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➢ P WC. <br />2. UMi <br />LONG 0% <br />DISCLOSURE OF LOBBYING ACTIVITIES <br />I. Type of Federal Action: <br />® a. contract <br />b. grant <br />C. cooperative agreement <br />d. loan <br />e. loan guarantee <br />£ loan insurance <br />2. Status of Federal Action: <br />® n. bid/offer/application <br />b, initial award <br />c. post -award <br />4. Name and Address of Reporting Entity <br />Prime ® Subawardee <br />MEL PANG COWAW <br />Tier , if known <br />:5 4 IfENUE <br />�H' M Ligressional District, if known <br />6. Federal Department/Agency: <br />& Federal Action Number, if known: <br />10. it. Name and Address of Lobby Entity <br />(If individual, last name, first name, MI) <br />3. Report Type: <br />® a. initial <br />b, material change <br />For Material Change Only: <br />year quarter <br />date of last report <br />5. If Reporting Entity in No. 4 is Subawardce, <br />Enter Name and Address of Prime: <br />Congressional District, if known <br />7. Federal Program Name/Description: <br />CFDA Number, if applicable <br />p. Award Amount, if known; <br />b. Individuals Performing Services (including <br />address if different from No. 10a) <br />(last name, first name, Mn <br />(attach Continuation Sheet(s) if necessary) <br />11. Amount of Payment (check all that apply) <br />$ n actual ® planned <br />12. Form of Payment (clerk all that apply): <br />a. cash <br />b. in-kind; specify: nature <br />13. Type of Payment (clack all that apply) <br />a. retainer <br />b. one -thee fee <br />c. commission <br />d. contingent fee <br />e deferred <br />£ other, specify i_ _ <br />14. Brief Description of Services Performed or to be performed and Dato(s) of Service, including <br />officer(s), employee(s), or member(s) contacted, for Payment Indicated in Item It: <br />(attach Continuation Sheet(s) if ne sary) <br />15. Continuation Sheet(s) attached: Yes IJ No <br />16. Information requested through this form is authorized by <br />Title 31 U.S.C. Section 1352. This disclosure of lobbying <br />reliance was placed by the tier above when his transaction <br />was made or entered late. This disclosure is required <br />pursuant to 31 U.S.C. 1352. This information will be <br />reported to Congress semiannually and will be available for <br />public inspection. Any person who fails to file the required <br />disclosure shall be subject to a civil penalty of not less than <br />$10,000 and not more than $160,000 for each such failnrc. <br />Federal Use Only, <br />Print Name: <br />Telephone No.: i�B21539 58$1 <br />Authorized for Local Reproduction <br />Standard Form - LLL <br />