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Application for Federal Assistance SF-424 <br /> 16.Congressional Districts Of: <br /> *a.Applicant wA02 *b.Program/Project wA02 <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: 10/01/2022 *b. End Date: 09/30/2025 <br /> 18.Estimated Funding($): <br /> *a. Federal 37,989.00 <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 37,989.00 <br /> *19.Is Application Subject to Review By State Under Executive Order 12372 Process? <br /> O 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 /> ® 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 /> ❑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 internet site where you may obtain this list, is contained in the announcement or agency <br /> specific instructions. <br /> Authorized Representative: <br /> Prefix: *First Name: Cassie <br /> Middle Name: <br /> *Last Name: Frankllin <br /> Suffix: <br /> *Title: Mayor <br /> *Telephone Number: 425-257-7112 Fax Number: <br /> *Email: CFranklin@everettwa.gov <br /> *Signature of Authorized Representative: Completed by Grants.gov upon submission. *Date Signed: Completed by Grants.gov upon submission. <br /> PREVIEW Date: Jun 30, 2022 Workspace ID: WS00936451 Funding Opportunity Number: O-BJA-2022-171368 <br />