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' Application for Federal Assistance SF-424 <br /> 16,Congressional Districts Of: <br /> *a.Applicant E:= *b.Program/Project E= <br /> Attach an additional list of Program/Project Congressional Districts if needed. <br /> Add Attachment I Delete Attachment I View Attachment <br /> ' 17.Proposed Project: <br /> a.Start Date: 01/01/2018 'b.End Date: 12/31/2018 <br /> 1 18.Estimated Funding($): <br /> *a.Federal 2,572,155.00 <br /> *b.Applicant <br /> ' c.State -� --� <br /> d.Local <br /> ' e.Other 45,000.00 <br /> f. Program Income 25,300.00 <br /> g.TOTAL 2,642,455.00 <br /> ' *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 /> ' 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 /> Yes ®No <br /> If"Yes",provide explanation and attach <br /> Add Attachment I 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 /> ® **IAGREE <br /> ' **The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency <br /> specific instructions. <br /> Authorized Representative: <br /> Prefix: I I *First Name: Pete <br /> Middle Name: <br /> *Last Name: Buttigieg <br /> ' Suffix: <br /> Title: Mayor, City of South Bend <br /> Telephone Number: 5792359261 Fax Number. <br /> Email: pbuttigieg @southbendin.gov <br /> *Signature of Authorized Representative: *Date Signed: <br /> 1 <br />