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DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB <br /> Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348 -0046 <br /> (See reverse for public burden disclosure.) <br /> 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: <br /> a . contract r a. bid /offer /application a j a. initial filing <br /> b. grant L b. initial award —J b. material change <br /> c. cooperative agreement c. post -award For Material Change Only: <br /> d. loan year __ quarter <br /> e. loan guarantee date of last report <br /> f. loan insurance <br /> 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is a Subawardee, Enter Name <br /> © Prime ❑ Subawardee and Address of Prime: <br /> Tier __, if known: <br /> LI of <br /> Tw h re3 DriPa(f m ".f- <br /> �5� f>Zrt <br /> 7 -46)1 <br /> Cong essional District, if known: Fourth Congressional District, if known: <br /> 6. Federal Department/Agency: 7. Federal Program Name /Description: <br /> epa mu�f of Q Z � M <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 Registrant b. Individuals Performing Services (including address if <br /> (if individual, last name, first name, MI): different from No. 10a) <br /> S,n : 1 G— D ,)s.E.. , ., - /}n ire S (last name, first name, MI): <br /> j voc, Co - i :. f ,�vt Al Jim Smith, Kirk Bailey, Tom Dawson, and Greg Andrews <br /> Sui +� 3a <br /> lc)as�1 1 h ,1 D.L. 2oD3(1, <br /> 11. Information requested through this form is authorized by title 31 U.S.C. section <br /> Signature: -- 1) F- ; C ) 1352. This disclosure of lobbying activities is a material representation of fact �.�..�� <br /> upon which reliance was placed by the tier above when this transaction was made Dennis M. Taylor <br /> or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This Print Name: <br /> information will be reported to the Congress semi- annually and will be available for City Manager <br /> inspection. Any person who fails to file the required disclosure shall be Title: Y g eC <br /> subject to a civil penalty of not less that $10,000 and not more than $100,000 for I 682 -5336 �� ; /d� <br /> each such failure. Telephone No.: ( 54 ) Date: 4 <br /> Federal Use Only: Authorized for Local Reproduction <br /> Standard Form LLL (Rev. 7 -97) <br />