HomeMy WebLinkAboutCops Application AttachmentOMB Number: 1103-0098
Expiration Date: 08/31/2011
COPS Application Attachment to SF -424
General Instructions:
The COPS Application Attachment to SF -424 is used in conjunction with all COPS program applications.
Please ensure that you have completed all of the required sections. If a section is not applicable, please
check the not applicable checkbox.
Section 1: COPS PROGRAM REQUEST
Federal assistance is being requested under the following COPS program:
Select the COPS Office grant program for which you are requesting federal assistance. Please DO NOT use
this form to apply for multiple grants at one time. A separate application must be completed for each COPS
program for which you are applying. Please ensure that you read, understand, and agree to comply with the
applicable grant terms and conditions as outlined in the COPS Application Guide before finalizing your
selection.
CHECK ONE PROGRAM OPTION ONLY
❑ Targeted -Tribal Resources Grant Program Targeted -Technology Program
❑ Targeted -Methamphetamine Initiative ❑ Universal Hiring Program
❑ Community Policing Development ❑ Child Sexual Predator Program
❑ Secure our Schools
Section 2: EXECUTIVE INFORMATION
Note: Listing individuals without ultimate programmatic and financial authority for the grant could delay the
review of your application, or remove your application from consideration.
A. Applicant ORI Number: FL01306
The ORI number is assigned by the FBI and is your agency's unique identifier. The first two letters are your
state abbreviation, the next three numbers are your county's code, and the final two numbers identify your
jurisdiction within your county. If you do not currently have an OR/ number, the COPS Office will assign one to
your agency for the purpose of tracking your grant.
❑ Check here if your agency has not been assigned an ORI #.
B. Law Enforcement Executive/Program Official Information:
For Law Enforcement Agencies: Enter the law enforcement executive's name and contact information. This is
the highest-ranking official within your jurisdiction (e.g., Chief of Police, Sheriff, or equivalent). For Non -Law
Enforcement Agencies: Enter the program official's name and contact information. If the grant is awarded, this
position would be responsible for the programmatic implementation of the award. If your agency is a "start-up" this
section can remain blank.
Title:
Prefix:
First Name:
Middle Name
Last Name:
Suffix:
Agency Name:
Street 1:
Street 2:
City:
County:
State:
Province:
Chief of Police
Mr.
John
F.
Timoney
Zip / Postal Code
Country:
City of Miami Police Department
400 NW 2 Avenue, 4th Floor
Miami
Miami -Dade
FL: Florida
33128-1786
USA: UNITED STATES
Telephone: 305-603-6100
Fax: 305-372-4609
E-mail: John.Timoney@miami-police.org
Type of Agency: Municipal
New Startup" (please specify):
Other* (please specify):
Agency types that have an asterisk next to them and that are applying for COPS hiring grants must provide
additional information. Please refer to the COPS Application Guide: Agency Supplemental Information section
for the questions that you will need to address. Please attach this information below:
C. Government Executive/Financial Official Information:
For Government Agencies: Enter the government executive's name and contact information. This is the
highest-ranking official within your jurisdiction (Mayor, City Administrator, Tribal Chairman, or equivalent). For
Non -Government Agencies: Enter the financial official's name and contact information. If the grant is awarded,
this position would be responsible for the financial management of the award. Please note that information for
non-executive positions (e.g. clerk, trustees, etc., are not acceptable).
Title:
lCity Manager
Prefix:
Mr. .
First Name:
Pedro
Middle Name:
IG •
Last Name:
Hernandez
Suffix:
Telephone:
Name of Government Entity/Financial Entity:
City of Miami, Florida
Street 1:
13500 Pan American Drive
Street 2:
City: Miami
County: Miami -Dade
State: FL: Florida
Province:
Zip / Postal Code: 33133-5595
Country:
USA: UNITED STATES
Telephone:
305-416-1025
Fax'
305-250-5410
E-mail:
pgh@miamigov.com
Type of Government Entity:
City