OMB Number: 4040-0004
Expiration Date: 11/30/2025
* 1. Type of Submission: * 2. Type of Application:
* 3. Date Received: 4. Applicant Identifier:
5a. Federal Entity Identifier: 5b. Federal Award Identifier:
6. Date Received by State: 7. State Application Identifier:
* a. Legal Name:
* b. Employer/Taxpayer Identification Number (EIN/TIN): * c. UEI:
* Street1:
Street2:
* City:
County/Parish:
* State:
Province:
* Country:
* Zip / Postal Code:
Department Name: Division Name:
Prefix: * First Name:
Middle Name:
* Last Name:
Suffix:
Title:
Organizational Affiliation:
* Telephone Number: Fax Number:
* Email:
* If Revision, select appropriate letter(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/Corrected Application
New
Continuation
Revision
05/05/202305/05/2023
B-23-MC-06-0028
City of Napa
94-6000380 NC13XARFZ4K7
955 School Street
Napa
CA: CaliforniaCA: California
USA: UNITED STATESUSA: UNITED STATES
94559-0660
City Manager's Office Housing Division
Stephanie
Gaul
Housing Manager
(707) 257-9628
[email protected]
EXHIBIT D
*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 ofFederal Agency:
11. Catalog of Federal Domestic Assistance Number:
CFDA Title:
*12. Funding OpportunityNumber:
* Title:
13. Competition Identification Number:
Title:
14. Areas Affected by Project (Cities, Counties, States,etc.):
*15. DescriptiveTitleof Applicant'sProject:
Attach supporting documents as specified in agency instructions.
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-23-MC-06-0028
Community Development Block Grant
Program Year 2023-2024 CDBG
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EXHIBIT D
* a. Federal
* b. Applicant
* c. State
* d. Local
* e. Other
* f. Program Income
* g. TOTAL
.
Prefix: * First Name:
Middle Name:
* Last Name:
Suffix:
* Title:
* Telephone Number:
* Email:
Fax Number:
* Signature of Authorized Representative: * Date Signed:
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, Title18, Section 1001) ** 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:
Application for Federal Assistance SF-424
* a. Applicant
Attach an additional list of Program/Project Congressional Districts if needed. * b. Program/Project
* a. Start Date: * b. End Date:
16. Congressional Districts Of:
17. Proposed Project:
CA-005 CA-005
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07/01/202307/01/2023 06/30/202406/30/2024
583,765.00
125,520.00
709,285.00
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", provide explanation and attach
EXHIBIT D