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N/A = Not Applicable <br />CITY OF SANTA ANA <br />PROJECT NO. 12 -6760: TRAFFIC SIGNAL MODIFICATION ON MCFADDEN AVE & LYON ST <br />PROPOSAL AND CONTRACT AGREEMENT <br />DISCLOSURE OF LOBBYING ACTIVITIES <br />Conwlete this fowl to disclose lobbying activities uursuant to 31 U.S.C. 1352 <br />1. Type of Federal Action N/A <br />2. Status of Federal Action N/A <br />3. Report Type: N/A <br />❑ a. Contract <br />❑ a. Bid /offer /application <br />❑ a, initial <br />b. Grant <br />b. initial award <br />b. material change <br />c. Corporate Agreement <br />e, post -award <br />d. Ban <br />For Material Change only: <br />e. Loan Guarantee <br />Year _ quarter_ <br />f Loan Insurance <br />date of last report <br />4. Name and Address of Repotting Entity <br />5. If Reporting Eutity ii No. 4 is Subawardee, Enter Name and <br />N/A <br />Address ofPtitne: N/A <br />❑ Prune ❑ Subwardee <br />Tier= Ifkmown <br />Congiessional District, i known <br />Congressional District, if/m msi <br />6. Federal Departtnent/Agency: N/A <br />7. Federal Program Nanle /Description N/A <br />CFDA Number, If applicable <br />8. Federal Action Number, ifknown <br />9. Award Amount ifknounv <br />NIA <br />NIA <br />S <br />10. a. Naule aid Address of Lobbying Entity N/A <br />b. hzdividual Performing Services (nvcludmg rxkfi�ssifc/, rptt from No. <br />r�indnzk .alkaslrr�nrG.firsl,A'4J <br />I(k) <br />(Ia lticang fnshvcmle ko <br />( attach Continuation <br />Sbeet(s) if necessary) <br />11. A lwltnt of payment (clmeok all that apply): <br />13. Type of Payment (check all that apply) <br />$ E] Actual ❑ Planned N/A <br />❑ a. retainer N/A <br />❑ b. one -time fee <br />❑ c. comulission <br />12. Form of payment (check all that apply): N/A <br />❑ a. cash <br />❑ d contingent fee <br />❑ b. in -kind; specify: nature <br />❑ e. deferred <br />value <br />❑ f other, specify <br />14. Blief Description of Services Performed or to be performed and Date(s) of Service, including officer(s), employee(s), ormnenmbei (s) contacted, for <br />Payment indicated in item 11: <br />N/A <br />(attach ConkmvalionS ieet(5) z necessar �) <br />15. Continuation Sheet (s) attaclmed: 01 es ® No <br />16.Inf ainationasIuLstzdduoug1141isfouuisauaborizedbyTitle31USCSecam <br />1352. <br />Signature / <br />whidlreliancewasplaredbytl> etierabovewhernd�hansactionwnsnladeoran� red <br />t <br />unto. 31U.S.C1352 Tbisinfoinia ionwillbe <br />PrintNaille Elizabeth H. Mendoza de McRae <br />ivpoitcd CO tint'�`011�PU Se(nl- aCRIlliif�at]dWlll Ile ll�lelOrpabhClCLSl.1EC`110n <br />AnypetsonwliokEsh) fir- drlcgireddisclosuteshallllesabjecttoaciv itNi,,ayof <br />Title President /CFO <br />notle3gdranSlO,( h) Oandnotnaole4 ><w$100,IX10foreach�.ich�ihue <br />Telephone No. 951- 710 -1000 Date 4 /2/2013 <br />FcnletalUseOnly: <br />I Ai., r izedforLocnlRgrocTmtiou <br />Stan lat'dPonn—LLL <br />TO BE INCLUDED IN BID PACKAGE <br />BP 21 of 27 <br />