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CITY OF SANTA ANA <br />PROJECT 12-7527, 12-7528, 12-7529, 12-7530 <br />PROPOSAL AND CONTRACT AGREEMENT <br />DISCLOSURE OF LOBBYING ACTIVITIES <br />Com fete this form to disclose lobb in activities ursuant to 31 U S C 1352 <br />1 . Type of Federal Action 2. Status of Federal Action 3. Report Type: <br />?] a. Contract ? a. Bid/other/application ? a. initial <br />b. Grant 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 quarter <br />f. Loan Insurance date of last re rt <br />4. Name and Address of Reporting Entity 5. If Reporting En[ity in No. 4 is Subawardee, Enter Name and <br /> <br />p'?rime Q Subwardee <br />x Address of Prime: <br />? <br />ALP 9PJC. ?f3A EXCEL f'AV?iVG C MPANY <br />Tier , lrknon?t?Z?C LEMOM AVENUE <br />Con ressional District, i knob BEACH, CA 90806 Con essional District, i known <br />G. Federal Deparnnent/Agency: 7. Federal Program Name/Description <br /> CFDA Number, If a livable <br />8. Federal Action Number, irknotvn 9. Award Amount, i1'knrnrn <br /> <br />10. a Name and Address of Lobbying Entity b. Individual Performing Services (rrr/irfavg ?t3rsijcL?iPrsfirxvr Na <br />C?irrfi?i fr>t ?m,?1r? MI) ??) <br />(Ic>sl?rnnelnsliraiae, M/) <br />attach Continuation Shee s ifnecess <br />1 1. Amount of Payment (check all that apply): ] 3. Type of Payment (check all that apply) <br />$ Q Actual ? Planned ? a. retainer <br /> Q b. one-time fee <br />12. Fonn of Payment (check all that apply): Q c. commission <br />Q a. cash ? d. contingent fee <br />? b. in-kind; specify: nature Q e. defer-ed <br />value Q f. other, s ci <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 1 1: <br />a[[ach Continziat[on Sheets [ necessar ) <br />15. Continuation Sheets attached: Q Yes o <br />16. Infanttation reques4?d th?ntrgl-t this form is atrti?tai?d by TNe 3 ] USC Section <br />1352. This disclostue ofktblrying activities is arna?ialtepresatlatiott offactupon Signature??. <br />--._.-- <br />wl-uchrelianoewasplaoedbythetierabovewhentttehar?.-tia?wasmadeorat?red <br />into. 'This discbstae is regtr;tc.d putst.Ettrtto 31 U.S.C.1352. This infomtaHon will be E?C`?* <br />Print Name v . ?' .. ? ?i (.? ? ie" , ? t _ <br />tc?x>,ted to Hie Cortgtss setni?annttal ly and will be available for public inspection. <br />Atry petsott who fails to file Hie requin3d disclostue shall be subjectto a civil penalty of Title <br />not lessilran$10,OOOandnotnxxethan$100,000for®chsuchfailtae. 7'ele hone No. X562) 59$-5847 Date JUN - 6 20 <br />Federal USa Only: Authorvxd for Local Reproduction <br /> ScvidaM F'onn - LLL. <br />TO BE INCLUDED IN BID PACKAGE <br />BP 3 1 of 37