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MODESTO POLICE DEPARTMENT OUTSIDE SERVICE REQUEST ORGANIZATION ORGANIZATION REQUESTING SERVICE: ORGANIZATION MAILING ADDRESS: ORGANIZATION TELEPHONE: ( ) - ORGANIZATION FAX: ( ) - REPRESENTATIVE REPRESENTATIVE MAKING REQUEST (LAST, FIRST, MI): POSITION WITHIN ORGANIZATION: WORK PHONE: ( ) - CELL/OTHER PHONE: ( ) - EMAIL ADDRESS: EVENT DETAILS ADDRESS OF EVENT: PURPOSE OF EVENT: DATE(S) OF EVENT: FROM: TO: HOURS OF EVENT: FROM: TO: NUMBER OF GUESTS ATTENDING: NUMBER AND TYPE OF PERSONNEL REQUIRED: ADDITIONAL VEHICLES NEEDED: CHECK IN INSTRUCTIONS: THE UNDERSIGNED HEREBY AGREES TO THE FOLLOWING CONDITIONS: Personnel from the Modesto Police Department are assigned to perform services in the capacity of on-duty police officers and are assigned for no other purpose, and shall at all times be subject to the supervision and control of the Department. The Organization listed above will be charged by the City of Modesto for services requested hereby at the rate scale of: Service Requested Rates Per Hour* Sergeant $ 85.00 Officer/Equestrian Officer $ 70.00 Community Service Officer $ 45.00 Vehicle / $10.00/ $3.00 *Rates subject to change without notification There is a 2 1/2 hour minimum for each officer assigned to the event. The Organization is required to pay the preparation and travel time to and from the location. This time will be added to the time spent at the requested event. In the event of any change or cancellation, if the Modesto Police Department is not notified at least 72 hours in advance, the Organization requesting will be billed for the minimum 2 1/2 hours for each officer requested and scheduled. The Organization further agrees to hold the City of Modesto, its City Council and all Officers, agents, and employees of said City, free and harmless from any loss, damage, liability, cost or expenses that may arise during or be caused in any way by the use of such services, except that any injury to personnel of the Modesto Police Department incurred while performing such service shall be covered by the City’s Compensation InsuranceCarrier. The Organization understands that their estimate will be prepared based on the information provided to the Police Department regarding number of attendees, planned times, and type of event. The Organization understands that staffing and length of time needed to cover this event may change and may affect the estimate. PRINT NAME: SIGNATURE: DATE: Effective 07/01/2021