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Home My WebLink AboutUnited States-Grant Application-08.17.2009 - )7 -05 OMB Number 4040-0004 Expiration Date:01(31/2009 Application for Federal Assistance SF-424 Version 02 *1.Type of Submission: *2.Type of Application: 'If Revision,select appropriate letter(s): Preapplication [l New j Application [I Continuation 'Other(Specify) Changed/Corrected Application 1=1 Revision *3.Date Received: 4.Applicant Identifier: Completed by Grants.gov upon submission. 5a.Federal Entity Identifier: *5b.Federal Award Identifier: State Use Only: 6.Date Received by State: 7.State Application Identifier: W, 8.APPLICANT INFORMATION: *a.Legal Name: L ty of waterloo, Iowa *b.Employer/Taxpayer Identification Number(EIN/TIN): 'c.Organizational DUNS: 42-6005327 075841684 d.Address: *Streett: '715 Mulberry St. Streett: *City: waterloo County: Black Hawk *State: IA: Iowa Province: `Country: USA: UNITED STATES Zip/Postal Code: 50703 e.Organizational Unit: Department Name: Division Name: f.Name and contact information of person to be contacted on matters involving this application: Prefix: "First Name: Noel Middle Name: *Last Name: Anderson Suffix: Title: Community Planning and Development Director 1 Organizational Affiliation: Lity of Waterloo `Telephone Number: 319-291-4 366 Fax Number: 319-291-4 262 'Email: noel.anderson@water.loo-ia.org OMB Number:4040-0004 Expiration Date:01/31/2009 Application for Federal Assistance SF-424 Version 02 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: Economic Development Administration 11.Catalog of Federal Domestic Assistance Number: 7.1.307 CFDA Title: SConocnc Adjustment Assistance •12.Funding Opportunity Number: EDA01092009DISASTERSUPPLEMENTAL2 *Title: Second Supplemental Appropriations Disaster. Relief Opportunity 13.Competition Identification Number: [03 Title: 14,Areas Affected by Project(Cities,Counties,States,etc.): Waterloo,, IA *15.Descriptive Title of Applicant's Project: Waterloo Storm Water Lift Station Project Attach supporting documents as specified in agency instructions. Add Attachments OMB Number:4040-0004 Expiration Date:01/31/2009 Application for Federal Assistance SF-424 Version 02 16.Congressional Districts Of: *a.Applicant IA-001 —1 `b.Program/Project IA-•001 Attach an additional list of Program/Project Congressional Districts if needed. Add Attachment • 17,Proposed Project: *a.Start Date: 07/01/2009 *b.End Date: 06/30/2011 18.Estimated Funding($): *a.Federal 7,000,000.00 b.Applicant *c.State 3,861,250.00 *d.Local 'e.Other •f. Program Income 'g.TOTAL 10,861,250.00 *19.Is Application Subject to Review By State Under Executive Order 12372 Process? El a.This application was made available to the State under the Executive Order 12372 Process fpr review on • ❑ b.Program is subject to E.O.12372 but has not been selected by the State for review. c.Program is not covered by E.O.12372. "20.Is the Applicant Delinquent On Any Federal Debt?(If"Yes",provide explanation.) El Yes No 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 la ccept an award.la m aware that any false,fictitious,or fraudulent statements or claims may subject me to criminal,civil,or administrative penalties.(U.S.Code,Title 218,Section 1001) Q "*I AGREE **The list of certifications and assurances, or an interne!site where you may obtain this list, is contained in the announcement or agency specific instructions. Authorized Representative: Prefix: `First Name: Timothy Middle Name: J. "Last Name: Hurley Suffix: Title: i422,or *Telephone Number: 319-291-4 3 01 Fax Number: 319••291-4286 'Email: mayor®waterloo-i.a.org Signature of Authorized Representative. *Date Signed: I O �/7-0 Q 1 Authorized for Local Reproduction Standard Form 424(Revised 10/2005) Prescribed by OMB Circular A-102 OMB Number:4040-0004 Expiration Date:01/31/2009 Application for Federal Assistance SF-424 Version 02 *Applicant Federal Debt Delinquency Explanation The following field should contain an explanation if the Applicant organization is delinquent on any Federal Debt. Maximum number of characters that can be entered is 4,000. Try and avoid extra spaces and carriage returns to maximize the availability of space. Waterloo, Iowa Strom Water Lift Station Project Appendix A: Applicant Certification Clause The applicant represents and certifies that it has used due diligence to determine that the description of the project site described herein is accurate with respect to the presence or absence of contamination from toxic and hazardous substances. The term "site" includes the entire scope of the project, including future phases of the project and all areas where construction will occur. 1. Is the site currently, or has it in the past 50 years, been used for any of the following operations or activities: a. Generation of hazardous substances or waste? Yes X No b. Treatment, storage (temporary or permanent), or disposal of solid or hazardous substances or waste? Yes X No c. Storage of petroleum products? Yes X No d. Used/waste oil storage or reclamation units? Yes X No e. Research or testing laboratory? Yes X No f. Ordnance research, testing, production, or storage? Yes X No g. Chemical manufacturing or storage? Yes X No h. Military weapons or ammunition training or testing? Yes X No i. Iron works/foundry? Yes X No j. Railroad yard? Yes X No k. Industrial or manufacturing operation? Yes X No If any of the above operations ever occurred at the site, and if appropriate cleanup or other mitigation actions were performed in accordance with the local, State, and federal laws, please attach documentation of these actions. 2. Do wells draw water from an underlying aquifer to provide the local domestic water supply? X Yes No 3. Has a federal, State, or local regulatory authority ever conducted an environmental assessment, environmental impact statement, or a preliminary assessment/site inspection, or similar environmental surveyor inspection report at the site? If yes,please attach copies of these reports or results. Yes X No 4. Have any environmental or OSHA citations or notices of violation been issued to a facility at the site? If yes, please attach copies. Yes X No 5. Have any unauthorized releases of hazardous substances occurred at any facility at the site which resulted in notification of the EDA's National Response Center? Yes X No 6. Is any material containing asbestos located at the site? If yes, please attach information concerning State and federal regulatory compliance. Yes X No 7. Is there any equipment(electrical transformers, etc.) containing polychlorinated biphenyls (PCB) on the site? If yes, please attach a description of the equipment. Yes X No 8. Are there underground storage tanks on the site? If yes, please attach a detailed description, including the number of underground storage tanks on the site, whether the tanks have been inspected (or removed) and the results of such inspections. Yes X No 9. Has the site been tested for radon? If yes, please attach results. Yes X No 10. Have there been or are there now any environmental investigations by federal, State or local government agencies that could affect the site in question? If yes, please attach available information. Yes X No The applicant acknowledges that this certification regarding hazardous substances and/or waste is a material representation of fact upon which EDA relies when making and executing an award. EDA reserves the right to terminate any award made in conjunction with the representations contained herein if, at any time during the useful life of the project, EDA becomes aware of the presence of hazardous materials or waste at the site, or that hazardous materials or waste have been inappropriately handled thereon. Further, if it is determined at any time that the presence of hazardous materials or waste, or handling thereof, has been misrepresented, EDA may pursue other available legal remedies against the applicant. Applicant Name: City of Waterloo, Iowa Name and title of applicant's authorized representative: Tim Hurley, Mayor Signature of applicant's authorized representative: Date signed: i I i I