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<br />APPENDICES, Page | 39 <br /> <br />REQUIRED ATTACHMENT: Applicants will be prompted to upload this document to the <br />BSCC Submittable Application Portal. This is a sample. <br />Download a fillable form from the Prop 64 Grant homepage. <br />Before grant funds can be awarded and a contract executed under the Proposition 64 <br />Cohort 4 Grant Program, the applying local jurisdiction (and all jurisdictions receiving <br />funds as a subcontractor or partner) must provide assurance that it is eligible to r eceive <br />funding pursuant to Section 34019, subdivision (f)(3)(C) of the Revenue and Taxation <br />Code, as amended by Senate Bill 141 (2025). It specifically provides that a local <br />government may be eligible for a grant “only if it either allows the retail sale o f cannabis <br />in storefronts or, for jurisdictions with a population of 10,000 residents or less, allows <br />cannabis delivery in the jurisdiction that serves both medicinal and adult-use consumers.” <br />For definitions, please refer to the Revenue and Taxation Code, Section 34010 and the <br />BSCC Glossary (Appendix J). <br />Below is sample assurance language that, at a minimum, must be included in the Letter <br />of Eligibility submitted to the Board of State and Community Corrections (BSCC). <br />Applicants may use the form provided by the BSCC or create their own. <br /> <br /> As an applicant, our jurisdiction allows: <br /> The retail sale of cannabis in storefronts. <br />Regulation(s), ordinance(s), and or amendment(s) to our local government <br />charter(s) that ensure the above are true. Provide information including <br />enacted/effective date(s) here: > <br /> <br />For jurisdictions with a population of 10,000 residents or fewer: <br /> As an applicant, our jurisdiction allows: <br /> Cannabis delivery in the jurisdiction that serves both medicinal and adult -use consumers. <br />Regulation(s), ordinance(s), and or amendment(s) to our local government <br />charter(s) that ensure the above are true. Provide information including <br />enacted/effective date(s) here: > <br /> <br />Documentation detailed above will be provided to the BSCC upon request. <br /> <br />AUTHORIZED SIGNATURE <br />(This document must be signed by the person who is authorized to sign the Grant Agreement.) <br />NAME OF AUTHORIZED OFFICER TITLE TELEPHONE NUMBER <br /> <br />STREET ADDRESS CITY STATE ZIP CODE <br /> <br />EMAIL ADDRESS <br /> <br />AUTHORIZED OFFICER SIGNATURE (Blue Ink Only or E-signature) DATE <br /> <br /> <br />APPENDIX A <br />SAMPLE Letter of Eligibility <br />7.C. - Page 47 of 101 <br />106