County of Los Angeles INSTRUCTIONS FOR REPORT OF PERSON OR ENTITY SPENDING $5,000 OR MORE TO INFLUENCE OFFICIAL COUNTY ACTION FORM LOB 9 CHAPTER 2.160 OF THE LOS ANGELES COUNTY CODE PERSONS OR ENTITIES SPENDING $5000: Persons or entities who are not lobbyist, who do not employ a lobbyist or contract with a lobbying firm but who make payments to influence official County action aggregating $5,000 or more in a calendar quarter must file (Form LOB 9). A Form LOB 9 must be filed for each calendar quarter in which the person or entity spends $5,000. The form is not required to be filed for any quarter in which the person or entity does not spend $5,000 to influence official County action. PERIOD COVERED BY REPORT: The periods covered and the filing deadlines for reports are as follows: PERIOD COVERED January, February and March April, May and June July, August and September October, November and December FILING DEADLINE April 30 st July 31 st October 31 st January 31 th IMPORTANT: A late filing fee of $25 per day will be assessed for the first ten days a report is filed beyond the due date. The late filing fee will then increase to $50 per day for the second ten days; and thereafter, the late filing fee will be $75 per day until the filer comes into compliance with the provisions of the lobbyist ordinance or the date that other sanctions or penalties are imposed, which may include, but are not limited to, a civil liability in the amount of up to $5000, an administrative fine of up to $5000 and a noncompliance fee of up to $5000. If a report is sent by first class mail, it is considered received on the date of the postmark. Filing deadlines which fall on a Saturday, Sunday or official County holiday are extended to the next regular business day. No fee is required for filing a Form LOB 9. FILE THIS FORM WITH ORIGINAL SIGNATURE WITH THE: Executive Officer of the Board of Supervisors County of Los Angeles Kenneth Hahn Hall of Administration 500 W. Temple Street, Room 383 Los Angeles, California 90012 (213) 974 -1093 INTERNET ACCESS The Los Angeles County Lobbyist Ordinance, rules, operational procedures, registration/ reporting forms, registrants and their quarterly activity reports are accessible at: http://bos.co.la.ca.us/ Rev. 12/07 American LegalNet, Inc. www.FormsWorkflow.com County of Los Angeles INSTRUCTIONS FOR COMPLETING THE REPORT OF PERSON OR ENTITY SPENDING $5000 OR MORE TO INFLUENCE OFFICIAL COUNTY ACTION FORM LOB 9 PERIOD COVERED BY REPORT: The period covered is the calendar quarter. (See the cover sheet of this form for the period covered.) SUMMARY OF PAYMENTS: Enter the total amount paid this period from each section of the report. With respect to campaign contributions, check the box which applies to your activities during the calendar quarter. VERIFICATION: The report must be verified and signed by the filer. In the case of an organization, a responsible officer of the organization, or an attorney or a certified public accountant must sign on behalf of the organization. American LegalNet, Inc. www.FormsWorkflow.com COUNTY OF LOS ANGELES OFFICIAL USE ONLY REPORT OF PERSON OR ENTITY SPENDING $5000 OR MORE TO INFLUENCE OFFICIAL COUNTY ACTION Form LOB 9 Page ________ of _________ Quarterly Report Covers from Type or Print in Ink Name of Filer: Business Address : (Number, Street & Suite) City Telephone Number & Extension State through ( ) Zip Code SUMMARY OF PAYMENTS THIS PERIOD A. Total Activity Expenses (from Part I, Section A).................................$ B. Total Other Payments to Influence (from Part I, Section B)...................$ TOTAL (A + B above)...................................................................................$ CAMPAIGN CONTRIBUTIONS: Part II completed and attached No Campaign Contributions made this period VERIFICATION I have used all reasonable diligence in preparing this Statement. I have reviewed this Statement and to the best of my knowledge the information contained herein is true and complete. I certify under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on (Date) At (City and State) By (Signature of Responsible Officer) Name of Responsible Officer (Type or Print) Title American LegalNet, Inc. www.FormsWorkflow.com FORM LOB 9 INSTRUCTIONS FOR COMPLETING PART I PART I ­ PAYMENTS MADE THIS PERIOD: SECTION A: ACTIVITY EXPENSES: Only include in Section A those activity expenses which were arranged, incurred or paid by you or your organization. An "Activity expense" is any expense incurred or payment made by a person or entity which benefits in whole of in part any County official or a member of the immediate family or a County official. Activity expenses include gifts, honoraria, consulting fees, salaries, and any other form of compensation but do not include campaign contributions. A "County official" is any member of the board of supervisors, the sheriff, the assessor, the district attorney, a County commissioner, and any other County officer or employee whose duties are not clerical or manual. A "Gift" shall be defined as set forth in the Political Reform Act, Government Code Section 81000 et seq. and the regulations adopted thereunder; except that the exclusion for campaign contributions shall be defined and governed as set forth in Chapter 2.160 of the Los Angele County Code You must itemize all "activity expenses" arranged, incurred or paid by you or your organization, and you must report activity expenses during the period in which they occurred regardless of whether they were actually paid during the period. · If you have paid, incurred any activity expense: DATE: Enter the date the expense was incurred or the event occurred. NAME, POSITION, AND ADDRESS OF PAYEE: List the name, position or title and address of the vendor or other person to whom payment was made or incurred, if different than beneficiary. NAME AND POSITION OF COUNTY OFFICIALS AND AMOUNT BENEFITING EACH: List the name and position, of each County official who benefited form the payment . Also, list the portion of the total expense which is attributable to each official. Note : You are not required to list in this section, members of your organization or any other person who benefited who is not a County official. You must, maintain in your record the total number of persons who benefited. DESCRIPTION OF CONSIDERATION: Describe the goods or services received by the County official(s), e.g., lunch,