19E - HOMELESSNESS PREVENTION AND RAPID RE-HOUSING PRGM

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OMB Number: 4040-0004 Expiration Date: 01/31/2009 Application for Federal Assistance SF-424 Version 02 16. Congressional Districts Of: *a. Applicant: 46 & 47 *b. Program/Project: 46 & 47 17. Proposed Project: *a. Start Date: 07/02/2009 *b. End Date: 09/30/2012 18. Estimated Funding ($): *a. Federal $2,831,989 *b. Applicant *c. State *d. Local *e. Other *f. Program Income *g. TOTAL $2,831,989 *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.) ^ Yes ®No 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: David Middle Name: N. *Last Name: Ream Suffix: *Title: City Manager *Telephone Number: 714-647-5200 Fax Number: 714-647-6713 * Email: achristensen~santa-ana.org *Signature of Authorized Representative: *Date Signed: Authorized for Local Reproduction Standard Form 424 (Revised 10/2005) Prescribed by OMB Circular A-102 19E-19