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SECTION 00644 - DISCLOSURE OF LOBBYING ACTIVITIES <br /> Complete this form to disclose lobbying activities pursuant to 31 U.S.C . 1352 <br /> (See reverse for public burden disclosure.) <br /> 1 . Type of Federal Action : 2. Status of Federal Action: 3. Report Type: <br /> a. contract a. bid/offer/application Ela. initial filing <br /> b. grantb. material change <br /> c . cooperative agreement b. initial award <br /> d. loan c. post-award For Material Change Only: <br /> e. loan guarantee <br /> £ loan insurance year quarter <br /> date of last report <br /> 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter Name <br /> and Address of Prime: <br /> ❑ Prime ❑ Subawardee <br /> Tier if known: <br /> Congressional District, if known: Congressional District, if known: <br /> 6. Federal Department/Agency: 7. Federal Program Name/Description: <br /> CFDA Number, if applicable: <br /> 8. Federal Action Number, if known: 9. Award Amount, if known: <br /> 10. a. Name and Address of Lobbying Entity b. Individuals Performing Services (including address if <br /> (if individual, last name, first name, MI) : differentfrom No. IOa) <br /> (last name, first name, MI) : <br /> attach Continuation Sheets SF-LLL-A, if necessary) <br /> Signature: <br /> 11. Information requested through this form is authorized by title 31 U.S.C. <br /> section 1352. This disclosure of lobbying activities is a material Print Name: <br /> representation of fact upon which reliance was placed by the der above <br /> when this transaction was made or entered into. This disclosure is required <br /> pursuant to 31 U.S.C. 1352. This information will be reported to Congress Title: <br /> semi-annually and will be available for public inspection. Any person who <br /> fails to file the required disclosure shall be subject to a civil penalty of not Telephone No. : Date: <br /> less than 5101000 and not more than 5100,000 for each such failure. <br /> Federal, Use Only Authorized for Local Reproduction <br /> Standard Form — LLL (Rev 7 — 97) <br /> 00644- 1 <br /> 00644 — Disclosure of Lobbying Activities <br /> F:\Engineering\Capital Projects\0219-Kitching Station Trailhead\0219 Kitching-Contract Docs\0219-00644 - Disclosure of Lobbying <br /> Activities.doc <br />