Dept of Housing and Urban Development (HUD) 6/3/2025

18. Estimated Funding ($): * a. Federal * b. Applicant * c. State * d. Local * e. Other * f. Program Income . * g. TOTAL 21. *By signing this application, I certify (1) to the statements herein are true, complete and accurate to the best of comply with any resulting terms if I accept an award. I am subject me to criminal, civil, or administrative penalties. (U.S. Co contained in the list of certifications** and (2) that the statements my knowledge. I also provide the required assurances** and agree to aware that any false, fictitious, or fraudulent statements or claims may de, Title 18, Section 1001) site where you may obtain this list, is contained in the announcem specific instructions. Authorized Representative: Prefix:* First Middle Name: Name: * Last Name: Suffix: * Title: * Telephone Number:Fax Number: * Email: * Signature of Authorized Representative:* Date Signed: ** The list of certifications and assurances, or an internet ent or agency Application for Federal Assistance SF-424 16. Congressional Districts Of: * a. Applicant * b. Program/Project Attach an additional list of Program/Project Congressional Districts if needed. 17. Proposed Project: * a. Start Date:* b. End Date: Add Attachment Delete Attachment View Attachment a. This application was made available to the State under the Executive Order 12372 Process for review on b. Program is subject to E.O. 12372 but has not been selected by the State for review. c. Program is not covered by E.O. 12372. Yes No Add Attachment Delete Attachment View Attachment ** I AGREE * 19. Is Application Subject to Review By State Under Executive Order 12372 Process? * 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.) If "Yes", provide explanation and attach WA-002 WA-002 07/01/2025 06/30/2026 869,124 150,000 1,019,124 X Cassie Franklin Mayor 425-257-7119 cfranklin@everettwa.gov 06/03/2025