DISCLOSURE OF LOBBYING ACTIVITIES.PDF

DISCLOSURE OF LOBBYING ACTIVITIES
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Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352 4040-0013
1. * Type of Federal Action: 2. *Status of Federal Action: 3.* Report Type:
a. contract 111 a. bid/offer/application 4 a. initial filing
x
El b. grant b. Initial award Cil b. material change
Ill c. cooperative agreement a post-award
111 d. loan
111 e. loan guarantee
El f. loan Insurance
4. Name and Address of Reporting Entity:
Prime Ei SubAwardee
` Name
Maricopa County Sheriff's Office
* Street 1 Street 2
550 West Jackson Street
` City State Zip
Phoenix AZ: Arizona 85003
Congressional District, If known:
6. If Reporting Entity in No.4 is Subawardee, Enter Name and Address of Prime:
6. * Federal Department/Agency: 7. * Federal Program Name/Description:
Office of National Drug Control Policy
CFDA Number, if applicable:
8. Federal Action Number, if known: 9. Award Amount, if known:
$
10. a. Name and Address of Lobbying Registrant:
Prefix ' First Name I I Middle Name
• Last Name Suffix
* Street 1 Street 2
• City State Zip
b. Individual Performing Services (Including address if different from No, 10a)
Prefix * First Name I 'Middle Name
* Last Name Suffix
"Street 1 Street 2
'City State Zip
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
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
the Congress semi-annually and will be available for public inspection. Any person who falls to file the required disclosure shall be subject to a civil penalty of not less than
$10,000 and not more than $100,000 for each such failure.
*Signature:
*Name: Prefix • First Name Middle Name
Bill
'Last Name Suffix
Gates
Title: Chairman Telephone No.: Date: I I
Authorized for Local Reproduction
Federal Use Only: Standard Farm. LLL (ReY. 7-97)
APPROVED AS TO FORM
This day of , 2019
Fran McCarroll Date By:
Clerk of the Board of Supervisors Deputy Maricopa County Attorney