2016 CBBG_Home Action Plan III - Laserfiche WebLink

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Application for Federal Assistance SF-424 16.Congressional Districts Of: *a.Applicant E== *b.Program/Project Attach an additional list of Program/Project Congressional Districts if needed. Add Attachment Delete Attachment View Attachment 17.Proposed Project: ' *a.Start Date: 01/01/2017 *b.End Date: 12/31/2017 18.Estimated Funding($): •a.Federal 377,344.00 •b.Applicant •c.State •d.Local •e.Other f. Program Income *g.TOTAL 377,344.00 *19.is Application Subject to Review By State Under Executive Order 12372 Process? ' a.This application was made available to the State under the Executive Order 12372 Process for review on �. b.Program is subject to E.O.12372 but has not been selected by the State for review. , ® c.Program is not covered by E.O.12372. *20.Is the Applicant Delinquent On Any Federal Debt? (If"Yes,"provide explanation in attachment.) F1 Yes ®No If"Yes",provide explanation and attach Add Attachment Delete Attachment I View Attachment 21.*By signing this application,I certify(1)to the statements contained in the list of certifications**and(2)that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply with any resulting terms if I accept an award.I am aware that any false,fictitious,or fraudulent statements or claims may subject me to criminal,civil,or administrative penalties.(U.S.Code,Title 218,Section 1001) ® **IAGREE **The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions. Authorized Representative: Prefix: *First Name: Pete Middle Name: *Last Name: Buttigieg Suffix: *Title: Mayor, City of South Bend *Telephone Number: 5742359261 1 Fax Number: *Email: lpbuttigieg@southbendin.gov *Signature of Authorized Representative: *Date Signed: I TIT 17