RES 231430 - Laserfiche WebLink

DocuSign Envelope ID:9145901C-086E-4E66-A344-FEEE32AD4436 CALI FOR' '' 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. By C13—Sego by 94OBF4B6 N (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 stategrants.fiscaiCcDlibrary.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 DuSignetl by: U f✓ 9/13/2023 By 1 CU/IZ 081351365FD493 Date (State Library Representative)