HomeMy WebLinkAbout131-06 RESOLUTIONRESOLUTION NO. 131-06
A RESOLUTION AUTHORIZING THE FAYETTEVILLE FIRE
DEPARTMENT TO APPLY FOR AND ACCEPT AN ARKANSAS
FORESTRY COMMISSION GRANT IN THE AMOUNT OF
$2,500.00 FOR THE FAYETTEVILLE FIREWISE MAILOUT; AND
APPROVING A BUDGET ADJUSTMENT RECOGNIZING THE
GRANT REVENUES.
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
FAYETTEVILLE, ARKANSAS -
Section 1. That the City Council of the City of Fayetteville, Arkansas
hereby authorizes the Fayetteville Fire Department to apply for and accept an
Arkansas Forestry Commission Grant in the amount of $2,500.00 for the
Fayetteville Firewise Mailout.
1 l
Section 2. That the City Council of the City of Fayetteville, Arkansas
hereby approves a Budget Adjustment recognizing the grant revenues.
PASSED and APPROVED this 1st day of August, 2006.
APPROVED: r t ATTEST:
By:
�G`�RIVTRcgtSif'
�,\1 Y o c s ;'•
•• F`3
cv
•13;
',FAYETTEVILLE•
04247 TON %C�.`t.
D COODY, Mayor: SONDRA SMITH, City Clerk
•
•
OMB Approval No. 0348-0043
APPLICATION FOR
FEDERAL ASSISTANCE
1. TYPE OF SUBMISSION •
Application Preapplication
0 Construction 0 Construction
® Non -Construction ❑ Non -Construction
2. DATE SUBMITTED
8/3/06
Applicant Identifier
3. DATE RECEIVED BY STATE
State Application Identifier
4. DATE RECEIVED BY FEDERAL AGENCY
Federal Identifier
5. APPUCANT INFORMATION
Legal Name: City of Fayetteville Fire Dept
Address (Give City, County, State, and Zip code):
303 W Center Street
Fayetteville, AR 72701
Washington County
6. EMPLOYER IDENTIFICATION NUMBER (EIN):
7
1
Organizational Unit: Fire Dept
Name and telephone number of the person to be contacted on matters
involving this application (Give area code)
Elizabeth Mann
(479) 575-8366
6
0
1
8
4
6
2
t TYPE OF APPLICATION
El New 0 Continuation ❑ Revision
If Revision, enter appropriate letter(s) in box(es):
A. Increase Award B. Decrease Award
C. Increase Duration D. Decrease Duration
Other (Specify)
7. TYPE OF APPLICANT: (Enter appropriate letter in box)
A. State
B. County
C. Municipal
D. Township
E. Interstate
F. Intermunicipal
G. Special District
C
H. Independent School District
I. State Control Instil. of Higher Learning
J. Private University
K. Indian Tribe
L Individual
M. Profit organization
N. Other (Specify)
•
9. NAME OF FEDERAL AGENCY: USDA - Forest Service, Southern Region
10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER
1
0
6
6
4
TITLE: Cooperative Fores ry Assistance
12. AREA AFFECTED BY PROJECT (Cities, counties, states, et)
11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
Fayetteville FireWise Board will mail inserts with app. 36,000
water bills in September promoting FireWise and Leaf Bag
Giveaway on FireWise Day. Project costs will include cost of
printing inserts and posters promoting the Fall FireWise Day.
13. PROPOSED PROJECT:
Start Date
8/1/06
15. ESTIMATED FUNDING
14. CONGRESSIONAL DISTRICTS OF:
End Date
12/31/06
a. Applicant
b. Project
Fayetteville FireWise Mailout
a. Federal
b. Applicant
c. State
d. Local
e. Other
$2,500.00
$
16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER
12372 PROCESS?
a. YES. This preapplication/application was made available to the
State Executive Order 12372 Process for review on:
DATE:
b. NO. 0 Program is not covered by E.O. 12372
❑ or Program has not been selected by State for review
f. Program
$
g. TOTAL
$2,500.00
17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
❑ YES - If "YES', attach an explanation. ® NO
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS
DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY
ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.
