Laserfiche WebLink
CITY OF SANTA ANA <br />Project No. 08-1732: Grand Avenue Widening from First Street to Fourth Street <br />Project No. 12-6604: Grand Avenue Storm Drain from First Street to Fourth Street <br />PROPOSAL AND CONTRACT AGREEMENT <br />DISCLOSURE OF LOBBYING ACTIVITIES <br />Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 <br />1. Type of Federal Action <br />2. Status of Federal Action <br />3. Report Type: <br />IN 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 />E 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, EnterNatne and <br />Address of Prime: <br />Prime ElSubwardee <br />Tierffknawn%`' <br />r r res hl i+�rYl- <br />Corilgessional District, i known - i'- • — - a d, ;o¢ ° ti <br />Congressional Dist4 f known <br />6. Federal Department/Agency: <br />7. Federal Program Name/Description <br />CFDANumber, Ifapplicable <br />8. Federal Action Number, iflcnawn <br />9. Award Amount, flinawn <br />10. a. Name and Address of Lobbying Entity b. Individual Performing Services (ux3ading ad,+egsich au#omNo J00 <br />(i/�Ia�veenQfasatYlG (lcstrxrm4firstnan�M� <br />attach Continuation 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 -tune fee <br />❑ c. commission <br />12. Fonn 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 />❑ E 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 Continuation Sheets i cess <br />15. Continuation Sheet(s) attached: ❑ Yes o <br />16.hilbirationmquesledthnugli UsfonnisauhmimdbyT&31USC Sedan <br />vaL <br />1352. ThsdiscbmoflobbyingadivifiesisamataWtgxesmbr onoffadupon <br />Signature <br />whichwliatwwasplwcdl) &t herabovewhm&,tmwlionwasmadeormkwd <br />r {s <br />CY° <br />into.'IhsdscicsmismgimedAnakfftb3lUS.C1352 Timsinfonnabonwllbe <br />Print Name <br />repoit dto4teCongtasssemi-aotnk*"wAbeavailableforp hcneon <br />Atrypemnwhofailstofilethetequitrddisclostnslta4besu oamacivdpenaltyof <br />Title <br />wtlm km $10,000 aadnotrmie4m $100,000fcreackisurhf iii <br />,A <br />Tel hone No. Date <br />FBda2lUseGnly: <br />Aul'horizedfml-ocalRepmductiou <br />Standard Form—LLL <br />TO BE INCLUDED IN BID PACKAGE <br />BP 25 of 31 <br />