Laserfiche WebLink
CITY OF SANTA ANA <br /> Project Nos. 04-6375, 04-7709 El Salvador Center Renovation <br /> Project No. 05-7806 El Salvador Park Improvements <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 2.Status of Federal Action 3.Report Type: <br /> 0 a.Contract 0 a.Bid/offer/application ❑ a.initial <br /> b.Grant b.initial award b.material change <br /> c.Corporate Agreement - c,post-award <br /> d.Ban For Material Change only: <br /> e.Loan Guarantee Year quarter <br /> f.Loan Insurance date of last report <br /> 4.Name and Address of Reporting Entity 5.If Reporting Entity in No.4 is Subawardee, Enter Name and. <br /> Address of Prime:. <br /> , 0 Prime ❑Subwardee <br /> Tier ,If known <br /> Congressional District,if known Congressional District,ifknown <br /> ' 6.Federal Department/Agency: 7.Federal Program Name/Description <br /> (JFDA Number,If applicable <br /> 8.Federal Action Number,Vknown 9.Award Amount,(known <br /> ' ` 10.a.Name and Address of Lobbying Entity b.Individual Performing Services(brim/Mg adcb-ess fd enentfvmNo. <br /> grinthiabstnaNfigM9 10a) <br /> 9astnamefn M9 <br /> (attach Continuation Sheet(s)if necessary) <br /> 11.Amount of Payment(check all that apply): 13.Type of Payment(check all that apply) <br /> $ ❑Actual ❑Planned ❑a.retainer <br /> 0 b.one-time fee <br /> 12.Form of Payment(check all that apply): 0 c.commission <br /> 0 a.cash ❑d.contingent fee <br /> 0 b.in-Idnd;specify:nature ❑e.deferred <br /> value 0 f.other,specify <br /> ' 14.Brief Description of Services Performed or to be performed and Date(s)of Service,including officer(s),employee(s),or member(s)contacted, <br /> for Payment indicated in item 11: <br /> (attach Continuation Sheet(s)ifnecessary) <br /> 15.Continuation Sheet(s)attached: 0 Yes ❑No <br /> 16.Infamtrnrequest:ddnai thsfinnisauflntizedbyTilte31USCSection <br /> ' 1352.This disclosure ofldmbyingactivities isanntetialrepie tiouoffctupon Signature <br /> whichteliatnewas pl dbythetieraboveweenthetruaactionwasnude centered <br /> into.This disclosure is requitedpcusuantto3lUS.01352.This inbanatiouwtAbe Print Name • <br /> repmkchnifeCongesssmi-anmBllyardwffibeavalablethrpublicinspection <br /> Anypersonw &ilshmfietheteqttmecldisclosutesha11besubjecttoacivlpetmllyof Title <br /> IIII <br /> witless than$10,000andnotnnrethan$100,000fareachsuchfarlinn <br /> Telephone No. Date <br /> ' FedetalUse Only: Authorized for Local Reproduction. <br /> Standard Forth—LLL <br /> TO BE INCLUDED IN BID PACKAGE <br /> BP 22 of 28 <br />