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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 />I. 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 />0911 (1' \,J i Q) Q Q -,OA r Y CA?-C-- lscy 4vu" <br />Street address of named subgrantee City <br />County Zip Code Telephone of authorized rep. <br />r `ear — fAmcff C -7)4)(cLf 7- C�LG <br />Coordinator /Director of program if different Telephone <br />AYU, Cl ::;?v <br />WHO SHOULD RECEIVE NOTIFICATION OF APPROVAL OR DENIAL Of L TA AWARD: <br />7 <br />` ,J 1,U tk-W-Ai f� -SL L-1 1, Lf p I- 0 -,-5 -& ,t WWSC& - ICi <br />WHO SHOULD RECEIVE INSTRUCTIONS FOR PREPARING REQUIRED REPORTS: C1� <br />(Provide name, address and telephone number. Use back if needed.) <br />20A -11 <br />