ATTACHMENT_B.pdf
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- Solicitation number
- 23-0400-RFP
- Issued by
- Pinellas County, Florida
About this file
This document is a Disclosure of Lobbying Activities form (Standard Form-LLL) authorized by the U.S. Office of Management and Budget (OMB) with control number 4040-0013. The form is designed to report lobbying activities pursuant to 31 U.S.C. 1352, with checkboxes indicating this is an initial filing for a grant in a post-award status. The form requires detailed disclosure of the reporting entity, federal agency, lobbying registrant, and individual performing lobbying services, with potential civil penalties of $10,000 to $100,000 for failure to file the required disclosure.
The form contains fields for capturing comprehensive information about lobbying activities, including the type of federal action, status of the action, reporting entity details, federal department/agency, program name, and award amount. While the specific fields are blank in this document, the form mandates that the information will be reported to Congress semi-annually and will be available for public inspection. The disclosure is considered a material representation of fact upon which transaction tiers are based, emphasizing the legal and transparency requirements associated with lobbying activities in federal grant and contract processes.
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| ATTACHMENT_A.pdf | ||
| Attachment_C.pdf |
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Text version
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352
I Review Public Burden Disclosure Statement I
Approved by 0MB
4040-0013
1. * Type of Federal Action: 2. * Status of Federal Action: 3. * Report Type:
D a. contract □ a. bid/offer/app lication IZ] a. initial filing
IZ] b. grant □ b initial award D b. matenal change
D c. cooperative agreement IZl c. post-award
D d. loan
D e. loan guarantee
D f. loan insurance
4. Name and Address of Reporting Entity:
□Prime IZ] SubAwardee Tier ifknown: D ... Name I I
• Street 1 I I Street 2 I I "City I I Slate I Bl z,;o I
I Congressional District, if known: I I
5. If Reporting Entity in No.4 is Subawardee, Enter Name and Address of Prime:
... Name
I I
• Street 1 I I Street 2 I I " City I I Slate I Bl z,;o I
I Congressional District , if known: ] I
6. * Federal Department/Agency: 7. * Federal Program Name/Description:
I I I
CFDA Number, If appl1cablff I
8. Federal Action Number, if known: 9. Award Amount, if known:
I I $ I I
10. a. Name and Address of Lobbying Registrant:
Prefix I GI • First Name I Middle Name I I
• Last Name I I Suffix
I Bl
• Street 1 I I Street 2 I I
• City I I Stale I Bl z,;o I
I
b. Individual Performing Services (including address if d ifferent from No 10a)
Prefix I
GI • First Name I I Middle Name I I
• Last Name I I Suffix
I Bl
• Street 1 I I Street 2 I I
• City I I Stale
I Bl2 'P I I
11. lnfonnat1on requested through this form is authonzed by tit le 31 U.S.C. section 1352 This disclosure of lobbying activ it ies is a matenal representation of fact upon which reliance was placed by the t ier above when the transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352 . This infonnation will be reported to the Congress semi-annually and will be available /or public inspection. Any person who fails to file the required disclosure shall be subject to a crvil penalty of not less lllan $1 0,000 and not more than $1 00,000 for eacll such failure
• Signature: I I •Name: Prefix
I Bl ... First Name I I Middle Name I I ... Last Name I I Suffix
I Bl Title: I I Telephone No.: I loate: I .I
Federal Use Only: I Au1horized tor Local Reproduction Standard Form• LLL (Rev. 7-87)
I
I
File details come from the government source that posted it. Updated .