SIGNED SF-424 09HE000185.PDF

OMB Number: 4040-0004
C-22-21-113-X-00 Expiration Date: 10/31/2019
Application for Federal Assistance SF-424
* 4. Type of Submission: * 2. Type of Application: * If Revision, select appropriate letter(s):
[_ ] Preapplication [] New lothex
Application [_] Continuation * Other (Specify):
[] Changed/Corrected Application Revision | ARP
* 3. Date Received: 4. Applicant Identifier:
| [osnmooo1es
5a, Federal Entity Identifier: 5b. Federal Award Identifier:
v/a |osum000185
State Use Only:
6. Date Received by State: [ 7. State Application Identifier: [
8. APPLICANT INFORMATION:
*a. Legal Name: |vartcopa, COUNTY OF
* b. Employer/Taxpayer Identification Number (EIN/TIN): *c, Organizational DUNS:
866000472 | 050391270
d. Address:
* Street: [234 N Central Ave |
Street2: [ri 3 |
* City: | Phoenix
County/Parish: [Maricopa County |
* State: laz Arizona |
:
Province: | |
* Country: lusa: UNITED STATES |
* Zip / Postal Code: [s5004-0948
e. Organizational Unit:
Department Name: Division Name:
HUMAN SERVICES DEPARTMENT [sarty EDUCATION
f. Name and contact information of person to be contacted on matters involving this application:
Prefix: luis * First Name: | EVE
.
Middle Name: | |
* Last Name: |
pew REAL
Suffix:
Title: lasstsTaNT DIRECTOR
Organizational Affiliation:
Imcusp EARLY EDUCATION DIVISION
* Telephone Number: Fax Number:
(602) 372-3700 x23710
* Email: leve .delreal@maricopa.gov

C-22-21-113-X-00
Application for Federal Assistance SF-424
* 9. Type of Applicant 1: Select Applicant Type:
[county Government
Type of Applicant 2: Select Applicant Type:
Type of Applicant 3: Select Applicant Type:
* Other (specify):
* 410. Name of Federal Agency:
[acr-Head Start
11. Catalog of Federal Domestic Assistance Number:
[93.600 |
CFDA Title:
Head Start
* 42. Funding Opportunity Number:
eGrants-N/A
* Title:
N/A
13. Competition Identification Number:
Not Applicable
Title:
Not Applicable
14. Areas Affected by Project (Cities, Counties, States, etc.):
EAST AND WEST MARICOPA COUNTY WITH THE BxcH
* 15. Descriptive Title of Applicant's Project:
ARP
Attach supporting documents as specified in agency instructions.

C-22-21-113-X-00
Application for Federal Assistance SF-424
16. Congressional Districts Of:
* a. Applicant b. Program/Project AZ-005
Attach an additionai list of Program/Project Congressional Districts if needed.
17. Proposed Project:
*a. Start Date: [94/01/2021 *b. End Date: | 03/31/2023
18. Estimated Funding ($):
* a, Federal | 1,489, 643|
*b. Applicant o|
*c. State | o|
*d, Local | |
*e. Other o|
*f. Program Income | |
*g. TOTAL | 1,489, 643|
* 49. 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 [.
LE] 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 in attachment.)
[_] Yes No
If Yes, provide explanation and attach
| |
21. *By signing this application, | 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. | also provide the required assurances** and agree to
comply with any resulting terms if | accept an award. | 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)
[¥] ** |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: {or | * First Name: | JACK |
.
Middie Name: |
* Last Name: | SELLERS |
Suffix: |
*
Title: [cuarrman, MARICOPA COUNTY BOARD OF SUPERVISOR |
* Telephone Number: | | Fax Number: | |
(602) 506-1776
* Email: | sellers}@mail .maricopa.gov |
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Zz E z LLnaht DL
a wT A
* Signature of Authorized Representative: | fee Le Act, * Date Signed: | fa) s- N1- 202)
A
to form: DawAlo \ Koul
Approved as
Deputy County Attorney

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