2017 CDBG Third Year Action Plan

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Application for Federal Assistance SF-424 ' 16.Congressional Districts Of: 'a.Applicant 'b.Program/Project Attach an additional list of Program/Project Congressional Districts if needed. Add Attachment Delete Attachment I View Attachment 17.Proposed Project: ' *a.Start Date: 01/01/2017 *b.End Date: 1?_/31/2017 18.Estimated Funding a.Federal 211,484.00 *b.Applicant *c.State , *d.Local *e.Other *f. Program Income *g.TOTAL 211,484.00 *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.) ❑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) ' ® **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: *Last Name: Buttigieg Suffix: ' *Title: Mayor, City of South Bend *Telephone Number: 57 4235 92 61 Fax Number: ' *Email: pbuttigieg @southbendin.gov Signature of Authorized Representative: 'Date Signed: