APPLICATION FOR FEDERAL ASSISTANCEREV.PDF

OMB Number: 4040-0004
Application for Federal Assistance SF-424
*1. Type of Submission: " 2. Type of Application: * If Revision, select appropriate letter(s):
Preapplication 121 New
0 Application Continuation * Other (Specify):
El Changed/Corrected Application El Revision
" 3. Date Received: 4. Applicant Identifier
5a. Federal Entity Identifier: 5b. Federal Award Identifier:
State Use Only:
6. Date Received by State: 7. State Application Identifier:
8. APPLICANT INFORMATION:
* a. Legal Name: Maricopa County
* b. Employer/Taxpayer Identification Number (EINMN): * c. Organizational DUNS:
866000472 1377835560000
d. Address:
" Street1: 550 West Jackson Street
Street2:
*City: Phoenix
County/Parish:
*State: AZ: Arizona
Province:
*Country: USA: UNITED STATES
* Zip / Postal Code: 85003 - 2412
e. Organizational Unit:
Department Name: Division Name:
Maricopa Cnty Sheriff's Office Special Investigations
f. Name and contact information of person to be contacted on matters involving this application:
Prefix: * First Name: Cindy
Middle Name:
* Last Name: Kenney
Suffix:
Title: Grant Administrator
Organizational Affiliation:
*Telephone Number: 602 - 876- 3266 Fax Number:
*Email: C_Kenney@MCSO.Maricopa.gov

Application for Federal Assistance SF-424
* 9. Type of Applicant 1: Select Applicant Type:
B: County Government
Type of Applicant 2: Select Applicant Type:
Type of Applicant 3: Select Applicant Type:
* Other (specify):
* 10. Name of Federal Agency:
Office of National Drug Control Policy
11. Catalog of Federal Domestic Assistance Number:
95.001
CFDA Title:
* 12. Funding Opportunity Number:
HIDTA
*Title:
High Intensity Drug Trafficking Area
13. Competition Identification Number:
N/A
Title:
14. Areas Affected by Project (Cities, Counties, States, etc.):
Add Attachment DeltlePAIdtment Vie0JAttidirnent
*15.DescriptiveTitleofApplicanrsPmject
High Intensity Drug Trafficking Area program
Attach supporting documents as specified In agency instructions.
Add Attachments Delete Attachments View Attachments

Application for Federal Assistance SF -424
16. Congressional Districts Of:
*a. Applicant AZ- *b. Program/Project AZ-
Attach an additional list of Program/Project Congressional Districts if needed.
Add Attachment Delete Attachment View Attachment
17. Proposed Project:
*a. Start Date: 01/01/2020 *b. End Date: 12/31/2021
18. Estimated Fund ng ($):
* a. Federal 652,796.00
*b. Applicant
*c. State I
*d. Local I
*e. Other I
*f. Program Income I
*g. TOTAL 652,796.00
*19. 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
111 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.)
ill Yes El No ,
If "Yee, provide explanation and attach
Acid Htlar,hmont Delete Attachment View Attachment
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, 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 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. Code, Title 218, Section 1001)
Z ** I 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: * First Name: Bill
Middle Name:
*Last Name: Gates
Suffix:
*Title: Chairman
*Telephone Number: 602 - 506- 7562 Fax Number:
*Emil: district3@mail.maricopa.gov
*Signature of Authorized Representative: *Date Signed:
ATTEST: APPROVED AS TO FORM
This day of , 2019
Fran McCarroll Date
Clerk of the Board of Supervisors
By:
rlphi [hi marirona Cnunty Attorney