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Application for Federal Assistance SF -424 , <br />16. Congressional Districts Of: <br />a. Applicant cA -097 b. Program /Project cA -097 <br />Attach an additional list of Program /Project Congressional Districts if needed. <br />Additional congressional District., Add Attachrpenf :' Delete AlfaChmant View Attechment J <br />17, Proposed Project: <br />* a. Start Date: 09/01/2011 * b. End Date: 08/31/2015 <br />.18. Estimated Funding ($): <br />`a. Federal 4, 997, 479..00 <br />* b. Applicant 0.00 <br />`a State 0.00 <br />* d. Local <br />* e. Other 0.00 <br />f. Program Income 0.00 <br />'g. TOTAL 4,997,479.00 <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 L� <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 in attachment.) <br />Yes . ®No <br />If "Yes ", provide explanation and attach <br />Add Attachment Delete Attachment ViewAttachm nt <br />21. `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. I also provide the required assurances ** and agree to <br />comply with any resulting terms if I accept an award. 1 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: r1 -First Name:' Linda <br />Middle Name: <br />* Last Name: Oberman <br />Suffix: <br />"Title: Director <br />• Telephone Number: 1714-565-2600 Fax Number: <br />*Email: LOberman @santa - ana.org <br />* Signature of Authorized Representative: Carlos de la Riva * Date Signed: 06/02/2011 <br />qjhlff;7 <br />