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Exhibit D
<br />BH-22-AR-04-198
<br />City of Everett
<br />Page 3 of 4
<br />INSTRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
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<br />This disclosure form shall be completed by the reporting entity, whether sub-awardee or prime Federal recipient, at the
<br />initiation or receipt of a covered Federal action, or a material change to a previous filing, pursuant to title 31 U.S.C.
<br />section 1352. The filing of a form is required for each payment or agreement to make payment to any lobbying entity
<br />for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or
<br />employee of Congress, or an employee of a Member of Congress in connection with a covered Federal action.
<br />Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance
<br />published by the Office of Management and Budget for additional information.
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<br />1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the
<br />outcome of a covered Federal action.
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<br />2. Identify the status of the covered Federal action.
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<br />3. Identify the appropriate classification of this report. If this is a follow-up report caused by a material change to the
<br />information previously reported, enter the year and quarter in which the change occurred. Enter the date of the last
<br />previously submitted report by this reporting entity for this covered Federal action.
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<br />4. Enter the full name, address, city, State and zip code of the reporting entity. Include Congressional District, if
<br />known. Check the appropriate classification of the reporting entity that designates if it is, or expects to be, a prime
<br />or sub-award recipient. Identify the tier of the sub-awardee, e.g., the first sub-awardee of the prime is the 1st tier.
<br />Sub-awards include but are not limited to subcontracts, sub-grants and contract awards under grants.
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<br />5. If the organization filing the report in item 4 checks "Sub-awardee," then enter the full name, address, city, State
<br />and zip code of the prime Federal recipient. Include Congressional District, if known.
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<br />6. Enter the name of the Federal agency making the award or loan commitment. Include at least one organizational
<br />level below agency name, if known. For example, Department of Transportation, United States Coast Guard.
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<br />7. Enter the Federal program name or description for the covered Federal action (item 1). If known, enter the full
<br />Catalog of Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan
<br />commitments.
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<br />8. Enter the most appropriate Federal identifying number available for the Federal action identified in item 1 (e.g.,
<br />Request for Proposal (RFP) number; Invitation for Bid (IFB) number; grant announcement number; the contract,
<br />grant, or loan award number; the application/proposal control number assigned by the Federal agency). Include
<br />prefixes, e.g., "RFP-DE-90-001."
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<br />9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter
<br />the Federal amount of the award/loan commitment for the prime entity identified in item 4 or 5.
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<br />10. (a) Enter the full name, address, city, State and zip code of the lobbying registrant under the Lobbying Disclosure
<br />Act of 1995 engaged by the reporting entity identified in item 4 to influence the covered Federal action.
<br />(b) Enter the full names of the individual(s) performing services, and include full address if different from 10 (a).
<br />Enter Last Name, First Name, and Middle Initial (MI).
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<br />11. The certifying official shall sign and date the form, print his/her name, title, and telephone number.
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<br />According to the Paperwork Reduction Act, as amended, no persons are required to respond to a collection of information unless it
<br />displays a valid OMB Control Number. The valid OMB control number for this information collection is OMB No. 0348-0046.
<br />Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for
<br />reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing
<br />the collection of information. Send comments regarding the burden estimate or any other aspect of this collection of information,
<br />including suggestions for reducing this burden, to the Office of Management and Budget, Paperwork Reduction Project (0348-
<br />0046), Washington, DC 20503.
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