Department of Housing and Urban Developmen 6/28/2018

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: 07/01/2018 *b.End Date: 06/30/2019 18.Estimated Funding($): *a.Federal 878,672.00 *b.Applicant 0.00 *c.State 0.00 *d.Local 0.00 *e.Other 0.00 *f. Program Income 300,000.00 *g.TOTAL 1,178,672.00 *19.Is Application Subject to Review By State Under Executive Order 12372 Process? ❑ 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. *20.Is the Applicant Delinquent On Any Federal Debt? (If"Yes,"provide explanation in attachment.) 0Yes ®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 intemet site where you may obtain this list, is contained in the announcement or agency specific instructions. Authorized Representative: Prefix: *First Name: Cassie Middle Name: *Last Name: Franklin Suffix: *Title: Mayor *Telephone Number: 425-257-7112 Fax Number: *Email: cfranklin@everettwa.gov *Signature of Authorized Representative: 404" *Date Signed: 06/28/2018 •AT, S : � — I .I /I A. ill APP OVED AS 0 M Cit Clerk City IAMES D.ILES,C y Of eY