HomeMy WebLinkAboutContracts & Agreements_39A-2023OMB Number: 4040-0004
Expiration Date: 12/31/2019
Application for Federal Assistance SF-424
* 1. Type of Submission:
Preapplication
Application
* 2. Type
of Application: * If Revision, select appropriate letter(s):
El New
Continuation
E Revision
* Other (Specify):
Application
Changed/Corrected
* 3. Date Received: 4. Applicant Identifier:
12/31/2022
5a. Federal Entity Identifier:
5b, Federal Award Identifier:
State Use Only:
6. Date Received by State:
7. State Application Identifier:
8. APPLICANT
INFORMATION:
*a. Legal Name:
City of Redlands, Redlands Municipal Airport
* b. Employer/Taxpayer Identification Number (EIN/TIN):
* c. Organizational DUNS:
95-6000766
0947122050000
d. Address:
*Streetl:
Street2:
* City:
County/Parish:
* State:
Province:
*Country:
*Zip /Postal Code:
P.O. Box 3005
35 Cajon Street, Suite 222
Redlands
San Bernardino
CA: California
USA: UNITED STATES
92373-4746
e. Organizational Unit:
Department Name:
Division Name:
Facilities and Community Services
Redlands Municipal Airport
f. Name and contact Information of person to be contacted on matters involving this application:
Prefix:
Middle Name:
* Last Name:
Suffix:
Mr.
* First Name: Adarian
Amiri-Jerome
Lawson
Title: Airport Supervisor
Organizational Affiliation:
Airport Grant Administrator
* Telephone Number:
909-557-8520 Fax Number:
*Email: alawson@cityofredlands.org
Application for Federal Assistance SF-424
* 9. Type of Applicant 1: Select Applicant Type:
C: City or Township Government
Type of Applicant 2: Select Applicant Type:
Type of Applicant 3: Select Applicant Type:
* Other (specify):
* 10. Name of Federal Agency:
Federal Aviation Administration
11. Catalog of Federal Domestic Assistance Number:
20.106
CFDA Title:
Airport Capital Improvement Plan
* 12. Funding Opportunity Number:
* Title:
Fuel Farm Design
13. Competition Identification Number:
N/A
Title:
14. Areas Affected by Project (Cities, Counties, States, etc.):
Add Attachment
Delete Attachment
View Attachment
* 15. Descriptive Title of Applicant's Project:
Develop design ready plans for the construction of a fuel farm that will service 100LL and Jet -A
Attach supporting documents as specified in agency instructions.
Add Attachments
Delete Attachments
View Attachments
Application for Federal Assistance SF-424
16. Congressional
* a. Applicant
Districts Of:
cA-031
* b. Program/Project cA-031
Attach an additional list of Program/Project Congressional Districts if needed.
Add Attachment Delete Attachment View Attachment
17. Proposed
* a. Start Date:
Project:
04/01/2023
* b. End Date: 06/01/2023
18. Estimated Funding ($):
*a. Federal
* b. Applicant
*c. State
* d. Local
* e. Other
*f. Program Income
*g.TOTAL
79,200.00
4,400.00
4,400.00
88,000.00
* 19. Is Application
Subject to Review By State Under Executive Order 12372 Process?
was made available to the State under the Executive Order 12372 Process for review on
is subject to E.O. 12372 but has not been selected by the State for review.
is not covered by E.O. 12372.
0 a. This application
b. Program
c. Program
* 20. Is the Applicant
Yes
If "Yes", provide
Delinquent On Any
Federal Debt? (If "Yes," provide explanation in attachment.)
I No
explanation and attach
Add Attachment Delete Attachment View Attachment
21. *By signing
herein are true,
comply with any
subject me to
this application, I certify (1) to the statements contained in the list of certifications** and (2) that the statements
complete and accurate to the best of my knowledge. I also provide the required assurances** and agree to
resulting terms if I accept an award. I am aware that any false, fictitious, or fraudulent statements or claims may
criminal, civil, or administrative penalties. (U.S. Code, Title 218, Section 1001)
and assurances, or an internet site where you may obtain this list, is contained in the announcement or agency
** I AGREE
** The list of certifications
specific instructions.
Authorized Representative:
Prefix:
Middle Name:
* Last Name:
Suffix:
Mr.
* First Name: Eddie
Tej eda
*Title: Mayor
*Telephone Number:
909-798-7531 Fax Number:
*Email: etejeda@cityofredlands.org
* Signature of Authorized Representative:
- -
r
/--(/
r
* Date Signed:
i -j
3