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<br />Agreement #W7 -GJC-1 0
<br />City of Santa Ana
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<br />Exhibit H
<br />INSTRUCTIONS FOR COMPLETION OF
<br />SF-LLL DISCLOSURE OF LOBBYING ACTIVITIES
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<br />This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient at the initiation or receipt of a
<br />covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing of a form is required for
<br />each pavment or agreement to make payment to any lobbying entity for infiuencing or attempting to influence an officer or employee of any
<br />agency, a Member of Congress, an officer or employee of Congress. or an employee of a Member of Congress in connection with a covered
<br />Federal action. Use the 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 impiementing guidance published by the Office of Management and
<br />Budget for additional information.
<br />1. Identify the type of covered Federal action for which lobbying is and has been secured to influence the outcome of a covered 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 information previously
<br />reported, enter the year and quarter in which the change occurred. Enter the date of the iast previously submiUed report by this reporting entity
<br />for this covered Federal action.
<br />4. Enter the full name, address, city, state and zip code of the reporting entity. Include congressional distrtct. if known. Check the approprtate
<br />ciassiflcation of the reporting entity that designates if it is, or expects to be a prime or subaward recipient
<br />Identify the tier of the subawardee, e. g. the flrst subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts.
<br />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 zip code of the prtme
<br />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 level below agency name, if
<br />known. For example, Department of Transportation, United States Coast Guard.
<br />7. Enter the Federal program name or description for the covered Federai action (item 1). If known, enter the full Catalog of Federal Domestic
<br />Assistance (CFDA) number for grants, cooperative agreements, loans and loan commitments.
<br />8. Enter the most appropriate Federai Identifying number available for the Federal action identified in item 1 (e. g. Request for Proposal (RFP)
<br />number; Invitation for Bid (IFB) number; grant announcement number the contract, grant. or loan award number; the application proposal
<br />control number assigned by the Federal agency). Include prefixes, e.g., "RFP DE 90 09."
<br />9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the
<br />awardlloan commitment for the primary 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 identified in item 4 to
<br />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 Name,
<br />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 lobbying entity (item
<br />10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material cI1ange
<br />report enter he cumulative amount of payment made or planned to be made.
<br />12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in kind contribution, specify the nature and
<br />value of the In kind payment .
<br />13. Check the appropriate box(es). 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 perform, and the
<br />date(s} of any services rendered. Include all preparatory and related activity, not just time spent in actual contact with Federal officials. Identify
<br />the Federal official(s) or employee(s) contacted and the officer(s), 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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<br />Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing
<br />Instructions. searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
<br />information. Send comments regarding the burden estimate or any other aspect of this collection of information, Including suggestions for
<br />reducing this burden, to the Office of Management and Budget Paperwork Reduction Project (0348 0046) Washington D.C., 20503.
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<br />WIA Cost Reimbursement Agreement - Green Jobs Corps
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<br />Exhibit H- Page 1 of 3
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