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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: 02/28/2025 <br />1.* Type of Federal Action: <br />a. contract <br />rb. grant <br />c. cooperative agreement <br />d. loan <br />e. loan guarantee <br />f. loan insurance <br />2. * <br />Status of Federal Action: <br />1 I a. bid/offer/application <br />0 b. initial award <br />c. post -award <br />3. * <br />Report <br />Type: <br />a. initial filing <br />b. material change <br />4. <br />Name <br />"Prime <br />and Address of Reporting Entity: <br />SubAwardee <br />* Name <br />City of Everett <br />* Street 1 <br />2930 Wetmore Ave <br />Street <br />2 <br />* City <br />Everett <br />State <br />WA: Washington <br />Zip <br />98201 <br />Congressional <br />District, if known: <br />WA02 <br />5. If Reporting <br />Entity in No.4 is Subawardee, <br />Enter Name <br />and <br />Address <br />of Prime: <br />6. * Federal <br />Department/Agency: <br />7. * <br />Federal Program Name/Description: <br />Department <br />of Justice <br />Edward <br />Byrne Memorial Justice Assistance Grant Program <br />CFDA <br />Number, if applicable: <br />16.738 <br />8. Federal <br />Action Number, if known: <br />9. Award <br />Amount, if known: <br />$ <br />37,989.00 <br />10. a. Name <br />and Address of Lobbying <br />Registrant: <br />Prefix <br />* First Name <br />NA <br />Middle <br />Name <br />* Last Name <br />NA <br />Suffix <br />* Street 1 <br />NA <br />Street <br />2 <br />* City <br />NA <br />State <br />Zip <br />b. Individual <br />Performing Services (including address if different from No. 10a) <br />Prefix <br />* First Name <br />NA <br />Middle Name <br />* Last Name <br />NA <br />Suffix <br />* Street 1 <br />NA <br />Street 2 <br />* City <br />NA <br />State <br />Zip <br />11. Information requested through this form is authorized by title 31 U.S.C. section 1352. This disclosure of lobbying activities is a material representation of fact upon which <br />reliance was placed by the tier above when the transaction was made or entered into. This disclosure is required pursuant to 31 U.S.C. 1352. This information will be reported to <br />the Congress semi-annually and will be available for public inspection. Any person who fails to file the required disclosure shall be subject to a civil penalty of not less than <br />$10,000 and not more than $100,000 for each such failure. <br />* Signature: <br />Completed on submission to Grants.gov <br />*Name: Prefix <br />* First Name <br />Cassie <br />Middle Name <br />* Last Name <br />Franklin <br />Suffix <br />Title: <br />Mayor <br />Telephone No.: <br />925-257-7112 <br />Date: <br />completed on submission to Grants.gov <br />Authorized for Local Reproduction <br />Federal Use Only: Standard Form - LLL (Rev. 7-97) <br />PREVIEW Date: Jun 30, 2022 <br />Workspace ID: WS00936451 Funding Opportunity Number: O—BJA-2022-171368 <br />