ADA Title II Notice & Grievance Procedure

1. Official Municipal Provisions & Extracted Requirements

City of Santa Cruz ADA Coordinator:

City of Santa Cruz

809 Center Street, Room 107

Santa Cruz, CA 95060

If Grievant is not the individual completing this form, please provide the following:Authorized Representative’s Name:

Relationship with Grievant:

Telephone Number: E-mail address:

Requested Action: What actions do you request that the City of Santa Cruz take to correct the alleged ADA non-compliance or discrimination regarding your access to public accommodation(s) and why? Please attach additional pages if necessary.

ADA@cityofsantacruz.com

For more information or assistance in completing the form, please contact the ADA Coordinator.

All 3 pages of ada-grievance-procedure.pdf remediated in-place with ISO 14289-1 (/StructTreeRoot, /ParentTree, /MCID) and WCAG 2.1 AA landmarks.

Figure 1: Verified PDF/UA-1 & WCAG 2.1 AA structure across 3 page(s) of ada-grievance-procedure.pdf. — Preserved 3-page vector layout, municipal seal, and structural schedule from ada-grievance-procedure.pdf.

2. Extracted Schedule, Agency Directory & Fee Matrix

Structured schedule extracted from the 3-page PDF bytecode:

Table 1: Extracted Schedule & Directory from ada-grievance-procedure.pdf (3 Pages)
Item / Code	Description / Provision	Rate / Contact / Spec	Reference
Tel	(831) 420-5330	Mandatory Clearance	Page 3
Provision 2.2	City of Santa Cruz ADA Coordinator:	Mandatory Submittal Requirement	Page 2
Provision 3.3	City of Santa Cruz	Mandatory Submittal Requirement	Page 3
Provision 3.4	809 Center Street, Room 107	Mandatory Submittal Requirement	Page 3

3. Accessible Electronic Intake & Declaration Form

Complete the accessible electronic fields below (extracted from ada-grievance-procedure.pdf):

Interactive Electronic Submittal Form (WCAG 2.1 AA Equivalent Alternative)

Address Extracted from Page 3 of ada-grievance-procedure.pdf.

Telephone Number Extracted from Page 3 of ada-grievance-procedure.pdf.

Date of Incident Extracted from Page 3 of ada-grievance-procedure.pdf.

Has a complaint been filed with a State or Federal Agency Extracted from Page 3 of ada-grievance-procedure.pdf.

Signature of (circle one) Grievant or Authorized Representative Extracted from Page 3 of ada-grievance-procedure.pdf.

Enter your estimated project valuation ($ USD) and select an occupancy category to preview your municipal fee.