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Exh. D - MSA with Siemens <br />Attachment 1 Approved by OMB. <br />DISCLOSURE OF LOBBYING ACTIVITIES e346-0046 <br />1. Type of Federal Action: <br />2. Status of Federal Action: <br />3. Report Type: <br />j� a. contract <br />❑a. bid/offer/application <br />a. initial fling <br />LL JJ b. grant <br />b. initial award <br />b, material change <br />c. cooperative agreement <br />c. post -award <br />For Material Change Only: <br />d. loan <br />year quarter <br />e. loan guarantee <br />date of last report <br />f. loan insurance <br />4. Name and Address of Reporting Entity: <br />5. If Reporting Entity in No. 4 is a Subawardee, Enter Name <br />Prime ❑ subawardee <br />and Address of Prime: <br />Tier , Ifknown: <br />Congressional District, if known: 4c <br />Congressional District, if known: <br />6. Federal Department/Agency: <br />7. Federal Program Name/Description: <br />CFDA Number, if applicable: <br />8. Federal Action Number, if known: <br />9. Award Amount, if known: <br />10. a. Name and Address of Lobbying Registrant <br />b. Individuals Performing Services (including address if <br />(if individual, last name, first name, Ml): <br />different from No. 10a) <br />(last name, first name, MI): <br />11, Informadon requested through No form Is authorized by Ilbe 31 U.S.C. section <br />of bet <br />Signature: <br />print Name: <br />1358 Thle allof lobbying activities is a matedai rapeasenbl <br />upon which reliance was placed byte bar above when this bansaadon was made <br />Title: <br />or entered Into. Thla sisal Is required pursuant to 31 U.S.O. 1352 This <br />Information will be available for publoInspection. Mypersanwho fare Wfile the <br />a,wlred d o, osure shell be subject b e cMl penalty of net less Nen $10,000 and <br />not mare Nan $100,000 her each such febure. <br />Telephone No.: Date: <br />Authorized for Local Reproduction <br />Federal Use Only: <br />Standard Form LLL (Rev. 7-97) <br />25D-33 <br />