Dept of Housing and Urban Development HUD 7/25/2017

Application for Federal Assistance SF-424 16.Congressional Districts Of: *a.Applicant 2nd *b.Program/Project 2nd Attach an additional list of Program/Project Congressional Districts if needed. Add Attachment Delete Attachment View Attachment 17.Proposed Project: *a.Start Date: 07/01/2017 *b.End Date: 06/30/2018 18.Estimated Funding($): *a.Federal 813,967.00 *b.Applicant 0.00 *c.State 0.0 0 *d.Local 0.00 *e.Other 0.00 *f. Program Income 300,000.00 *g.TOTAL 1,113,967.00 *19.Is Application Subject to Review By State Under Executive Order 12372 Process? El a.This application was made available to the State under the Executive Order 12372 Process for review on n 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. *20.Is the Applicant Delinquent On Any Federal Debt? (If"Yes,"provide explanation in attachment.) Yes ®No If"Yes",provide explanation and attach Add Attachment Delete Attachment View Attachment 21.*By signing this application, I certify(1)to the statements contained in the list of certifications**and(2)that the statements herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply with any resulting terms if I accept an award.I am aware that any false,fictitious,or fraudulent statements or claims may subject me to criminal,civil,or administrative penalties.(U.S.Code,Title 218,Section 1001) ® **I AGREE ** The list of certifications and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency specific instructions. Authorized Representative: Prefix: *First Name: Ray Middle Name: *Last Name: Stephanson Suffix: *Title: Mayor *Telephone Number: 425-257-7112 Fax Number: *Email: rstephanson@everettwa.gov *Signature of Authojjzed Representative: , *Date Signed: (7pA'1f/'10v AT E STe 4 I/ ,1 A 1 ' ` ,` APPR VED AST FORM Ci y ler