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a? <br />CITY OF SANTA ANA <br />Project No, 13 -6796: Chestnut Avenue Class 11 Bikeway born Standard Avenue to <br />Grand Avenue; CM- 5063(148) <br />PROPOSAL, AND CONTRACT AGREEMENT <br />DISCLOSURE OF LOBBYING ACTIVITIES <br />Com lero this torn to disclose lobbying activities oursuRnt to 31 U.S.C. 1352 <br />1. Type of Federal Action <br />2. Status of Federal Action <br />❑ a. Contract <br />❑ a. Bid/offer /application <br />b, Grant <br />b. initial award <br />ial change <br />/atcrdi'al <br />c, Corporate Agreement <br />c, post -award <br />d. Ban <br />ge only: <br />e. Loan Guarantce <br />___rter <br />f Loan Insurance <br />date of last report <br />4. Name and Address of Reporting Entity <br />5, If Reporting Entity' o. 4 is Subawanlee, Enter Name and <br />Address of Prime: <br />❑ Prime ❑ Subwardee <br />Tier, IJ'hnown <br />CcngrcssioaalDisftic jf/a7own <br />Co ssional Disb'ict, i 'known <br />6. Federal :Deparhnent /Agency: <br />7. 4ml Program Name/Description <br />CFDA Number, If applicable <br />S. Fedetut Action Number, iflmown <br />f9. Award Amount, i -known <br />10, a. Name and Address of Lobbying Entry <br />b. Individual Performing Services (a60ig akhrsaijclr�errn# mNa <br />�/rre6iratr$ kahzrr� joss tvlq <br />1(kr) <br />(m o f s 1q) <br />attach Continuation <br />Sheets if necess <br />11, Amount of Payment (check all da appI ): 13. Type of Payment (check all that apply) <br />$ F1 (_I Planned ❑ a. repiner .. <br />❑ b, one -time fee <br />l2. Form of Payment (check all a apply): ❑ c. commission <br />❑ a. cash ❑ d. contingent fbe <br />❑ b. in -kind; fy: nature ❑ e. deferred <br />value ❑ f. other, specify <br />14. Brief Description of e v ces Performed or to be performed and Dates) of Service, including officer(s), employee(s), or member(s) contacted, for <br />Payment indicated <br />anach Continuadar+ Sheet s i necessa <br />15. Conlinualio Sheets attached: Yes El No <br />l6,InhurigliftlermisatWraizedbyTit le3lU5CS�n <br />1352flnbyrgacftviriesi arrcttetbingae,=tatmoflbetupon <br />Signature 2, <br />y4kwas P1 <br />into,txlctittlpw9aantto3 1US.C.1352Thtfijfan>oliarwMbe <br />Print Name�p� <br />epassemarrnnllyandwllteaualablefLrinbc gxctiaL <br />"falc v <br />My Sle ho arimeda ckm esfwlrbesubjedtoacvlp�a yaf <br />fY! QQY6� <br />w s t <br />notlesslum,$ IO, OOOandnotmaenan $loo,WOfcreachsuchrarue <br />Tel hone No, W-79 •711Gc 6 ! Date 1� <br />Fo etAUse0 . Authodzal for Laval 11MMduciou <br />_ Stundardronn —LLL <br />BP 21 of 27 <br />23A -32 <br />TO BE 1NCl: ' D>IN °81*D PACKAGE <br />