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OMB Number- 4040-000,. <br />Expiration Date: 01/31/2009 <br />i <br />pplication for Federal Assistance SF-424 Version 02 <br />i. Congressional Districts Of. <br />oR-009 <br />a. Applicant OR-004, ' b. Program/Project <br />ttach an additional fist of Program/Project Congressional Districts if needed. <br />1 <br />7. Proposed Project <br />a. Start Date: 08/01/2009 *.b. End Date: 07/31/2011 <br />8. Estimated Funding (S1: <br />' a. Federal 1, 642, 302.00 <br />b. Applicant 48, 802.00 <br />c. State 148, 961.00 <br />d. Local 0.00 <br />e. Other 0.00 <br />f. Program Income 0.00 <br />g. TOTAL 1,840,065.00 <br />i <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 U <br />b. Program is subject to E.O. 12372 but has not been selected by the State for review. <br />J ^ c. Program is not covered by E.O. 12372. <br />.20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes", provide explanation.) <br />-JYes QX No <br />11. `By signing this application, I certify (1) to the statements contained In the list of certifications"' and (2) that the statements <br />ierein are true, complete and accurate to the best of my knowledge. I also provide the required assurances" and agree to <br />;omply with any resulting terms If I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may <br />subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218; Section 1001) <br />" I AGREE' <br />The list of certifications and assurances, or an Internet 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 />Fax Number. <br />' Telephone Number. 591-662-5024 <br />'Email: debbie.1.wydra@ci.eugene.or.us <br />Signature of Authorized Representative: completes by Grents.gov upon suhmissan. *Date Signed: cornpWted by Grmts.Cm upon submission. <br />Standard Form 424 (Revised 1012005) <br />Authorized for Local Reproduction <br />Prescribed by OMB Circular A-102 <br />I <br />