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DocuSign Envelope ID:A6134E61D-095E-4A51-9823-BOEE0861F374
<br /> Contract Number 00041435, Amendment Number 4/ Page 17 of 20
<br /> 1. 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 /> 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 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 /> 4. 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 /> 5. 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 /> 6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational
<br /> level below agency name, if known. For example, Department of Transportation, United States 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 (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 /> 9. 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 /> 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). Enter Last
<br /> 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 the
<br /> lobbying entity (Item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all
<br /> boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be
<br /> made.
<br /> 12. Check the appropriate boxes. Check all boxes that apply. If payment is made through an in-kind contribution, specify
<br /> 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 to
<br /> perform, and the date(s) of any services rendered. Include all preparatory and related activity, not just time spent in
<br /> actual contact with Federal officials. Identify the Federal official(s) or employee(s) contacted or the officer(s),
<br /> 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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