OMBNumber:4040-0004
ExpirationDate:12/31/2022
*1.TypeofSubmission: *2.TypeofApplication:
*3.DateReceived: 4.ApplicantIdentifier:
5a.FederalEntityIdentifier: 5b.FederalAwardIdentifier:
6.DateReceivedbyState: 7.StateApplicationIdentifier:
*a.LegalName:
*b.Employer/TaxpayerIdentificationNumber(EIN/TIN): *c.UEI:
*Street1:
Street2:
*City:
County/Parish:
*State:
Province:
*Country:
*Zip/PostalCode:
DepartmentName: DivisionName:
Prefix: *FirstName:
MiddleName:
*LastName:
Suffix:
Title:
OrganizationalAffiliation:
*TelephoneNumber: FaxNumber:
*Email:
*IfRevision,selectappropriateletter(s):
*Other(Specify):
State Use Only:
8.APPLICANT INFORMATION:
d. Address:
e.Organizational Unit:
f. Nameand contact information of person to be contactedon matters involving this application:
Application for Federal Assistance SF-424
Preapplication
Application
Changed/CorrectedApplication
New
Continuation
Revision
07/14/202207/14/2022
B-22-MC-06-0028
City of Napa
94-6000380 070158399
955 School Street
Napa
CA: CaliforniaCA: California
USA: UNITED STATESUSA: UNITED STATES
94559
City Manager's Office Housing Division
Stephanie
Gaul
Acting Housing Manager
(707) 257-9628
[email protected]
EXHIBIT D
*9. Type of Applicant 1: Select Applicant Type:
TypeofApplicant2:SelectApplicantType:
TypeofApplicant3:SelectApplicantType:
*Other(specify):
*10. Name ofFederal Agency:
11. Catalog of Federal Domestic Assistance Number:
CFDATitle:
*12. Funding OpportunityNumber:
*Title:
13. Competition Identification Number:
Title:
14. Areas Affected by Project (Cities, Counties, States,etc.):
*15. DescriptiveTitleof Applicant'sProject:
Attachsupportingdocumentsasspecifiedinagencyinstructions.
Application for Federal Assistance SF-424
C: City or Township GovernmentC: City or Township Government U S Department of Housing and Urban Development
14-218
Community Development Block Grant
B-22-MC-06-0028
Community Development Block Grant
Program Year 2022-2023 CDBG
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EXHIBIT D
*a.Federal
*b.Applicant
*c.State
*d.Local
*e.Other
*f. ProgramIncome
*g.TOTAL
.
Prefix: *FirstName:
MiddleName:
*LastName:
Suffix:
*Title:
*TelephoneNumber:
*Email:
FaxNumber:
*SignatureofAuthorizedRepresentative: *DateSigned:
18. Estimated Funding ($):
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 anyfalse, fictitious, or fraudulent statementsor claims may subject me to criminal, civil, or administrative penalties. (U.S. Code, Title218,Section 1001) **Thelistofcertificationsandassurances,oraninternetsitewhereyoumayobtainthislist,iscontainedintheannouncementoragencyspecific instructions.
Authorized Representative:
Application for Federal Assistance SF-424
*a.Applicant
AttachanadditionallistofProgram/ProjectCongressionalDistrictsifneeded. *b.Program/Project
*a.StartDate: *b.EndDate:
16. Congressional Districts Of:
17. Proposed Project:
CA-005 CA-005
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07/01/202207/01/2022 06/30/202306/30/2023
605,036.00
138,500.00
743,536.00
a.This applicationwasmadeavailable tothe StateundertheExecutive Order 12372 Processforreview on b.Programis subjecttoE.O.12372buthasnotbeenselectedby theStateforreview. c.Programis notcovered byE.O.12372.
Yes No
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**IAGREE
Steve
Potter
City Manager
(707) 257-9501
[email protected]
* 20.Is the Applicant Delinquent On Any Federal Debt? (If"Yes," provide explanation in attachment.) * 19.Is Application Subject to Review By State Under Executive Order 12372 Process? If"Yes",provideexplanationandattach
EXHIBIT D