ESBD_359947_1716215746849_RFQ Air Quality.docx

Ark-Tex Council of Governments 4808 Elizabeth Street, Texarkana, TX 75503

Request for Statement of Qualifications Air Quality Modeling and Emissions Inventory

Due Date: June 10th, 2024 Time Due: 12:00 P.M.

Table of Contents

Scope of Work……………………………………………………………………………………5

RFQ

Events Timetable

ACTION

Public media notification of RFQ RFQ made available for distribution Deadline to Submit Questions Questions must be emailed by 5:00pm to Debbie Purifoy, dpurifoy@atcog.org

Deadline for responses to questions Response deadline Proposals must be received & date-stamped by 12:00 pm via email sent to dpurifoy@atcog.org

Review and evaluation process begins Selection of Consultant and Board Approval

DATE

May 20th, 2024

May 20th, 2024

May 27th, 2024

May31st, 2024

June 10th, 2024

June 12th, 2024

June 27th,2024

General Information

Request for Statement of Qualifications

INTRODUCTION

Ark-Tex Council of Governments (ATCOG) is a political subdivision of the State of Texas defined as a voluntary association of municipal and county governments and special purpose districts. Our office organization is based in Texarkana Tx and serves Bowie, Cass, Delta, Franklin, Hopkins, Lamar, Morris, Red River, and Titus counties in Texas. We are dedicated to establishing programs and services that affect the region's wide range of physical, economic, and social concerns. An essential element of the organization is developing and implementing coordinated activities within the region.

PURPOSE

Ark-Tex Council of Governments invites qualified parties to submit a statement of qualifications to provide service for inventorying emissions, monitoring of pollution levels, air pollution and data analysis, and modeling pollution levels. The statement of qualifications should be no more than 25 pages (8.5” by 11”) in length, exclusive of required attachments. 12-point font, single-sided, including cover letter.

RESPONSES

ATCOG seeks an air quality consulting service with experience in areas described in the Scope of Work. Please include in your proposal a list of past client regions, names and contact information of references, and resumes of the implementation team, including the Project Manager for each technical area. Please also provide a copy of your current certificate of insurance for professional liability.

SCOPE OF WORK

The Consultant will complete the following tasks in order to assess the extent and magnitude of ambient PM2.5 concentrations in Bowie County, TX, for projects most beneficial for the SIP and limited to:

· Inventorying emissions

· Monitoring of pollution levels;

· Air pollution and data analysis; and

· Modeling pollution levels

· Develop a stationary source PM2.5 emissions inventory for all stationary sources in Bowie County TX required to complete TCEQ annual emissions reports.

· Develop a stationary source PM2.5 air dispersion modeling inventory that will include point and fugitive emissions source characteristics necessary to complete an air dispersion modeling analysis, including, stack heights, stack diameters, stack temperatures, stack flow rates, and stack locations. For fugitive sources, information on the fugitive release's dimensions will be compiled to develop initial dispersion parameters.

· Utilize U.S. EPA’s Moves model to develop a PM2.5 mobile source emissions inventory of vehicular traffic within Bowie County.

· Conduct an air dispersion modeling assessment utilizing U.S. EPA regulatory modeling AERMOD to evaluate the PM2.5 ambient impacts in Bowie County, TX, resulting from stationary and mobile PM2.5 emissions sources.

· Review the last 5 years of PM2.5 ambient monitoring data measured at Bowie County PM2.5 ambient monitoring station.

· Develop a report summarizing the air dispersion modeling assessment findings and review of ambient monitoring data. The report will also summarize the inputs to the air dispersion modeling assessment and the technical options utilized. Should Bowie County be designed as a PM2.5 nonattainment area, TCEQ could potentially utilize the report to develop a PM2.5 nonattainment State Implementation Plan (SIP).

EVALUATION CRITERIA

Proposals received will be evaluated and ranked according to the following criteria:

1. Experience (60%)

a. Qualifications of firm and staff – 30%

b. Necessary skills – 30%

2. Work Performance (25%)

a. Timely completion of previous projects – 10%

b. References – 15%

3. Capacity to Perform (15%)

a. Financial condition and Resources to Sustain Project – 5%

b. Demonstration of Professional Responsibility – 10%

By submitting a Statement of Qualifications, the respondent accepts the evaluation process described in this document and acknowledges that the determination of the “most qualified” firm may require subjective judgments of the evaluation committee. The method described in this document is intended to comply with Texas Government Code Chapter 2254, Subchapter A, so that the selected firm will be secured based on demonstrated competence and qualifications through

Deadline for Submission

June 10th, 2024

Submission Requirements

Submit 1 (one) electronic copy to:

Debbie Purifoy dpurifoy@atcog.org Subject line: Air Quality Modeling and Emissions Inventory

Contact Person

All questions concerning this RFQ packet should be directed to Debbie Purifoy via email at dpurifoy@atcog.org. Questions and answers will be posted for all interested parties -atcog/.

Limitations and Reservations

ATCOG reserves the right to accept or reject any and all proposals received as a result of this request, to negotiate with all qualified sources, or to cancel this RFQ in part or its entirety if found to be in the best interest of ATCOG. This RFQ does not commit ATCOG to award a contract, pay any costs incurred to prepare proposals or procure or contract for any services.

ATCOG specifically reserves the right to vary the provisions set forth herein at any time prior to the execution of a contract where such variance is deemed to be in the best interest of the needs of ATCOG. While every effort has been made to ensure the accuracy and completeness of the information in this RFQ, ATCOG recognizes that the information is not exhaustive in every detail and that all work and materials may not be expressly mentioned in the requirements of the RFQ. Therefore, it is the responsibility of the proposer to include in their proposal all requirements which are necessary for the full performance of the goods or services. If selected for negotiations, the proposer may be required to prepare and submit additional information prior to final vendor(s) selection in order to reach terms for the provision of services which are agreeable to both parties.

Modification and Renewals

ATCOG reserves the right to negotiate a modification in connection with any executed agreement/contract funded through this RFQ without repeating the RFQ process for a period of up to five (5) years from the original proposal initiation. Vendor modifications and renewals shall be considered based upon the vendor’s ability to meet ATCOG needs.

Signatures

A proposal shall be signed by the business’s official authorized to bind that business and shall contain a statement to the effect that the proposal is a firm bid for a thirty (30) day period from the date that the submission is received by ATCOG. The proposal shall also provide the name, title, address, and telephone number of the individual(s) with the authority to negotiate during the proposal evaluation period.

Evaluation Criteria

The selection of a proposal is to be made after a careful evaluation of the proposals received. Each proposal will be evaluated for acceptability, emphasizing the various factors enumerated in the evaluation table. Each element is assigned a numerical score. The scores will determine vendor(s) with whom negotiations may be conducted. Evaluations will be based upon the table on page 6 for which up to 100 points may be awarded. Total evaluation values of less than 70 points will invalidate a proposal.

Protest Rights

All protests or complaints regarding this RFQ process shall be referred to the ATCOG Grievance Procedures for resolution. Procedures are outlined beginning on page 10 of this RFQ.

Conflict of Interest

To avoid any real or apparent conflict of interest in the procurement of this RFQ, no ATCOG employee or their family member may vote on or financially benefit from any award connected with this request. Chapter 176 of the Texas Local Government Code requires vendors and consultants contracting or seeking to contract with ATCOG to file a conflict of interest questionnaire (CIQ) if they have an employment or other business relationship with an officer of ATCOG or an ATCOG officer's close family member. The CIQ must be completed and filed with the response if an employment or business relationship defined in the law exists.

Open Records

All proposals and accompanying attachments become the property of ATCOG upon submission and are subject to the Texas Open Records Act.

1. If the respondent considers any portion of its proposal to be privileged or confidential by statute or judicial decision, including trade secrets and commercial or financial information, clearly identify those portions.

2. Proposals will be opened in a manner that avoids disclosure of the contents to competing proposers and keeps them secret during negotiations. All proposals are open for public inspection after the contract is awarded, but trade secrets and confidential information in the submissions are not.

3. ATCOG will honor the respondent’s notation of trade secrets and confidential information and decline to release such information initially. The final determination of whether a particular portion of the proposal is, in fact, a trade secret or commercial or financial information that may be withheld from public inspection will be made by the Texas Attorney General.

4. In the event a public information request is received for a portion of the proposal that has been noted as being confidential information, the respondent will be notified of the request, and the respondent will be required to justify its legal position in writing to the Texas Attorney General pursuant to Section 552.305 of the Government Code. In the event that it is determined by the opinion or order of the Texas Attorney General that such information is, in fact, not privileged and confidential, then such information will be made available to the requester.

5. Marking the entire proposal CONFIDENTIAL/PROPRIETARY is not in conformance with the Texas Open Records Act.

Subcontracting

The services of any vendor(s) awarded from this RFQ must be delivered by the vendor named on the proposal. Subcontracting will not be allowed unless prior authorization from ATCOG is given.

. Submission Requirements

A proposal must include all items listed on the RFQ Submission Checklist, page 13, to be considered responsive and receive an evaluation.

Procurement Grievance Procedures

A. Definitions

1. A grievance is defined as a dispute regarding an alleged improper interpretation, application, or violation of an individual’s terms and conditions regarding the Request For Proposal/Bid/Information or Invitation For Bid/Proposal (RFQ, RBP, RFI, OR IFB, IFP) process.

2. A “party of interest” is the person or persons making the appeal and any person who might be required to take action or against whom action might be taken to resolve the claim.

3. Workdays are those days when administrative offices are scheduled to be open.

B. Purpose

The purpose of this procedure is to secure, at the lowest possible level, equitable solutions to the problems which may, from time to time, arise affecting individuals. Both parties agree that these proceedings will be kept confidential as may be appropriate at any level of the procedure.

It is the policy of this agency to respond promptly to any complaints or grievances which may arise.

C. Procedure – General

1. Failure by the Administration at any step of this procedure to communicate the decision on a grievance within the specified time limits shall permit the aggrieved to proceed to the next step.

2. The time limits specified may be extended by mutual agreement and shall be exclusive of discretionary leave and scheduled vacation.

3. Failure by the aggrieved at any step of the procedure to appeal a grievance to the next step within the specified time limits shall be acceptance of the decision rendered at that step.

D. Action and Appeal

Level 1

The grievance must be discussed with the Program Coordinator within ten (10) calendar workdays after the individual(s) first knew or should have known of the event or series of events causing the complaint. If the matter is not resolved by the Program Coordinator within ten (10) calendar workdays, then the aggrieved shall present the grievance in writing, proceeding to Level 2.

Level 2

If the outcome of the conference at Level 1 is not to the individual’s satisfaction, the individual(s) must submit a grievance in writing with a request to meet with the Deputy Director/Procurement Officer within ten (10) calendar workdays. The grievance shall specify:

· The matter at issue or in dispute.

· The reason for grieving.

· The remedy sought.

The document shall contain all points to be included in the grievance. Facts not contained in the document may be introduced at appeal levels and in the procedure only with the consent of all interested parties.

The meeting shall be held within ten (10) calendar workdays or at a mutually agreed time after the Deputy Director/Procurement Officer receives the request to discuss the complaint.

The Deputy Director/Procurement Officer will then investigate the matter fully and render a decision within ten (10) calendar workdays.

Level 3

If the grievance is not resolved to the individual’s satisfaction at Level 2, then the individual may appeal to the Executive Director in writing within ten (10) calendar workdays. The Executive Director will render a decision within ten (10) calendar workdays and will be final.

In cases where a Conflict of Interest may be viewed, an individual shall appeal to the Board of Directors within ten (10) calendar workdays after receipt of the final decision made by the Executive Director.

The appeal shall be submitted in writing within ten (10) calendar workdays through the Secretary to the Board, who shall obtain all related papers from each Level and forward the appeal to the Board President.

The Board President will designate a committee of three (3) of its own members to determine only whether the decision was reasonable on the basis of record and not capricious or irresponsible. The Board committee will give its report to the Board of Directors for the final decision. The Board’s final decision shall be rendered in writing to the parties involved.

RFQ Submission Checklist

· Required Elements in Response Format page 5

· Certification of Compliance with Required Elements page 14

· Assurances page 15

· Certification of Lobbying and Conflict of Interest Questionnaire pages 16,18

· Submission of 1 (one) electronic proposal by June 10th, 2024, 12:00 pm (CST) to Debbie Purifoy at dpurifoy@atcog.org Subject line: Air Quality Modeling and Emissions Inventory

Certification of Compliance with Required Elements

This is to certify that to the best of the undersigned’s knowledge and belief, the information in this proposal is responsive and is true and correct. The undersigned understands that a non- responsive proposal, as defined by ATCOG, may not be reviewed and considered for agreement/contract selection. Further, the submission of the proposal has been authorized by the governing body of the proposer.

(Signature) (Date)

(Print Name and Title)

(Print name and title of person authorized to negotiate a contract if different from person listed above.)

(Organization)

(Address) (City) (State) (Zip)

(Telephone Number)

Assurances

We understand and agree that this proposal is not a contract and does not obligate the Ark-Tex Council of Governments to pay for costs incurred in the preparation of this proposal or costs incurred prior to the execution of a written contract or prior to the receipt of funds designated for this program from the funding agency.

