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Local Assistance Procedures Manual EXHBIT 10-R <br />Disclosure of Lobbying Activities <br />Exhibit 10-Q Disclosure of Lobbying Activities <br />DISCLOSURE OF LOBBYING ACTIVITIES <br />l.yiytrLb i1=, t rata r UKNt t v iJLJC LUJb LVt31i Y I NU AU 1 1 V I L I hS YUKSUANT TO 31 U <br />1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: <br />a. contract ? a. bid/offer/application ? a. initial <br />b. grant b. initial award b. material change <br />c. cooperative agreement c. post-award <br />d. loan For 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 No. 4 is Subawardee, <br />Enter Name and Address of Prime: <br />? Primc ? Subawardee <br />Tier __. `, if known <br />Congressional District, if known Congressiono r' t <br />6. Federal Department/Agency: Oed o am cription: <br />'O' ber, if applicable <br />8. Federal Action Number, if kno and Amount, if known: <br />10. a. Nam d d s Lobb bIndividuals Performing Services (including <br />'d , la e, fi, baddress if different from No. 10a) <br />(last name, first name, MI) <br />(attach Continuation Sheet(s) ifnecessary) <br />11. Amount of Payment (check all that apply) 13. Type of Payment (check all that apply) <br />S ? actual ? planned a, retainer <br />b. one-time fee <br />12. Form of Payment (check all that apply): c. commission <br />8 a. cash d. contingent fee <br />b. in-kind; specify: nature a deferred <br />Value f. other, specify <br />14. Brief Description of Services Performed or to be performed and Datc(s) of Service, including <br />officer(s), employee(s), or member(s) contacted, for Payment Indicated in Item 11: <br />(attach Continuation Sheet(s) if necessary) <br />15. Continuation Sheet(s) attached: Yes [] No <br />16. Information requested through this form is authorized by Title <br />31 U.S.C. Section 1352. This disclosure of lobbying reliance Signature <br />was placed by the tier above when his transaction was made or <br />entered into. This disclosure is required pursuant to 31 U.S.C. Print Name: Michael Tahan <br />1352. This information will be reported to Congress <br />semiannually and will be available for public inspection. Any <br />person who fails to file the required disclosure shall be subject Title: Senior Vice President <br />to a civil penalty of not less than S 10,000 and not more than <br />6100,000 for each such failure. Telephone No.. (949) 474-2908 Date: <br />Authorized for Local Reproduction <br />Federal Use Only: <br />Fomf <br />Standard Form - LLL <br />LPP 06-02 Page 10-77 <br />May 1, 2006 <br />MLIL City of Santa Ana I Public Works Agency Page 1 18 <br />First Street Bridge Replacement I Construction Management