Attachment_G_-_OMB_Standard_Form_LLL_-_Lobbying_Activities.pdf
PDF 15 KB Posted
- Attached to
- Nationwide Cardiac Testing Services Federal contract opportunity
- Solicitation number
- 15-233-SOL-00286
About this file
Attachment G SF-LLL-Disclosure of Lobbying Activities
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Questions_and_Answers_-_FOH_Cardiac_Testing_Services(2015-09-27).pdf | ||
| 15-233-SOL-00286_SOLICITATION_IDIQ_-_REVISED_(2015-09-27).pdf | ||
| Attachment_E_-_FOH-74_Referral_Ticket_(M.89).pdf | ||
| Attachment_D_-_List_of_Cities.xlsx | XLSX spreadsheet | |
| Attachment_F_-_FBI_Security_Forms.pdf | ||
| Attachment_B_-_Non-Disclosure_Agreement.pdf | ||
| Attachment_A_-_Past_Performance_Questionnaire.pdf | ||
| 15-233-SOL-00286_Nationwide_Cardiac_Testing_Services.pdf | ||
| Attachment_C_-_Price_Proposal_Form.xlsx | XLSX spreadsheet |
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Text version
DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 0348-0046 (See reverse for public burden disclosure.)
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
a. contract a. bid/offer/application a. initial filing
b. grant b. initial award b. material change
c. cooperative agreement c. post-award For Material Change Only:
d. loan year _________ quarter _________
e. loan guarantee date of last report ______________
f. loan insurance
4. Name and Address of Reporting Entity: 5. If Reporting Entity in No. 4 is a Subawardee, Enter Name and Address of Prime:
Tier ______, if known :
Congressional District, if known : Congressional District, if known :
6. Federal Department/Agency: 7. Federal Program Name/Description:
CFDA Number, if applicable: _____________
8. Federal Action Number, if known : 9. Award Amount, if known :
10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services (including address if ( if individual, last name, first name, MI): different from No. 10a )
(last name, first name, MI ):
11. Signature:
Print Name:
Title:
Telephone No.: _______________________
Authorized for Local Reproduction Standard Form LLL (Rev. 7-97)
Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be available for public inspection.
required disclosure shall be subject to a not more than $100,000 for each such failure.
Prime Subawardee
Federal Use Only:
Date:
who fails to file the Any person $10,000 and thancivil penalty of not less
4c
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