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1 <br /> ' Application for Federal Assistance SF-424 <br /> 16.Congressional Districts Of: <br /> *a.Applicant E== *b.Program/Project <br /> Attach an additional list of Program/Project Congressional Districts if needed. <br /> Add Attachment Delete Attachment View Attachment <br /> 1 17.Proposed Project: <br /> *a.Start Date: 01/01/2017 *b.End Date: 12/31/2017 <br /> 18.Estimated Funding($): <br /> •a.Federal 734,817.00 <br /> ' <br /> •b.Applicant <br /> *c.State <br /> •d.Local <br /> 'e.Other 360,434.00 <br /> *f. Program Income 172,758.00 <br /> *g.TOTAL 1,268,009.00 <br /> 1 *19.Is Application Subject to Review By State Under Executive Order 12372 Process? <br /> ❑ a.This application was made available to the State under the Executive Order 12372 Process for review on <br /> 1 ❑ b.Program is subject to E.O.12372 but has not been selected by the State for review. <br /> ® c.Program is not covered by E.O.12372. <br /> '20.Is the Applicant Delinquent On Any Federal Debt? (If"Yes,"provide explanation in attachment.) <br /> ' F Yes ®No <br /> If"Yes",provide explanation and attach <br /> Add Attachment Delete Attachment View Attachment <br /> ' 21.*By signing this application,I certify(1)to the statements contained In the list of certifications**and(2)that the statements <br /> herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to <br /> comply with any resulting terms if I accept an award.I am aware that any false,fictitious,or fraudulent statements or claims may <br /> subject me to criminal,civil,or administrative penalties.(U.S.Code,Title 218,Section 1001) <br /> ® **I AGREE <br /> *'The list of certifications and assurances,or an intemet site where you may obtain this list, is contained in the announcement or agency <br /> ' specific instructions. <br /> Authorized Representative: <br /> Prefix: *First Name: Pete <br /> Middle Name: <br /> *Last Name: Buttigieg <br /> 1 Suffix: <br /> *Title: Mayor, City of South Bend <br /> ' *Telephone Number. 5742359261 Fax Number: <br /> *Email: pbuttigieg @southbendin.gov 1— <br /> *Signature of Authorized Representative: r�.�' *Date Signed: <br /> i <br />