We understand and agree that the contract provisions may vary from the provisions set forth in this request, when deemed necessary by the Ark-Tex Council of Governments. However, we agree to abide by the contract provisions contained in the proposed contract.

We understand and agree that we may be subject to an on-site review and must be able and willing to provide documentation of information in the proposal at the request of the Ark-Tex Council of Governments prior to execution of a contract.

We understand and agree that the Ark-Tex Council of Governments is not required to select the lowest cost proposal.

We understand and agree that any material misrepresentation or deliberate omission of a fact in this proposal may be justification for rejection of the proposal.

We understand and agree to abide by all federal, state and local laws, policies and regulations governing these and those additional rules which may be promulgated, or as amended, subsequent to the execution of a contract.

· Clean Air Act (42 U.S.C. § 7401-7671q)

· Federal Water Pollution Control Act as amended (33 U.S.C. § 1251-1387)

· Executive Orders 12549 and 12689 that requires “a contract award (see 2 CFR 180.220) must not be made to parties listed on the government-wide exclusions in the System for Award Management (SAM)”, in accordance with the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR part 1986 Comp.,

p. 189) and 12689 (3 CFR part 1989 Comp., p. 235), “Debarment and Suspension.”

· Section 1352 of the Program Fraud and Civil Remedies Act, Title 31 U.S. Code for the Department of Agriculture (7CFR part 3018) (29 CFR Part 39) (34 CFR Part 82) (45 CFR Part 93)

· Pursuant to 2155.004, Government code Texas Sales and Use Tax We understand and agree that we may be subject to a monitoring review or audit by the Texas Office of the Governor Public Safety Office, U.S. Department of Homeland Security and/or Ark-Tex Council of Governments.

We understand and agree to submit this proposal in a good faith effort to provide services to the benefit of economically disadvantaged individuals eligible for services under this proposal.

Signature: Date:

Printed Name: Title:

CONFLICT OF INTEREST QUESTIONNAIRE

For vendor doing business with local governmental entity

FORM CIQ

This questionnaire reflects changes made to the law by H.B. 23, 84th Leg., Regular Session.

This questionnaire is being filed in accordance with Chapter 176, Local Government Code, by a vendor who has a business relationship as defined by Section 176.001(1-a) with a local governmental entity and the vendor meets requirements under Section 176.006(a).

By law this questionnaire must be filed with the records administrator of the local governmental entity not later than the 7th business day after the date the vendor becomes aware of facts that require the statement to be filed. See Section 176.006(a-1), Local Government Code.

A vendor commits an offense if the vendor knowingly violates Section 176.006, Local Government Code. An offense under this section is a misdemeanor.

OFFICE USE ONLY

Date Received

Check this box if you are filing an update to a previously filed questionnaire. (The law requires that you file an updated completed questionnaire with the appropriate filing authority not later than the 7th business day after the date on which you became aware that the originally filed questionnaire was incomplete or inaccurate.)

Name of Officer

officer, as described by Section 176.003(a)(2)(A). Also describe any family relationship with the local government officer. Complete subparts A and B for each employment or business relationship described. Attach additional pages to this Form CIQ as necessary.

A. Is the local government officer or a family member of the officer receiving or likely to receive taxable income, other than investment income, from the vendor?

Yes No

B. Is the vendor receiving or likely to receive taxable income, other than investment income, from or at the direction of the local government officer or a family member of the officer AND the taxable income is not received from the local governmental entity?

Yes No

other business entity with respect to which the local government officer serves as an officer or director, or holds an ownership interest of one percent or more.

Check this box if the vendor has given the local government officer or a family member of the officer one or more gifts as described in Section 176.003(a)(2)(B), excluding gifts described in Section 176.003(a-1).

Signature of vendor doing business with the governmental entity

Date

Revised 1/1/2021 Form provided by Texas Ethics Commission www.ethics.state.tx.us

CONFLICT OF INTEREST QUESTIONNAIRE

For vendor doing business with local governmental entity

A complete copy of Chapter 176 of the Local Government Code may be found at http://www.statutes.legis.state.tx.us/ Docs/LG/htm/LG.176.htm. For easy reference, below are some of the sections cited on this form.

Local Government Code § 176.001(1-a): "Business relationship" means a connection between two or more parties based on commercial activity of one of the parties. The term does not include a connection based on:

(A) a transaction that is subject to rate or fee regulation by a federal, state, or local governmental entity or an agency of a federal, state, or local governmental entity;

(B) a transaction conducted at a price and subject to terms available to the public; or

(C) a purchase or lease of goods or services from a person that is chartered by a state or federal agency and that is subject to regular examination by, and reporting to, that agency.

