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Santa Ana Urban Areas Security Initiative/ <br />Public Safety Interoperable Communications Grant <br />Reimbursement Request for Grant Expenditures <br />Mai! RelaibNrseaient Regress to: <br />D This is the final reimbursement request <br />_- <br />^ FYQ?PSIC <br />Santa Ana Police Department <br />Attn: Sgt. Enrique Esparta, Grant Coordinator <br />60 Civic Center Plaza <br />P.O. Box 1981 <br />Santa Ana, CA 92702 <br />Agency /City Requesting Rcimbursemest <br />Tot:! AtnoNnt Requested: S <br />Atac11 c ies of s i~voiyes <br />Under penalty of perjury, I certify that: <br />• I am an authorized officer of the claimant herein. <br />• This claim is in all respects true, correct, and all expenditures were made in <br />accordance with applicable laws, rules, regulations and grant conditions and <br />assurattces. <br />• All attached invoices for items and/or services have been received in full. <br />• Authorized Agent <br />Printed Name <br />Plwne Number <br />Titk E~Mail Addee~a <br />Mailing Adderda Fax Nueuber <br />City, State, Zip Code <br />Signaprr I)a1e <br />(Please sign in blue ink.) <br />FOr Syt11a Ass UA31R91C Gnait Coorditsstor Use O <br />Aped tr <br />Pr+ec 1)at1s: <br />Rergont Traetd~ Ny~Ysr: ~~~ N: <br />cryt~: PSIC cry"' <br />~°~ s.t.n.. <br /> Yeah: ' Area: <br />3~ccid Iyr/rae:tl•tas / <br />CayDAta~ <br />35 <br />