04222024-4City of Anaheim
Office of the City Clerk
200 S. Anaheim Blvd., Suite 217
Anaheim, CA 92805
714) 765-5166 • fax (714) 765-4105
www.anaheim.net X12 wR 212 A 10: 51
REQUEST FOR PUBLIC RECORDS
STEP 1: COMPLETE all fields on 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 request must be sufficiently focused and specific to allow
the City to locate the requested record(s).
STEP 2: SUBMIT completed form by mail, fax, email, or in person to Custodian of Records, Office of the City Clerk,
200 S. Anaheim Blvd., Suite 217, Anaheim, CA 92805; tbassnemaheim.net; fax (714) 765-4105.
STEP 3: WAIT to receive a response from the City. The City shall determine within 10 -days from receipt of a public records request,
whether the request, in whole or in part, seeks copies of discloseable public records in possession of the City [GC 7927.535(a)].
Please note that if you are requesting the opportunity to inspect records, you will be requested to make an appointment to return at a
later date/time to 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
REQUESTER INFORMATION
Full Name : Craig Durfey
Company Name:
Mailing) Address:
Date: 04/22/2024
City/State/Zip Code: Garden Grove, CA 92842
Phone number: Email:
Preferred method of contact in the event of questions; Phone
DESCRIPTION OF REQUESTED RECORD(S): (Describe the specific public record(s) e.g., date, type, time period covering
documents requested, etc.)
Contract between City of Anaheim and BeWell OC, amount of contract, taxpayer funds
spent on the contract, and their services
I understand that I will be contacted 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
mailing) prior to the production of the requested documents.
I wish to inspect City records Will Pick -Up Records Please Mail
Please note that information contained in any PRA request is a public record and may be subject to public inspection
pursuant to the California Public Records Act.
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Request for Public Records
SIGNATURE OF REQUESTER
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CC 1002 Rev. 01/23
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