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Application fait' F4.49rall As>siltlitile W9 SF-424 <br />18. Congressional Distr cls Of <br />g <br />a. Applicant IrL-008 `1t. PrID)yrMlnfAdrCjabt: �--- <br />Attach an additional list of ProgminMroject Congressional Districjtts" if needed. <br />I ACC Aft*n 1 t3�3 ^hese 5 JiriW AtFTv:%! i + ! f <br />�++�+•.. <br />17. Proposed Project: . <br />• a. StartDate: 10/01/202.5 • b.:W Doty. 3t1�21�?6: <br />18. Estimated Funding ($): <br />a. Federal <br />0.:0 <br />be Applicant <br />90:, 0.00.00 <br />• a State <br />• d. Local <br />90, 00D.9 , <br />• e. Other <br />0. <br />• L Program Income <br />0, <br />3:68:000.0 <br />" g. TOTAL <br />• 19. Is Application Subject to Review By State Under Executive Order 12372 Process? . <br />a. This application was made available to the State under the Executive Order 12372 Process for review on �'.. . <br />b. Program is subject to E.O. 12372 but has not been selected by the State for review. <br />�x c. Program is not covered by E.O. 12372. <br />` 20. Is the Applicant Delinquent On Arty.ft"W DWt7 (N'YiM,'' pfOtAd� ttI�IMMtNattin attdchm, <br />Yes x� No <br />If "Yes", provide explanation and attach <br />.. .. .. <br />21, *By signing this application, i certify (1) to the statements contained In the list of certifications- and (2) that the stiltelnents <br />herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances- and agree to <br />comply with any resulting terms if 1 accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may <br />subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 18, Section 1001) <br />xx ••I AGREE <br />- The list of certifications and assurances, or an internal site where you may obtain this list: is contained in the announcement or agency <br />specific instructions. <br />Authorized Representative: <br />Prefix: �PhettiiRl� yen <br />Middle Names <br />Last Name: 0.**ney . ... .. <br />_ <br />Suffix: <br />Title, t:.' Planning and Div St vices Direct" <br />•TNsphoniNutMIN 7?2-226-1239 iaxNumbrr: .: <br />s$wveneyfindianriver 93" <br />• 81gnalure of Authorized Representathw. <br />` Date Slgh tB 512.9 /29?5 <br />.. <br />106 <br />