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LSTA GA Certification <br />California State Library LSTA GRANT AWARD #40-7793 <br />Fiscal Office <br />P.O. Box 942837 <br />Sacramento, CA 94237-0001 <br />Project Title: "Small Steps Towards Healthy Living/Pasos Pequenos Para Una Vida Sana" <br />System/Agency: Santa Ana Public Library <br />PLEASE COMPLETE AND RETURN THIS PAGE <br />CERTIFICATION <br />1. 1 affirm that the subgrantee named below is the legally designated fiscal agent for this <br />program and is authorized to receive and expend funds for the conduct of this program. <br />I affirm that all information provided to the California State Library for review in association <br />with this award is correct and complete to the best of my knowledge; that as the authorized <br />representative of the subgrantee, I have the legal authority to commit my organization to the <br />conditions of this award. <br />III. 1 affirm that any or all other subgrantees participating in the program have agreed to the <br />terms of the application/grant award, and have entered into an agreement(s) concerning <br />the final disposition of equipment, facilities, and materials purchased for this program from <br />the funds awarded for the activities and services described in the attached, as approved <br />and/or as amended in the application. <br />SIGNED DATE <br />Authorized r presentative <br />Type or print name and title, of authorized representative <br />-- o,- <br />Legal name of local subgrantee <br />Project name as listed on the application <br />x911 (1' \,J i Q) Q Q ,OA ? Y CA2-C-- lscyd(k 4vu" <br />Street address of named subgrantee city <br />(D YC' (.ay,? G?2CS ? x"71') <br />County Zip Code Telephone of authorized rep. <br />CSC `eN - fA 1?Cc? C-7)4) (c L-t 7- 5-acl LG <br />Coordinator/Director of program if different Telephone <br />C? AY? <br />WHO SHOULD RECEIVE NOTIFICATION OF APPROVAL OR DENIAL Of L TA AWARD: <br />7 <br />WHO SHOULD RECEIVE INSTRUCTIONS FOR PREPARING REQUIRED REPORTS: C1? <br />(Provide name, address and telephone number. Use back if needed.) <br />20A-11