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OMB Number 4040-0004 <br />F.nbnnnn nom nvwwa <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: 07/01/2013 *b. End Date: 06/30/2014 <br />18. Estimated Funding <br />*a. Federal 5,680,480 <br />*b. Applicant <br />*c. State <br />*d. Local <br />*e. Other (Carry Forward) $300,000 <br />*f. Program Income <br />•g. TOTAL 5,980,480 <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. 0.12372 <br />*20. Is the Applicant Delinquent On Any Federal Debt? (if "Yes", provide explanation.) <br />? Yes ® No <br />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, <br />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 <br />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. <br />Code, Title 218, Section 1001) <br />® **I AGREE <br />** The list of certifications and assurances, or an intemet site where you may obtain this list, is contained in the announcement or agency specific <br />instructions <br />Authorized Representative: <br />Prefix: *First Name: Kevin <br />Middle Name: <br />*Last Name: O'Rourke <br />Suffix: <br />*Title: Interim City Manager <br />*Telephone Number: 714-647-5200 Fax Number: 714-647-6713 <br />* Email: korourke@santa-ana.org <br />-Signature of Authorized Representative: --T .Date Signed: <br />-L- ?.„ - L. 1 -P-1-U.. <br />DRAFT 04/22/2013 <br />Standard Form 41-4 (Revised 10/2005) <br />Prescribed by OMB Circular A-10'- <br />29A-12