a. Type Name of Authorized Representative b. Title
Tony Johnson
•
APPUCATION/PREAPPUCATION ARE TRUE AND CORRECT. THE
OF THE APPUCANT AND THE APPLICANT WILL COMPLY WITH THE
•
Fire Chief
c. Telephone Number
(479) 575-8365
d. Signature of Authorized Representative
e. Date Signed
8/3/06
Previous Edition Usable
Authorized for Local Reproduction
•
Standard Form 424 (Rev. 7-97)
Prescribed by OMB Circular A-102
• INSTRUCTIONS FOR THE SF 424
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collodion of information. Send comments regarding the
burden estimate or any otheraspect of this collection ofinfer/nation, including suggestions for ?educing this burden, to the Office of Management and Budget,
Paperwork Reduction Project (0348-0043), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFRCE OF MANAGEMENT AND BUDGET, SEND IT TO THE ADDRESS PROVIDED
BY THE SPONSORING AGENCY.
This is a standard form used by applicants as a required facesheet for preapplications and applications submitted for Federal assistance. It
will be used by Federal agencies to obtain applicant certification that States which have established a review and comment procedure in
response to Executive Order 12372 and have selected the program to be included in their process, have been given an opportunity to
review the applicant's submission.
ITEM ENTRY
1. Self-explanatory.
2. Date application submitted to Federal agency (or State if
applicable) & applicant's control number (if applicable).
3. State use only (if applicable).
4. If this application is to continue or revise an existing award,
enter present Federal identifier number. If for a new
project, leave blank.
5. Legal name of applicant, name of primary organizational
unit which will undertake the assistance activity, complete
address of the applicant, and name and telephone number
of the person to contact on matters related to this
application.
6. Enter Employer Identification Number (EIN) as assigned by
the (Memel Revenue Service.
7. Enter the appropriate letter in the space provided.
8. Check appropriate box and enter appropriate letter(s) in the
space(s) provided:
--'Never' means a new assistance ataard.
----Continuation'' means an extension for an additional
funding/budget period for a project with a projected
completion date.
Revision" means any change in the Federal
Government's financial obligation or contingent liability
from an existing obligation.
9. Name of Federal agency from which .assistance is being
requested with this application.
10. Use the Catalog of Federal Domestic Assistance number
and title of the program under which assistance is
requested.
ITEM ENTRY
,11. Enter a brief descriptive title of the project. If more than one
program is involved, you should append an explanation on a
separate sheet. If appropriate (e g construction or real
property projects), attach a map showing project location.
For preapplications, use a separate sheet to provide a
summary description of this project.
12. List only the largest political entities affected (e.g., State,
counties, cities).
13. Self-explanatory.
14. List the applicant's Congressional District and any District(s)
affected by the program or project.
15. Amount requested or to be contributed during the first
funding/budget period by each contributor. Value of in-kind
contributions should be included on appropriate lines as
applicable. If the action will result in a dollar change to an
existing award, indicate onlythe amount of the change. For
decreases, enclose the amounts in parentheses. If both
basic and supplemental amounts are included show
breakdown. on an attached sheet. For multiple program
funding, use totals and show breakdown using same
categories as Item 15. •
16. Applicants should contact the State Single Point of Contract
(SPOC)tor Federal Executive Order 12372 to determine
whether the application is subject to the State
intergovernmental review process.
17. This question applies to theapplicant organization, not the
person who signs as the authorized representative.
Categories of debt include delinquent audit disallowances,
loans and taxes.
18. To be signed by the authorized representative of the
applicant. A copy of the governing body's authorization for
you to sign this application as official representative must be
on file in the applicant's office. (Certain Federal agencies •
may require that this authorization be submitted as part of
the application.) •
SF -424 (Rev. 7-97) Back
City of Fayetteville, Arkansas
Budget Adjustment Form
Budget Year
2006
Department: Fire
Division: Fire
Program: Operations
Date Requested
7/20/2006
Adjustment Number
Project or Item Added/Increased:
$2,500 is requested in Office Supplies/Printing
Project or Item Deleted/Reduced:
$2,500 is requested in Misc Revenue
Justification of this Increase:
The Arkansas Forestry Commission grant will pay for the
printing of Firewise pamphlets to be included with the
customers water bills.
