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DISCLOSURE OF LOBBYING ACTIVITIES Complete this form to disclose lobbying activities pursuant to (See reverse for public burden disclosure.) 0348-0046 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: ® a. contract E] a. bid/offer/application ® a. initial filing b. grant yxb. initial award b. material change c. cooperative agreement c. post-award For Material Change Only: d. loan year quarter e. loan guarantee date of last report f. loan insurance 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is a Subawardee, Enter Name and Address ?Prime OSubawardee of Prime: Santa Ana Workforce Investment Board Tier if known: Santa Ana, CA Congressional District, if known: 47 Congressional District, if known: 6. Federal Department/Agency: 7. Federal Program Name/Description: Department of Labor H-1B Technical Skills Training Grant CFDA Number, if applicable: 59.037 8. Federal Action Number, if known: 9. Award Amount, if known: $784,450 10. a. Name and Address of Lobbying b. Individuals Performing Services ( including address Entity if different from No. 10a) ( if individual, last name, first name, MI): (last name, first name, MI): Not Applicable Not Applicable (attach Continuation Sheet(s) SF-LLLA, if necessary) 11. Amount of Payment ( check all that apply): 13. Type of Payment (check all that apply): $ ? actual ? planned ? a. retainer ? b. one-time fee ? c. commission 12. Form of Payment ( check all that apply): ? d. contingent fee ? a. cash ? e. deferred ? b. in-kind; specify: nature ? f. other; specify: value 14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or Member(s) contacted, for Payment Indicated in Item 11: attach Continuation Sheets SF-LLLA, if necessary) 15. Continuation Sheet(s) SF-LLLA attached: Yes No 16. Signature: Information requested through this form is authorized by title 31 Print Namey clash _.__ U.S.C. section1352. This disclosure of lobbying activities is a Title: Vice ante o material representation of fact upon which reliance was placed Telephone No.: Date: c by the tier above when this transaction was made or entered r (714) 480-7340 into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually 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 that $10,000 and not more than $100,000 for each such failure. Authorized for Local Reproduction Federal Use Onl : Standard Form LLL (Rev. 7-97 Approved by OMB 31 U.S.C. 1352 EXHIBIT C