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Application for Federal Assistance SF -424 16. Congressional Districts Of: ' a. Applicant FL -8 ' b. Program/Project FL -8 Attach an additional list of Program/Project Congressional Districts if needed. Add Attachment Delete Attach -lent Vicev Attachrner•,i 17. Proposed Project: ' a. Start Date: 01/01/2016 `b. End Date: 12/31/2016 18. Estimated Funding (a): ' a. Federal 65,214-001 ' b. Applicant " c. State ` d. Loca I 65,214.001 ` e. Other ' f. Program Income "g. TOTAL 130,428.00 * 19. Is Application Subject to Review By State Under Executive Order 12372 Process? 1-1 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 Attechfr:ert' View'A"tachment 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: Stan Middle Name: ` Last Name: soling Suffix: `Title: Community Development Director .Telephone Number: F772-226-1253 Fax Number: 'Email: sboling@ircgov.com ' Signature of Authorized Representative: ` Date Signed: C� 20