Local Government Code § 176.003(a)(2)(A) and (B):

(a) A local government officer shall file a conflicts disclosure statement with respect to a vendor if:

(2) the vendor:

(A) has an employment or other business relationship with the local government officer or a family member of the officer that results in the officer or family member receiving taxable income, other than investment income, that exceeds $2,500 during the 12-month period preceding the date that the officer becomes aware that

(i) a contract between the local governmental entity and vendor has been executed; or

(ii) the local governmental entity is considering entering into a contract with the vendor;

(B) has given to the local government officer or a family member of the officer one or more gifts that have an aggregate value of more than $100 in the 12-month period preceding the date the officer becomes aware that:

(i) a contract between the local governmental entity and vendor has been executed; or

(ii) the local governmental entity is considering entering into a contract with the vendor.

Local Government Code § 176.006(a) and (a-1)

(a) A vendor shall file a completed conflict of interest questionnaire if the vendor has a business relationship with a local governmental entity and:

(1) has an employment or other business relationship with a local government officer of that local governmental entity, or a family member of the officer, described by Section 176.003(a)(2)(A);

(2) has given a local government officer of that local governmental entity, or a family member of the officer, one or more gifts with the aggregate value specified by Section 176.003(a)(2)(B), excluding any gift described by Section 176.003(a-1); or

(3) has a family relationship with a local government officer of that local governmental entity.

(a-1) The completed conflict of interest questionnaire must be filed with the appropriate records administrator not later than the seventh business day after the later of:

(1) the date that the vendor:

(A) begins discussions or negotiations to enter into a contract with the local governmental entity; or

(B) submits to the local governmental entity an application, response to a request for proposals or bids, correspondence, or another writing related to a potential contract with the local governmental entity; or

(2) the date the vendor becomes aware:

(A) of an employment or other business relationship with a local government officer, or a family member of the officer, described by Subsection (a);

(B) that the vendor has given one or more gifts described by Subsection (a); or

(C) of a family relationship with a local government officer.

ATCOG

CERTIFICATION REGARDING LOBBYING

The undersigned certifies, to the best of his or her knowledge and belief, that:

(1) No Federal appropriated funds have been paid or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding of any Federal grant, the making of any Federal loan, the entering into of any cooperative agreement, and the extension, continuation, renewal, amendment or modification of any Federal contract, grant, loan, or cooperative agreement.

(2) If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative agreement, the undersigned shall complete and submit Standard Form- LLL, "Disclosure of Lobbying Activities," in accordance with its instructions.

(3) The undersigned shall require that the language of this certification be included in the award documents of all sub-awards at all tiers (including subcontracts, sub-grants, and contracts under grants, loans, and cooperative agreements) and that all sub- recipients shall certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. Submission of this certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, United States Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure.

Organization:

Street address:

City, State, Zip:

Certified By: Title: Signature:

Date:

Certification Regarding Lobbying V9.17.20 Page 1

Approved by OMB 0348-0046 Disclosure of Lobbying Activities Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352 (See reverse for public burden disclosure)

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

For material change only: Year quarter Date of last report

Congressional District, if known:

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

Congressional District, if known:

CFDA Number, if applicable:

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

b. Individuals Performing Services (including address if different from No. 10a) (last name, first name, MI):

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 this 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: Print Name: Title: Telephone No.: Date: _

Federal Use Only

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

Certification Regarding Lobbying V9.17.20

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

Certification Regarding Lobbying V9.17.20

This disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31U.S.C. section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer or employee of any agency, 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 for which lobbying activity is and/or has been secured to influence the outcome 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 material change to the information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by this reporting entity for this covered Federalaction.

4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if known. Check the appropriate classification 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 prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards under grants.

5. If the organization filing the report in item 4 checks “Subawardee,” then enter the full name, address, city, State and zip code of the prime Federal recipient. Include Congressional District, if known.

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

7. Enter the Federal program name or description for the covered 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. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g., Request for Proposal (RFP) number; Invitations for Bid (IFB) number; grant announcement number; the contract, grant, or loan award number; the application/proposal control number assigned by the Federal agency). Included prefixes, 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 registrant under the Lobbying Disclosure Act of 1995 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. The certifying official shall sign and date the form, print his/her name, title, and telephonenumber.

According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it displays a valid OMB control Number. The valid OMB control number for this information collection is OMB No. 0348-0046. Public reporting burden for this collection of information is estimated to average 10 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 image1.png