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Request & Agreement for Police Services
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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
Applicant Information
First Name
Last Name
Date of Request
Date of Request
Phone Number
Fax Number
Email
Street Number
Street Name
Street Type
Apt #
City
State
ZIP
Event Information
Event Name
Event Date
Event Date
Location
Number of Officers Requested
Marked patrol vehicles required:
Yes
No
Type of Services
One-time event
Ongoing service
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
Ongoing Service
For ongoing service, please check which days and fill out the times requested per week.
Sunday
Sunday
Sunday Time
Sunday Time Start Time
—
Sunday Time End Time
Monday
Monday
Monday Time
Monday Time Start Time
—
Monday Time End Time
Tuesday
Tuesday
Tuesday Time
Tuesday Time Start Time
—
Tuesday Time End Time
Wednesday
Wednesday
Wednesday Time
Wednesday Time Start Time
—
Wednesday Time End Time
Thursday
Thursday
Thursday Time
Thursday Time Start Time
—
Thursday Time End Time
Friday
Friday
Friday Time
Friday Time Start Time
—
Friday Time End Time
Saturday
Saturday
Saturday Time
Saturday Time Start Time
—
Saturday Time End Time
Number of Attendees
Will alcoholic beverages be served?
Yes
No
Occupational License Number (if applicable)
Special Event Permit Number (if applicable)
Is this a grand opening?
Yes
No
Certificate of occupancy provided:
Yes
No
Is the officer required to check in upon arrival?
Yes
No
If yes, what's the name of the contact person?
Contact Person's Phone Number
Services requested, specific responsibilities, other comments:
Number of Officers
at $50 per hour for
Number of Hours
Total Fee
Number of Sergeants
at $55 per hour for
Number of Hours
Total Fee
Number of Vehicles
at $4 per hour for
Number of Hours
Total Fee
Total Amount
Total Amount for Week
For ongoing services only
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
.
Billing Information
Send bill to:
First Name
Last Name
Street Number
Street Name
Street Type
Apt #
City
State
ZIP
Email
May we email your invoice?
Yes
No
Phone Number
Fax Number
Accounts Payable Representative
Phone Number
Fax Number
Received by
Date Received
Date Received
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Receive an email copy of this form.
Email address
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