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• EXHIBIT D • <br />Anaheim and Santa Ana Urban Areas Security Initiative <br />Reimbursement Request for Grant Expenditures <br />Mail Reimbursement Request To: <br />'" ~ ASI Grant Pr 'gain <br />Sgt. Enrique Esparza, Grant Coordinator <br />Santa Ana Police Department <br />Homeland Security Division <br />60 Civic Center Plaza-P.O. Box 1981 <br />Santa Ana, CA 92702 <br />This is the fmal reimbursement request. <br />'ak'Y10 Cif°5I Grant Proara:in <br />„ ~. b b <br />- ~ n <br />r <br />Cindy Nickel, Grant Fiscal Coordinator <br />Anaheim Police Department <br />East Station-Homeland Security Bureau <br />425 S. Harbor Boulevard <br />Anaheim, CA 92805 <br />Agency/ City Requesting Reimbursement <br />Pa roll Total (Salaries, Overtime, Backfill, etc <br />Travel Total (Tuition, Meals, Lodging, etc) <br />E ui ment & Su lies Total <br />Total Amount Re uested _ <br />Under Penalty of perjury, I certify that: <br />I am the duly authorized officer of the claimant herein. This claim is in all respects true, correct, and all <br />expenditures were made in accordance with applicable laws, rules, regulations, and grant conditions and <br />assurances. All attached documents for items and/or services have been received in full. <br />.. ,. ,r u - <br />,:: '° _ ~Author~ed, Agent ....__m. ._ .. <br />Printed Name <br />Title <br />Mailing Address <br />City, State, Zip Code <br />Signature (Please sign in blue ink) <br />Phone Number <br />E-Mail Address <br />Fax Number <br />Date <br />'1`Or!~.Il~9h~e1M~~~Fitlt,l4,4ti~YTTAC~~(;rant~~`,~ ,-.7, ,r,~~T.T,: r1~~.t.~4~~~ '~~.1R~'k:-..kf;. ~;i!'- ,a~ :t:. <br /> ,~hY~-~ <br />A roved or Processin Date <br /> <br />Account and Activity Number <br /> <br />Grant Year/Grant Project and Solution Area <br /> <br />Special Instructions/Comments <br />38 <br />