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<br />CITY OF SANTA ANA - PUBLIC WORKS AGENCY <br />TITLE VI COMPLAINT PROCEDURES <br />Any person who believes that she or he has been discriminated against on the basis of race, <br />color, or national origin by the City of Santa Ana, Public Works Agency, may file a Title VI <br />complaint with the Equal Opportunity Officer. The following steps describe the procedures to <br />file a complaint and how the City of Santa Ana will respond. <br />1. The complaint must be submitted to the Equal Opportunity Officer no later than 180 <br />days after the date of the alleged discrimination. <br />2. A Title VI Complaint Form can be obtained by calling (714) 647-5157 or by downloading <br />the form from our website at www.santa-ana.org. Please provide the following <br />information on the complaint form or you may submit a signed written statement that <br />contains all of the following written information. <br />• Your name, address and how to contact you (phone number, email address, <br />etc.). <br />• The basis of the alleged discrimination complaint (race, color, or national origin). <br />• How, why, when and where you believe you were excluded from participation in, <br />were denied the benefits of, or were subjected to discrimination. <br />• Include the location, names and contact information of any witnesses. <br />• Indicate whether you have filed the complaint with the Federal Transit <br />Administration. <br />• You must sign your letter of complaint. <br />If you as the Complainant are unable to write a complaint, the Equal Opportunity Officer <br />will assist you with the complaint. The City of Santa Ana is committed to providing open <br />access to its services to persons with limited ability to speak or understand English; if <br />2 <br />25B-42