Justification of this Decrease:
The money has already been appropriated by the State of
Arkansas.
Increase Expense Budget (Decrease Revenue Budget)
Account Name . Account Number Amount Project Number
Office supplies/printing
Account Name
1010 3020 5200 00 2,500
Decrease Expense Budget (Increase Revenue Budget)
Account Number Amount
#N/A
1010 0001 4996 05 2,500
Project Number
st' By
(Apppmval y : rn es
IQO(Q(p
Date
Budget Manager Date
Department Director Date
F
i
,,.
I Services Director
ayor
Date
Date
Budget Office Use Only
Type: A B
Posted to General Ledger
Posted to Project Accounting
Entered in Category Log
D E
Initial Date
Initial Date
Initial Date
Tony Johnson
Submitted By
•
City of Fayetteville
Staff Review Form
City Council Agenda Items
or
Contracts
aunt
City Council Meeting Date
Fire
Division
Action Required:
Department
This request is for approval to apply for and accept a non-matching grant from the Arkanasas Forestry Commission in the
amount of $2,500.
2,500.00
Cost of this request
1010.0001.4996.05
Account Number
Project Number
Budgeted Item
•
1,200.00
Category / Project Budget
1,380.00
Funds Used to Date
Misc Revenue
Program Category / Project Name
Revenue
Program / Project Category Name
(180.00) General Fund
Remaining Balance
Budget Adjustment Attached
X
Fund Name
Department Director
7.2/.0G
Date
City Attomey
Date
0
FiSancc and Internal Service Director ate
Mayor
Date
Previous Ordinance or Resolution #
Original Contract Date:
Original Contract Number:
Comments
RESOLUTION NO.
A RESOLUTION AUTHORIZING THE FAYETTEVILLE FIRE
DEPARTMENT TO APPLY FOR AND ACCEPT AN ARKANSAS
FORESTRY COMMISSION GRANT IN THE AMOUNT OF
$2,500.00 FOR THE FAYETI'LVILLE FIREWISE MAILOUT; AND
APPROVING A BUDGET ADJUSTMENT RECOGNIZING THE
GRANT REVENUES.
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF
FAYETTEVILLE, ARKANSAS•
Section 1. That the City Council of the City of Fayetteville, Arkansas
hereby authorizes the Fayetteville Fire Department to apply for and accept an
Arkansas Forestry Commission Grant in the amount of $2,500.00 for the
Fayetteville Firewise Mailout.
Section 2. That the City Council of the City of Fayetteville, Ark-
hereby approves a Budget Adjustment recognizing the grant revenu
PASSED and APPROVED this 1st day of August
AT EST:
4By:
SSIDRA SMIH,it Clerk
Mayor
Clarice Pearman - Res. 131-06 Page 1 [
From: Clarice Pearman
To: Johnson, Tony
Date: 8.8.06 1:20PM
Subject: Res. 131-06
Chief,
Attached is a copy of the above resolution passed by City Council, August 1, 2006 regarding the
encroachments. I'm forwarding to you via interoffice mail the original of the grant signed by the mayor.
Please send me a copy of the grant when you have completed the blanks on first page. I am also
forwarding the budget adjustment to Budget & Research. If anything else is needed please let me know.
Thanks.
Clarice
CC: Audit
OMB Approval No. 0348-0043
:A P
-'FEDERAL
Pt I CAlal.
