7 - Bread Bid Disclosure Lobbying.pdf

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Approved by OMB Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to31 U.S.C. 1352

(See attached for public burden disclosure)

1. Type of Federal Action

(enter letter of choice)

a. contract

b. grant

c. cooperative agreement

d. loan

e. loan guarantee

f. loan insurance

2. Status of Federal Action:

(enter letter of choice)

a. bid/offer/application

b. initial award

c. post-award

3. Report Type:

a. initial filing

b. material change

For material change only:

Year quarter Date of last report

0348-0046

Nameand Address of Reporting Entity:

Prime Sub awardee Tier , ifknown:

Congressional District, if known:

5. If Reporting Entity in No. 4 is Subawardee, Enter Name and Address of Prime:

6. Federal Department/Agency-:

8. Federal Action Number, ifkr

10. a. Name and Address of Lobbying Registrant (if individual, last name, firstname. Ml):

11. Amountof Payment (cheek all that apply):

$ U actual I—I planned

12. Form of Payment (check all thatapply):

_ a. cash

_ b. in-kind; specify: nature value

9. Award Amount. // known:

Congressional District, if known:

Federal Program Name/Description:

CFDA Number, if applicable:

b. Individuals Performing Services (including address if differentfrom No. 10a) /last name, first name. Ml):

13. Type of Payment (check allthat apply) a retainer c commission e deferred

f. other; specify:

b one-time fee

d. contingent fee

14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officers), emplovee(s) or Member(s) contacted, for Payment Indicated in Item 11:

— {Attach Continuation Sheet(s) SF-LLL-A, ifnecessary)

15. Continuation Sheet(s) SF-LLL-A attached: Yes No

16. Information requested through this form isauthorized by Title31 U.S.C. Section 1352. This Disclosure of Lobbying Activities isa material representation of fact uponwhich reliance was placed by the tier above when this transaction was made or entered into. This disclosure is required pursuant to 31 L.S.C. 1352.This information will be reported to theCongress semi-annually and will beavailable for public inspection. Any personwhofails to file the required disclosure shall be subject to a civil penalty of not less than S10.000 and not more than SI00.000 for each such failure.

Signature:

Print Name:

Title:

Telephone No.: Date:

Federal Use Only Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97)

Office of Chief Financial Officer, USDA Pt. 3018, App. B

DISCLOSURE OF LOBBYING ACTIVITIES Approved by0MB

CONTINUATION SHEET 0348-0046

Reporting Entity: Page.

Authorized for Local Reproduction Standard Form - LLL-A of

INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES

This disclosure form shall be completed by the reporting entity, whether subawardee orprime Federal recipient, at the initiation or receipt ofa covered Federal action, ora material change to a previous filing, pursuant to title 31 U.S.C. section 1352. The filing ofa form isrequired for each payment oragreement tomake payment toanylobbying entity for influencing oranempting to influence an officer or employee of anyagency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action. Complete all items that apply for both the initial filing and material change report, Refer to the implementing guidance published by the Office of Management and Budget for additional information.

1. Identify the type of covered Federal action forwhich lobbying activity is and or has been secured to influence theoutcome of a covered Federal action.

2. Identify the status of the covered Federal action.

3. Identify the appropriate classification of this report. If this is a followup report caused by a materialchange to the information previously reported, enter the year andquarter in which the change occurred. Enter the dateof the last previouslysubmitted report by this reporting entity for this covered Federal action.

4. Enterthe full name, address, city. Stateandzipcodeof the reporting entity. Include Congressional District, if known.

Checkthe appropriateclassification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify the tier of the subawardee, e.g., the first subawardee of the primeis the 1sttier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

5. If theorganization filing the report in item4 checks "Subawardee," then enter the full name,address, city. Stateand zip code of the prime Federal recipient. Include CongressionalDistrict, if known.

6. Enter the name of the federal agency making the award or loan commitment. Include at least one organizational level belowagency name, if known. For example, Department of Transportation, United States Coast Guard.

7. Enterthe Federal program nameor description for thecovered Federal action (item 1). If known, enter the full Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments.

8. Enterthe mostappropriate Federal identifying number available for the Federal action identified in item 1(e.g., Request for Proposal (RFP) number; Invitations for Bid(IFB) number; grantannouncement number; contract, grant,or loan award number;application/proposal control numberassignedby the Federalagency). Includeprefixes, e.g., "RFP-DE-90-001."

9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5.

10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in item 4 to influence the covered Federal action.

(b) Enter the full names of the individual(s) performing services, and include full address if different from 10(a). Enter Last Name, First Name, and Middle Initial (MI).

11. Enter the amount of compensation paid or reasonablyexpected to be paid by the reporting entity (item 4) to the lobbying entity (item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a material change report, enter the cumulative amount of payment made or planned to be made.

12. Check the appropriate box(es). Check all boxesthat apply. If payment is made through an in-kind contribution, specify the nature and value of the in-kind payment.

13. Check the appropriate box(es). Check all boxes that apply. If other, specify nature.

14. Provide a specific and detailed description of the services that the lobbyist has performed, or will be expected to perform, and the date(s) of any services rendered. Include all preparatory and related activity, not just time spent in actual contact with Federal officials. Identify the Federal official(s) or employee(s) contacted or the officer(s), employee(s), or Member(s) of Congress that were contacted.

15. Check whether or not a SF-LLL-A Continuation Sheet(s) is attached.

16. The certifying official shall sign and date the form, print his her name, title, and telephone number.

Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-0046), Washington, DC 20503