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00474
<br /> PROCUREMERr
<br /> ftle2on
<br /> INSTRUCTIONS FOR COMPLETION OF SF-LLL,DISCLOSURE OF LOBBYING ACTIVITIES
<br /> This disclosure form shalt be completed by the reporting entity,whether subawardee or prime Federal recipient,at the
<br /> initiation or receipt of a covered Federal action,or a material change to a previous filing,pursuant to title 31 U-S-C.
<br /> section 1352.The filing of a form is required for each payment or agreement to make payment to any lobbying entity for
<br /> Influencing or attempting to influence an officer or employee of any agency,a Member of Congress,an officer or
<br /> employee of Congress,or an employee of a Member of Congressin connection with a covered Federal action.Complete
<br /> all items that apply for both the initial filing and material change report.Refer to the implementing guidance published by
<br /> the Office of Management and Budget for additional information.
<br /> 1. Identify the type of covered Federal action for which lobbying activity Is and/or has been secured to Influence the
<br /> outcome of a covered Federal action.
<br /> 2- Identify the status of the covered Federal action.
<br /> 3- Identify the appropriate classification of this report.If this Is,a followup report caused by a material change to,the
<br /> information previously reported,enterthe year and quarter in which the change occurred.Enterthe date of the last
<br /> previously submitted report by this reporting entity for this covered Federal action.
<br /> 4. Enter the fuliname,address,city,State and zip code of the reporting entity.Include Congressional Dlstdcl,if
<br /> known-Check the appropriate classilikationof the reporting entity that designates I it Is,or expects to be,a prime
<br /> or subaward recipient Identify the ter of the subawardee,e.g,the first subawardee of the prime is the Ist tier.
<br /> Subawards,Include but are not limited to subcontracts,subgrants and contract awards under grants-
<br /> 5. If the organization fi[Ing the report in Item 4 checks"subawardee"then enter tha full name,address,city,State
<br /> and zip code of the prime 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
<br /> level below agency name,If known.For example.Department of Transportation,United States Coast Guard.
<br /> 7� Enter the Federal program nameDr description for the.covered Federal action(item 1).If known,enter the full
<br /> Catalog of Federal Domestic.Assistance(GFDA)number for grants,cooperative agreements,loans,and loan
<br /> commitments.
<br /> 8. Enter the most appropriate Federal Identifying number available for the Federal action Identified,in item 1(e-g.,
<br /> Request for Proposal(RFP)number,Invitation for Bid(EFB)number,grant announcement number,the contract
<br /> grant,or loan award number,the application/proposal control number assigned by the Federal agency).Include
<br /> prefixes,eg.,"RIP-DE-0-00V
<br /> 9. For a covered Federal action where there has been an award or loan commitment by the Federal agency,enter
<br /> the Federal amount of the awardAban commitment for the prime entity identified In item 4 or 5.
<br /> 10- (a)Enter!the full name,address,city,State and zJp code of the lobbying registrant under the Lobbying
<br /> Disclosure Act of 1995 engaged by the reporting entity,Identified in item 4 to influence the covered Federal
<br /> action.
<br /> (b)Enter the full names of the individual(s)performing services,and Include full address if different from 10(a).
<br /> Enter Last Name,First Name,and Middle Initial(MI).
<br /> 11-The certifying official shall sign and date the form,print his/her name,title,and telephone number.
<br /> Accor dding to the PapenNorkReduction Act,as amended,no persons are req*W to.resporktitoacollecUan of Inibirriatforb unless it displays a
<br /> vandOW Control Nua-ber-ThevaridOMB oonWnunterforihisinformation coleclion is OMB No.D3418-MO.Public reportkV burdenforlIft
<br /> collection ofinformalion is estimated to average 10 minutes per response,Indludin firneforrevBewl insliruclions.searching e�s►ing data sources,
<br /> M ng
<br /> pthedng and maintaining thedata needed,and completing and reviewing thecollecilan ofinfbffnation.-Send comments regarding the burden
<br /> estimate or-any atheraspeot ofthis coillecdon offtmufmn,including sKgesWm kw redudno this burden,to ffie Orrice of Management and
<br /> Budget.Paperwork Reducilcm Project @348-1)048,WasWriglim.DC 26503.
<br /> 00474-3
<br /> FAPubllc WorkskENGINEERING DIVISION PROJECTSkI213C IRC Shooting Range Hunter Eduction Classroom\l-Admin\Bid
<br /> DocurnentsWaster Contract Documents\00474-CERTIFICATION for DISCLOSURE OF LOBBYING ACTIVITIES.doc
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