Form Center

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* - $50</li><li>Per hour for each sergeant* - $55</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 $10 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>Halloween</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>St. Patrick's Day</li><li>Thanksgiving Day</li><li>Day After Thanksgiving</li></ul> Note: 5-9 officers require 1 sergeant, 10-14 officers require 2 sergeants

   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.

    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
    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.

96. Billing Information
    Send bill to:

    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:


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

     This field is not part of the form submission.

125. Submit

* indicates a required field