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* LV <br />Santa Ana Urban Areas Security Initiative/ <br />Public Safety Interoperable Communications Grant <br />Reimbursement Request for Grant Expenditur,i <br />Mail Reimbursement Request to. <br />request <br />FJ FY07MC <br />Santa Ana Police Department <br />Attn: Sgt Enrique Esparza, Grant Coordinator <br />60 Civic Center Plaza <br />P.O. Box 1981 <br />Santa Ana, CA 92702 <br />Agency / City Requesting <br />Total Amount Requested; <br />Attach COPieS Or SUDDOrtino in—i—'k <br />❑ This is the final reimbursement <br />Under penalty ofperjun-, I certif}� 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 «ith applicable la" s, rules, regulations and grant conditions and <br />assurances. <br />• All attached invoices for items and/or services have been received in full. <br />Authorized Agent <br />Bart Lewis <br />Rirtcd `•::�me <br />Fire Chief <br />Title <br />-- `.!ailing Addres, --- -- <br />City, State, Zip Code <br />�na <br />sign in blue ink..) <br />or Santa Am UASIP-31C C.r u& <br />.pproved for <br />Request Tracking Number- <br />TantFPSICFGrant Year: project: <br />Special Instructions / <br />25 <br />Fh"nc '".'Mzrtr <br />E-Mail Address <br />Fas <br />Account #: <br />