24. DISCLOSURE OF LOBBYING ACTIVITIES.pdf
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- Solicitation number
- 147067
- Issued by
- Sacramento County, California
About this file
This is a Disclosure of Lobbying Activities form (Standard Form LLL) required for federal contracting purposes under 31 U.S.C. 1352. The form applies to the Laguna Creek Trail and Bruceville Road Sidewalk Improvements Project in California and requires disclosure of any lobbying activities conducted in connection with federal actions including contracts, grants, cooperative agreements, loans, loan guarantees, and loan insurance. The form mandates submission with the bid and requires identification of the type of federal action, status of the action, report type, reporting entity information, prime contractor or subawardee status, federal agency and program details, federal action number, and award amount if known.
The form requires detailed disclosure of lobbying entities, individuals performing lobbying services, payment amounts and forms, and a description of services performed or to be performed. Payment may be disclosed as actual or planned and may take the form of retainers, one-time fees, commissions, contingent fees, deferred value, or other specified arrangements. Failure to file the required disclosure subjects the responsible party to civil penalties ranging from not less than $10,000 and not more than $100,000 for each failure. The disclosed information will be reported to Congress semiannually and made available for public inspection. The form must be signed by an authorized representative and include printed name, title, telephone number, and date.
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THIS FORM MUST BE SUBMITTED WITH THE BID
71 Part III. Federal Provisions
24. Disclosure of Lobbying Activities
24. DISCLOSURE OF LOBBYING ACTIVITIES
COMPLETE THIS FORM TO DISCLOSE LOBBYING ACTIVITIES PURSUANT TO 31 U.S.C. 1352
1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type:
a. contract
a. bid/offer/application
a. initial
b. grant b. initial award b. material change
c. cooperative agreement c. post-award
d. loan For Material Change Only:
e. loan guarantee year ____ quarter _________
f. loan insurance date of last report ___________
4. Name and Address of Reporting Entity 5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime:
Prime Subawardee 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. Name and Address of Lobby Entity 11. Individuals Performing Services
(If individual, last name, first name, MI)
(including address if different from No. 10)
(last name, first name, MI)
(attach Continuation Sheet(s) if necessary)
12. Amount of Payment (check all that apply) 14. Type of Payment (check all that apply)
$ _____________ actual planned a. retainer
b. one-time fee
13. Form of Payment (check all that apply): c. commission
a. cash d. contingent fee
b. in-kind; specify: nature ______________ e deferred value _____________ f. other, specify __________________________
15. Brief Description of Services Performed or to be performed and Date(s) of Service, including officer(s), employee(s), or member(s) contacted, for Payment Indicated in Item 12:
(attach Continuation Sheet(s) if necessary)
16. Continuation Sheet(s) attached: Yes No
17. Information requested through this form is authorized by Title 31 U.S.C. Section 1352. This disclosure of lobbying reliance was placed by the tier above when his transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to Congress semiannually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.
Signature: _________________________________________
Print Name: _______________________________________
Title: ____________________________________________
Telephone No.: ____________________ Date: __________
Authorized for Local Reproduction
Federal Use Only: Standard Form - LLL
Standard Form LLL Rev. 04-28-06
File details come from the government source that posted it. Updated .