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Application for Federal Assistance SF-424 <br />16. Congressional Districts Of: <br />* a. Applicant 10 ' b. Program /Project 10 <br />Attach an additional list of Program /Project Congressional Districts if needed. <br />Add Attachment Delete Attachment View Attachment <br />17. Proposed Project: <br />* a. Start Date: 07/01/2016 ' b. End Date: 06/30/2017 <br />18. Estimated Funding ($): <br />• a. Federal 272, 699.00 <br />• b. Applicant 0 . 00 <br />*c. State 0.00 <br />• d. Local 0.00 <br />• e. Other 0.00 <br />• f. Program Income 0.00 <br />*g. TOTAL 272,699.00 <br />• 19. Is Application Subject to Review By State Under Executive Order 12372 Process? <br />Fla. 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 />® c. Program is not covered by E.O. 12372. <br />' 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment) <br />F] Yes ®No <br />If "Yes ", provide explanation and attach <br />Add Attachment Delete Attachment View Attachment <br />21. *By signing this application, I certify (1) to the statements contained in the list of certifications ** and (2) that the statements <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 I 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 218, Section 1001) <br />® ** I AGREE <br />** The list of certifications and assurances, or an intemet site where you may obtain this list, is contained in the announcement or agency <br />specific instructions. <br />Authorized Representative: <br />Prefix: * First Name: Brian <br />Middle Name: <br />* Last Name: Dolan <br />Suffix: <br />*Title: Assistant City Manager <br />* Telephone Number: 925- 931 -5002 Fax Number: <br />*Email: bdolan @cityofpleasantonca.gov <br />* Signature of Authorized Representative: <br />* Date Signed: <br />