 See reverse for ublic burden disclosure. 2. Status of Federal Action: 3. Report Type: Da. bidlofferlapplication D a. initial filing b. initial award b. material change c. post-award For Material Change Only: year quarter __ date of last report Approved by OMS 0348-0046 5. If Reporting Entity in No.4 is a Subawardee, Enter Name and Address of Prime: Con ressional District, if known: 6. Federal Department/Agency: Con resslonal District, if known: 7. Federal Program NamelDescription: CFDA Number, If applicable: 8. Federal Action Number, If known: 10. a. Name and Address of Lobbying Entity (If individual, last name, first name, MI): 9. Award Amount, if known: $ b. Individuals Performing Services (including address if different from No. 10a) (last name, first name, MI): (attach Continuation Sheet 0 SF-LLLA, if necesoary) 11. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply): $ ___ 0 actual 0 planned 0 a. retainer D b. one"time fee D c. commission D.d. contingent fee o a. deferred o f. other, epeclfy: 12. Form of Payment (check all that apply): o a. cash o b. in-kind; specify: nature ______ value ____ 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: (anach Continuation Shaat(o) SF-LLLA, If necassa j 15. Continuation Sheet s SF-LLLA attached: 0 Yo 0 No 16 Information requnled lhraugh lhis form iI Ilulhorized by tiUe 31 U.s.C. section Signature' . 1352. This disdosulll of lobbying .clivitiu is . material reprtWltallon of fact. . upon which reliance was placecl by the Uer ebovewhen lhillral1$8Clion WIIS mede P . t N or entered Inlo. Thll dlldolUre iI IlIqulrecl pl.RU8nt to 31 U.S.C. 1352, 11111 rtn ame: lnformlltioo will be repor1llcllo \he Congesa aeml-ennUllly .nd WIll '- avtlllble for pubic Inspectia1. MY person who fellB to "Ie the requQd dltdoeure Ihllll bJ subject to a clYil penalty of not leu \het $10,000 end not more than 1100.000 for nchsudlfalkue. Fe.deral Use Only: Tille: Telephone No.: Date: Authorized for Local Reproduction Standard Fonn LLL (Rev. 7-97)