SF424 Application.pdf

Application for Fedefal Aaalatuice 8F^

*1. Type of Subtnissian:

Q Preappticatioii

*a.DateR8oeh«il:

07/01/2017

6a FMera! Entty UenllSer.

SMaUseOn^:

* 2. Typo ofAppHoeaon'

I^New

QConftiwattoo [~|Reelak>n

4.AppbcanlldentMer

•(fRe»Won.«ctect appfoprtete lellBf(«):

*0(t)ar(Speotfy):

6b Federal Award (denttfier

6. Data ReceKod by State: 7. State AppNcalton idenldier

8. APPUCANnNRmMAIHM:

•aUgalName: jfaiying Coast Discovery Center

*b.Emptoyer/Taatpayer tdaififlcaflon number (HNrnW):

j33-0750177 tf.Atfdfe8s:

Stiaell.

Strsel2:

IIOOO Gunpowder Point Drive

-cOiganteationalDUNS

6189413920000

0MB Number: 4040-0004 bxpbsson Oete; 1001/2010

^hula Vista 1 %•

Cout^/Patlsh: 1 *Stale: |

CA; California

Pravince: | % •

•Country; p USA: UNITRD STATES 1 •2p/Postal Code: j9i9io-8222

Ou Ofgsfdaflofvl IMI:

4 . .

DepatinentNane: OMslonName: _ ••

1 • •

f. Nameami contact brfDcmtiBti of penon to be contetad on mMItm fawolvbiB Mb appQeaBon:

1^ h.. 1 -FWItenK iBenedict

Last Name:

SuRx:

jvallejt

TWe: Isxecutive Director

OiganizBtionBlACKaflon:

TelBptwweNumber 619-409-5911

Effisfl: jbenSthelivingcoast.erg

Fax Number

Applte«tlon forFederal Assletsnce 8F'424

.Type cfAppltcent 1:SelectAppHcant Type;

X: nonprofit, with 501C3 IRS itatua iCthar than Institution of H^ghfer Education) Type ofAppHcart 2: Setea AppBcem Type —

Type ofAppJlcanl a:8eteclAppilcmttType:

' Other (apedfy)

• 10. Name of Federal Ageoey:

Ijpepartinent ot Interior / Sen Diego MW Coaplex 11.CatdogofPedsial DamaeOc AasfBtanoe Numben

CfmiWa:

IYouth Kngagmenc, education, and Bnploynutii programn

12.FOndtog Owoittmtly Number

'TSe:

hi" r r

13.Coinpetitioii MetdBtcofloa Neaiber

14.AreasAlfacttdbyPreloet(Clflee, Coanflee, awee, ete.):

•• v.". ^

• 18.DeacriptteaTMaolAppllcafrfe Prelect living coaat Discovety Center - Refuge Living Lab and Teacher STEM Training

Attach aivipotllngdocumentsoaapecfRedbtasener Iratiuclions.

Application for Federal Assistance SF'424

16. Congressional Districts Of:

* a. Applicant

Attach an acWitional list of Program/Project Congressional Districts if needed.

Add Attachment

17. Proposed Project:

' b. Program/Project 52.53

Delete Attacnmeni View Anac:>".rnent

' a. Start Date: 07/01/2017 •b. End Date: 06/30/2018

18. Estimated Funding <$):

* a. Federal

*b. Applicant ^ *c. State I *d. Local I *e. Other | *f. Program Income | •g TOTAL

95,724.00

95,724.00

* 19. is Appiication Subject to Review By State Under Executive Order 12372 Process?

• a.This application was made available to the State under theExecutive Order 12372 Process for review on n b. Program issubject to E.0.12372 but has not beenselected by theState for review.

15^ c. Program isnot covered byE.G. 12372.

* 20. is the Arqiticant Delinquent On Any Federal Debt? (If"Yes," provide explanation in attachment)

• Yes ^No

If"Yes", provide explanation and attach if:

•4

Aftc! Attscnment Delete A^acnnierii View AisachmoiU 1

21. "By signing this application, I certify (1) to the statements contained in the list of certifications'* and (2) that the stateiaents herein are true, complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to comply widi any resulting terms if i accept an award. I am aware ttiat any false, fictitious, or fraudulent statements or claims may subj^ me tocriminal, civil, oradministrative penalties. (U.S. Code. Title 218, Section 1001)

(3 " IAGREE

*" 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:

Prefix; Mr

Middle Name

* Last Name:

Suffix;

'Title:

Valiejos

Executive Director

' Telephone Number 619-409-5911

• First Name; Benedict

Fax Numt)er