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(101) (a) <br /> Approved by OMB <br /> 0348 -0046 <br /> • 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 a. initial filing <br /> b. grant A b. initial award A b. material change <br /> c. cooperative agreement c. post -award <br /> d. loan For material change only: <br /> e. loan guarantee Year quarter . <br /> f. loan insurance Date of last report <br /> 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is Subawardee, Enter <br /> )C Prime Subawardee Name and Address of Prime: <br /> Tier , if Known: <br /> G O-E _ t1).• <br /> s F� <br /> Congressional District, if known: - 1)1sAvicj t - ( Congressional District, if known: <br /> 6. Federal Department/Agency: 7. Federal Program Name/Description: F <br /> V.S. .t)-e.■ark wke.4- v c- CA. grcakta.. Fund, Fvr TUN4eeVelmark of <br /> eAucoA -i or <br /> CFDA Number, if applicable: <br /> 8. Federal Action Number, i jknown: 9. Award Amount, if known: <br /> �o �r `r�VWWN. $ 1 - ,OOO <br /> 10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including-address if <br /> ((individual, last name, first name, MI): different from No. !Oa) <br /> 51n^1 .=Dawsa" - Is44.coAs, (last name, first name, ML): i�owar i Smarr. <br /> tado Cs.wwsdtwk Ate. NvJ,Su•p 3aZ <br /> Wac••4.4i)." C.• 2.403 <br /> 11. Information requested through this form is authorized by <br /> dde 31 U.S.C. section 1352. This disclosure of lobbying Signature: <br /> activities is a material representation of fact upon which <br /> reliance was placed by the tier above when this transaction Print Name: Le-S. ' e <br /> was made or entered into. This disclosure is required <br /> pursuant to 31 U.S.C. 1352. This information will be reported Title: C a Sem etnc_ ".r <br /> to the Congress semi- annually and will be available for public <br /> Inspection. Any person who fails to file the required <br /> disclosure shall be subject to a dvil penalty of not less than Telephone No.: 11') (e13Z5Z t Date: ?S - 22 - o1 <br /> 510,000 and not more than 5100,000 for each such failure. <br /> Federal Use Only Authorized for Local Reproduction <br /> Standard Form - ILL (Rev. 7-97) <br />