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60 <br /> Application for Federal Assistance SF-424 <br /> 16.Congressional Districts Of: <br /> a Applicant 19 ! *b Program/Project 4 <br /> I <br /> Attach an additional list of Program/Project Congressional Districts if needed. <br /> Add Attachment Delete Attachment View Attachment <br /> 17.Proposed Project: <br /> a.Start Date: 07/01/2016 *b.End Date: 06/30/2017 <br /> 18.Estimated Funding(S): <br /> a.Federal 308,538.001 <br /> b.Applicant 0.00 <br /> *c.State 0.00 <br /> At <br /> d.Local ( 0.00 <br /> 'e.Other 0.00 <br /> f. Program Income 38,069.00 <br /> *g.TOTAL 346,607.001 <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 /> 1 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: Ms. *First Name: 'Bonnie <br /> Middle Name: 1B. <br /> Last Name: 'Hammers ley <br /> Suffix: <br /> 'Title: 'County Manager <br /> *Telephone Number: 19192952300 Fax Number. 19196943009 <br /> *Email: 'bhammersley @orangecountync.gov <br /> Signature of Authonzed Representative. Date Signed: 05/03/2016 <br />