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PALP, <br />2> <br />LUG <br />CITY OF SANTA ANA <br />PROTECT TITLE & NO. # <br />PROPOSAL AND CONTRACT AGREEMENT <br />DISCLOSURE, OF LOBBYING ACTIYPI'IES <br />Comolete this form to disclose lobbvina antivitiee nursuanrm 41 it e r, r aco <br />1. Type of Federal Action <br />2. Status ofPedeml Action <br />3. Report Type: <br />Al a. Contract <br />,�] a. Bid/offer /application <br />KI 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 />Por Material Change only: <br />e. Loan Guaantee <br />Year_ qumfer <br />f. Loan Insurance, <br />dale of Irstre oat <br />4. Nano and Address ofReponing Entity <br />5. If Reporting Entity in No. 4 is Subawardee, Enter -Name and <br />of Prime: <br />.EMM AWNUE <br />HEA gaWistrirt i latmvn <br />Con essionalDistrict, i knoimn <br />6. Federal Department/Agency: <br />7. Federal Program Name/Description <br />07DANwnber Ifapplicable <br />8. Federal Action Number, ifknowm <br />9. Award Amount; ifknom <br />10. a, Name and Address of Lobbying Entity <br />b. Individual Performing Services (#vhd#rg ak6zasJ/ V,,,ef,,uNa <br />(tzd'rttaf..a(&d»vr'efas4 <br />ILtr) <br />(lanrem�,�oS1 trmrG M� <br />attach Continuation <br />Sheets ifnecess <br />11. Amount of Payment (check all that apply): <br />11 Type of Payment (ebeck all that apply) <br />$ ❑ Actual ❑ Planned <br />❑ a. retainer <br />❑ b. one -tune fee <br />❑ c. commission <br />12. Fonn ofPaymant (check all that apply): <br />❑ a. cash <br />❑ d. contingent fee <br />❑ b. in -ldnd; specify: nature <br />❑ e. deferr <br />value <br />f, other, s ecify <br />14. Brief Description of Services Performed or to be performed and Date(s) of Service, including officer(s), enployee(s), or member(s) contacted, for <br />Payment indicated in item 11: <br />attach Continuation Sheet s i cessa <br />15. Continuation Shee s attached: Yes o <br />16.hamnEicnral mbdfm 4hibisfwnis"mwdbyTide31USCSa4m <br />1352 Thisds lmmof obbymgadivifiesisannk ialmpes�offadupon <br />Signature <br />whichidaarcewaspl,mibyfttaabomwhenftft 3adiortwasmadeaenbcreil <br />C. P, BROWN, PREME W <br />he. Tlnsdiscicstwis tiedpa&=b3l U.S.C135Z Thisudmmlimwillbe <br />PrintNarne <br />aepxle bt rCagteasmlik%mLdR andwi7lbem ,i&bleforpubliciispcion <br />4nypr�` onwfiofaiLstoSfe�raTuit eddi�lcaueshallbesubjectfoaciv7paraltyof <br />Title <br />notless6=$ 10, 000andnatnraedm $100,000faaachsudifailura <br />(562) 599 -5041 SEP °� � 2014 <br />Tel hone No. Date <br />FedsalUs;Grry <br />Aubodwd for I ocal RepvducGon <br />Smidmd Foma —LLL <br />BP 20 of 26 <br />23BB -30 <br />