2017 CDBG Third Year Action Plan

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' Application for Federal Assistance SF-424 16.Congressional Districts Of: ' *a.Applicant LJ *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 2,365,622.00 ' •b.Applicant *c.State l — d.Local *e.Other 494,000.00 *f. Program Income 100,000.00 *g.TOTAL 2,959,622.00 ' *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) ' F]Yes ®No If"Yes",provide explanation and attach Add Attachment Delete Attachment 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: I I *First Name: Pete Middle Name: *Last Name: Buttigieg ' Suffix: *Title: Mayor, City of South Bend ' Telephone Number: 57 42 3592 61 Fax Number: *Email: pbuttigieg @southbendin.gov Signature of Authorized Representative: *Date Signed: