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Docusign Envelope ID:AA62266B-5580-4103-ACBB-2EE04A18A333 <br /> 010 STATE LIBRARY <br /> CA LIBRARY LITERACY AND ENGLISH ACQUISITION SERVICES <br /> FINANCIAL CLAIM <br /> 1st PAYMENT <br /> Grant Award #: CLLS24-60 Date: 9/7/2024 <br /> Invoice#: CLLS24-60-01 PO#: 7623 <br /> Payee Name: Pleasanton Public Library <br /> (Legal name of authorized agency to receive,disburse and account for funds`) <br /> Complete Address: 123 Main Street, Pleasanton, CA 94566 <br /> Street Address, City, State, Zip Code(Warrant will be mailed to this address) <br /> Amount Claimed: $38,653 Type of Payment: <br /> (Payable Upon Execution of Agreement) © PROGRESS <br /> Grantee Name: Pleasanton Public Library ❑ FINAL <br /> (Name on Award Letter and Agreement) ❑ IN FULL <br /> Project Title: California Library Literacy Services ❑ AUGMENT <br /> For Period From: upon execution to end of grant period <br /> CERTIFICATION <br /> I hereby certify under penalty of perjury: that I am the duly authorized representative of the claimant herein; <br /> that this claim is in all respects true, correct and in accordance with law and the terms of the agreement; and <br /> that payment has not previously been received for the amount claimed herein. <br /> By 323909 b'f, ,, <br /> 9406F <br /> (Signature of the Authorized Representative) <br /> Gerry Beaudin City Manager <br /> (Print Name) (Title) <br /> "Legal payee name must match the payee's federal tax return. Warrant will be made payable to payee name. Payee <br /> discrepancies in name and/or address may cause delay in payment. If you need to change payee name and/or address, <br /> please contact Fiscal Services at stategrants.fiscal(a)libra�ca gov <br /> State of California, State Library Fiscal Office <br /> ENY: 2024 ITEM NO: 6120-213-0001, Chapter 22, Statutes of 2024 <br /> PURCHASING AUTHORITY NUMBER: CSL-6120 REPORTING STRUCTURE: 61202000 <br /> COA: 5432000 PROGRAM#: 5312 <br /> FAIN: LS or N/A <br /> By Date <br /> (State Library Representative) <br />