:ASSISTANCE
c. OR
2. DATE SUBMITTED
Applicant
Identifier
1 TYPE OF SUBMISSION
Application
Preapplication
3. DATE RECEIVED BY STATE
State Application Identifier
4. DATE RECEIVED BY FEDERAL AGENCY
Federal
Identifier
•
Construction
•
Construction
0 Non -Construction ❑ Non -Construction
5. APPLICANT INFORMATION
Legal Name:
Organizational Unit:
Address (Give City, County, State, and Zip code):
involving
Name and telephone number of the person to be contacted on matters
this application (Give area code)
6. EMPLOYER IDENTIFICATION NUMBER (EIN):
7. TYPE OF APPLICANT: (Enter appropriate letter in box)
A. State . H. Independent School District
B. County 1. State Control Instit. of Higher Leaming
C. Municipal J. Private University
D. Township K. Indian Tribe
E. Interstate L. Individual
F. Intermunicipal M. Profit organization
G. Special District N. Other (Specify)
8. TYPE OF APPLICATION
0
New
•
Continuation ❑ Revision
If Revision, enter appropriate letter(s) in box(es):
A. Increase Award B. Decrease Award
C. Increase Duration D. Decrease Duration
Other (Specify)
9. NAME OF FEDERAL AGENCY: USDA - Forest Service, Southern Region
10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER
11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
Fayetteville FireWise Board will mail inserts with app. 36,000
water bills in September promoting FireWise and Leaf Bag
Giveaway on FireWise Day. Project costs will include cost of
printing inserts and posters promoting the Fall FireWise Day.
1
0
-
6
6
4
TITLE: Cooperat've Fores ry Assistance
12. AREA AFFECTED BY PROJECT (Cities, counties, states, etc.)
13. PROPOSED PROJECT:
14. CONGRESSIONAL DISTRICTS OF:
Start Date
8/1/06
End Date
12/31/06
a. Applicant
b. Project
Fayetteville FireWise Mailout
15. ESTIMATED FUNDING
16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER
12372 PROCESS?
a. YES. This preapplication/application was made available to the
State Executive Order 12372 Process for review on:
DATE:
a. Federal
$2,500.00
b. Applicant
$
c. State
$ -
b. NO. 0 Program is not covered by E.O. 12372
❑ or Program has not been selected by State for review
d. Local
$
e. Other
$
f. Program
$
17. IS
■
THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
YES - If "YES", attach an explanation. ® NO
g. TOTAL
$2,500.00
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT. THE
DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE
ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.
a. Type Name of Authorized Representative
ban Coo•V
b. Title
Amick_
c. Telephone
tog-
Number
575-g330
d. Signature of Autho • IRe re
9 P
-ntative/
e.
QIJ
D e Sied
�^
Previous Edition UsKble
Authorized for Local Reproduction
Standard Form 424 (Rev. 7-97)
Prescribed by OMB Circular A-102
INSTRUCTIONS FOR THE SF 424
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the
burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget,
Paperwork Reduction Project (0348-0043), Washington, DC 20503.
PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET, SEND IT TO THE ADDRESS PROVIDED
BY THE SPONSORING AGENCY.
This is a standard form used by applicants as a required facesheet for preapplications and applications submitted for Federal assistance. It
will be used by Federal agencies to obtain applicant certification that States which have established a review and comment procedure in
response to Executive Order 12372 and have .selected the program to be included in their process, have been given an opportunity to
review the applicant's submission.
ITEM ENTRY
1. Self-explanatory.
2. Date application submitted to Federal agency (or State if
applicable) & applicants control number (if applicable).
3. State use only (if applicable).
4. If this application is to continue or revise an existing award,
enter present Federal identifier number. If for a new
project, leave blank.
5. Legal name of applicant, name of primary organizational
unit which will undertake the assistance activity, complete
address of the applicant, and name and telephone number
of the person to contact on matters related to this
application.
6. Enter Employer Identification Number (EIN) as assigned by
the Internal Revenue Service.
7. Enter the appropriate letter in the space provided.
8. Check appropriate box and enter appropriate letter(s) in the
space(s) provided:
—"News' means a new assistance award,
--"Continuation" means an extension for an additional
funding/budget, period for a project with a projected
completion date.
—"Revision" means any change in the Federal
Government's financial obligation or contingent liability
from an existing obligation.
9. Name of Federal agency from which assistance is being
requested with this application.
10. Use the Catalog of Federal Domestic Assistance number
and title of the program under which assistance is
requested.
ITEM
11.
ENTRY
Enter a brief descriptive title of the project. If more than one
program is involved, you should append an explanation on a
separate sheet. If appropriate (e.g., construction or real
property projects), attach a map showing project location.
