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City of Anaheim
Office of the City Clerk
200 S. Anaheim Blvd., Suite 217
Anaheim, GA 92805
(714)765-5166• fax (714) 7GS-4105
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Request for Public Records
STEP L COMPLETE all fields an this form This form is to facilitate and expedite the processing of your public records request.
Describe identifiable records in the possession of the City; your reyno't must be sufficiently focused and specific to
allo.. the City to locate the requested record(s).
STEP : SUBM IT completed farm by mail,fax, email or in person to Cwodisn of Records, Office of the City Clerk,
200 S. nnahciin Blvd, Suite217, Anaheim, CA 92805; (bass a ana he i at net fax: (714) 7654105
STEP 3: WAIT to receive a response from the City. The City shall determ inc within 10.days from receipt of apublic records
request, whether the request, in whole in in part, seeks copies of disc instable public records in possession of the City
[GC 7927.535(a)]. Please now that if you are requesting the oppon unity to inspect records, you will be requested In
make an appointment to return at a later datehime A view the documents.
Charges for the direct cost of duplication will apply. Documents will not be copied until payment has been received. If
payment is not received within 20 days after invoice is sent, you may be required to submit a new request. Please see
backside for additional information.
REQUESTER INFORMATION
Full Name: Andrea McCormick
Date: 1110124 10:07AM
Company Name: The Claims Center on behalf of Southern California Gas
(Mailing) Address: City/Smte/Zip Code: Plymouth, MN, 55447
Phonenumber: Email:
Preferred method of contact in the event ofquestions:
Email
DESCRIPTION OF REQUESTED RECORD(S): (Desenbe the specific public records) e.g., date, type, fimeperion covering documrnts requested etc)
I am seeking on behalf of Somhem Gashamla Gas Company to obtain a copy of Me card icate a Habillty insurance for the contractorA-1
Fence Company that covers the date 02 17/2021. Does the G y ofMaheim keep records of lisbildy insurance for licensing, penmifting or
registraflw?
I understand that I will be connected once documents have been identified. If production of records is requested, an estimated cost will be
provided to me and I agree that I will be required to submit Payment for duplication costs (and mni ing) prior to the production of the
requested documents.
❑ I wish to inspect City records ❑ Will Pick -Up Records �X Please Mail
Please note that information contained in my PRA request is a public record and may be subject in public inspection pursuant to the
California Public Records AM.
Efectromcally Signed/Submi@ed 1119241007AM
SIGNATURE OF REQUESTER