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lM <br />Zoo (0 <br />Version 7/03 <br />tkrruvn r rv,v . v,. <br />FEDERAL ASSISTANCE <br />2. <br />DATE SUBMITTED <br />—...._.. <br />Applicant Identifier <br />1. TYPE OF SUBMISSION: 3. <br />DATE RECEIVED BY <br />STATE State Application Identifier <br />Application Pre -application <br />4. <br />DATE RECEIVED BY <br />FEDERAL AGENCY Federal Identifier <br />F Construction C Construction <br />Non -Construction 0 Non -Construction <br />5. APPLICANT INFORMATION <br />Legal Name: <br />Organizational Unit: <br />Department: <br />Indian River CountyBoard of County Commissioners <br />ty <br />Board of County Commissioners <br />Organizational DUNS: <br />Division: <br />079.208-989 <br />Address: <br />Name and telephone number of person to be contacted on matters <br />involving this application (give area code) <br />Street <br />County Administration Bldg, 1840 25th Street <br />Prefix: <br />First Name: <br />Mr. <br />Jason <br />City: <br />Middle Name <br />Vero Beach <br />County: <br />Last Name <br />Indian River <br />Brown <br />State: <br />Zip C�Ode <br />suffix: <br />92 <br />USA rY: <br />Email: <br />Jmil: IRCGOV.COM <br />6. EMPLOYER IDENTIFICATION NUMBER (EIN): <br />Phone Number (give area code) Fax Number (give area code) <br />5❑�9 6 0� 0 0�©7 ® <br />772-567-8000x1257 772-77D-5331 <br />8. TYPE OF APPLICATION: <br />7. TYPE OF APPLICANT: (See back of form for Application Types) <br />I0 New Fil Continuation <br />Revision <br />B <br />f Revision, enter appropriate letter(s) in box(es) <br />See back of form for description of letters.) ❑ <br />her (specify) <br />S. NAME OF FEDERAL AGENCY: <br />Other (specify) <br />RENEWAL <br />US DEPT. OF HOUSING AND URBAN DEVELOPMENT <br />10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE <br />NUMBER: <br />11. DESCRIPTIVE TITLE OF APPLICANTS PROJECT: <br />AL OF TRANSITIONAL HOUSING PROJECT <br />ONFAMILY <br />OPTIONS <br />TITLE (Name of Program): <br />Continnuum of Care Homeless Assistance <br />12. AREAS AFFECTED BY PROJECT (Cities, Counties, States, etc.): <br />FL 509 -FL Pierce/St. Lucie, Indian River, Martin <br />13. PROPOSED PROJECT <br />14. CONGRESSIONAL DISTRICTS <br />OF: <br />Start Date: Ending Date: <br />a. Applicant <br />05!01/2007 0413012008 <br />15AB <br />S -i6Project <br />5 <br />1S. ESTIMATED FUNDING: <br />16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE <br />ORDER 12372 PI OC SSI <br />a. Federal <br />THIS PREAPPLICATION/APPLICATION WAS MADE <br />70,063.67 <br />70,064 <br />a. Yes. AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 <br />PROCESS FOR REVIEW ON <br />DATE: <br />b. Applicant <br />c State <br />(,)T} PROGRAM IS NOT COVERED BY E. O. 12372 <br />d. Local <br />b. No. <br />C( OR PROGRAM HAS NOT BEEN SELECTED BY STATE <br />a. Other17 <br />515. <br />FOR REVIEW <br />I. Program Income <br />17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? <br />Wes" attach an planation. � No <br />0 Yes If Wex <br />— <br />U. TOTAL <br />87,579 <br />87,578.67 <br />18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, <br />ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT. THE <br />DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF <br />THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE <br />ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED. <br />a. Authorized Representative <br />Prefix <br />���q� <br />FFiirrsst.Naq)a <br />iddle Name <br />Last Name _ <br />uffix <br />NEUBERGER " <br />b. TWO <br />. Telephone Number (give area code) <br />CHAIRMAN <br />772.667-8000 <br />. Sign M&A=MMA <br />Date Signed May 16, 2006 <br />Previous Edition Usable / <br />Authorised for LocaiReoroduction <br />U <br />Standard Form 424 (Rev.5.4w.a) <br />Prescribed by OMB Circular A-102 <br />