American Recovery - application for Federal Assistance

Application for Federal Assistance SF-424                                                                                                                          Version 02

*1.  Type of Submission:

  Preapplication

  Application

  Changed/Corrected Application

*2.  Type of Application

  New

  Continuation

 Revision

* If Revision, select appropriate letter(s)

*Other (Specify)

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:  City of Arvada                                      

*b.  Employer/Taxpayer Identification Number (EIN/TIN):

84-000633                           

*c.  Organizational DUNS:

085285138                          

d.  Address:

*Street 1:                               8001 Ralston Road                                           

  Street 2:                               Annex - Municipal Building                                               

*City:                                       Arvada                                   

  County:                                Jefferson                                              

*State:                                    Colorado                                              

   Province:                                                                    

 *Country:                              USA                                       

*Zip / Postal Code               80002                                   

e.  Organizational Unit:

Department Name:

Community Development

Division Name:

Housing and Neighborhood Revitalization

 f.  Name and contact information of person to be contacted on matters involving this application:

Prefix:                     Mr.                                           *First Name:    Edward                      

Middle Name:       George                 

*Last Name:         Talbot                    

Suffix:                                             

Title:                       Manager, Housing and Neighborhood Revitalization                 

 Organizational Affiliation:

City                                                        

 *Telephone Number:   720-898-7494                                              Fax Number:  720-898-7490                          

 *Email:    ed-t@ci.arvada.co.us                      

OMB Number:  4040-0004

Expiration Date:  01/31/2009

Application for Federal Assistance SF-424                                                                                                                            Version 02

*9. Type of Applicant 1: Select Applicant Type:

Type of Applicant 2:  Select Applicant Type:

Type of Applicant 3:  Select  Applicant Type:

*Other (Specify)

*10 Name of Federal Agency:

US Department of Housing and Urban Development

11. Catalog of Federal Domestic Assistance Number:

14.253 for Entitlement                       

CFDA Title:

Community Development Block Grant                                           

*12  Funding Opportunity Number:

*Title:

13. Competition Identification Number:

Title:

14. Areas Affected by Project (Cities, Counties, States, etc.):

City of Arvada, Colorado  Jefferson County

*15.  Descriptive Title of Applicant’s Project:

Community Development Block Grant Program Funding Under the American Recovery and Reinvestment Act of 2009

OMB Number:  4040-0004

Expiration Date:  01/31/2009

Application for Federal Assistance SF-424                                                                                                                            Version 02

16. Congressional Districts Of:

*a. Applicant:  7th                                                                                 *b. Program/Project:  7th

17.  Proposed Project:

*a. Start Date:  July 1, 2009                                                                                               *b. End Date:  December 31, 2010

18. Estimated Funding ($):

*a.  Federal

*b.  Applicant

*c.  State

*d.  Local

*e.  Other

*f.  Program Income

*g.  TOTAL

136700

136700

*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.

  c.  Program is not covered by E. O. 12372

*20.  Is the Applicant Delinquent On Any Federal Debt?  (If “Yes”, provide explanation.)

  Yes                    No   

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)

  ** 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:  Craig                                                              

Middle Name:                                               

*Last Name:         Kocian