SF-424 FOR GRANT 09HET001850 SIGNED.PDF

OMB Number: 4040-0004
Expiration Date: 10/31/2019
Application for Federal Assistance SF-424
* 1. Type of Submission: * 2. Type of Application: * if Revision, select appropriate letter(s):
[__] Preapplication New
Application [_| Continuation * Other (Specify):
["] Changed/Corrected Application [| Revision
* 3. Date Received: 4. Applicant identifier:
| |ooumT001850
5a. Federal Entity Identifier: 5b. Federal Award Identifier:
lua |ooum7001850
State Use Only:
6. Date Received by State: [ 7. State Application Identifier: |
8. APPLICANT INFORMATION:
* a. Legal Name: |yarTcopa,
COUNTY OF
* b. Employer/Taxpayer Identification Number (EIN/TIN): * co. Organizational DUNS:
866000472 || 050391270
d. Address:
* Streett: [234 N Central Ave |
Street2: [e1 3 |
* City: | Phoenix |
County/Parish: [Maricopa County |
* State: laz: Arizona |
Province: | |
* Country: lusa: UNITED STATES |
* Zip / Postal Code: 15004-0948
e. Organizational Unit:
Department Name: Division Name:
Human Services | [early Education
f. Name and contact information of person to be contacted on matters involving this application:
Prefix: | | * First Name: [Eve |
Ms.
Middle Name: |
* Last Name: [pe1
Real
Suffix: | |
Title: lassrsrant DIRECTOR
Organizational Affiliation:
Imcusp EARLY EDUCATION DIVISION
* Telephone Number: Fax Number: |
(602) 372-3700
* Email: leve .delreal@maricopa.gov

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
* 12. Funding Opportunity Number:
OHS~HE~21-028
* Title:
NCN Announcement - Region 09 - HE - 2021 - April
13. Competition identification Number:
OHS-HE-21-028-092037
Title:
14, Areas Affected by Project (Cities, Counties, States, etc.):
EAST MARTCOPA
* 45, Descriptive Title of Applicant's Project:
COVID RELIEF FUNDS
Attach supporting documents as specified in agency instructions.

C-22=No OW O19
Application for Federal Assistance SF-424
16. Congressional Districts Of:
* a. Applicant b. Program/Project [az-o05
Attach an additional list of Program/Project Congressional Districts if needed.
17. Proposed Project:
*a. Start Date: [04/01/2021 *b. End Date: | 03/31/2023
18. Estimated Funding ($):
* a. Federal | 374, 706|
* b. Applicant o|
*c. State | 0 |
* d. Local | |
* e. Other | 0 |
*f. Program Income |
*g. TOTAL | 374, 706|
* 19. Is Application Subject to Review By State Under Executive Order 12372 Process?
L] 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 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)
XI | 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: lar | * First Name: [sack
Middle Name: |
* Last Name: [se11ers |
Suffix: |
*
Title: |chaiyman, Maricopa County Board of Supervisor |
* Telephone Number: | Fax Number: | |
(602) 506-1776
* Email: |sellers}
@mail.maricopa.gov
Date Signed: APR U 0 7071
|
D awd Lv rele
Approved as to form:
Deputy County Attorney