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OtiB Number: 4040.0004 <br />m. vu, 11-wy <br />Application for Federal Assistance SF-424 Version 02 <br />16. Congressional Districts Of. <br />*a. Applicant: 46 & 47 *b. Program/Project: 46 & 47 <br />17. Proposed Project: <br />*a. Start Date: 07/01/2012 *b. End Date: 06/30/2013 <br />18. Estimated Funding $ <br />*a. Federal 1,228,217 <br />*b. Applicant <br />*c. State <br />*d. Local <br />*e. Other <br />*f. Program Income <br />*g. TOTAL 1,228,217 <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 0 No <br />21. *By signing this application, I certify (l) to the statements contained in the list of certifications** and (2) that the statements herein <br />are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply with any <br />resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may subject me to criminal, <br />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 <br />agency specific instructions <br />Authorized Representative: <br />Prefix: Mr. *First Name: Paul <br />Middle Name: M. <br />*Last Name: Walters <br />Suffix: <br />*Title: Interim City Manager <br />*Telephone Number: 714-647-5200 *Telephone Number: 714-647-5200 <br />* Email: pwalters@santa-ana.org <br />*Signature of Authorized Representative: <br />A,ithnri,rri f- t -I R.-A *Date Signed: <br />atanaam tOrm 424 (KeMed 102005) <br />Prescribed by OMB Circular A-102 <br />2012-2013 ANNUAL ACTION PLAN 10 DRAFT 04/08/2012 <br />29B-17