For preapplications, use a separate sheet to provide a
summary description of this project.
12. List only the largest political entities affected (e.g., State,
counties, cities).
13. Self-explanatory.
14. List the applicant's Congressional District and any District(s)
affected by the program or project.
15. Amount requested or to be contributed during the first
funding/budget period by each contributor. Value of in-kind
contributions should be included on appropriate lines as
applicable. If the action will result in a dollar change to an
existing award, indicate only the amount of the change. For
decreases, enclose the amounts in parentheses. If both
basic and supplemental amounts are included show
breakdown on an attached sheet. For multiple program
funding, use totals and show breakdown using same
categories as Item 15.
16. Applicants should contact the State Single Point of Contract
(SPOC) for Federal Executive Order 12372 to determine
whether the application is subject to the State
intergovernmental review process.
17. This question applies to the applicant organization, not the
person who signs as the authorized representative.
Categories of debt include delinquent audit disallowances,
loans and taxes.
18. To be signed by the authorized representative of the
applicant. A copy of the goveming body's authorization for
you to sign this application as official representative must be
on file in the applicants office. (Certain Federal agencies
may require that this authorization be submitted as part of
the application.)
SF -424 (Rev. 7-97) Back
OMB Approval N'-0348-0043
APPLICATION FOR
FEDERAL ASSISTANCE
2. DATE SUBMITTEDAppyd'moi
i=i C
1. TYPE OF SUBMISSION
Application Preapplication
3. DATE RECEIVED BY STATE
\
0 Construction ❑ Construction
4. DATE RECEIVED BY FEDERAL AGENCY �•
-
® Non-Construction
•
Non-Construction
\
5. APPLICANT INFORMATION
Legal Name:
Organizational Unit:
Address
(Give City, County, State, and Zip code):
Name and telephone
involving this
number
application (Give
of
tf\
are:,
.., to be contacted
code)
on matters
6. EMPLOYER IDENTIFICATION NUMBER EIN):
7. TYPE OF APPLICANT: (Enter appropriate letter in box)
8. TYPE OF APPLICATION
A. State H. Independent School District
@
New
•
Continuation ❑ Revision
B. County I. State Control Instit. of Higher Learning
If Revision, enter appropriate
letter(s) in box(es):
C. Municipal J. Private University
D. Township K. Indian Tribe
A. Increase Award B. Decrease Award
C. Increase Duration D. Decrease Duration
Other (Specify)
E. Interstate L. Individual
F. Intermunicipal M. Profit organization
G. Special District N. Other (Specify)
9. NAME OF FEDERAL AGENCY: USDA - Forest Service, Southern
Region
10. CATALOG OF FEDERAL DOMESTIC ASSISTANCE NUMBER
11. DESCRIPTIVE TITLE OF APPLICANT'S PROJECT:
Fayetteville FireWise Board will mail inserts with app. 36,000
water bills in September promoting FireWise and Leaf Bag
Giveaway on FireWise Day. Project costs will include cost of
printing inserts and posters promoting the Fall FireWise Day.
1
0
-
6
6
4
TITLE: Cooperative Fores ry Assistance
12. AREA AFFECTED BY PROJECT (Cities, counties, states, etc.)
13. PROPOSED PROJECT:
14. CONGRESSIONAL DISTRICTS OF:
Start Date
8/1/06
End Date
12/31/06
a. Applicant
b. Project
Fayetteville FireWise Mailout
15. ESTIMATED FUNDING
16. IS APPLICATION SUBJECT TO REVIEW BY STATE EXECUTIVE ORDER
12372 PROCESS?
a. YES. This preapplication/application was made available to the
State Executive Order 12372 Process for review on:
DATE:
a. Federal
$2,500.00
b. Applicant
$
c. State
$
b. NO.
•
•
Program is not covered by E.O. 12372
or Program has not been selected by State for review
d. Local
$
e. Other
$
f. Program
$
17. IS THE APPLICANT DELINQUENT ON ANY FEDERAL DEBT?
g. TOTAL
$2,500.00
■
YES - If "YES", attach an explanation.
