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CITY OF SANTA ANA <br />PROJECT NO. 10 -7557: GARFIELD EXERCISE PARK <br />PROPOSAL AND CONTRACT AGREEMENT <br />DISCLOSURE OF LOBBYING ACTIVITIES <br />Complete this form to disclose lobb i aR activities pursuant to 31 U.S.C. 1352 <br />1. Type of Federal Action <br />2. Status of Federal Acfion <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 i quarter_ <br />f. Loan Insurance <br />date of last repair <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 Ifknown <br />Congressional District, ifknown <br />Congressional District, i known <br />6. Federal Department/Agency: <br />7. Federal Program Name/Description <br />CFDA Number, Ifapplicable <br />8. Federal Action Number, ifknown <br />9. Award Amount, ifknown <br />10. a. Name and Address of Lobbying Entity <br />b. Individual Performing Services rtixledgg cxkGrsf y4&v nfwmAr¢ <br />rr"Ari aa,'kdavgf g 11'1 <br />I Lbi) <br />(kV1 inIV,f#st&Mr, 1Y19 <br />attach Continuation <br />Sheets 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 />❑ c. commission <br />12. Form of Payment (check all that apply): <br />❑ a. cash <br />❑ d, contingent tee <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 Cont alati07 Sheet (s) i necessat <br />15. Continuation Sheets) attached: E Yes No <br />16.Infommationwq estlthougrihisfamisattlhorizeIbyWe31 USC Section <br />1 352, This discicsweoflobbyingactividesisamaterialte ptcsentationoffictupon <br />Signature <br />wlvehrelh=wasplaa d lb/ dietierabowwhe mthet -, m,doiiwnsnrade aait2ied <br />into. Thisdi. immisra7uiedpwsantto3lUS .C1352.7hisinfonnationWIlbe <br />Print Name ROBERT LLOYD <br />repottec RotheCongwsemi- annually and ,41beaYA-bleforpublicfispection <br />PRESIDENT <br />Arrypascnvhofaflstofile& mquuWdLs cicsLueshallbesubjedtoacivilpakknllyof <br />Title <br />notless k m $10,000 and notmoce than $100,000 fa• each stdtfaihne. <br />Tele hone No. (714) 434- 0104Date 8 -14 -13 <br />Federal UseDtily: <br />Audrorized for Loea1 Reproduction <br />Standard Form —LLL <br />TO BE INCLUDED IN BID PACKAGE <br />BP 23 of 28 <br />