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DISCLOSURE OF LOBBYING ACTIVITIES Approved by OWiB <br />Complete Ihia form to disclose 3obbying activltlas ptnatrant to 31 U.S,C. 1352 0349.0046 <br />(See reverse for public burden dlscioaure) <br />1. Type of Federal Action: .2 Status of F?rai Aotlen:' Report Typo: <br />[] a. cmhaat ] o. bidral7arlspphna1le, I] a. Initial aling <br />1b, grant b. intflalaward b, material change <br />r,. anoparatlve agreement a. post-award For Material Change Only: <br />d. loon year_ quarter <br />a, loan gearantaa date of goal report <br />, <br />f, loan insurance <br />4.-Name »nd Addreso nt Reporting 4ntlty: ?'?p?'?' u"' 6, If Reporting Entity INo. 4 ks a Subawprdee, Enter Name anal Address <br />C1 Prime ? isubawardes of Prime: <br />Tier _, If known: <br />Congressional Olstrlcl, if known: <br />. Congressional District, If known: <br />E FFcideral Oaparbnent(Aganoy: --.,- -Mil Programm NamegascHptlon: <br /> MA Number, if appilcatrim <br />. <br />_ <br />... <br />... <br />e.W <br />9. Fadenrl Action Number, it known; .. <br />. <br />. <br />a <br />. ,. _ <br />%Award Amount, If known; - <br /> <br />10, a. Name and Address of Loaaying? lT.. Individuals Per#arming Sarvicae { htctudhty oldness <br />Entity If differantfrom No. 100) <br />l itindlvlduaf, last ruens, first nsma, Mq: Oast name, first norns, Mb: <br />(attach Coninns9e n Shael{s) SP-LLLA, ffnemaeary) <br /> <br />11. Amount of ayment ( cha a that apply): _ <br />45, Tyype o Payment (check all that scrjjcly)? <br />$ 0 actual [,I Planned C) a. retainer <br /> I? b. one-dine fee <br /> L' o, commission <br />22. Form of Payment (crack all that,applylr [J d. contingerd tee <br />a 0. Mesh © e, deferred <br />Ll b. In-kind; sneaky: naluro__ f. other, Specify: <br />..Y.._.._? <br />value <br />14'.8rfef Descdjrgon of 8vrvlaes?f?orfarme3 onto two Parfarmnd and Data{a »f 3arvica, lncludirip <br />offloar(s), employea(s), or Mombar(s) contacted, for payment indicated In horn 11: <br />attach Ccnnnumion Shestfc_) SFULA, Ifneosseary?? <br />' <br />15. Continuation Entails) 8P4.LLA attached: <br />JYe% E) No <br />- <br />16, Signature: - _ _ <br />_ <br />]Information requested through thin form to Palo odzod by title 11 Print Nams: <br />V.S.C. sootlon1352. Thin dlsdusure of lobbying activities Is a Me: <br />material representation of fact upon watch Warm was placed Telephone Na: Dols: <br />by the her above when tits transaction was. made or entered <br />Into. Thgs disclosure is required pursuant to 31l U,S.C. 1352. This <br />Information will be reported to Irw Congress sern"nbaally and <br />will no available for puNio Inspection. Any person who fails to Ilia <br />the required disclosure shall Im subiao€ to a civil penalty of not <br />less that $10,000 and net more than $160,000 for each such <br />failure. <br />Augrodzed for Local Froproductimi <br />Fsdera( Uaa QnfYt _______,___._?______? Standard Form LLL (Rev. 7.97) <br />EXHIBIT C <br />SVI-115212v2 16