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CITY OF SANTA ANA <br />06 -1723: FIRST STREET BRIDGE REPLACEMENT PROJECT <br />DISCLOSiJRE OF LOBBYING ACTIVITIES <br />- �.....� �. -�.�.� .- ucs wsumu tv J l U.J.L.. l3JL <br />lO. TType of Federal Action 2. Status of Federal Action 3. Report T e: <br />a Contract Q a Bid/ofFer /application � .initial <br />b. Grant b. initial award b. material change <br />c. Corporate Agreerrtent c, post -award <br />d. Ban F Material Change only: <br />e. Loan Guarantee Year quarter <br />f. Loan Insurance date of last report <br />4. Name and Address of Reporting Entity 5. if Reporting Entity in o. 4 is Subawardee, Enter Name and <br />Q Prime Address of Prime: <br />� Subwardee <br />Tier /fknou•n <br />Con essional District, ifknrn vrr Con Tonal District, ifknoirn <br />6. Federal DeparhnenVAgency: 7. Federa rogram Name/Description <br />CFDA Number, Ifap livable <br />8. Federal Action Number, ifknouvr "Award Amount, ifknrnvrx <br />1 O. a. Name and Address of Lobbying Entity b. Individual Performing Services (ixh,dirrg crck/rass ijdifferzrr<,/fa�rr No <br />C4a���1kv,�r���na0 � <br />,xv,r�fu sl,xn,r� n-9!) <br />(a ch Continuation Sheets) i ecessary) <br />1 1. Amount of Payment (check all that apply): <br />13. Type oB ayment (check all that apply) <br />$ 0 Actual Q Plann <br />�. retainer <br />� b�ene -time fee <br />12. Form of Pa merit check all that a 1 <br />Y ( pP Y)� <br />Q c" cO�nmission <br />� a cash <br />� d" contingent fee <br />� b. in -kind; specify: nature <br />� e. deferred <br />value <br />� f other, s \ -ci <br />14. Brief Description of Services Pert ed or to be performed and Dates) of Service, including offic �"(s), employee(s), or members) contacted, for <br />Payment indicated in item 1 1 : \ <br />\ <br />(altnch Continua /ion .Sheet(s) ifnc cessai ) <br />15. Continuation Sheets) a ached: Yes No � <br />]6. Lifaniatim regt�d Utisfrnnis at.rthaixdbyTitle3l USC Section <br />\ <br />1352 "'Ibis disclosu-e ofl 'ig activities isatnata"ial represe�,lation offact opal <br />Signature_ <br />�+d�idi reliance wasp by thetia� above whaithe haisamrn was made Lratla�d <br />�'� <br />into" Tltis disdostn�e" lured pttrstatrt toil U.S.C.1352 This infamamat will be <br />Print Name `\ <br />reputed to Ure Con< sani �uinually and will be avalable fo- public insl�Ugt <br />\� <br />Anypasatwho ..' Istofiletl�et�uueddisclostreshallbest .,bjacttoaciv�lpaialtyof <br />Title ___ <br />no[ Icy U�vt $1 ,000 and rid moretltan $100,000 fa- ®d� srFt failtna <br />Telephone No. <br />FedetsU U Qliy: <br />_Date <br />Authorized for Loud Reproduction <br />Standard Form — LLL <br />BP 23 of 29 <br />