RE-BID ITB # 23-10-01 JOINT PROCUREMENT CENTRAL ISLAND

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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:2.Status of Federal Action:3.Report Type: a.contracta.offer/applicationa.initial filing ____ b. grant _____ b. initial award _____ b. material change c.cooperative agreementc.post-award d.loan For material change only: e.loan guaranteeYear _______ quarter _______ f.loan insuranceDate of last report___________ 4.Name and Address of Reporting Entity:5.If Reporting Entity in No. 4 is Subawardee, ____ Prime _____ Subawardee Enter Name and Address of Prime: Tier______, if Known: Congressional District,if known:Congressional District,if known: 6.Federal Department/Agency:7.Federal Program Name/Description: CFDA Number, if applicable: ____________ 8.Federal Action Number, if known:9.Award Amount,if known: $ b.Individuals Performing Services (including address if 10.a. Name and Address of Lobbying Registrant (if individual, last name, first name, MI): 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 Signature: __________________________________ activities is a material representation of fact upon which reliance was placed by the tier above when this transaction Print Name: _____ was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported Title: _____ to the Congress semi-annually and will be available for public inspection. Any person who fails to file the required Telephone No.: ____________ Date: _______ disclosure shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each such failure. Authorized for Local Reproduction Federal Use Only Standard Form -LLL (Rev. 7-97)