E0
NO
18. TO THE BEST OF MY KNOWLEDGE AND BELIEF, ALL DATA IN THIS APPLICATION/PREAPPLICATION ARE TRUE AND CORRECT. THE
DOCUMENT HAS BEEN DULY AUTHORIZED BY THE GOVERNING BODY OF THE APPLICANT AND THE APPLICANT WILL COMPLY WITH THE
ATTACHED ASSURANCES IF THE ASSISTANCE IS AWARDED.
a. Type
Dan
Name of
eoo•
Authorized
Representative
b. Title
MAYOR.
c. Telephone
q7q-
575-
Number
g330
d. Signature of
Au���
pr�ntative
e. �e Signed
�3°
Previous Edition Usable
Authorized for Local Reproduction
tandard Form 424 (Rev. 7 -
Prescribed by OMB Circular A-102
INSTRUCTIONS FOR THE SF 424
Public reporting burden for this collection of information is estimated to average 45 minutes per response, including time for reviewing instructions, searching
existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding the
burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the Office of Management and Budget,
Paperwork Reduction Project (0348-0043), Washington, DC 20503.
'PLEASE DO NOT RETURN YOUR COMPLETED FORM TO THE OFFICE OF MANAGEMENT AND BUDGET, SEND IT TO THE ADDRESS PROVIDED
BY THE SPONSORING AGENCY.
This is a standard form used by applicants as a required facesheet for preapplications and applications submitted for Federal assistance. It
will be used by Federal agencies to obtain applicant certification that States which have established a review and comment procedure in
response to Executive Order 12372 and have selected the program to be included in their process, have been given an opportunity to
review the applicants submission.
ITEM ENTRY
1. Self-explanatory.
2. Date application submitted to Federal agency (or State if
applicable) & applicant's control number (if applicable).
3. State use only (if applicable).
4. If this application is to continue or revise an existing award,
enter present Federal identifier number. If for a new
project, leave blank.
5. Legal name of applicant, name of primary organizational
unit which will undertake the assistance activity, complete
address of the applicant, and name and telephone number
of the person to contact on matters related to this
application.
6. Enter Employer Identification Number (EIN) as assigned by
the Internal Revenue Service.
7. Enter the appropriate letter in the space provided.
8. Check appropriate box and enter appropriate letter(s) in the
space(s) provided:
--"New" means a new assistance award.
--"Continuation" means an extension for an additional
funding/budget period for a project with a projected
completion date.
-"Revision" means any change in the Federal
Govemment's financial obligation or contingent liability
from an existing obligation.
9. Name of Federal agency from which assistance is being
requested with this application.
10. Use the Catalog of Federal Domestic Assistance number
and title of the program under which assistance is
requested.
ITEM ENTRY
11. Enter a brief descriptive title of the project. If more than one
program is involved, you should append an explanation on a
separate sheet. If appropriate (e.g., construction or real
property projects), attach a map showing project location.
For preapplications, use a separate sheet to provide a
summary description of this project.
12. List only the largest political entities affected (e.g., State,
counties, cities).
13. Self-explanatory.
14. List the applicant's Congressional District and any District(s)
affected by the program or project.
15. Amount requested or to be contributed during the first
funding/budget period by each contributor. Value of in-kind
contributions should be included on appropriate lines as
applicable. If the action will result in a dollar change to an
existing award, indicate only the amount of the change. For
decreases, enclose the amounts in parentheses. If both
basic and supplemental amounts are included show
breakdown on an attached sheet. For multiple program
funding, use totals and show breakdown using same
categories as Item 15.
16. Applicants should contact the State Single Point of Contract
(SPOC) for Federal Executive Order 12372 to determine
whether the application is subject to the State
intergovernmental review process.
17. This question applies to the applicant organization, not the
person who signs as the authorized representative.
Categories of debt include delinquent audit disallowances,
loans and taxes.
18. To be signed by the authorized representative of the
applicant. A copy of the goveming body's authorization for
you to sign this application as official representative must be
on file in the applicant's office. (Certain Federal agencies
may require that this authorization be submitted as part of
the application.)
SF -424 (Rev. 7-97) Back