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Application for Federal Assistance SF-424 16.Congressional Districts Of: *a.Applicant 10 *b.Program/Project 10 Attach an additional list of Program/Project Congressional Districts if needed. Add Attachment Delete Attachment View Attaohmer 17.Proposed Project: *a.Start Date: 07/01/2022 "b. End Date: 06/30/2023 18.Estimated Funding($): "a. Federal 368,034.00 *b.Applicant 0.00 "c.State 0.00 *d.Local 0.00 *e.Other 0.00 *f. Program Income 0.00 "g.TOTAL 368,034.00 *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 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: Mr. "First Name: Brian Middle Name: *Last Name: Dolan Suffix: *Title: Interim City Manager "Telephone Number: 925-931-5002 Fax Number: "Email: bdolan@cityofpleasantonca.gov *Signature of Authorized Representative: "Date Signed: