**<strong>Flowers</strong> <strong>Baking</strong> Co <strong>of</strong> <strong>Tyler</strong>, LLC. has no lobbying activities to disclose**Disclosure <strong>of</strong> Lobbying ActivitiesComplcrc rhis form to disclose lobbying activities pursuant to ll U.S.C' 1352(See next page for public burden disclosure.)Approved by OMB0348-0046l. Type <strong>of</strong> Federal Action:r--1 a. contractlJ b. grantc. cooperative agreementd. loan[. loan insurance2. Status <strong>of</strong> Federal Action:n a. bid/<strong>of</strong>fer/applicationlJ b. inirial awardc. post-award3. Report'l'ype:a. initial filing- lJ b. material changeFor Materinl Change Only:quarterveardale <strong>of</strong> last report-4. Name and Address <strong>of</strong> Reporting Entity:5. lf Reporting Entity in No, 4 is Subawardce, Enter Nameand Address <strong>of</strong> Prime:!T-'l Subawardeel-l Tier_, if known:Congressional District, if known?Congrcssional District, if known:6. Federal Departmenr / Agency: 7. Federal Program Name / Description:CFDA Number, if applicable:lu. a. t\amg auq /\uqtcss ur wuuylrB clllry(if individual, last name, first namc, MI):5u. ltrulvtuuall rgt lurullllt JEI vl96(including address ifdiffetent from No. lOaXlast name,first name, Ml):(attach Continuat rn Sheet(s) SF-LLL-A. if necessary)I Amount ot Payment (check ail tnat appryr:J ? actual ? Dlann€d ? a. retainer? b, one-timc feeI 2. Form <strong>of</strong> Payment (check all that apply)? c. commission? a. esh? d. contingent fcc? b, in-kind; specify: nature? e. deferredvalue? f. othcr; specify:l4- Brief Descriotion <strong>of</strong><strong>Service</strong>s Performed or to be Performed and Datesonlacted. for Pavment lndicated in ltem I l:;) <strong>of</strong> Servicc, including <strong>of</strong>ficer(s), employee(s), or Membe(s)(artach Cootinution Sheet(s) SF-LLL-A, if necessary)l5.ContinuationSheet(s)SF-LLL-Aattached: ? Yes ? No16. lntbrmation requested through this form is authorized by article3l U.S.C. section 1352. This disclosure <strong>of</strong> lobbying activities is amaterial represenration <strong>of</strong> fact upon which reliance was placed bythe tier above when this transaction was made or entered into. Thisdisclosure is required pursuant to 3 I U.S.C. 1352. This informatioowill be reported to the congress semiaonually and will be availabletor public inspection. Any person who fails to file the requireddisclosure shall be subiect to a civil penalty <strong>of</strong> not less than $ <strong>10</strong>,000and not more than $ I 00,000 for each such failure,Federal Use Only:Signature:Print Name:Title:Telephone No:Date:_Authorized for Local ReproductjonStandard From - LLLFresh Bread RFP # 2012-09 Paoe 24 <strong>of</strong> 30
PROCUREMENTInstructions lor Completion <strong>of</strong> SF.l-Lh Disclosure'<strong>of</strong> Lobbying ActivitiesThis disclosure torm shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at theinifiafion or receipt <strong>of</strong> a covered Federal iction, or a material change to a previous filing, pursuant to title 31 U'S.C.section 't 352. Tfre filing <strong>of</strong> a form is required for each payment or agreement to make payment lo any lobbying enti$ forinfluencing or attempting to influence an <strong>of</strong>ficer or employee ol any agency, a Member <strong>of</strong> Congress, an <strong>of</strong>ficer oremployee-<strong>of</strong> Congress, Jr an employee <strong>of</strong> a Member <strong>of</strong> Congress in connection with a covered Federal action. Use theSf-U-L-n Continuation Sheet for additional information if the space on the form is inadequate. Complete all items thatapply for both the initial filing and material change report. Refer to the implementing guidance published by the Office olManagement and Budget for additional information.1. ldentify the type <strong>of</strong> covered Federal action for which lobbying activity is and / or has been secured to influencethe outcome <strong>of</strong> a covered Federal Action.2. ldentify the status <strong>of</strong> the covered Federal Action.3. ldentify the appropriate classification <strong>of</strong> this report. lf this is a follow-up report caused by a material change tothe infbrmation previously reported, enter the year and quarter in which the change occurred. Enter the date <strong>of</strong>the lasl