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OMB Number: 4040-0004 C-22-20-003-G-06 Expiration Date: 10/31/2019 Application for Federal Assistance SF-424 * 41. Type of Submission: * 2. Type of Application: * if Revision, select appropriate letter(s): [__] Preapplication [|New Other Application CE] Continuation * Other (Specify): [Budget Revision | [] Changed/Corrected Application Revision * 3. Date Received: 4. Applicant Identifier: | |osHP000200 | ; 5a. Federal Entity Identifier: 5b. Federal Award Identifier: [n/a |o9xp000200 State Use Only: 6. Date Received by State: [ss 7. State Application Identifier: 8. APPLICANT INFORMATION: a.LegalName: [yartcopa, COUNTY OF * b. Employer/Taxpayer Identification Number (EIN/TIN): *c. Organizational DUNS: 866000472 | 1050391270 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: [35004-0948 | e. Organizational Unit: Department Name: Division Name: Maricopa County Human Services [early Education f. Name and contact information of person to be contacted on matters involving this application: Prefix: ms | *FirstName: [ave . Middle Name: | | * Last Name: |De1 Real Suffix: | Title: lassistant Director Organizational Affiliation: [mcusp Early Education Division “Telephone Number: | (692) 372-3710 Fax Number: * Email: leve .delreal@maricopa.gov C-22-20-003-G-06 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): | * 40. Name of Federal Agency: lacr-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.): Maricopa County excluding City of Phoenix * 15. Descriptive Title of Applicant's Project: Barly Head Start-Child Care Partnership COLA and Quality Improvement (QT) Attach supporting documents as specified in agency instructions. C-22-20-003-G-06 Application for Federal Assistance SF-424 16. Congressional Districts Of: *a. Applicant b. Program/Project AZ-003,AZ-005,AZ-008, AZ-009 Attach an additional list of Program/Project Congressional Districts if needed. 17. Proposed Project: *a. Start Date: 107/01/2020 *b. End Date: |096/30/2021 18. Estimated Funding ($): * a. Federal [ o| *b. Applicant [ -42, 411 *c. State [ | *d. Local | | *e, Other [ o| *f. Program Income | | *g. TOTAL [ -42, 411 * 19. Is Application Subject to Review By State Under Executive Order 12372 Process? C] a. This application was made available to the State under the Executive Order 12372 Process for review on [ss . CJ 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) bt | 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: | mx | * First Name: [sack | Middle Name: | | * Last Name: |se1lers | Suffix: | | * Title: Chair, Maricopa County Board of Supervisors | * Telephone Number: | Fax Number: | (602) 506-1776 * Email: |sellers} @mail.maricopa.gov WAR Z i Luct ==Bate Signed: | D antl Kosta MAR 24 2024 Approved as to form: Deputy County Attorney