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t '' <br />CITY OF SANTA ANA <br />• Project No. 10-7554 Mid-City Neighborhood Improvement (west of Bristol St.) <br />Project No. 07-7577 Edinger Ave. Improvement from Mohawk St. to 400' e/o Mohawk St. <br />PROPOSAL AND CONTRACT AGREEMENT <br />DISCLOSURE OF LOBBYING ACTIVITIES <br />Complete this form to disclose lobbying activities Dursuant to 31 U.S.C. 1352 / <br />1. Type of Federal Action 2. Status of Federal Action 3. Report T <br />^ a. Contract ^ a. Bid/offer/application ^ .initial <br />b. Grant b. initial award b. material change <br />c. Corporate Agreement c, post-award <br />d. Ban or Material Change only: <br />e. Loan Guarantee y~• quarter <br />f. Loan Insurance date of last rt <br />4. Name and Address of Reporting Entity 5. If Reporting En ' in No. 4 is Subawardee, Enter Name and <br /> Address of <br />^ Prirrie ^ Subwardee <br />Tier , If known <br />Co essional District, i known on Tonal District, i known <br />6. Federal Department/Agency: 7 ederal Program Name/Description <br /> CFDA Number, If a livable <br />8. Federal Action Number, if known \ <br />~,.J 9. Award Amount, if known <br /> $ <br />0. a. Name and Address of Lobbying Entity b. Individual Performing Services (incbe~g a,s if il~ei~rtfivmNo, <br />~+~ IGI!r) <br />~.~`~ ~ <br />(attach Continuation Sheets if neces ) <br />11. Amount of Payment (chec that apply): 13. Type of Payment (check all that apply) <br />$ Actual ^ Planned ^ a. retainer <br /> ^ b. one-tirr~ fee <br />12. Form of Payment eck all that apply): ^ c. commission <br />^ a. c ^ d. contingent fee <br />^ b. ~ kind; specify: nature ^ e. deferred <br />value ^ f. other, ify <br />14. Brief cription of Services Performed or to be performed and Date(s) of Service, including officer{s), employee(s), or member(s) contacted, for <br />Pa dicated in item 11: <br />(attach Continuation Sheet s) i necessa <br />15. Continuation Shee s attached: ^ Yes No <br />16.I~'orrrafjonieques~dflavugliflrisficamisat~edbyTide31 USCSac~im <br />1352. Thisdiscbs~aeofbbbyingactivitiesisarr>~lioffarkupon Signature .c' <br />vvlrichrelianoevvasplaoadbytbetiaabove wlter-thehar~sactiaiwasm~decaenterod <br />" <br />iribo. <br />Ihisdiscbs~eisreq~medpu6uaz~tto31USC1352. Tl~isw~llbe ~ntName !~j f~ <br />repatedtuB~eCor>gresssenri-arxnrallyarrlw>Tlbeavm~blefcxp~blic <br />A 1 r <br />V ~ ~ ~ <br />~ <br />trypasaiwl~fa~tofiletheta~eddisclosureshallbet~acivllpenahyof Title <br />~ <br />mt less than$1Q000 arrlmtmore~$1OQ000 foreac~istac~fath>te. <br />Tel hone No. ~S~-~ - ~ Date -S - ( ~ <br />Use Only: Authorized for Local ltelxnduction <br />Standard Form- LLL <br />TO BE INCLUDED IN BID PACKAGE <br />BP 25 of 31 <br />