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CITY OF SANTA ANA <br />PROJECT 11 -2612 — MAPLE STREET BIKE TRAIL ENHANCEMENT <br />PROJECT 11 -2605 — GOLDEN LOOP BIKE TRAIL REHABILITATION <br />PROPOSAL AND CONTRACT AGREEMENT <br />DISCLOSURE OF LOBBYING ACTIVITIES <br />(�U /" / <br />Ccirn Iete thic form to rlicclnce lnhhvin¢ activities nursuant to 31 U.S.C. 1352 <br />1. Type of Federal Action <br />2. Status of Federal Action <br />3. Report Type: <br />❑ a. Contract <br />❑ a. Bid/offer /application <br />❑ a. initial <br />b. Grant <br />b. initial award <br />b. material change <br />c. Corporate Agreement <br />c, post -award <br />d. Ban <br />For Material Change only: <br />e. Loan Guarantee <br />Year quarter_ <br />f. Loan Insurance <br />date of last report <br />4. Name and Address of Reporting Entity <br />5. If Reporting Entity in No. 4 is Subawardee, Enter Name and <br />Address of Prime: <br />❑ Prime ❑ Subwardee <br />Tier , If known <br />Congressional District, i known <br />Congressional District, i known <br />6. Federal Department/Agency: <br />7. Federal Program Name/Descdption <br />CFDA Number, If applicable <br />8. Federal Action Number, f known <br />9. Award Amount, f known <br />10. a. Name and Address of Lobbying Entity <br />b. Individual Performing Services (urhdng ad4rssifd fi=No. <br />(¢tW <br />Ilkr) <br />(last ncaw fu& nwg Ml) <br />(attach Continuation <br />Sheet(s) if necessary) <br />11. Amount of Payment (check all that apply): <br />13. Type of Payment (check all that apply) <br />$ ❑ Actual ❑ Planned <br />❑ a. retainer <br />❑ b. one -time fee <br />❑ a commission <br />12. Form of Payment (check all that apply): <br />❑ a. cash <br />❑ d. contingent fee <br />❑ b. in -kind; specify: nature <br />❑ e. deferred <br />value <br />❑ f. other, specify <br />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 <br />Payment indicated in item 11: <br />(attach Continuation Sheet(s) if necessary) <br />15. Continuation Sheet(s) attached: ❑ Yes ❑ No <br />16. k&nnation mWestodthrough this ftmn is mdior � by Tide 31 USC Section <br />1352. This disclosureoflobbying acMes isatimterial rqxesmbfion offactupon <br />Signature <br />which reliancewasp lacedbythetierabove when d etransacionwasmadeorentaw <br />inlo. Thisdisclos ureisrequuedpumimto31 U.S.C.1352. This uifomration will be <br />Print Name <br />reportedtio the Congress semi annually and will be avxlable forpublic inspec6m <br />Any person who fails b file the required disclosure shall be subject l o acivil penalty of <br />Title <br />not less than $10,000 and not more than $100,000 foreach such failure. <br />Telephone No. Date <br />Federal Use Only: <br />Authorized for Local Reproduction <br />Standard Form —LLL <br />TO BE INCLUDED IN BID PACKAGE <br />BP 22 of 28 <br />