Attachment 3 Sol_72011121R00002.pdf
PDF 96 KB Posted
- Solicitation number
- 72011121R00002
- Issued by
-
US Agency for International Development
About this file
This attachment is a lobbying disclosure form related to a solicitation from the US Agency for International Development. The solicitation seeks proposals for an Armenia Improved Water Management for Sustainable Economic Growth Program. The program aims to transform Armenia's approach to water management through developing improved approaches and tools to support sustainable water governance. It will advance water governance and spread best practices in water conservation and use. The program will also provide technical assistance to the Armenian government, local communities, and private sector to improve water management and implementation of small-scale pilot projects. Eligible offerors are required to complete the lobbying disclosure form to report any lobbying activities pursuant to federal regulations. The completed form must be submitted with any response to the solicitation.
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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
Approved by OMB
0348-0046
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:
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
Suffix* Last Name
11. 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: Authorized for Local Reproduction Standard Form - LLL (Rev. 7-97)
5. If Reporting Entity in No.4 is Subawardee, Enter Name and Address of Prime:
Completed on submission to Grants.gov
Completed on submission to Grants.gov
ATTACHMENT 3.
Prime
X X
X
File details come from the government source that posted it. Updated .