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<br />1. Type of Federal Action: <br />~ a. contract <br />b. grant <br />c. cooperative agreement <br />d.loan <br />e. loan guarantee <br />f. loan insurance <br />4. Name and Address of Reporting Entity: <br />o Prime 0 Subewordee <br />Tier , if known: <br /> <br />- DlscLos.)Re OF LOBBYING ACTIVITIES <br />Complete this form to disclose lobbying actlv~ies pursuant to 31 U.S.C. 1352 <br />See reverse for ublic burden disclosure. <br />2. Status of Federal Action: 3. Report Type: <br />0a. bid/offer/application ~ a. initial filing <br />b. initial award b. material chenge <br />c. post-award For Material Change Only: <br />year quarter <br />date of last report <br /> <br />~ <br /> <br />Approved by OMS <br />0348-0046 <br /> <br />5. If Reporting Entity In No.4 Is a Subawardee, Enter Name <br />and Address of Prime: <br /> <br />N/A <br /> <br />N/A <br /> <br />Con ressional District, if known: <br />6. Federal Department/Agency: <br /> <br />Con resslonal District, if known : <br />7. Federal Program NamelDescription: <br /> <br />N/A <br /> <br />CFDA Number, ifepplicab/e: N/ A <br /> <br />B. Federal Action Number, ifknown: <br /> <br />N/A <br />10. a. Name and Address of Lobbying Entity <br />(if individual, iast name, first name, M/): <br /> <br />N/A <br /> <br />9. Award Amount,if known: <br />$ N/A <br /> <br />b. Individuals Performing Services (including address if <br />different from No. 1 De 1 <br />(/est neme, first name, Mil: <br /> <br />N/A <br /> <br />(attach CcntlnusUon Shaat a SF-LLLA. If nees" <br />11. Amount of Payment (check a/l that apply): 13. Type of Payment (check all thet apply): <br /> <br />$ N / A 0 ecluel 0 pllnned D L rotolnlr <br />D b. ons-timlloe <br />o Co commission <br />D d. continglnt fol <br />D e. doforrod <br />D f. other; specify: <br /> <br />12. Form of Payment (check e/l thet apply): <br />D I. cI.h <br />D b.ln-l<lnd, splclfy: <br /> <br />N/A <br /> <br />N/A <br /> <br />nature <br />value <br /> <br />14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including offlcer(s), <br />employee(s), or Member(s) contacted, for Payment Indicated In Item 11: <br /> <br />N/A <br /> <br />,',.,'" <br />fe~~~,I'~~~;c:>,~jy:.'.... . <br /> <br /> <br />a SF-LLLA If noesssa <br />Dyo. <br /> <br />Signature: <br /> <br />PrintNa <br /> <br />Title: Executive D:l:rector <br /> <br />Telephone No.: (714) 897-3221 <br /> <br /> <br />(attach ConUnusUon Sho <br />15. Continuation Sheet s SF.LLLA attached: <br /> <br />16 Inrorm.tlon rMllMIs\ed through Itlls fonn .. aulhorlDd by 101 31 U.s.C. ..CIltm <br />. 1352. ThlI dltdoalTB of lcbb!ilng actlvlllel II . materl.' n1p,.......UOn of fact <br />upon which Rlllance WBII pI.Dld by the hi' abowWhen ttUllm..act1cm WIll made <br />Dr enilntd Into. ".. lfiadO&lre 18 MqUlrtd purauanl to 31 U.s.c. 1362. This <br />IrifDrTMtlcrI v.tIl be ~DttedtD the ConliJU1lumi-annudy.nd wi! ~ .VII~bl.lor <br />pubic inIJ;Ilctla1. Any perIOn whQ fab to ilia ItlfI ,..qulNd dlldoauJe lhall be <br />IUbject 10 e civil penllty at not I... Ihlt 110.000 Ind not more than I1QO,o00 lor <br />elChlUchfalkJrl. <br /> <br />Date: '09/11'/02 <br /> <br />Authorized for Local Reproduction <br />Standard Form LLL (Rov. 7-97) <br />