RELAMPAGO DEL CIELO 3 -2002 - Laserfiche WebLink

Home Browse Search

'-' '-' 1. Type of Federal Action: o a. contract b. grant c. cooperative agreement d.loan e. loan guarantee f. loan insurance 4. Name and Address of Reporting Entity: o Prim. 0 Subaward.. Tier _____, ifknown: DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 See reverse for ublic burden disclosure. 2. Status of Federal Action: 3. Report Type: Oa. bidlofferlapplication 0 a. initial filing b. initial award b. material change c. post-award For Material Change Only: year quarter ___ date of last report Approved by OMS 0348.0046 5. If Reporting Entity in No.4 is a Subawardee, Enter Name and Address of Prime: Con ressional District, if known: 6. Federal Department/Agency: Con ressional District, if known: 7. Federal Program Name/Description: CFDA Number, if applicable: ____ 8. Federal Action Number, if known: 10. a. Name and Address of Lobbying Entity (if individual, last name, first name, MI): 9. Award Amount, If known: $ b. Individuals Performing Services (Including address if different from No. 10a) (last name, first name, MI): altach ContinuaUon Sheet(s) SF-LLLA, if neceSSBlJ') 11. Amount of Payment (check a1/ that apply): 13. Type of Payment (check all that apply): $ ___ 0 .ctual 0 plannad 0 .. ratalne, D b. one-time fee o c. commission o d. conlin gent fee o e. deferred o f. other; specify: 12. Form of Payment (check all that apply): o a. cash o b. in-kind; specify: nature value 14. Brief Description of Services Performed or to be Performed and Cate(s) of Service, including officer(s), employee(s), or Member(s) contacted, for Payment Indicated in Item 11: (attach Continuation Sheel(s) SF-LLLA, Ifnecessa j 15. Continuation Sheet s SF-LLLA attached: 0 Yes 0 No 16 Information requelt&d Ihrcugh Ihls form 18 I!IlIthoriz&d by tiUe 31 U.s.C. MCIIon Signature' . 1352. ThIs disclosure 0( lobbying ectlviliN Is . materill NPre.nlallon of fact' . upon wt\1c11 reliance was placed by the tier aboYe""".n lhillransac:tion was made Print Name: or entered Into. ThIs dlsd.OSUfe it required ptnUanl to 31 U.s.C. 1352. ThIS Information will be reported 10 \he Congren seml-annualy WId will be .....Ilable for pubic Inspe:ctID'l. Any perIOfl who falls 10 nle the required d1sdOIUI8 shaD be aubfect lo a civil peIlally of not lass that $10.000 and not more than $100.000 for eaett sum failure. Title: Telephone No.: Date: Federa.1 Use Only: , ,. ,", Authorized for Local Reproduction Standard Form LLL (Rev. 7-97)