previously submitted report by this reporting entity for this covered Federal Action.4. Enter the full name, address, city, state and ztp code <strong>of</strong> the reporting entity. Include Congressional District, ifknown. Check theappropriataclassifcation <strong>of</strong> the rep.orting entity that designaleS it it is, or expects to be, aprime or subaward recipient. ldentify the tier <strong>of</strong> the subawardee, e.9., the first subawardee <strong>of</strong> the prime is the1o tier. Subawards include but are not limited to subcontracts, subgrants, and contract awards under grants.5. lf the organization filing the report in item 4 checks "Subawardee," then enter the full name, address, city, stateand zip code <strong>of</strong> the prime Federal recipient. lnclude Congressional District, if known.6. Enter the name <strong>of</strong> the Federal Agency making the award or loan commitment. Include at least oneorganizational level below agency name, if known. For example, Department <strong>of</strong> Transportation, United StatesCoast Guard.7. Enter the Federal program name or description for the covered Federal action (item 1). lf known, enter the tullCatalog <strong>of</strong> Federal Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loancommitrnents.B. Enter the most appfopriate Federal identifying number available for the Federal action identified in item 1(e.9.,Request for Proposal (RFP) number; Invitation for Bid (lFB) number; grant announcement number; thecontract, grant, or loan award numbeq the application proposal control number assigned by the Federalagency). Include prefixes, e.g, "RFP-DE-90-001."9. For a covered Federal action where there has been an award or loan commitment by the Federal agency,enter the Federal amount <strong>of</strong> the award / loan commitment for the prime entity identified in item 4 or 5.<strong>10</strong>. (a) Enter the full name, address, city, state and zip code ol the lobbying entity engaged by the reporting entityidentified in item 4 to influence the covered Federal action.(b) Enter the tull names <strong>of</strong> the individual(s) performing services, and include full address if different from <strong>10</strong> (a).Enter Last Name, First Name, and Middle Initial (Ml)..11. Enter the amount <strong>of</strong> compensation paid or reasonably expected to be paid by the reporting entity (item 4) to thelobbying entity (item <strong>10</strong>). Indicate whether the payment has been made (actual) or will be made (planned).Check all boxes that apply. lf this is a material change report, enter the cumulative amount <strong>of</strong> payment madeor planned to be made.12. Check the appropriate box(es). Check all boxes that apply. lf payment is made through an in-kind contribution,specify the nature and value <strong>of</strong> the in-kind payment.13. Check the appropriate box(es). Check all boxes that apply. lf other, specity nature.14. Provide a specific and detailed description <strong>of</strong> the services that the lobbyist has performed, or will be expecledto perform, and the date(s) <strong>of</strong> any services rendered. Include all preparatory and related activity, not iust timespent in actual contact with Federal <strong>of</strong>ficials. ldentify the Federal <strong>of</strong>ficial(s) or employee(s) contacted or the<strong>of</strong>ficer(s), employee(s), or Member(s) <strong>of</strong> Congress that were contiacted.15. Check whether or not a SF-LLL-A Continuation Sheet(s) is attached.16. The certifying <strong>of</strong>icial shall sign and date the form, print his/her name, title, and telephone number.Public reporting burden for this collectron <strong>of</strong> information is estimated to average 30 minutes per response, including time forreviewing instructions, searching existing data sources, gathering and maintaining he data needed, and completing andreviewing the mllection <strong>of</strong> information. Send comments regarding the burden estimate or any other aspect <strong>of</strong> this collection <strong>of</strong>information, including suggestions for reducing this burden, to the ffice <strong>of</strong> Management and Budget, Paperwork ReductionProject (0348-0046), Washington, D.C. 20503.Fresh Bread RFP # 2O12-Og Page 25 <strong>of</strong> 30
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