COLA AND QI APPLICATION SF-424.PDF
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C-22-22-174-X-08 OMB Number: 4040-0004 Expiration Date: 12/31/2022 Application for Federal Assistance SF-424 *4. Type of Submission: * 2. Type of Application: * IF Revision, select appropriate letter(s): Increase Award O Preapplication [_] New * Other (Specify): Application OQ Continuation (_] Changed/Corrected Application Revision | * 3, Date Received: 4. Applicant Identifier: | [oscnoiz079 5a, Federal Entity Identifier: 5b, Federal Award (dentifier: [nea [oscno12079 State Use Only: 7. State Application Identifier: | 6, Date Received by State: | 8. APPLICANT INFORMATION: *a, Legal Name: [marrcora, county oF *b. Employer/Taxpayer Identification Number (EIN/FIN): *o. UE!: 866000472 | MHENFHVYWDD9 d. Address: * Streett: [234 N Central Ave | Street2: [rz 3 | * City: | Phoenix County/Parish: [waricopa County | * State: (nz: Arizona | Province: | | * Country: [usa: UNITED STATES | *Zip/ Postal Code: |gso04-0948 | e. Organizational Unit: Department Name: Division Name: Human Services [pariy Education f. Name and contact information of person to be contacted on matters involving this application: * First Name: [Eve Middle Name: | | * Last Name: [oer Real Title: [ass istant Director Organizational Affiliation: [ucusp Early Education Division *Telephone Number: | (692) 372-3710 Fax Number: * Email: [eve .delreal@maricopa.gov C-22-22-174-X-08 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: lACE-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 43. Competition Identification Number: Not Applicable Title: Not Applicable 14. Areas Affected by Project (Cities, Counties, States, etc.): Maricopa County with Exception of the city * 45. Descriptive Title of Applicant's Project: HS/EHS COLA/QUALITY IMPROVEMENT FUNDS Attach supporting documents as specified in agency instructions. G-22-22-174-X-08 Application for Federal Assistance SF-424 16. Congressional Districts Of: * a, Applicant b. Program/Project AZ~005 Attach an additional list of Program/Project Congressional Districts if needed. 17, Proposed Project: *a, Start Date: [07/01/2023 *b. End Date: [06/30/2024 418. Estimated Funding ($): * a, Federat | 1,532,409] *b, Applicant [ o| *o. State [ | *d. Local | | *e, Other | 0 | *f. Program income | | *g. TOTAL | 2,532,409] * 49. 1s Application Subject to Review By State Under Executive Order 12372 Process? LI a. This application was made available to the State under the Executive Order 12372 Process for review on [. a 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.0. 12372. * 20. Is the Applicant Delinquent On Any Federal Debt? (if "Yes," provide explanation in attachment.) (J Yes [X] 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) “| 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: [eine | Middle Name: [1, | * Last Name: [Hickman | * Title: [chairman, Maricopa County Board of Supervisor | * Telephone Number: | (602) 506-7642 | Fax Number: | *Email: [ctint shickman@maricopa.gov DA. 7, | LS fff Ad. * Signature of Authorized Representative: | £ TAC FF | Date Signed: [ APR TU 2023 | Attested ou Avavate jun APR_1 0 2023 Approved as to Form: vA L—~ SJuénita Garza, Clerk @f the Board 37% Kimberly Miles, Deputy County Attorney