APPLICATION SIGNED.PDF

OMB Number: 4040-0004
Expiration Date: 10/31/2019
Application for Federal Assistance SF424
*1. Type of Submission: *2. Type of Application: • If Revision, select appropriate letter(s):
Preapplication New Increase Award, Increase Duration
X Application Continuation • Other (Specify):
fl Changed/Corrected Application X Revision
*3. Date Received: 4. Applicant Identifier:
09CH010385
5a. Federal Entity Identifier: 5b. Federal Award Identifier:
N/A 09CH010385
State Use Only:
6. Date Received by State: 7. State Application Identifier:
8. APPLICANT INFORMATION:
*a. Legal Name: MARICOPA, COUNTY OF
* b. Employer/Taxpayer Identification Number (EIN/TIN): *c. Organizational DUNS:
866000472 050391270
d. Address:
* Street1: 234 N Central Ave
Street2: El 3
*City: Phoenix
County/Parish: Maricopa County
*State: AZ: Arizona
Province:
*Country: USA: UNITED STATES
* Zip / Postal Code: 85004-0948
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
Middle Name:
* Last Name: Del Real
Suffix:
Title: Early Education Director
Organizational Affiliation:
*Telephone Number: (602) 372- 3700 x23710 Fax Number:
* Email: eve. delreal@maricopa.gov
DEPUTY MAP A COUNTY ATTORNEY

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):
* 10. Name of Federal Agency:
ACF -Head Start
11. Catalog 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:
Not Applicable
Title:
Not Applicable
14. Areas Affected by Project (Cities, Counties, States, etc.):
East Maricopa County
* 16. Descriptive Title of Applicant's Project:
Head Start Duration
Attach supporting documents as specified in agency instructions.

Application for Federal Assistance SF424
16. Congressional Districts Of:
a. Applicant AZ-007 b. Program/Project AZ-005
Attach an additional list of Program/Project Congressional Districts if needed.
17. Proposed Project:
a. Start Date: 07/01/2018 * b. End Date: 06/30/2019
18. Estimated Funding ($):
a. Federal 111,889
b. Applicant 0
c. State
d. Local
e. Other 0
f. Program Income
g. TOTAL 111,889
* 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
b. Program is subject to E.O. 12372 but has not been selected by the State for review.
X 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 X No
If "Yes", provide explanation and attach
I I
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)
sIZ ** 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: Mr. * First Name: Steve
Middle Name:
* Last Name: Chucri
Suffix:
* Title: Chairman, Maricopa County Board of Supervisor
* Telephone Number: (602) 506-7431 Fax Number:
* Email: chucris@mail.maricopa.gov
* Signature of Authorized Representative: * Date Signed: NOV 20 7018
8.1v 20 2010
Deputy Clerk of the rd tuMkS7 DEPUTY ilAPiCOPA COUNTY ATTORNEY

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