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CITY OF SANTA ANA <br />PROJECT NO. 11-7509 CITYWIDE RESIDENTIAL STREET REPAIR -PHASE 15 <br />PROPOSAL AND CONTRACT AGREEMENT <br />DISCLOSURE OF LOBBYING ACTIVITIES <br />C?cimnlete this fnrm to rlicrlr.ce l..i.F.?.:.... s..t:..:tie? .. ..r ?.. z i t i e n i z c? <br />1. Type Federal Action 2. Status of Federal Action 3. Report Type: <br />p a rnract p a. Bid/o$er/application p a. initial <br />b• b. initial award b. material change <br />c- Aunt q post-award <br />d. Ban For Material C11A ?e only: <br />e. Loan y? <br />f. Loan date of last <br />4. Name and Addr>rss of Entity 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and <br />p Prune. p Slyb Address ofPrirne: <br />Tier , If <br />sional District, i beown Co 'oral District, i lorolvrt <br />6. Federal Departrnent/Agency: 7. Federal Progarn Name/Description <br /> CFDA Number, 7f livable <br />8. Federal ActionNutnber, ifJaeowrt 9. Award Amount, iflaeown <br /> <br />" 3. Name and Address of Lobbyaig b. Individual Perfornvng Services (irrhrlvg acddrss ifiufiorn]Ua <br />??,li'?M? ILt? <br /> (last?rm?????? ? <br />attach Continuation if <br />11. Amolnt of Payment (c ?all <br />?ap? p <br />13. T Pay <br />check all that <br />apply) <br />( <br />A <br />?? <br />?? <br />r <br />b. fee <br />12. Form of Payment (check all that applyj: p <br />p a. ? p d contingent <br />p b. in-lid; specify: ?tin-e p e. defeued <br />value f. other, <br />14. Brief Descaiption of Services Performed or to be perfozaned and Date(s) of Service, inch ding officer(s), emplo or member(s) contacted, for <br />Payment indicated in item 11: <br />attach Continuation Sheets necessa <br />15. Continuation s attached: Yes No <br />16.Iab'mr?ann?les?dflmugh8asf?nisa?dby,Ti?e® 31USCSe?m <br />1352. Tk?d?c]o®aeof7ol?lryioga?tivitiesisans?almpre?ma?'fach?pm Si?ature <br />whidin?oe vc?splawdby87e tierabore wltaithe hansadionvc? made Q?ed <br />ir?i. TI>sdisdosaeisaegmedpi>rs?Yto31U.SC.1352.11risa>?r?mwitlbe Print Name Q??1?y-?- ?r ?? V <br />xepetadio?e Cmgtess saga-am?Ilyst?dwr?be av?'lable fapulalic in?ectim <br />' <br />.Anypasmwhofa>ZsbLletheroquaeddsc3oa=esl?IIbeai?ja?Ytoacavilpe®11ycrF Title ?/ <br />1Cf pr?Si e?PVI'? <br />notlessTl>ati$10;000 andmtaaefl?$1Og000for®chsldifa?3ae. <br /> Te No. Date <br />FederalLTse Only. Auiho/iaed frr 7 M 7 Reproaucuan <br /> SmMsad Fom?- l r l . <br />TO BE INCLUDED IN BID PACKAGE <br />BP 23 of 29