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ONn3 Number. 4040-0004 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: 07/01/2012 *b. End Date: 06/30/2013 18. Estimated Funding *a. Federal 538,354 *b. Applicant *c. State *d. Local *e. Other (Prior Year) *f. Program Income *g. TOTAL, 538,354 *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: Paul Middle Name: M. *Last Name: Walters Suffix: *Title: Interim City Manager *Telephone Number: 714-647-5200 -Telephone Number: 714-647-5200 * Email: pwalters@santa-ana.org *Signature of Authorized Representative: *Date Signed: Standard Form 424 (Revised 1012005) Prescribed by OMB Cirwlar A-102 DRAFT 04/08/2012 13 2012-2013 ANNUAL ACTION PLAN 29B-20