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STATE OF FLORIDA D=P.AFTAIENT OF TRANOMR7ATION 37543 IU <br />DISCLOSURE OF LOBBYING ACTIVITIES ?RaOtAREME,6 <br />D2 <br />Is this form applicable to your firm? <br />YES ❑ NO <br />If no, then please complete section 4 <br />below for "Prime' <br />1. Type of Federal Action: <br />2. Status of Federal Action: <br />3. Report Type: <br />a. contract <br />a. bid/offer/application <br />a. initial filing <br />b. grant <br />b. initial award <br />b. material change <br />c. cooperative agreement <br />d. loan <br />c. post-miward <br />For Material Change Only: <br />Year: Quarter <br />e. loan guarantee <br />f. loan insurance <br />Date of last report: <br />(mm/dd/yyyy) <br />4. Name and Address of Reporting Entity: <br />© Prime ❑ Subawardee <br />5. If Reporting Entity in No. 4 is a Subawardee. Enter Name and <br />Address of Prime: <br />Tier . if known. <br />PRP Construction Group.LLC <br />19300 SW Springhaven Ave <br />Indiantown, FI <br />Congressional District, if known: <br />Congressional District, if known: 4c <br />6. Federal Department/Agency: <br />7. Federal Program Name/Description: <br />CFDA Number, if applicable: <br />8. Federal Action Number, if known: <br />9. Award Amount, if known: <br />10. a. Name and Address of Lobbying Registrant <br />b. Individuals Performing Services (including address if <br />(if individual, last name, first name, Ml): <br />different from No. 10a) <br />(last name, first name, Ml): <br />11. Information requested through this form is authorized by title 31 <br />U.S.C. section 1352. This disclosure of lobbying activities is a <br />material representation of fact upon which reliance was piaced <br />Signature:i4 <br />by the tier above when this transaction was made or entered <br />into. This disclosure is required pursuant to 31 U.S.C. 1352. <br />Print Name: <br />This information will be available for public inspection. Any <br />person who fails to file the required disclosure shall be subject <br />to a civil penalty of not less than 510,000 and not more than <br />Title: President <br />5100,000 for each such failure. <br />Telephone No.: 772-597-6923 Date (mmldd/yyyy): 01/21/2020 <br />Federal Use Only: <br />Authorized for Local Reproduction <br />Standard Form LLL Rev.7-97 <br />00474-2 <br />F:\Public Works\ENGINEERING DIVISION PROJECTS\1503-43rd Ave Swk Airport Dr to 41st St\1-Admin\Bids\Bid Documents\LAP <br />Documents\00474 - CERTIFICATION for DISCLOSURE OF LOBBYING ACTIVITIES.doc <br />