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DocuSign Envelope ID:8953AD6C-C803-4BE3-B456-79DFD2637F3E
<br /> by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil
<br /> penalty of not less than$10,000.00 and not more than$100,000.00 for each such failure.
<br /> VI.Disclosure of Lobbying Activities
<br /> Instructions
<br /> This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the
<br /> initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C.
<br /> section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for
<br /> influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or
<br /> employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Use the
<br /> SF-LLL-A Continuation Sheet for additional information if the space on the form is inadequate. Complete all items that
<br /> apply for both the initial filing and material change report. Refer to the implementing guidance published by the Office of
<br /> Management and Budget for additional information.
<br /> Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the
<br /> outcome of a covered Federal action.
<br /> 1. Identify the status of the covered Federal action.
<br /> 2. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the
<br /> information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last
<br /> previously submitted report by this reporting entity for this covered Federal action.
<br /> 3. Enter the full name, address, city, state and zip code of the reporting entity. Include Congressional District, if known.
<br /> Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or sub-
<br /> award recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards
<br /> include but are not limited to subcontracts, subgrants and contract awards under grants.
<br /> 4. If the organization filing the report in Item 4 checks "Subawardee", then enter the full name, address, city, state and
<br /> zip code of the prime Federal recipient. Include Congressional District, if known.
<br /> 5. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational level
<br /> below agency name, if known. For example,Department of Transportation,United States Coast Guard.
<br /> 6. 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 /> 7. Enter the most appropriate Federal Identifying number available for the Federal action identified in Item 1 (e.g.,
<br /> Request for Proposal(RFP)number, Invitation for Bid(IFB)number, grant announcement number, the contract grant,
<br /> or loan award number, the application/proposal control number assigned by the Federal agency). Include prefixes,
<br /> e.g., "RFP-DE-90-001."
<br /> 8. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the
<br /> Federal amount of the award/loan commitment for the prime entity identified in Item 4 or 5.
<br /> 9. (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). Enter
<br /> Last Name,First Name and Middle Initial(MI).
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