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Created in the Office of the City Clerk 2014 REQUESTER INFORMATION Full Name: Date: Company Name (if applicable): Mailing Address: City/State/Zip: Phone Number: Email: Preferred method of contact: DESCRIPTION OF REQUESTED RECORD(S) Please be as specific as possible, for example, provide the date, time, and type of record(s) being requested. If additional space is needed, please attach a separate page. I understand that I will be contacted once record(s) have been identified. If duplication costs are involved, an estimated cost will be provided to me. I agree that I will be required to submit payment for duplication costs and postage prior to the production of the requested record(s). I wish to inspect City Record(s) I will pick-up Record(s) Please mail Record(s) Please note that information contained any Public Records Act request becomes a public record and may be subject to public inspection pursuant to the California Public Records Act. SIGNATURE OF REQUESTER Step 1: COMPLETE - all blank spaces of the Public Records Request Form. This will facilitate and expedite the processing of your public record(s) request. Please be specific and give as much information as possible to allow the City to locate the requested record(s) Step 2: SUBMIT your completed form by e-mailing, mailing or faxing to the City Clerk at the address, e-mail or fax number listed above. Step 3: PLEASE BE PATIENT – The City will make a determination within 10 days from receipt of your request whether the request, in whole or in part, seeks copies of discloseable public record(s) in possession of the City [GC 6253(c)]. Please note that if you are requesting to inspect the record(s), you will be asked to make an appointment to view the documents. If you are requesting copies, an invoice will be sent to you. Charges for the direct cost of duplication will apply. Please note – Record(s) will be copied upon receipt of payment. If payment is not received within 10 days after invoicing, you may be required to submit a new request. Please see Page 2 for additional information regarding Public Records Request. City of Palmdale Office of the City Clerk PUBLIC RECORDS REQUEST 38300 Sierra Hwy., Suite C Palmdale, CA 93550 (661) 267-5151. Fax (661) 267-5193 E-mail: [EMAIL REDACTED] ---PAGE BREAK--- Created in the Office of the City Clerk 2014 ADDITIONAL INFORMATION REGARDING PUBLIC RECORD(S) REQUEST 1. In order to expedite your request, requests for record(s) should be in writing. A public Records Request Form is available online at http://www.cityofpalmdale.org/Your-City-Hall/City-Clerk. The form can be downloaded, and when completed you may submit your request via mail to: Office of the City Clerk, 38300 Sierra Hwy., Suite C, Palmdale, CA 93550; e-mailed to: [EMAIL REDACTED]; or via fax: (661) 267-5193 2. If your request is to inspect rather than receive copies, the responsive Department will contact you to schedule an appointment for the inspection of such record(s). This is necessary to allow time to compile and review documents for compliance within the provisions of the Public Records Act. 3. Requests (inspection and copies) must be for record(s) in the possession of, prepared, owned, used, or retained by the City of Palmdale [GC §6252(e)] and must be for clearly identifiable record(s). City staff is available to assist you in identifying record(s) that are in the Department/City’s possession. The City is not required by law to create a record or list from an existing record. Copies will not be provided if disclosure is exempt in accordance with State law. 4. The City will make every effort to respond to your request in a reasonable time. You will be notified within ten (10) days from the date of your request: Whether the City has record(s) responsive to your request and the page count to produce such record(s) (if copies have been requested). Whether the City has record(s) responsive to your request, but which are exempt from disclosure and the reasons for exemption. Whether the City requires an extension of time to determine whether it has record(s) responsive to your request. 5. The charge for duplication is listed on the City’s Fee Schedule as adopted by the City Council. The standard charge for copies is $0.25 per page for regular documents and $0.10 per page for Statements of Economic Interests and Campaign Statements. Records copied to CD are $1.00 per CD. DVD’s are $5.00 per DVD. Per California Government Code §81008, the City Clerk Department may charge a retrieval fee of up to $5.00 per request for copies of campaign statements that are five or more years old. A single request for more than one report or statement is subject to one retrieval fee. Special or oversized documents may be charged at a higher rate. The City is not required to produce record(s) in an electronic format when the requested record(s) are not available in electronic format at the time of the request. If the record(s) are to be mailed, your invoice will include the approximate cost of postage. Please Note – Some departments have differing copy charges which may appear on your invoice. The City’s adopted Fee Schedule is available to view upon request, and is available on the City’s website at www.cityofpalmdale.org. 6. The City will provide an invoice for anticipated charges due (duplication costs and, if mailed, postage costs). These charges are due and payable upon receipt of the invoice. Upon remittance of payment, the record(s) requested will be copied and made available. If arrangements for payment and production are not made within ten (10) days of the date of the City’s response, a new request may have to be submitted. 7. For further information, please refer to the California Public Records Act ( California Government Code §6250 et seq.) or contact the Office of the City Clerk, 38300 Sierra Hwy., Suite C, Palmdale, CA 93550; Phone: (661) 261-5151.