Laserfiche WebLink
5311 Funding Application +a� <br /> Treld <br /> for Public Transportation Operating Assistance "tom' <br /> Project Year beginning July 1, 2014 thru June 30, 2015 <br /> Application and all supporting documents must be received 60 days <br /> prior to project start date (for July 1 start date, forward by May 1). <br /> Please complete the entire application (Pages 1-16). <br /> SPONSOR/APPLICANT INFORMATION <br /> "Sponsor/Applicant Name: <br /> Senior Citizen Industries, Inc. dlb/a Hall County Public Transportaton <br /> Data Universal Numbering System(DUNS): Employer Identification No.(EIN): <br /> 02-160-5345 47-0543381 <br /> Entity Status with the Internal Revenue Service:(Check one) Private Not for Profit 0 Public Entity <br /> Applicant Address: <br /> 304 E. Third St. c rand I an NE 68801 <br /> Applies t Aut •re n 's ame: Title:64 <br /> Telephone: Email: <br /> Is the authorized representative also responsible for the transit operations? <br /> ®Yes <br /> ❑ No (If No, complete the following information) <br /> Person Responsible for the Transit Operations: <br /> p pe <br /> Title: <br /> Telephone: Email: <br /> Is there a subcontractor who will provide and/or manage the transit operations? <br /> ❑ No ❑Yes(If Yes, complete the following information) Provide complete contact Information on Pape 6. <br /> Subcontractor Name: <br /> Data Universal Numbering System(DUNS): ❑ Private for Profit <br /> Employer Identification Number(EIN): ❑ Private Not for Profit <br /> Provide evidence the subcontractor Is not on the excluded parties/suspension and debarment list. <br /> Search the excluded parties/suspension and debarment list HERE. Print a copy of the screen search and <br /> attach to this application. <br /> PUBLIC TRANSPORTATION OPERATING ASSISTANCE FUNDS REQUESTED <br /> (The cells below are locked. They will autopopulate with information provided on Page 4.) <br /> Federal: $349,066 State: $93,664 Local Match; $93,665 <br /> * This name will appear on the agreement. Please note the sponsor/applicant has annual drug and alcohol <br /> testing requirements. <br /> Modal 25(2014-2015) Page 2 <br />