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' t <br /> APPLICATION FOR oM6 Approval No. o34s-oo43 <br /> FEDERAL ASSISTANCE 2. DATE SUBMITTED Applicant Identifier <br /> August 25, 2006 ' <br /> 1. TYPE OF SUBMISSION: 3. DATE RECEIVED BY STATE State Application Identifier <br /> A licatfon Preapplication <br /> Construction Q Construction 4. DATE RECEIVEb BY FEDERAL AGENCY Federal Identifier <br /> ? Non-Construction Non-Construction <br /> 5. APPLICANT INFORMATION <br /> Legal Name; Organizational Unit: <br /> .city of Eugene. Public Works Department <br /> Address (give city, county, State, and zip code): Name and telephone number of person to be contacted on matters involvin <br /> Eugene, Lane County, OR, 97402 this application (give area code) <br /> Jean Jancaitis, (541) 682-4927 <br /> 6. EMPLOYER IDENTIFICATION NUMBER (EIN): 7. TYPE OF APPLICANT: (enter appropriate letter in box) <br /> '~s° 9 3- 6 0 0 2 1 6 0 C? <br /> A. State H. Independent School Dist. <br /> 8. TYPE OF APPLICATION: B. County I. State Controlled Institution of Higher Learning <br /> New ? Confinuation ?Revision C. Municipal J. Private University <br /> D. Township K. Indian Tribe <br /> If Revision, enter appropriate letter(s) in box(es) ~ ? E. Interstate L. Individual <br /> F. Intermunicipal M. Profit Organization <br /> A. Increase Award B. Decrease Award C. Increase Duration G. Special District N. Other (specify) <br /> D. Decrease Duration Other(specify): <br /> 9. NAME OF FEDERAL AGENCY: <br /> U.S. Bureau of Land Management <br /> 10: CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER: 11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT: <br /> Wildlife Management 1 5 - ~ A K Assistance Agreement HAA031 M00 <br /> TITLE: <br /> 12. AREAS AFFECTED BY PROJECT (Cities, Counties, States, etc.): Task Order HAF061 M 12 <br /> Eugene, Lane County, Oregon <br /> 13. PROPOSED PROJECT 14. CONGRESSIONAL DISTRICTS OF: <br /> f <br /> <br /> ~try~ <br /> as: Start Date Ending Date a. Applicant ib. Project <br /> 8/21/06 8/31/2007 Fourth ~ Fourth <br /> ~r <br /> J _ 15. ESTIMATED FUNDING: 16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE <br /> ORDER 12372 PROCESS? <br /> a: Federal $ 39,591 " <br /> a. YES. THIS PREAPPLICATION/APPLICATION WAS MADE <br /> b. Applicant $ °D AVAILABLE TO THE STATE EXECUTIVE ORDER 12372 <br /> PROCESS FOR REVIEW ON: <br /> c. State $ ~ <br /> ' -DATE <br /> d. Local $ <br /> b. No. PROGRAM IS NOT COVERED BY E. 0.12372 <br /> e. Other $ 0° ? OR PROGRAM HAS NOT BEEN SELECTED BY STATE <br /> FOR REVIEW <br /> f. Program Income °0 <br /> 1 T. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT? <br /> g. TOTAL $ o0 <br /> 39 591 ? Yes If "Yes," attach an explanation. ~ No <br /> , <br /> 18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE-TRUE AND CORRECT, THE <br /> DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE <br /> . ATTACHED ASSURANCES IF THE AS5ISTANCE IS AWARDED. <br /> a. Type Name of Authorized Representative b. Title c. Telephone Number <br /> ~,'Q~ Kurt A. Core Public Works Director (541) 682-5241 <br /> d. Signature of Authorized se a ' e e. Date Signed ~ O~ <br /> , <br /> Previous Edition Usable Standard Form 424 (Rev. 7-97)' <br /> Authorized for Local Reproduction Prescribed by OMB Circular A-102 <br /> <br />