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explanation to this application regarding the particular statement that cannot be certified. Please check the box if an explanation is
<br /> attached to this application. Please note that the applicant is still required to sign the Certifications form to certify to all the other
<br /> applicable statements.
<br /> False statements or claims made in connection with COPS grants(including cooperative agreements)may result in fines,
<br /> imprisonment,disbarment from participating in federal grants or contracts,and/or any other remedy available by law.
<br /> I certify that the assurances provided are true and accurate to the best of my knowledge.
<br /> Elections or other selections of new officials will not relieve the grantee entity of its obligations under this grant.
<br /> Signature of Law Enforcement Executive/Agency Executive(For your electronic signature, please type in your name)
<br /> Deryl Loar
<br /> Deryl Loar
<br /> Date:
<br /> 06/11/2015
<br /> Signature of Government Executive/Financial Official(For your electronic signature, please type in your name)Kelly
<br /> Goodwin
<br /> Kelly Goodwin
<br /> Date:
<br /> 06/11/2015
<br /> SECTION 16: DISCLOSURE OF LOBBYING ACTIVITIES
<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 initiation or
<br /> receipt of a covered Federal action, or a material change to a previous filing,pursuant to title 31 U.S.C. section 1352.The filing of
<br /> a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to
<br /> influence an officer or employee of any agency,a Member of Congress.an officer or employee of Congress, or an employee of a
<br /> Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and
<br /> material change report. Refer to the implementing guidance published by the Office of Management and Budget for additional
<br /> information.
<br /> 1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a
<br /> 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 follow-up report caused by a material change to the information
<br /> previously reported,enter the year and quarter in which the change occurred. Enter the date of the last previously submitted
<br /> report by this reporting entity for this covered Federal action.
<br /> 4.Enter the full name,address,city,state and zip code of the reporting entity. Include Congressional District number, if known.
<br /> Check the appropriate classification of the reporting entity that designates if it is,or expects to be, a prime or subaward recipient.
<br /> Identify the tier of the subawardee,e.g.,the first subawardee of the prime is the 1st tier. Subawards include but are not limited to
<br /> 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 and zip code of
<br /> 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 level below
<br /> 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 Catalog of
<br /> Federal Domestic Assistance(CFDA)number for grants,cooperative agreements, loans and loan commitments.
<br /> 8.Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for
<br /> Proposal(RFP)number; Invitation for Bid(IFB)number;grant announcement number;the contract,grant,or loan award number;
<br /> the application/proposal control number assigned by the Federal agency). Include prefixes,e.g.."RFPD E-90-001."
<br /> 9.For a covered Federal action where there has been an award or loan commitment by the Federal agency,enter the Federal
<br /> amount of the award/loan 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 entity engaged by the reporting registrant identified in
<br /> item 4 to influence the covered Federal action.
<br /> (b)Enter the full name(s)of the individual(s)performing services,and include full address if different from 10(a). Enter Last
<br /> 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 /> According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless
<br /> it displays a valid OMB Control Number. The valid OMB control number for this information collection is OMB No. 0348-0046.
<br /> Public reporting burden for this collection of information is estimated to average 10 minutes per response,including time for 102
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