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2. Request & Agreement for the Purchase of Police Services
   Rates:
   
   

   • Per hour for each officer* - $50
   • Per hour for each sergeant* - $55
   • Per hour for each vehicle - $4

   *A 3-hour minimum per officer is required.
   
   Holidays & Special Days
   : An additional $10 per hour will be charged on the following holidays and special days:

   • Christmas Day
   • Christmas Eve
   • Easter
   • Halloween
   • Independence Day
   • Labor Day
   • Memorial Day
   • New Year’s Eve
   • Super Bowl Sunday
   • St. Patrick's Day
   • Thanksgiving Day
   • Day After Thanksgiving

   Note: 5-9 officers require 1 sergeant, 10-14 officers require 2 sergeants
4. Applicant Information
6. First Name
7. Last Name
8. Date of Request
   Date of Request
10. Phone Number
11. Fax Number
12. Email
14. Street Number
15. Street Name
16. Street Type
17. Apt #
19. City
20. State
21. ZIP
23. Event Information
25. Event Name
26. Event Date
    Event Date
28. Location
30. Number of Officers Requested
31. Marked patrol vehicles required:

    1. Yes

    1. No
33. Type of Services

    1. One-time event
    2. Ongoing service
34. Starting / Ending Dates & Times
    Starting / Ending Dates & Times Start Date

    Starting / Ending Dates & Times Start Time

    —

    Starting / Ending Dates & Times End Date

    Starting / Ending Dates & Times End Time
36. Ongoing Service
    For ongoing service, please check which days and fill out the times requested per week.
38. Sunday

    1. Sunday
39. Sunday Time
    Sunday Time Start Time

    —

    Sunday Time End Time
41. Monday

    1. Monday
42. Monday Time
    Monday Time Start Time

    —

    Monday Time End Time
44. Tuesday

    1. Tuesday
45. Tuesday Time
    Tuesday Time Start Time

    —

    Tuesday Time End Time
47. Wednesday

    1. Wednesday
48. Wednesday Time
    Wednesday Time Start Time

    —

    Wednesday Time End Time
50. Thursday

    1. Thursday
51. Thursday Time
    Thursday Time Start Time

    —

    Thursday Time End Time
53. Friday

    1. Friday
54. Friday Time
    Friday Time Start Time

    —

    Friday Time End Time
56. Saturday

    1. Saturday
57. Saturday Time
    Saturday Time Start Time

    —

    Saturday Time End Time
59. Number of Attendees
60. Will alcoholic beverages be served?

    1. Yes

    1. No
62. Occupational License Number (if applicable)
63. Special Event Permit Number (if applicable)
65. Is this a grand opening?

    1. Yes

    1. No
66. Certificate of occupancy provided:

    1. Yes

    1. No
68. Is the officer required to check in upon arrival?

    1. Yes

    1. No
70. If yes, what's the name of the contact person?
71. Contact Person's Phone Number
73. Services requested, specific responsibilities, other comments:
75. Number of Officers
76. at $50 per hour for
77. Number of Hours
78. Total Fee
80. Number of Sergeants
81. at $55 per hour for
82. Number of Hours
83. Total Fee
85. Number of Vehicles
86. at $4 per hour for
87. Number of Hours
88. Total Fee
90. Total Amount
92. Total Amount for Week
    For ongoing services only
94. Additional Details
    Applications will be processed Monday through Friday between 8:00 am and 5:00 pm. All applications received after 5:00pm will be processed the next business day.
    A. Application should be received at least 48 hours prior to the scheduled event.
    B. Cancellation of the request must be made in writing 24 hours before the scheduled starting time, otherwise the 3-hour minimum will apply. Once an officer reports for a scheduled detail, he / she will be compensated in full, regardless of if the vendor chooses to release them before the end of the shift. Therefore, the vendor will be billed for all scheduled hours.
    C. The City of Palm Beach Gardens shall have the right to recover from the requesting organization all costs of collection of any unpaid bill, including reasonable attorney fees.
    D. Call the extra duty detail coordinator 48 hours prior to the detail to check on staffing. In the event the coordinator is unavailable, contact the Police Department directly at 561-799-4445.
    E. Payment is required by check or money order upon receipt of invoice.
    F. Out of state vendors must prepay all police services requested.
    G. No cash accepted.
    H. Send remittance to:
    City of Palm Beach Gardens
    Attention: Finance Department
    10500 North Military Trail
    Palm Beach Gardens, FL 33410
    Please include invoice number on check.
    
    Contact Information
    Extra Duty Details Coordinator
    Phone: 561-799-4522
    Please fax completed request to: 561-799-4408 or send an email.
96. Billing Information
    Send bill to:
98. First Name
99. Last Name
101. Street Number
102. Street Name
103. Street Type
104. Apt #
106. City
107. State
108. ZIP
110. Email
111. May we email your invoice?

     1. Yes

     1. No
113. Phone Number
114. Fax Number
116. Accounts Payable Representative
118. Phone Number
119. Fax Number
121. Received by
122. Date Received
     Date Received
Leave This Blank:


124. 1. Receive an email copy of this form.
125. Email address

     This field is not part of the form submission.

126. Submit

* indicates a required field