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San Leandro Community Library Invoice #20-7132-1 <br /> <br /> <br />PLEASE COMPLETE AND RETURN THIS PAGE <br /> <br /> <br />Claim Form <br /> <br />State of California <br />California Library Literacy and English Acquisition Services (CLLS) <br /> <br />California Education Code; Section 18880-18883 <br />Budget Citation Chapter 21 – Budget Item 6120-213-0001 <br /> <br />Fiscal Year: 2021-2022 <br />Reporting Structure: 61202000 COA: 5432000; Approp. Ref: 213 <br />Purchasing Authority Number: CSL-6120 Category: 84121600 Program #: 5312 <br />FOR PAYMENT OF CALIFORNIA LIBRARY LITERACY SERVICES GRANT <br /> <br />Amount Claimed – $100,285 <br />$35,035 for ALS (90% of award) and $65,250 for FLS (100% of award) <br /> San Leandro Community Library <br />claims the indicated allowance for the purposes of carrying out the functions stated in its CLLS <br />application and in Sections 18880-18883 of the California Education Code. <br />Warrant to be issued for payment to the library to be addressed to: <br /> San Leandro Public Library, 300 Estudillo Ave, San Leandro, CA 94577-4706 <br />(Authorized agency to receive, disburse and account for CLLS funds) <br /> <br />I hereby certify under penalty of perjury: that the library named above shall use their allowance <br />solely for the purposes indicated in their CLLS application and in Sections 18880-18883 of the <br />California Education Code. <br /> <br /> <br />Official Representative or Fiscal Agent (Signature Required) Title <br /> <br /> <br />State Library Local Assistance Office Use Only <br />STATE OF CALIFORNIA, State Library Fiscal Office <br /> <br />By <br /> State Library Representative <br />Approval by State: <br />CLLS $ <br />Date: <br />*The warrant address must match that on file in Fi$Cal. If you need to change the authorized library name and/or address, <br />please contact Gina Iwata, CSL Fiscal Office. (gina.iwata@library.ca.gov ) <br />DocuSign Envelope ID: E6A2CB0F-40CC-4A12-BF54-7B6E6605AFF3 <br />In Process