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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: 2.*Status of Federal Action: 3.*Report Type: <br /> ❑ a.contract ❑ a.bid/offer/application ®a.initial filing <br /> ® b.grant ® b.initial award ❑ b.material change <br /> • c.cooperative agreement c.post-award <br /> d.loan <br /> e.loan guarantee <br /> f. loan insurance <br /> 4. Name and Address of Reporting Entity: <br /> ®Prime SubAwardee <br /> *Name <br /> City of Everett <br /> •Street 1 Street 2 <br /> 2930 Wetmore Ave <br /> *City State Zip <br /> Everett WA: Washington 98201 <br /> Congressional District,if known: WAO2 <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 Edward Byrne Memorial Justice Assistance Grant Program <br /> CFDA Number,if applicable: 16.738 <br /> 8. Federal Action Number,if known: 9.Award Amount,if known: <br /> $ 37,989.00 <br /> 10. a. Name and Address of Lobbying Registrant: <br /> Prefix *First Name NA Middle Name <br /> •Last Name Suffix <br /> NA <br /> *Street 1 Street 2 <br /> NA <br /> •City NA State Zip <br /> b.Individual Performing Services(including address if different from No.10a) <br /> Prefix *First Name NA Middle Name <br /> *Last Name Suffix <br /> NA <br /> •Street 1 Street 2 <br /> NA <br /> *City NA State Zip <br /> 1 1. 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: Completed on submission to Grants.gov <br /> *Name: Prefix First Name Middle Name <br /> Cassie <br /> *Last Name Suffix <br /> Franklin <br /> Title: Mayor Telephone No.: 425-257-7112 Date: Completed on submission to Grants.gov <br /> Authorized for Local <br /> Fede • -4 Standard Form-LLL Rev.7-7ion <br /> PREVIEW Date: Jun 30, 2022 Workspace ID: WS00936451 Funding Opportunity Number: O-BJA-2022-171368 <br />