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DISCLOSURE OF LOBBYING ACTIVITIES <br />This disclosure form shall be completed by the reporting entity, whether subawardee or prime recipient, at the initiation or receipt of a <br />covered action, or a material change to a previous filing. The filing of a form is required for each payment or agreement to make payment <br />to any lobbying entity for influencing or attempting to influence an employee of KTB, a Member of the Regional Transportation Council <br />(RTC), an officer or employee of the Regional Transportation Council (RTC), or an employee of a Member of the Regional Transportation <br />Council (RTC) in connection with a covered action. Use the SF -LLL -A Continuation Sheet for additional information if the space on the form <br />is inadequate. Complete all items that apply for both the initial filing and material change report. <br />1. Identify the type of covered action for which lobbying activity is and/or has been secured to influence the outcome of a covered <br />action. <br />2. Identify the status of the covered action. <br />3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the information <br />previously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted <br />report by this reporting entity for this covered action. <br />4. Enter the full name address city, state and zip code of the reporting entity. Check the appropriate classification of the reporting <br />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 <br />subawardee of the prime is the 1st tier. Subawards include but are not limited to subcontracts, subgrants and contract awards <br />under grants. <br />5. If the organization filing the report in item 4 checks "Subawardee," then enter the full name, address, city, state and zip code of <br />the prime recipient. <br />6. Enter the name of the agency making the award or loan commitment. <br />7. Enter the program name or description for the covered action (item 1.) <br />8. Enter the most appropriate identifying number available for action identified in item 1 (e.g., Request for Proposal (RFP) number; <br />invitation for Bid (B) number, grant announcement number; the contract grant, or loan award number; the application/proposal <br />control number assigned by the agency.) Include prefixes, e.g. "RFP -DE -90-001." <br />9. For a covered action where there has been an award or loan commitment by the agency, enter the amount of the award/loan <br />commitment for the prime entity identified in item 4 or 5. <br />10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in item <br />40 to influence the covered action. <br />(b) Enter the full names of the individuals(s) performing services, and include full address if different from 10(a). Enter Last <br />Name, First Name and Middle Initial (MI). <br />11. Enter the amount of compensation paid or reasonably expected to be paid by the reporting entity (item 4) to the lobbying entity <br />(item 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is a <br />material change report, enter the cumulative amount of payment made or planned to be made. <br />12. Check the appropriate box(es). Check all boxes that apply. If payment is made through an in-kind contribution, specify the nature <br />and value of the in-kind payment. <br />13. Check the appropriate boxes(s). Check all boxes that apply. If other, specify nature. <br />14. Provide a specific and detailed description of the services that the lobbyist has performed or will be expected to perform and the <br />date(s) of any services rendered. Include all preparatory and related activity, not just time spent in actual contract with officials. <br />Identify the employee of KTB, the Member of the Regional Transportation Council (RTC), an officer or employee of the Regional <br />Transportation Council (RTC), or the employee of a Member of the Regional Transportation Council (RTC) in connection with a <br />covered. <br />15. Check whether or not a SF -LLL -A Continuation Sheet(s) is attached. <br />16. The certifying official shall sign and date the form, print his/her name, title, and the telephone number. <br />Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing <br />instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of <br />information. <br />Memorandum of Understanding Page 2 <br />