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M <br />n ODI IPATlnhl FnR <br />Version 7/03 <br />FEDERAL ASSISTANCE <br />2. DATE SUBMITTED <br />Applicant Identifier <br />1. TYPE OF SUBMISSION: <br />3. DATE RECEIVED BY STATE <br />State Application Identifier <br />Application <br />Pre -application <br />4. DATE RECEIVED BY FEDERAL AGENCY <br />Federal Identifier <br />1_I Construction <br />'.tel Construction <br />Non -Construction <br />rl Non -Construction <br />5. APPLICANT INFORMATION <br />Legal Name: <br />Organizational Unit: <br />Department <br />Indian River Count Board of Count Commissioners <br />Y Y <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 />Prefix: <br />First Name: <br />County Administration Bldg, 1840 25th Street <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 />p <br />32960 a <br />Suffix: <br />Country. <br />USA - <br />J R�OWNQIRCGOV.COM <br />G. EMPLOYER IDENTIFICATION NUMBER (EIN): <br />Phone Number (give area code) <br />Fax Number (give area code) <br />5❑❑9 —©MK�]©ff® <br />772-567.8000x1257 <br />772-770-5331 <br />8. TYPE OF APPLICATION: <br />T. TYPE OF APPLICANT: (See back of form for Application Types) <br />J New l"] Continuation Revision <br />g <br />If Revision, enter appropriate letter(s) in box(es) <br />See back of form for description of letters.) ❑Other <br />(specify) <br />9. NAME OF FEDERAL AGENCY: <br />Other (specify) <br />RENEWAL <br />US DEPT. OF HOUSING AND URBAN DEVELOPMENT <br />10, CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: <br />11. DESCRIPTIVE TITLE OF APPLICANTS PROJECT: <br />LL==JJ <br />ONE YEAR RENEWAL OF COC -WIDE HMIS EXPANSION <br />TITLE (Name of Program): <br />Continnuum of Care Homeless Assistance <br />12. AREAS AFFECTED BY PROJECT (Cities, Counties, States, etc.): <br />FL 509 -Ft. Pierce/St. Lucie, Indian River, Martin <br />13. PROPOSED PROJECT <br />14. CONGRESSIONAL DISTRICTS OF: <br />Start Date: <br />Ending Date: <br />a. Applicantb. <br />Project <br />05/01/2007 <br />04/30/2008 <br />15-16 <br />5-16 <br />15. ESTIMATED FUNDING: <br />16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE <br />ORDER 12372 PROCESS? <br />a. Federal <br />THIS PREAPPLICATION/APPLICATION WAS MADE <br />Yes. <br />25,856 <br />25,856 <br />a. AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 <br />PROCESS FOR REVIEW ON <br />DATE: <br />Yl PROGRAM IS NOT COVERED BY E. 0.12372 <br />b, Applicant <br />c. State <br />d. Local <br />UV <br />b. No. <br />OR PROGRAM HAS NOT BEEN SELECTED BY STATE <br />e. Other <br />VU( <br />6,464 <br />6.464 <br />— FOR REVIEW <br />f. Program Income <br />17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? <br />F � Yes If "Yes" attach an explanation. 1(J No <br />g. TOTA32,320 <br />18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT. THE <br />DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE <br />ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED, <br />a. Authorl d <br />R resents We <br />Prefix <br />ARTN <br />Middle Name <br />Filt <br />LIM <br />R <br />Last Name <br />Suffix <br />NEUBERGER <br />. Title <br />c. Telephone Number (give area code) <br />CHAIR% N <br />772-567-8000 <br />. Signure prized R ental <br />LAA, <br />. Date SignedI <br />May 16s-/2006 <br />Previous Edition Usable e `(\ Standard Form 424 (Rsv.9-2003) <br />Authorized for Local Reproduction QJ Prescribed by OMB Circular A-102 <br />