Federal Emergency Management Agency FEMA 11/5/2021

DISCLOSURE OF LOBBYING ACTIVITIES Approved by OMB Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352 0348-0046 (See reverse for public burden disclosure) 1. Type of Federal Action: 2. Status of Federal Action: 3. Report Type: na.contract Eia.bid/offer/application na.initial filing b.grant b.initial award b.material change c.cooperative agreement c.post-award For Material Change Only: d.loan year quarter e.loan guarantee date of last report f.loan insurance 4. Name and Address of Reporting Entity: 5. If Reporting Entity in No.4 is Subawardee,Enter Name Prime nSubawardee 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: 10. a. Name and Address of Lobbying Registrant b. Individuals Performing Services(including address if (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 activities is a material Signature: representation of fact upon which reliance was placed by the tier above when this transaction was made or entered into. This Print Name: Cassie Fran in disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to the Congress semi-annually and will be Title: Mayor available for public inspection. Any person who fails to file the / required disclosure shall be subject to a civil penalty of not less Telephone No.: Date: ///5 /I than$10,000 and not more than$100,000 for each such failure. Federal Use Only: Authorized for Local Reproduction Standard Form LLL(Rev.7-97) Office cfthe City Attorney APPROVED ASTO FORM David C.Hall,City Attorney A ST: City Clerk