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California State Library Grant Agreement & Certification of Compiiance <br />Fiscal Office The Knowledge Mobile "Know-Mo": Bringing Mobile Library Services Back to Santa Ana <br />PO Box 942837 Santa Ana Public Library, Invoice# SVBT-026-001 <br />Sacramento, CA 94237-0001 Section 5: Claim for Payment, Page 1 of 1 <br />FINANCIAL CLAIM <br />FIRST PAYMENT <br />ENY: 2019 <br />ITFIVI NO: 6120-217-0001, Chapter 23, Statutes of 2019 <br />PURCHASING AUTHORITY NUMBER: CSL-6120 <br />REPORTING STRUCTURE: 61202000 <br />COA: 5432000 <br />PROGRAM #i: 531.2 <br />SCHEDULE NO; Date: 8/18/20 <br />SCHEDULE DATE: <br />Claim of: Santa Ana Public Library <br />Address: 26 Civic Center Plaza, Santa Ana, CA 92701 <br />Amount Claimed: $72,000 <br />For Period From: upon execution to end of grant period <br />Type of Payment PROGRESS <br />Grant Award Number: SVBT-026 <br />FINAL <br />Payable Upon Execution of Agreement <br />---------------------------------------------------- <br />CERTIFICATION <br />IN FULL <br />I hereby certify under penalty of perjury: that I am the duly authorized <br />representative of the claimant herein; that this claim is in all respects true, <br />with law and the terms of the agreement; and that <br />payment has not previously been received for the amount claimed erein, <br />By a!�th <br />(ue authorized representative) <br />State of California, State Library Fiscal Office <br />by <br />/I�GCe�2U.rU <br />(State Library Representative) <br />Kristine Ridge <br />(Print name) <br />City Manager <br />(Title) <br />Date 09/16/2020 <br />MAIL ONE ORIGINAL SIGNATURE TO: <br />California State Library <br />Fiscal Office — Local Assistance <br />State Funded Programs <br />PO Box 942837 <br />Sacramento, CA 94237-0001 <br />