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APPI [CATION FOR <br />Version 7103 <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 />U <br />C Construction <br />Construction <br />Non -Construe" n <br />FJ Non -Construction <br />5. APPLICANT INFORMATION <br />Legal Name: <br />Organizational Unit: <br />m <br />Department: <br />Indian River CountyBoard of County Commissioners <br />ty <br />Board 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 Riverpp <br />Brown <br />ZI Coe - <br />Suffix: <br />State: <br />Country: <br />Email: <br />USA <br />JBROWN IRCGOV.COM <br />S. EMPLOYER IDENTIFICATION NUMBER (E1N): <br />Phone Number (give area code) <br />Fax Number (give area code) <br />772-567-8000x1257 <br />772-7705331 <br />8. TYPE OF APPLICATION: <br />7. TYPE OF APPLICANT: (See back of form for Application Types) <br />UJ New (rI Continuation Revision <br />B <br />If Revision, enter appropriate letter(s) in box(es) <br />See back of form for description of letters.) ❑Other <br />(specify) <br />8. NAME OF FEDERAL AGENCY: <br />Other (specify) <br />RENEWAL -TWO YEARS <br />US DEPT. OF HOUSING AND URBAN DEVELOPMENT <br />10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: <br />11. DESCRIPTIVE TITLE OF APPLICANTS PROJECT: <br />T®�EQF5] <br />TWO YEAR RENEWAL OF COC -WIDE HMIS <br />TITLE (Name of Program): <br />Continnuum of Cara Homeless Assistance <br />12. AREAS AFFECTED BY PROJECT (Cities, CounHws, States, etc.): <br />FL 509 -Ft. Pierce/St. Lucie, Indian River, Martin <br />13. PROPOSED PROJECT <br />14. CONGRESSIONAL <br />DISTRICTS <br />OF: <br />Start Date: <br />Ending Date: <br />a. Applicant b. Project <br />05/01/2007 <br />04/3012009 <br />15-16 5-16 <br />16. ESTIMATED FUNDING: <br />46. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE <br />ORDER 12S72 PROCESS7 <br />a. Federal <br />' <br />THIS PREAPPLICATION/APPLICATION WAS MADE <br />Yes. <br />72354 <br />72,354 <br />a. AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 <br />PROCESS FOR REVIEW ON <br />DATE: <br />b. No. V1 PROGRAM IS NOT COVERED BY E. O. 12372 <br />OR PROGRAM HAS NOT BEEN SELECTED BY STATE <br />b. Applicant <br />a State <br />d. Local <br />e. Other <br />180088.50 <br />160,089 <br />FOR REVIEW <br />I. Program Income <br />17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? <br />0 Yes If "Yes' attach an explanation. No <br />9 TOTAL0 <br />9044Z18. <br />80,443 <br />TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATIONIPREAPPLICATION 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.Authorized s resentative <br />Prefix <br />ryarns <br />AIRT <br />Middle Name <br />ryl)I( <br />uFNc <br />NEUBERGER <br />. Title <br />o. Telephone Number (give area code) <br />CHAIRMAN <br />772-567-8000 <br />. Signature"t dRepresogtetiye <br />. Data Signed <br />May 16 200 <br />Previous Edition Usable 1 7 N V Standard rorm 424 (K9V.y-zurre) <br />Authorized for Local Reproduction Prescribed by OMB Circular A-102 <br />