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Application for Federal Assistance SF-424 <br /> 16.Congressional Districts Of: <br /> •a.Applicant NE 3 •b.Program/Project NE 3 <br /> Attach an additional list of Program/Project Congressional Districts if needed. <br /> Adtl"°Atta Jir" 111A1 Aigid A at 4*11t r Viewa4(techM4W <br /> 17.Proposed Project: <br /> •a.Start Date: 10/01/2021 *b.End Date: 09/30/2023 <br /> 18.Estimated Funding(S): <br /> *a.Federal 35,909.00 <br /> b.Applicant 21,088.00 <br /> •c.State 0.00 <br /> 'd.Local 0.00 <br /> e.Other 0.00 <br /> *f. Program Income 0.00 <br /> 'g.TOTAL 56,997.00 <br /> "19.Is Application Subject to Review By State Under Executive Order 12372 Process? <br /> ® a.This application was made available to the State under the Executive Order 12372 Process for review on 07/27/2021 . <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 /> Yes ®No <br /> If"Yes",provide explanation and attach <br /> mi 7s.7 7°,7 t ° gi ee <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 terms 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 /> ® **I AGREE <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: Mr. *First Name: James <br /> Middle Name: Dale <br /> •Last Name: Duering <br /> Suffix: <br /> Title: Captain <br /> Telephone Number: 308-385-5400 Fax Number: 308-385-5398 <br /> *Email: rjduering@gipolice.org <br /> *Signature of Authorized Representative: James o Doering 'Date Signed: [07/15/2021 <br /> Tracking Number:GRANT13425318 Funding Opportunity Number:O-BJA-2021-35004 Received Date:Jul 15,2021 03:22:17 PM EDT <br />