MINNIE STREET LEARNING CENTER - Laserfiche WebLink

Home Browse Search

nisclosure of Lobbying Activr -is Complete uas form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse side for Instructions and Public Reporting burden statement) 1. Type of Federal Action' ❑a. contract b. grant c. cooperative agreement d. loan e. loan guarantee f. loan insurance 2. Status of Federal Action ❑a. bid/offer/application b. initial award c. post -award 4. Name and Address of Reporting Entity ElPrime ❑ Subawardee Tier if known: Congressional District, if known v. r"tnui uepanmenuAgency B. Federal Action Number, if known 10a. Name and Address of Lobbying Registrant (if individual, last name, first name. MI) continuation 11. Amount of Payment (check all that apply) $ LJ actual planned 12. Form of Payment (check all that apply) ❑ a, cash b. In -kind; specify: nature value Approved by OMB 0348-0046 3. Report Type ❑a. initial filing b. material change For Material Change Only year (yyyy) quarter date of last report (mm/d vyyyy) 5. If Reporting Entity in No. 4 Is Subawardee, enter Name and Address of Prime - - Congressional District, If known 7. Federal Program Name/Deserlptlon CFDA Number, if applicable 9. Award Amount, if known b. Individuals Performing Services {including address if different from No. i0a.) (last name, first name, MI) eet(s) if necessary) 13. Type of Payment (check all that apply) ❑ a. retainer ❑ b. one-time fee ❑ c. commission ❑ d, contingent fee ❑ o. deferred ❑ I. other (specify) 14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including afficer(s), employee(s), or Member(s) contacted, for Payment Indicated in item 11 15. Continuation sheets attached ❑ Yes (attach continuation sheet(s) if No 16. Information requested through this form is authorized by Sec.319, Pub. L.101-121, 103 Stat. 750, as amended by sec. 10; Pub. L.104- 65, Stat. 700 (31 U.S.C. 1352). This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.G. 1352. This information' will be reported to the Congress semiannually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000- and not more than $100,000 for each such failure. Signature Print Name - Title Telephone. No. Date (mm/dd/v k Y rt serer} r - Authorized for Local Reproduction Standard Forme LL (7/97) ATT.ACHMFNT I TO EXHIBIT C -- PAGE 1Fof 2