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DocuSign Envelope ID:9145901C-086E-4E66-A344-FEEE32AD4436 f. All KnYWI Nd STATE LIBRARY CALIFORNIA LIBRARY LITERACY AND ENGLISH ACQUISITION SERVICES FINANCIAL CLAIM 1St PAYMENT Grant Award #: CLLS23-60 Date: 9/13/2023 Invoice #: CLLS23-60-01 PO#: 6729 Payee Name: Pleasanton Public Library (Legal name of authorized agency to receive, disburse and account for funds*) Complete Address: 123 Main Street, PO Box 520, Pleasanton, CA, 94566-0802 Street Address, City, State, Zip Code (Warrant will be mailed to this address) Amount Claimed: $39,398 Type of Payment: (Payable Upon Execution of Agreement) ® PROGRESS Grantee Name: Pleasanton Public Library ❑ FINAL (Name on Award Letter and Agreement) ❑ IN FULL Project Title: California Library Literacy Services ❑ AUGMENT For Period From: upon execution to end of grant period CERTIFICATION I hereby certify under penalty of perjury: that I am the duly authorized representative of the claimant herein; that this claim is in all respects true, correct and in accordance with law and the terms of the agreement; and that payment has not previously been received for the amount claimed herein. DO-81ned by: By t ,,,,hW 3239C9 1940BF486. (Signature of the Authorized Representative) Gerry Beaudin City Manager (Print Name) (Title) *Legal payee name must match the payee's federal tax return. Warrant will be made payable to payee name. Payee discrepancies in name and/or address may cause delay in payment. If you need to change payee name and/or address, please contact Fiscal Services at statearants.fiscaI(a)libra rv.ca.gov. State of California, State Library Fiscal Office ENY: 2023 ITEM NO: 6120-213-0001, Chapter 12, Statutes of 2023 PURCHASING AUTHORITY NUMBER: CSL-6120 REPORTING STRUCTURE: 61202000 COA: 5432000 PROGRAM #: 5312 FAIN: N/A DocuSigned by: By I gt1SUU'#L 0" Date 9/13/2023 108 1 351365FD493 (State Library Representative)