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DISCLOSURE OF LOBBYING ACTIVITIES <br /> Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352 OMB Number:4040-0013. <br /> Expiration Date:02/28/2022 <br /> 1.*Type of Federal Action: 2.*Status of Federal Action: 3.* Report Type: <br /> El a.contract ® a.bid/offer/application ®a.initial filing <br /> ®b.grant El b.initial award n b.material change <br /> c.cooperative agreement El c.post-award <br /> d.loan <br /> ne.loan guarantee <br /> f. loan insurance <br /> 4. Name and Address of Reporting Entity: <br /> ®Prime El SubAwardee <br /> *Name • . <br /> City of Everett <br /> "Street 1 Street 2 <br /> 2930 Wetmore Ave <br /> City Everett State WA: Washington Zip 98201-4067 <br /> Congressional District,if known: WA02 <br /> 5.If Reporting Entity in No.4 is Subawardee, Enter Name and Address of Prime: <br /> 6.*Federal Department/Agency: 7.*Federal Program Name/Description: <br /> Department of Justice Body Worn Camera Policy and Implementation <br /> CFDA Number,if applicable: 16.835 <br /> 8.Federal Action Number,if known: 9.Award Amount,if known: <br /> $ <br /> 10.a. Name and Address of Lobbying Registrant: <br /> Prefix *First Name Middle Name <br /> Lisa <br /> "Last Name Suffix <br /> Barkovic • <br /> "Street 1 Street 2 <br /> 800 17th St NW, Suite 1100 Holland & Knight, LLP <br /> *City Washington State DC: District of Columbia Zip 20006 <br /> b. Individual Performing Services(including address if different from No.10a) <br /> Prefix *First Name Middle Name <br /> Lisa I <br /> *Last Name Suffix <br /> Barkovic <br /> *Street 1 Street <br /> 800 17th Street NW, Suite 1100 <br /> Zip <br /> "City Washington State DC: District of Columbia cuuuo <br /> tuegicercn�n6e§1�'gfna /retome <br /> 11. Information requested through this form is authorized by title 31 U.S.C.section 1352. This disclosu o re sentation o rt fact upon which <br /> reliance was placed by the tier above when the transaction was made or entered into. This disclosu is vit}}�� 1/��sr.� atio will be reported to <br /> the Congress semi-annually and will be available for public inspection. Any person who fails to file t req�h€ddi�l ISe s'Cibjec to a civ ty ofrioti less than <br /> $10,000 and not more than$ r':• • - •such failure. David C. Hall, City Attorney��\ <br /> *Signature: i_ \ <br /> *Name: Prefix *First Name Middle Name AT/ <br /> ST. <br /> Cassie <br /> *Last Name Suffix _ , <br /> AMILOI 41(22 <br /> Franklin <br /> City C erk <br /> Title: Mayor Telephone No.: 4252577112 Date: <br /> Authorized for Local Reproduction <br /> F..euerai Use,0 - Standard Fenn-LLL(Rev.7-97) <br /> PREVIEW Date: Apr 20, 2020 Workspace ID: WS00469770 Funding Opportunity Number: BJA-2020-17732 <br />