Laserfiche WebLink
CITY OF SANTA ANA <br />PROJECT 12-2620, RPSTPLE 5063 (143) — FLOWER STREET BIKE TRAIL GAP CLOSURE <br />PROPOSAL AND CONTRACT AGREEMENT <br />DISCLOSURE OF LOBBYING ACTIVITIES <br />Complete this form to disclose lobbvine activities nnranant to 31 11. S.0 1252 <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 re ort <br />4. Name and Address of Repo 'QEnl, <br />5. eporting Entity in No. 4 is Subawardee, EnterNameand <br />ddress of Prime: <br />F-1 Prime ❑ Subw <br />Tier__,I,flm <br />Congressional District, i known <br />Congressional District, i known <br />6. Federal Departmerrt/Ageney: <br />7. cral Program Name/Description <br />CFDA Number, If applicable <br />8. Federal Action Number, ifknawn <br />fg. Aw dAmount, ifknown <br />$ <br />10. a. Name and Address of Lobbying Ent <br />b. Individual Performing Services (mrhk-&V cube fd rrtfrxnNa <br />f�lwrcng fMIJ <br />10x1 <br />attach Continuation <br />Sheet(s ifneces <br />11. Amount of Payment (chec all that apply): <br />13. Type ofPayment (check all that apply) <br />$ ❑ Actual ❑ Planned <br />❑ a. retainer <br />❑ b. one-time fee <br />❑ c. 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 />El 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 members) contacted, for <br />Payment indicated in item 11: <br />(attach ConhnuationShee s i ne <br />15. Continuation Sh s attached: El Yes NNo, <br />16inferm ation requesledthough this form is audictizedby Tide31 USC Seem <br />1352 Tbisdisckw=ofloblryingadiviliesisarrtataialr4xw"moffactupmr <br />whicbrelmwwasomdb3t tierabowwhaathetr&mWonwwniadeermkwd <br />A <br />Inc. Thisdisdosuteisfalie R=aiatto31USC1352 7hisinbanafienwillbe <br />PritaName <br />relxatedmiheCmsani�uuuallyandwillbeavai4ablefarpublicimpectiaa. <br />�Yf�jl !,�-QU' <br />AnypusmrwhofailstofiledlerequWddlg*aw llbeai*ctbadvilpenaltycf <br />Title l G <br />notlmtmu$10,000andnanm tn$100,000fcreadrsdlfaikm <br />t, <br />Tel hone No. q C1 0 <br />50-0 I UDate <br />FedealUseOnly: <br />Artho sdfprLocalReproductim <br />Standard Fonn—LLL <br />TO BE INCLUDED IN BID PACKAGE <br />BP 23 of 29 <br />