Attachment 3 Standard Form LLL Certification Regarding Lobbying.pdf
PDF 91 KB Posted
- Attached to
- Moakley Cafeteria Services Federal contract opportunity
- Solicitation number
- 47PB0025Q0015
About this file
The document is a Standard Form LLL Disclosure of Lobbying Activities form, which requires disclosure of lobbying activities pursuant to 31 U.S.C. 1352. The form captures details about federal actions, including contract type, status, and reporting entity information. Key sections include identifying the type of federal action (in this case, a contract), the status of the federal action (bid/offer/application), and report type (initial filing). The form requires disclosure of the reporting entity, federal department/agency, and details about any lobbying registrants or individuals performing lobbying services. The form emphasizes that failure to file the required disclosure can result in civil penalties ranging from $10,000 to $100,000 for each failure, and that the information will be reported to Congress and available for public inspection.
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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 Number: 4040-0013
Expiration Date: 02/28/2025
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:
Assistance Listing 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:
Completed on submission to Grants.gov
Completed on submission to Grants.gov
*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)
File details come from the government source that posted it. Updated .