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CITY OF SANTA ANA <br />Project No. 13-6796: Chestnut Avenue Class II Bikeway from Standard Avenue to <br />¢t,r Grand Avenue; CM -5063(148) <br />PROPOSAL AND CONTRACT AGREEMENT <br />DISCLOSURE OF LOBBYING ACTIVI'T'IES <br />CmmMetn. thio f.. n fn d;,Aue !Qbb j—..rvdvl i;.. n...--1 r,71 Tic r+ 119q <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 />'t a1 <br />b. Great <br />b. initial award <br />aterial change <br />c, Corporate Agreement <br />c, post -award <br />/Faterialm <br />d. Ban <br />Change onlye. <br />Loan Guarantee <br />quarter_ <br />f, Loan Insurance <br />date of last re rt <br />4. Name and Address of Reporting Entity <br />5. If Reporting Entity' o, 4 is Subawadee, Enter Name and <br />Address of Prime: <br />❑ Prime ❑ Subwarriee <br />Tier___ _,lflaiown <br />Con sional District, ;mown <br />Co ssional District, i '/mown <br />6. Federal Department/Agency: <br />7.17 ral Program Name/Description <br />CFDA Number, If applicable <br />B. Federal Action Number, iflmown <br />9. Award Amount, iflmown <br />10, a. Name and Address of Lobbying Entity <br />b. individual Performing Services (oideeiig cei6acsya.V ,,tfirotnNo. <br />(0thiird tzb"WA)%M9 <br />tor) <br />attach Cantinuation <br />Sheet(s) if necessary) <br />11. Amount of Payment (check all ds apply): 13, Type of Payment (check all that apply) <br />$ ❑ A ❑ Planned ❑ a. retainer '. <br />_ ❑ b. one-time fee <br />12. Foma of Payment (check all at apply): ❑ c. commission <br />❑ a. cash �❑ d. contingent fee <br />❑ b, in-kind; s fy: nature ❑ e. deferred <br />value ❑ f other, s e6i <br />14. BriefDescription of ervices Performed or to be performed and Dates) of Service, includurg officer(s), employce(s), or member(s) contacted, for <br />Payment indicated in i m 11: <br />(attach Coratim n on Sheet s) i 'recess'' <br />15, Coutinuatio Sheets attached: Yes No <br />16.1afaamtiom laeughUvsfanrisaukdwdbylide3IUSCSedion <br />1352,7his'ofkrUtryingactiwtiesisatmk'r'wlrel'Bticnaffr'ctupar <br />Signature .m <br />dmk el' waspindbydrtierabrnewhn0'eftmwiclmwasnmdeerenLted <br />iTh..'Ilis kanesralrte pmsuantto3lU.S,C1352,Thisirilamadarwdlbo <br />PritaName <br />reported dreCongre�seniararra,,ymdwrllbeavailableforpublichTection <br />Any wfiaralo6ethemgmeddckxa wlrhsbottoacvlpaayof <br />Title�/L YISIQdh <br />nale8sdran$10,000adnatmaed 100,0001breerluarhfailua <br />Tel hone No, SSI" 7 - WeDU Date �I <br />Fedml I wOnly <br />IAuihn zed fur o al Rcp ucl on <br />Standw]F( nn—LLL <br />TO BE INCMiWD IN-B1v PACKAGE <br />BP 21 of 27 <br />