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DocuSign Envelope ID: BOFE06B7-7OC7-44D2-A46C-D41E904EED9B
<br /> Contract Number 00041659 /Page 19 of 22
<br /> 1, Identify the type of covered Federal action for which lobbying activity Is and/or has been secured to influence
<br /> the outcome of a covered Federal action.
<br /> 2. Identify the status of the covered Federal action.
<br /> 3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to
<br /> the Information previously reported, enter the year and quarter in which the change occurred, Enter the date
<br /> of the last previously submitted report by this reporting entity for this covered Federal action.
<br /> g, Enter the full name, address, city, state and zip code of the reporting entity., Incfu'de Con gres616 ial District, if
<br /> known, Check the appropriate classification of the reporting entity that designates If It is, or expects to be, a
<br /> prime or sub-award recipient, Identify the tier of the subawardee, e,g., the first subawardee of the prime Is the
<br /> 1st tier. 'Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.
<br /> S. If the organization filing the report in Item 4 checks "subawardee", then enter the full name, address, city,
<br /> state and zip code of the prime Federal recipient, Include Congressional District, If known.
<br /> b, Enter the name of the Federal agency making the award or loan commitment. Include at least one
<br /> organizational level below agency name, If known, For example, Department of Transportation, United States
<br /> Coast Guard.
<br /> 7, Enter the Federal program name or description for the covered Federal action (Item 1). If known, enter the full
<br /> Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan
<br /> commitments.
<br /> 8. Enter the most appropriate Federal Identifying number available for the Federal action identified in item 1
<br /> (e.g., Request for Proposal (RFP) number, Invitation for Bid (IFS) number, grant announcement number, the
<br /> contract grant, or loan award number, the appilcation/proposal control number assigned by the Federal
<br /> agency), Include prefixes, e,g., "RFP-DE-90-001,"
<br /> 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency,
<br /> enter the Federal amount of the award/loan commitment for the prime entity Identified in Item 4 or 5.
<br /> 10, (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity
<br /> Identified in Item 4 to Influence the covered Federal action.
<br /> (b) Enter the full names. of the Individual(s) performing services, and Include full address If different from 10(a).
<br /> Enter Last Name, First Name and Middle Initial(MI),
<br /> 11, Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to
<br /> the lobbying entity (item 10), Indicate whether the payment has been made (actual) or will be made
<br /> (planned), Check all boxes that apply. If this Is a material change report, enter the cumulative amount of
<br /> payment made or planned to be made.
<br /> 12, Check the appropriate boxes. Check all boxes that apply. If payment is made through an in-kind contribution,
<br /> specify the nature and value of the in-kind payment,
<br /> 13, Check the appropriate boxes. Check all boxes that apply. If other, specify nature.
<br /> 14. Provide a specific and detailed description of the services that the lobbyist has performed, or will be expected
<br /> to perform, and the date(s) of any services rendered. Include all preparatory and related activity, not Just time
<br /> spent In actual contact with Federal officials, Identify the Federal official(s) or employee(s) contacted or the
<br /> off leer(s), employee(s), or Member(s)of Congress that were contacted,
<br /> 15, Check whether or not a SF-LLL-A Continuation Sheet(s) is attached.
<br /> 16. The certifying official shall sign and date the form, print his/her name, title, and telephone number.
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