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<br /> 1. TYpe of Fed8raj Action: 2. Stau... of FedwaI Action: 3. Report Ty..: <br /> D~ contnlCt o a. bidlofterlapplicatian D~ initJat filing <br /> grant b. initial award matariat cnange <br /> Co coaperaave ag,...nwnt Co poar-awar:a For UatariaJ Change OnJy: <br /> do loan <br /> e. loan guarant.. year quaner <br /> t. loan insurance es;ue of last napen <br /> 4- Name and Add,... of Reponing Enttty: 5. I' ReportJng EntIty In No.. 4 Ia SuDIIwardM, Enter Name <br /> and add..... of Prime: <br /> 0 Prlnw 0 SubawardH <br /> reer . , known: <br /> CO",......on8I Dlatrict, I known: <br /> 7. Federal Program fUmelo..crtptJon: <br /> _n9reaaio'" DI8b1c:t, if known: <br /> e. Federalo.p.rtmentlAgency: <br /> CFOA Number, If ~lcabl.: <br /> S. Federal Action Number, , known: 8. Award- Amount9 /I known: <br /> S <br /> 10.a. Name and Add..... 01 Lobbying EnU~ b. Indlvldu." Performing Servlca {/neJuding at:kJr.ss if <br /> {if /ndlvidUllJ. Jut name. firsr MmB. AI. : dIII.",ne from No. 7 Da} <br /> {last naine. Om nIlI'M. MI}: <br /> ..,. CGnIif-ll_. .... SFoUL..4. ''* J_"-'H <br /> 11. Amount of Paymant (ch<<:k aJ/tJMt WIY): 13. Type of Payment (check aJ/ that 1IfJP1y): <br /> $ 0 Ac:IuaI o pC8nned .~ a. nara;ner <br /> b. one-Ume f.. <br /> 12. Form of Payment (chet:k all that ~): c. commiAk)n <br /> d. contingent f.. <br /> 0 a. cash e. defend <br /> 0 b. In-kind;specify:naw,. t. other, specify: <br /> vatua <br /> ~ .f D.-cr1pdon of Setvlc:a Perfarmed orto be Pwtonntld and Datll(a) of Service, Inctudlng offlcer(a), employH(s). <br /> or Member(a) contacted for Payment Indiclltad In ...... 11: <br /> (.-ctI ~ SItwIl(., ,$F.'''....I.''tK....11 <br />I 15. ContJnuatlon Sh_t(a) SF-l11-A attached: C Va 0 No <br /> 16. lNI:lrmacIn,...,... lIW'DUgn IN laIm . aulnarInO Dy .. 31 u.s.c. <br /> MCIClI'll352. ThII clIIaoanotlDClClylnglliClMllee..._......~1 SignatunI: <br /> Of IIa UDOI'l wncn tlIIIIInOt .. ..... or .. ... .oave ... .. Print Name: <br /> lnInACIICln wu lNlIe Of' ~ lnID. T1lIa GItlCIOiIUIW . ~ ...... <br /> lD 3' U.S.C. 1352. nu IttclrmaDon WIII_ reQClI1IIG ID .. Congresa.... TitJe: <br /> lIrlIlU8Iy II1G WIll lie lIYaIIIIl:IIe/at puaIIC 1RIQeClIOn. AlP( I*'IClft wno... III <br /> ".II'l. teQUlfeo dIICloIure ..... _ ~ III a CMI .... Of nar"'lIM Telepnone No.: Oar.: <br /> SIO.ClOG lInG nor more .., S'OO.OOO lOr..... lUCrI 1lIIlur.. <br /> I "'-'&"lIIr~ A-.~ <br /> S-F_..'t <br /> <br />DISCLOSURE OF LOBBYING ACTlVmES <br />Can1P'ere this tonr. to discloM loCCyinQ aC:zivitle.pursuant to 31 U.S.C. 1352 <br />(See ,...,erse tor ~ic burden disdasure.) <br /> <br />ADDf'ovCiICI ~ 0.. <br />03.aa.GO-i6 <br />