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MODESTO POLICE DEPARTMENT TEMPORARY PERMIT SOLICITATION (MMC 4-2.35) FEEPAID: PERMISSION IS HEREBY GRANTED MODESTO MUNICIPAL CODE § 3-2.1705 provides that: RD BEAT MPD CASE Person in Charge of (NAME OF ORGANIZATION) (ADDRESS) (ADDRESS) (FULL NAME) (PHONE) (PHONE) • Permittee, its successors and assigns, during the term of the permit, shall indemnify and save the City harmless of an from all damanges, costs and charges of any kind or character arising out of or relating thereto, or in any way connected with the exercise of the rights granted by the permit. • Permittee, its successors and assigns, shall comply with all laws of the City. • Permittee, its successors and assigns, at its own cost and expense, shall defend any and all law suits, if any, arising out of or in any way connected with the exercise of the rights granted by the permit. I have read and understand the above and agree to comply with the conditions set forth. Applicant Signature Issuing Officer: IBM MODESTO POLICE DEPARTMENT APPROVAL Signed for the Chief of Police Administrative Services Supervisor TO TEMPORARILY: Use Street Use Sidewalk Use Parking Spaces Between: and (LOCATION) (LOCATION) Purpose: DATE(S): Permittee shall be required to: • Evidence of insurance naming the City of Modesto as additional insured may be required. • Adequately close the designated streets with barricades as directed by the Police Department • remove the barricades from the streets at the times listed on the permit. • Obtain permission from all residents/businesses located within the enclosed area prescribed. Names, addresses, phone and signatures required at time permit is submitted for approval. • Permittee shall designate for First Amendment groups/persons a 10x10 designated space for First Amendment Activity. • Each individual or group shall be limited to one(1) permit during any twelve(12) month period. Additional LOCATION(S) (If more than one location, attach a listing of all locations to this application)