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Disclosure of L(dbtOag 4MMOM254, Amendment Number 11 Page 14 of 16 <br />(Approved by OMB 03460046) <br />Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 <br />1. Type of Federal Action : <br />2. Sttusal FederelAction: <br />3. Report Type: <br />❑ a. assured <br />❑ a. BidNRer /applbafia <br />❑ a. Inifalgllrg <br />b Award <br />❑ terial change <br />b. ma <br />• c. coepealive agreement <br />❑ . Post Aware <br />❑ d. loan <br />For Malarial Change Only: <br />[3 e loan <br />❑ C loan Insurance su ance <br />Year Ouader <br />Dab of Lae Rep� <br />4. Name and Address of Repodtng Entity: <br />S. tReponng Entityln NO.4ls EUbavardee,Bnbr Name <br />❑ Pdme <br />and Address of Prime: <br />❑ SubewaNee Tier_, ofisoan) <br />Congressional Dbbid It known <br />Can restone Dishkt If gravel I <br />T. Federal Progress NamauDesagtbr: <br />6. Federal DepaumentlAgenar: <br />CFDA Number Of appliable) <br />B. Federal Action Number (it knmvn) <br />9. Award Amount(R known): <br />E <br />10, e. Name as Lobbying <br />b. tedleteuate Servl®ame.priMga <br />kAkee, hat e, hislrenl <br />(NIntllWtlal, bar rame,Me oams, MS: <br />IN <br />nNor 10h "am, <br />b'Rersnl from NO lOa) panorama,! mama, MS: <br />(SHOW COnf Ulvn SMa1(eI SFCL Aifnxeaary) <br />(WISCIP cold Oadow EMORS) MoULA, amces MA <br />11. Amount of Payment bobeor 0that apply): <br />13. Type of Payment bugook all that apt <br />g actual planned <br />❑ a retainer <br />❑ b. one -Gore fee <br />❑ c. commission <br />12. Form of Payment (check at/ Mat apply): <br />❑ d. comngentba <br />❑ a. cash <br />❑ e. deferr ed <br />❑ b. In defspecify: beat. <br />❑ f. oPer,spedry: <br />Value <br />14. Bdel Description of Servicas Performed or to be Performed and Dealt) of Serdws, indudag ofhoe ), empbyee(5), or <br />Member(s) palacted for Payment Indicated In Item Masson Caucasian Shoed(n) MF A,Rnrwssyl: <br />15. Contraction Sheens) SF -U-LA injuries: ❑ Yea ❑ <br />NO <br />16. Information requested drought this farm is authorized by <br />Signore: <br />tide 31 U. S. C. section 1352. TWO disclosure of lobbying <br />waddled is a materbl representation of roar upon which <br />reliance was placed by Pe tar above when this Inspection <br />Pont Nave: <br />was made or entered into TWO disclosure Is required <br />pursuant b 31 U. S. C. 1352 This information we bas <br />Toe: <br />recorded 0 Me Congress uml-anraally and will be <br />available ter public Inspection. My person who thMS W die <br />Telephone NO: Dale: <br />Oise required dbdasure shall be subject to acivll penalty of <br />not less than $10, W e aM trod mom Nan S 100.000 for each <br />such failure. <br />Federal Use Only <br />Mlhodaetl fa Leal <br />Repaductim <br />Standard Form -= <br />Public winning When for INS mseco n OI iniarmthon Is consoled b erwa9e an manor per response, Indian" was fw reubMig Nalmtlbm. <br />watching eWWg data souses, gathering wk maintaining the data Mai ON emission and massive the mauled 0 inlomatbn. Shad <br />comments regaabp the When engines or any apes aspect of this mission of lnbnmtiM. convig sv;9alwns Itt stocks Ph laden, b IM <br />dfire of Manamnent and &WOel. l+emmma Red od on Pmiect (DUB-D046). Washington. D. C. 20500 _ <br />