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i i Application for Federal Assistance SF 424 16.Congressional Districts Of: ' a.Applicant E==1 *b.Program/Project [2:= Attach an additional list of Program/Project Congressional Districts if needed. Attachment Delete Attachrr eht VIe N Attachment 17.Proposed Project: *a.Start Date: 01/01/2017 *b.End Date: 12/31/2017 18.Estimated Funding($) *a.Federal 734,817.00 *b.Applicant j •c.State "d.Local •e.Other 360,434.00 *f. Program Income 172,758.00 ' *g.TOTAL 1,268,009.00 b *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 ) El 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. 1 *20.Is the Applicant Delinquent On Any Federal Debt? (if"Yes,"provide explanation in attachment.) £ Yes ®No 3 If"Yes",provide explanation and attach ' e �De lute-�.A.-taohmepta�' e t e L ' ( 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) ®**I AGREE **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: *fast Name: Buttigieg 3 k ' Suffix 4 *Title: Mayor, City of South Bend *Telephone Number. 5742359261 Fax Number. *Email: ipbuttigieg@southbendin.gov G *; Date Signed: Signature of Authorized Representative: *i t I t 1