Request & Agreement for Police Services

2. Request & Agreement for the Purchase of Police Services

   <b>Rates:</b><br><br> <ul><li>Per hour for each officer* - $47</li><li>Per hour for each sergeant* - $52</li><li>Per hour for each vehicle - $4</li></ul> *A 3-hour minimum per officer is required.<br><br> <b>Holidays & Special Days</b><br>: An additional $5 per hour will be charged on the following holidays and special days: <ul><li>Christmas Day</li><li>Christmas Eve</li><li>Easter</li><li>Independence Day</li><li>Labor Day</li><li>Memorial Day</li><li>New Year’s Eve</li><li>Super Bowl Sunday</li><li>Thanksgiving Day</li></ul> Note: 5-9 officers require 1 sergeant, 10-14 officers require 2 sergeants

   Rates:
   
   

   • Per hour for each officer* - $47
   • Per hour for each sergeant* - $52
   • Per hour for each vehicle - $4

   *A 3-hour minimum per officer is required.
   
   Holidays & Special Days
   : An additional $5 per hour will be charged on the following holidays and special days:

   • Christmas Day
   • Christmas Eve
   • Easter
   • Independence Day
   • Labor Day
   • Memorial Day
   • New Year’s Eve
   • Super Bowl Sunday
   • Thanksgiving Day

   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.

    For ongoing service, please check which days and fill out the times requested per week.

38. Sunday

    1. Sunday

39. Monday

    1. Monday

40. Tuesday

    1. Tuesday

41. Wednesday

    1. Wednesday

43. Sunday Time
    Sunday Time Start Time

    —

    Sunday Time End Time

44. Monday Time
    Monday Time Start Time

    —

    Monday Time End Time

45. Tuesday Time
    Tuesday Time Start Time

    —

    Tuesday Time End Time

46. Wednesday Time
    Wednesday Time Start Time

    —

    Wednesday Time End Time

48. Thursday

    1. Thursday

49. Friday

    1. Friday

50. Saturday

    1. Saturday

52. Thursday Time
    Thursday Time Start Time

    —

    Thursday Time End Time

53. Friday Time
    Friday Time Start Time

    —

    Friday Time End Time

54. Saturday Time
    Saturday Time Start Time

    —

    Saturday Time End Time

56. Number of Attendees

57. Will alcoholic beverages be served?

    1. Yes

    1. No

59. Occupational License Number

60. Special Event Permit Number

62. Is this a grand opening?

    1. Yes

    1. No

63. Certificate of occupancy provided:

    1. Yes

    1. No

65. Is the officer required to check in upon arrival?

    1. Yes

    1. No

67. If yes, what's the name of the contact person?

68. Contact Person's Phone Number

70. Services requested, specific responsibilities, other comments:

72. Number of Officers

73. at $47 per hour for

74. Number of Hours

75. Total Fee

77. Number of Sergeants

78. at $52 per hour for

79. Number of Hours

80. Total Fee

82. Number of Vehicles

83. at $4 per hour for

84. Number of Hours

85. Total Fee

87. Total Amount

89. Total Amount for Week

    For ongoing services only

91. Additional Details

    A. Application should be received at least 48 hours prior to the scheduled event.<br> 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.<br> 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.<br> 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.<br> E. Payment is required by check or money order upon receipt of invoice.<br> F. Out of state vendors <b>must</b> prepay all police services requested.<br> G. No cash accepted.<br> H. Send remittance to:<br> City of Palm Beach Gardens<br> Attention: Finance Department<br> 10500 North Military Trail<br> Palm Beach Gardens, FL 33410<br> Please include invoice number on check.<br> <br> Contact Information<br> Extra Duty Details Coordinator<br> Phone: 561-799-4522<br> Please fax completed request to: 561-799-4408 or send an <a class="Hyperlink" target="_blank" href="mailto:extraduty@pbgfl.com">email</a>.

    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.

93. Billing Information

    Send bill to:

    Send bill to:

95. First Name

96. Last Name

98. Street Number

99. Street Name

100. Street Type

101. Apt #

103. City

104. State

105. ZIP

107. Email

108. May we email your invoice?

     1. Yes

     1. No

110. Phone Number

111. Fax Number

113. Accounts Payable Representative

115. Phone Number

116. Fax Number

118. Received by

119. Date Received
     Date Received

Leave This Blank:


120. 1. Receive an email copy of this form.
121. Email address

     This field is not part of the form submission.

122. Submit

* indicates a required field