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3.r:-93334
<br />PrxO . ZEMENT
<br />W14
<br />Payr 2 ut 2
<br />INSTRUCTIONS FOR COMPLETION OF SF -LLL, DISCLOSURE OF LOBBYING ACTIVITIES
<br />This disclosure form shall 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 Congress in 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 andfor 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, enter the year and quarter in which the change occurred. Enter the date of the last
<br />previously submitted report by this reporting entity for this covered Federal action.
<br />4. Enter the fullname, address, city, State and zip code of the reporting entity. Include Congressional District, if
<br />known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime
<br />or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier_
<br />Subawards include but are not limited to subcontracts, subgrants and contract awards under grants_
<br />5. If the organization filing the report in item 4 checks "Subawardee," then enter the 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 matting 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 name or description for the covered Federal action (item 1). If known, enter the full
<br />Catalog of Federal Domestic Assistance (CFDA) 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 (IFB) 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, e.g_,'"RFP-DE-90-001"
<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 awardtloan commitment for the prime entity identified in item 4 or 5.
<br />10_ (a) Enter the full name, address, city, State and zip 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 (Ml) -
<br />11. The certifying official shall sign and date the form, print hWher name, title, and telephone number_
<br />Awarding to the IPapenwrk Reducition Act, as amended, no persons are required to respond to a oolleabon of inforrnaborr unla;s it delays a
<br />valid 07c48 Control Number. The valid OMS contrail number for this information correction is OMB No. 03484)446. P.ubiic repo" !burden for this
<br />coaection or information is estimated to average 14 minutes per response, including t ne for reviewng instruebans. searching e>asfirg data sources,.
<br />gathering and maintaining the data needed, and completing and revAeaving the collection of information_ :cid comments regarding the burden
<br />a timate or any other aspect of this coCJ--ckn of infcirrrcation, including suggestions for reducing this burden, to the Office of Management and
<br />Budget, Papernvrir Reduction Project P348-W46k, Washington. DC 2DM3_
<br />00474-3
<br />F:\Public Works\ENGINEERING DIVISION PROJECTS\1415-IR Blvd Sidewalk 37th St to 53rd St\1-Admin\bid documents\LAP
<br />Documents\00474 - CERTIFICATION for DISCLOSURE OF LOBBYING ACTIVITIES.doc
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