7-7.1 SFLLL 1 2 P-V12a-2.pdf
PDF 14 KB Posted
- Attached to
- Re-bid Paving Services
- Solicitation number
- ITB-2026-17JK
- Issued by
- Mckinley County, New Mexico
About this file
This is a Standard Form LLL, a federal disclosure of lobbying activities form, related to a state and local contract opportunity for re-bid paving services in New Mexico. The form is designed to comply with 31 U.S.C. 1352 requirements and applies to various types of federal actions including contracts, grants, cooperative agreements, loans, loan guarantees, and loan insurance. The document requires disclosure of lobbying activities and identifies the reporting entity, whether as a prime contractor or subcontractor, along with details regarding the federal department or agency involved, the federal program name and description, and the federal action number if known.
The form mandates disclosure of any lobbying registrants and individuals performing lobbying services, including their names, addresses, and congressional districts. The document carries significant legal weight, as it represents a material representation of fact upon which the tier above relies when entering into the transaction. Failure to file the required disclosure subjects the responsible party to civil penalties ranging from a minimum of $10,000 to a maximum of $100,000 for each violation. The semi-annually reported information becomes available for public inspection. The form was last revised on July 1, 1997, with an OMB control number of 4040-0013 and an expiration date of February 28, 2022.
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Text version
10. a. Name and Address of Lobbying Registrant:
9. Award Amount, if known:
* Street 1
* City State Zip
Street 2
* Last Name
Prefix * First Name Middle Name
Suffix
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352
OMB Control Number: 4040-0013 Expiration Date: 2/28/2022
1. * Type of Federal Action:
a. contract
b. grant
c. cooperative agreement
d. loan
e. loan guarantee
f. loan insurance
2. * Status of Federal Action:
a. bid/offer/application
b. initial award
c. post-award
3. * Report Type:
a. initial filing
b. material change
4. Name and Address of Reporting Entity:
Prime SubAwardee
* Name
* Street 1 Street 2
* City State Zip
Congressional District, if known:
5. If Reporting Entity in No.4 is Subawardee, Enter Name and Address of Prime:
6. * Federal Department/Agency: 7. * Federal Program Name/Description:
CFDA Number, if applicable:
8. Federal Action Number, if known:
b. Individual Performing Services (including address if different from No. 10a)
Prefix * First Name Middle Name
* Street 1
* City State Zip
Street 2
11.
* Last Name Suffix
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 the transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually 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:
*Name: Prefix * First Name Middle Name
* Last Name Suffix
Title: Telephone No.: Date:
Federal Use Only: STANDARD FORM LLL (REV. 7/1997) Authorized for Local Reproduction
File details come from the government source that posted it. Updated .