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OMB Number 4040-000 <br /> Expiration Date: 01/31/2009 <br /> Version 02 <br /> pplication for Federal Assistance SF-424 <br /> <br /> I 3. Congressional Districts Of: <br /> a. Applicant OR-004. * b. Program/Project oR-004 <br /> ttach an additional list of Program/Project Congressanal Distncts if needed <br /> f a 4 t•~~ 't?'_ *.pf~~eie t~t.'tlfil~nt,~es.,~sl~'V <br /> ~7rV~.~..~~ <br /> 7. Proposed Project: <br /> a. Start Date: 08/01/2009 * b. End Date: 07/31/2011 <br /> 8. Estimated Funding <br /> a. Federal 1, 642, 302 .00 <br /> b. Applicant 48, 802.00 <br /> c. State 148, 961.00 <br /> d. Coral 0.00 <br /> e. Other 0.00 <br /> f. Program Income 0.00 <br /> g. TOTAL 1,840,065.00 <br /> 19. Is Application Subject to Review By State Under Executive Order 12372 Process? <br /> 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.) <br /> Yes []X No "z , ct~' <br /> t1. *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. 1 also provide the required assurances** and agree to. <br /> ;ompty with any resulting terms ff I accept an award. l am aware that any false, fictitious, or fraudulent statements or claims, may <br /> :ubjectme to criminal, civil, or administrative penalties. (U.S. Code, Title 218; Section 1001) <br /> 1 AGREE _ , <br /> The list of certifigtions and assurances, or an intemet site where you .may obtain this list, is contained in the announcement or agency <br /> specific instructions. <br /> Authorized Representative: <br /> Prefix: Ms . * First Name: Debbie <br /> Middle Name: L . <br /> * Last Name: wydra • <br /> Suffix: . <br /> *Title: Senior Management Analyst, Finance <br /> * Telephone Number: 541-682-5024 Fax Number: <br /> *Email: debbie.l.wydra@ci.eugene.or.us <br /> • * Signature of Authorized Representative: Completed by Grents.gov upon submission. * Date Signed: Completed by Grants.gov upon submission. <br /> Authorized for Local Reproduction Standard Form 424 (Revised.10/2005) <br /> Prescritred by OMB Circular A-102 <br /> <br />