SFLLL_2_0-V2.0.PDF

Maricopa County — Formal (2024-06-12)

View PDF Item 16 Meeting page

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10. a. Name and Address of Lobbying Registrant:
9. Award Amount, if known: 
$ 
* Street 1
* City
State
Zip
Street 2
* Last Name
Prefix
* First Name
Middle Name
Suffix
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C.1352
OMB Number: 4040-0013 
Expiration Date: 02/28/2025
1. * Type of Federal Action:
a. contract
b. grant
c. cooperative agreement
d. loan 
e. loan guarantee
f.  loan insurance
2. * Status of Federal Action:
a. bid/offer/application
b. initial award
c. post-award
3. * Report Type:
a. initial filing
b. material change
 4.   Name and Address of Reporting Entity:
Prime
SubAwardee
* Name
Maricopa County Sheriff's Office
* Street 1
550 West Jackson Street
Street  2
* City
Phoenix
State
AZ: Arizona
Zip
85003
Congressional District, if known:
5. If Reporting Entity in No.4 is Subawardee, Enter  Name and Address of Prime:
6. * Federal Department/Agency:
Office of National Drug Control Policy
7. * Federal Program Name/Description:
CFDA Number, if applicable: 
8. Federal Action Number, if known: 
b. Individual Performing Services (including address if different from No. 10a) 
Prefix
* First Name
Middle Name
* Street 1
* City
State
Zip
Street 2
11.
* Last Name
Suffix
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 fails 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
Jack
Middle Name
* Last Name
Sellers
Suffix
Title:
Chairman
Telephone No.: 602-506-1776
Date:
  Federal Use Only: 
Authorized for Local Reproduction 
Standard Form - LLL (Rev. 7-97)

HIDTA CY25 Application SF-LLL (Lobbying Disclosure) Form 
1a 
Maricopa County 
ATTEST: 
 Juanita Garza       
  Date 
 Clerk of the Board of Supervisors 
APPROVED AS TO FORM 
This ____ day of ____________________, 20__ 
By: ___________________________________ 
  Deputy Maricopa County Attorney