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Application for Federal Assistance SF-424 <br />16. Congressional Districts Of- <br />. a. Applicant wA- 07 ` b. Program/Project wA- 06 <br />Attach an additional list of Program/Project Congressional Districts if needed. <br />Add Attachment Delete Attachment r View Attachment <br />17. Proposed Project: <br />'a. Start Date: os/15/zola ' b. End Date: o4/a1/2o21 <br />18. Estimated Funding (S): <br />• a. Federal 937, 500.00 <br />• b. Applicant <br />* c. State 937, 500.00 <br />' d. Local <br />" e. Other <br />" f. Program Income <br />•g. TOTAL 1,875,000.00 <br />` 19. Is Application Subject to Review By State Under Executive Order 12372 Process? <br />n a. This application was made available to the State under the Executive Order 12372 Process for review on <br />b. Program is subject to E.O. 12372 but has not been selected by the State for review. <br />® c. Program is not covered by E.O.12372. <br />* 20. Is the Applicant Delinquent On Any Federal Debt? (If "Yes," provide explanation in attachment.) <br />n Yes ® No <br />If "Yes", provide explanation and attach <br />Add Attachment I Delete Attachment . View Attachment <br />21. 'By signing this application, I certify (1) to the statements contained in the list of certifications" and (2) that the statements <br />herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances" and agree to <br />comply with any resulting terns if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may <br />subject me to criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001) <br />® ••IAGREE <br />" The list of certifications and assurances, or an intemet site where you may obtain this list, is contained in the announcement or agency <br />specific instructions. <br />Authorized Representative: <br />Prefix: iMr • First Name: Adam <br />Middle Name: <br />` Last Name: Draper <br />Suffix: <br />"Title: Corporate Counsel <br />• Telephone Number. 206-905-6956 Fax Number. <br />"Email: adrapereforterra.org <br />` Signature ofAuthorized Representative: <br />'Date Signed: 07/05/2018 <br />