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Exhibit 5 <br />DISCLOSURE OF LOBBYING ACTIVITIES <br />Comolete this form to disclose activities pursuant to 31 U.S.0 1352 <br />1. Type of Federal Actions: <br />2. Status of Federal Actions: <br />3. Report Type: <br />a. contract <br />a, bid/offer/application <br />a. initial filing <br />b. grant <br />b. initial award <br />b. material change <br />C. cooperative agreement <br />C. post -award <br />d. loan <br />For material change only: <br />e. loan guarantee <br />Year: Quarter: <br />f. loan insurance <br />Date of last report: <br />4. Name and Address of Reporting Entity <br />5. If Reporting Entity in No. 4 is a Subawardee: <br />Prime Subawardee <br />Enter Name and Address of Prime: <br />Tier if known <br />Con ressional District, if known: <br />Congressional District, if known: <br />6. Federal Department / Agency: <br />7. Federal Program Name/Description <br />8. Federal Action Number, if known: <br />9. Award Amount, if known: <br />10a. Name and Address of Lobbying Entity <br />10b. Individual Performing Services <br />(if individual, last name, first name, MI): <br />(including address if different from No. 10a) <br />(last name, first name, MI): <br />attach Continuation Sheets SF -LLL -A, if necessary) <br />11. Amount of Payment (check all that apply): <br />13. Type of Payment (check all that apply) <br />$ Actual <br />a. retainer <br />Planned <br />b. one-time free <br />C. commission <br />12. Form of Payment (check all that apply): <br />a. cash <br />d. contingent fee <br />b. in-kind: specify: <br />e. deferred <br />nature: <br />f. other specify: <br />value: <br />14. Enter Description of Services performed or to be Performed and date(s) of Service, including officer(s), employee(s), or Member(s) <br />contacted, for Payment indicated on item 11: <br />15. Continuation sheets SF -LLL -A attached: ❑ Yes ❑ No <br />16. Information requested through this form authorized by Title <br />31 U.S.C. Section 1352. This disclosure of lobbying activities is a <br />Signature: <br />material representation of fact upon which reliance was placed by the <br />tier above when this transaction was made or entered into. This <br />disclosure is required pursuant to 31 U.S.C. 1352. This information <br />Print Name: <br />will be reported to the Congress semiannually and will be available for <br />public inspection. An person who fails to file the required disclosure <br />shall be subject to a civil penalty of not less than $10,000 and not <br />Title: <br />more than $100,000 for each such failure. <br />Telephone No: <br />Date: <br />County of Orange Page 2 of 3 City of Santa Ana <br />OC Community Resources Contract # 16-28-0039-RWS-P <br />20A-54 <br />