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Community Policing Information Worksheet <br />This worksheet will provide the COPS Office with information about the public safety <br />concerns of your community and your department's community policing goals and <br />activities. For assistance in completing this worksheet, contact the U.S. Department <br />of Justice Response Center at 1-800-421-6770. <br />Your Community Policing Information Worksheet is complete by signing and dating <br />below. Both the law enforcement executive and the government executive must sign. <br />Applicant Organization's Legal Name: ___City of San Leandro <br />ORI #: CA 0011200 <br />We, the undersigned, attest to the accuracy of the Community Policing Information <br />Worksheet submitted below. <br />Law Enforcement Executive: Title: ~h-i €~ g f ~ 1 i s € <br />Name (typed): Joseph W. Kitchen <br />Department: <br />San Leandro Police Department <br />Date: '-`f~ `'~ ~ ~ ~ <br />Signature: .J~ ~ L` <br />Government Executive: Title: City Manager <br />Name (typed): _____John Jermanis <br />Government Entity: City of San Leandro <br />Date: ~~ -~ ~° o <br />......_._._.,..m.. _ .. _..-._~ -~--.. <br />Signature: <br />~~ <br />Person Completing Form: Title: Captain _-..Bu.reau of Operations <br />Name (typed): <br />James O'Meara <br />Date: `~ ~ y~® r <br />Signature: ~~~ ~' l'L s.Q CLt c.__ <br />