ATTACHMENT 7 SF LLL - DISCLOSURE OF LOBBYING ACTIVITIES.pdf
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- Solicitation number
- 720
About this file
This document contains the Standard Form LLL disclosure of lobbying activities. It collects information on the type of federal action, status, report type, names and addresses of reporting entities and lobbyists, as well as the federal department, program name, and award amount. The related federal contract opportunity is solicitation number 720 for a Request for Proposals from USAID South Sudan for a residential compound data cabling project. Vendors must respond by the specified date to be considered for the award, which will be issued by USAID for cabling services to support their residential compound in South Sudan.
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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
Congressional District, if known:
Zip
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: 9. Award Amount, if known:
10. a. Name and Address of Lobbying Registrant:
Prefix * First Name Middle Name
* Last Name Suffix
* Street 1 Street 2
* City State Zip
b. Individual Performing Services (including address if different from No. 10a)
Prefix * First Name Middle Name
* Last Name Suffix
* Street 1 Street 2
* City State Zip
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)
Review Public Burden Disclosure Statement
| a contract: Off |
| b grant: Off |
| a initial filing: Off |
| b material change: Off |
| c cooperative agreement: |
| undefined: Off |
| undefined_2: Off |
| undefined_3: Off |
| d loan: |
| e loan guarantee: Off |
| f loan insurance: Off |
| Prime: Off |
| SubAwardee: Off |
| Name: |
| Street 1: |
| Street 2: |
| City: |
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| Zip: |
| Congressional District if known: |
| 5 If Reporting Entity in No4 is Subawardee Enter Name and Address of Prime: |
| undefined_4: |
| 10 a Name and Address of Lobbying Registrant: |
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| Prefix: |
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| Middle Name: |
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| Authorized for Local Reproduction Standard Form LLL Rev 797: |
| View Burden Statement: |
| 7: |
| Federal Program Name/Description: |
CFDA Number if applicable:
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