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• • <br />CITY OF SANTA ANA <br />PROJECT NO. 10-7503; Bella Vista, Casa Bonita, Central City and Pico-Lowell Neighborhood <br />lmprovements <br />PROPOSAL AND CONTRACT AUREEMENT <br />DISCLOSURE OF LOBBYING ACTIVITIES <br />CO171D1CtC tI715 form YO fIISCI(15P. InhhVinv artivihPC nnrcnant to 'i l 1 I fi !' I Z G7 <br />1. Type of Federal Action 2. Status of Federal Action 3 -Report Type: <br />^ a. Conhact ^ a. Bid/offer/application ^ a. initial" <br />b. Crrant b. initial award b. material change <br />c. Corporate Agreement c, post-award <br />d. Ban For Material Change only: <br />e. Loan Guarantee Year <br />grwrter <br /> <br />f. Loan insurance _ <br />_ - <br />ddte of last report <br />4. Name and Address of Reporting Entity ~. If Reporting Entity in No. 4 is Subawardee, Enter Name and <br /> Address of Prime: <br />^ Prime ^ Sabwardee <br />'Tier ___ , If known <br />Congressional District, r known Con essio ' l District, i knowzz <br />6. Federal Depaltnrent/Agency: 7. Federal Program Name/Descliption <br /> CFDA Ntrmirer, if applicable <br />8. Federal Action Number, if known 9. Aovard Amount, iJ-known <br /> $ <br />a. Natne acrd Address of Lobbying Entity b. Individual Perforrrring Services (rrnkrling cukLvcs~~G~rrztfrvmNo <br />(fnr>fVr>I,rtllcnrrrar,~~# tt~ 1 Ckr) <br />(lastiuzrne,Jrr51» cznze, r1~1Q <br />(attach Continuation Sheet(s) if necessary) <br />11. Amount of Payment (check all that apply): 13. Type of Payment (check all that apply) <br />$___ ^ Actual ^ Planned ^ a. retainer <br /> ^ b. one-time fee <br />12. Form of Payment {check all that apply): ^ c. commission <br />^ a. cash ^ d. contingent fee <br />^ b. in-kind; specify: nature !` ^ e. deferred <br />_ <br />i' value ^ f. other, ify <br />14. Brief Description of Services P . omied or to be performed and Date(s) of Service, including officer(s), employee(s), or member(s) contacted, for <br />Payment indicated in item 1 1: <br />(attach Continuation Sheet(s) ifnecessan) <br />15. Continuation Sheets ttached: ^ Yes No <br /> <br />16. hrfomnricnztegrlested drisfotmisaud~iaerlbyTide31USCSedxxt _ <br />1352. Thsdiscbslzreo~IE~ acrivitiesisan~iialtelaesetoffactt}ion Signature X ___ _ ______ <br />wtnchre}>i¢rewas~l~oedbydzetraabrr,~ewhendletr~mcharwdsrr>adeoliat~ed <br /> <br />itrto. Thisdiscbsy~isregttmedlx~r~mt~i31 U.S.C.1352. 'Ihisu~fonrratiaiwrIlbe ichael J. Carver <br />Print Natne _ <br /> <br />tepotiedtothe Berri-ar¢alallyatYlw>Ilbeavallableforpublicuspaction - ----- -- <br />Any faz7stofiledrertidi9cbaueshal(bestlbjattoacivrlper~lhyof Titie President -__ __ <br />rot less $10,000 acrd rot mrxe than $100,000 fcxeach such faihne. <br /> 714 - 6 3 7 -15 5 0 0 2 / 18 / 2 010 <br />T'el hone No. Date <br />"'~IH"dIUSeClllly' Authcxizexl for Lixal Relmrxiucttem <br /> Standatrl Form- LLI, <br />TO BE INCLUDED IN BID PACK.AGI: <br />BP 24 of 30 <br />