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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 Attachment View Attachment 17. Proposed Project: ' a. Start Date: 01/01/2017 ' b. End Date: 12/31/2017 18. Estimated Funding ($): * a. Federal 69, 776.00 ' b. Applicant 0.00 ' c. State 34, 888.00 ' d. Local 34,888.001 ' e. Other 0.00 ' f. Program Income 0.00 'g. TOTAL 139,552.00 * 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.) 0 Yes ® No If "Yes", provide explanation and attach Add Attachment I 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) ® **IAGREE ** 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: Boling Suffix: *Title: Community Development Director `Telephone Number: 772-226-1253 Fax Number: 'Email: sboling@ircgov.com 'Signature of Authorized Representative: ' Date Signed: 06/1 018 45 4