Agenda - 05-03-2007-4f - Laserfiche WebLink

Browse Search

as DISCLOSURE OF LOBBYING ACTIVITIES. ApprovedbvoMB Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046 (Spa rpvarse fnr rmhlic hurdpn disclosure) 1. Type of Federal Action: ~a. contract 2. Status of Federal Action: ~a. bid/offer/application 3. Report Type: ~a. initial filing b. grant b. initial award b. material change c. cooperative agreement c. post-award For Material Change Only: d. loan year quarter e. loan guarantee date of last report f. loan insurance 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter Name Prime Subawardee and Address of Prime: Tier ,if known: Congressional District, if known: Congressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: CFDA Number, if applicable 8. Federal Action Number, if known: 9. Award Amount, if known: 10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if (if individual, last name, first name, MI): different from No. 10a) (last name, first name, MI): 11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material Signature: representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This Print Name: disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be Title: available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less Telephone No.: Date: than $10,000 and not more than $100,000 for each such failure. Federal Use Only: Authorized for Local Reproduction Standard Form LLL (Rev. 7-97)