CARRYOVER FUNDS SF-424 SIGNED.PDF

C-22-20-003-G-00
OMB Number: 4040-0004
Expiration Date: 10/31/2019
Application for Federal Assistance SF-424
* 4. Type of Submission: * 2. Type of Apptication: * If Revision, select appropriate letter(s):
|] Preapplication [|New Increase Award
Application [_] Continuation * Other (Specify):
|} Changed/Corrected Application Revision
* 3. Date Received: 4. Applicant identifier:
| fosxeao0200
5a, Federal Entity identifier: 5b, Federat Award Identifier:
[n/a |o9HP000200
State Use Only:
6. Date Received by State: [| 7. State Application dentifter: |
8. APPLICANT INFORMATION:
“a. LegalName: [wartcopa,
COUNTY OF
*b. Employer/Taxpayer Identification Number (EIN/TIN): * c, Organizational DUNS:
866000472 [050391270
d. Address:
* Streeft: |234 N Central Ave |
Streef2: [ra 3 |
* City: Phoenix |
County/Parish: IMaricopa County |
* State: laz: Arizona
Province: | |
* Country: [usa: UNITED STATES |
* Zip / Postal Code: |35004-0948
e. Organizational Unit:
Department Name: Division Name:
Maricopa County Human Services learly Education
f. Name and contact information of person to be contacted on matters involving this application:
Prefix: {sas | * First Name: leve
.
Middle Name: |
* Last Name: [pe1
Real
Suffix: |
Title: jassistant Director
Organizational Affiliation:
[ucusp Early Education Division
* Telephone Number: | (692) 372-3710 Fax Number:
* Email: leve -delreal@maricopa.gov

C-22-20-003-G-00
Application for Federal Assistance SF-424
* 9. Type of Applicant 4: 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. Catatog of Federal Domestic Assistance Number:
[93.600
CFDA Title:
Head Start
* 12. Funding Opportunity Number:
eGrants-N/A
* Title:
N/A
13. Competition Identification Number:
lnot Applicable
Title:
Not Applicable
14. Areas Affected by Project (Cities, Counties, States, etc.):
Maricopa County excluding City of Phoenix |
* 45, Descriptive Titte 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-00
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: [97/01/2020 *b. End Date: {96/30/2021
18. Estimated Funding ($):
* a. Federal | 33,549
* b. Applicant | 0|
*c, State | |
*d. Local | |
* @, Other | o|
*f Program Income | |
*g. TOTAL | 33,543|
* 19. ls 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 [sds
[J b. Program is subject to £.0, 12372 but has not been selected by the State for review.
c. Program is not covered by E.0. 12372.
* 20. Is the Applicant Delinquent On Any Federal Debt? (if Yes, provide exptanation 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 1 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)
i] ** F 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: lise * First Name: [crint |
Middle Name: | |
* Last Name: [Hickman
Suffix: |
*
Title: |chair, Maricopa County Board of Supervisors
* Telephone Number: ‘| Fax Number: | |
(602) 506-7642
* Email: forint |
-hickman@maricopa,. gov
* Signature of Authorized Representative: ( AAA. * Date Signed:
2 g -2 >)
fo-
t ~
Dow) 1Okrute _12fogfroro
Approved as to form:
Deputy County Attorney