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THMPfl POLICE CIB

8132763652

POLICE

Criminal Intelligence Bureau - 411 N. Franklin Street -Tampa, Florida 33602 Office #(813)276-3651 - Fax#(813)276-3652

FACSIMILE COVER LETTER DATE:

TO: (Name) Phone #:

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FROM: Phone #: 9/ll Law Enforcement Privacy

RE: TOTAL NUMBER OF PAGES (including cover): (

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CAR USED: YES («««« Circle One)

TAMPA POLICE DEPARTMENT EXTRA-DUTY PAY VOUCHER Please Print RANK

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_, TAMPA POLICE DEPARTMENT OFFICER, HEREBY CERTIFY THAT THE Q Please check it substitute

ABOVE IS TRUE AND CORRECT. SUBSTITUTED FOR: OFfjfcER'S SIGNATURE

_, AS OWNER/DESIGNEE OF THE BUSINESS, ORGANIZATION, FUNCTION, OR INDIVIDUAL REQUESTING EXTRA-DUTY POLICE SERVICES, HEREBY AGREE THAT THE ABOVE IS TRUE AND CORRECT.

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PERMITTEBDESIGNEE'S SIGNATURE PERMITTEE'S SIGNATURE/MASTER VOUCHER SIGNED BYy^ERMITTEE

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ON-STTE' SUP^RVISOR'S/DESIGNEE-S SIGNATURE TPD 238-EX (8/96)

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While-Coordinator; Yellow-Permittee; Plnk-Olfitier

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TAMPA POLICE DEPARTMENT EXTRA DUTY PERMIT APPLICATION 18&P

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PERMITTED SERVICE DATEfS). DAYS AND HOURS TO BE WORKED

PREDICTED ATTENDANCE

OFFICERS REPORT TO:

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STAFFING REQUIREMENTS AND RATES AT$ ATS

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NAME OF APPLICANT (Business. Organization. Function, Customer)

ADDRESS OF EVENT

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NOTE: ALL OFFICERS WORKING A PERMIT ASSIGNMENT WILL RECEIVE A MINIMUM NUMBER OF HOURS PAY. AS DUE THEIR RANK. THE ABOVE RATES ARE SUBJECT TO CHANGE. FOLLOWING SUCH CHANGE, THE DEPARTMENT SHALL GIVE NOTICE TO THE CUSTOMER WITHIN 1« DAYS. MINIMUM NUMBER OF HOURS 3 (hours)

PERMIT CANCELLATION THE POLICE DEPARTMENT CAN CANCEL A PERMIT ANYTIME, WITH OR WITHOUT CAUSE THE CUSTOMER MAY CANCEL A PERMIT BY CONTACTING THE COORDINATOR AT 276-3383 48 HOURS PRIOR TO EVENT DURING BUSINESS HOURS. OR NON-BUSINESS HOURS BY CONTACTING THE SHIFT COMMANDER - D-l 354-6699. Dm 931-6599, D-lll 276-370$. IF THIS CANCELLATION IS NOT MADE AT LEAST 48 HOURS PRIOR TO THE DATE AND TIME OF THE

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I . INDIVIDUALLY AND AS AUTHORIZED REPRESENTATIVE OF AFOREMENTIONED CUSTOMER, HEREBY ACKNOWLEDGE THAT I HAVE READ AND UNDERSTAND THIS PERMIT APPLICATION. AND THE 'CONDITIONS OR PERMIT". AND FURTHER AGREE THAT I WILL ABIDE BY AND BE SUBJECT TO THESE CONDITIONS IN ALL RESPECTS. AND BE RESPONSIBLE FOR PAYMENT OF ALL SUMS DUE FOR EXTRA DUTY SERVICES PROVIDED.

SIGNATURE OF CUSTOMER OR AUTHORIZED REPRESENTATIVE

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OFFICE USE ONLY

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ABOVE APPLICATION FOR PERMIT is HEREBY GRANTED, AND THE ABOVE APPLICATION, TOGETHER WITH THE AFOREMENTIONED -CONDITIONS OF PERMIT ARE HEREBY ADOPTED, BY REFERENCE, ANpkjKRE MADE A PART OF AND CONSTITUTE THE TERMS AND CONDITIONS OF THIS PERMIT.

THE

DATE TPD 226-EX (9/01) Pagel

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•Jun 04

9/11

04 02:34 P

TRMPR POLICE GIB

8132763652

Personal Privacy

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TAMPA POLICE DEPARTMENT EXTRA DUTY PERMIT APPLICATION SHORT TERM SERVICE Contact Person:. Contact Phone Number:

Name of Business/Customer

™y Phone:

Address: &*./> Dafe lie of Event:

Specific or Special Instructions or duties required:

LONG TERM SERVICE The authorizing party agrees individually, and on behalf of the named applicant, that the below listed individuals are authorized representatives of the applicant and may request services: Name (please print)

Title:

Phone #:

Name (please print)

Title:

Phone*:

Name (please print)

Title:

Phone #:

Date:

Name of applicant:

Authorizing party (please print name) Title (if applicable):

Authorizing party signature:

TPD 226-EX (9/01) Page 2

Jun 04 04 02=35p

TflMPH POLICE CIB

8132763652

Tampa Police Department - Extra Duty Office NOTICE TO CUSTOMERS The officers are at all times subject to the policies of the City of Tampa and the rules and regulations governing employees of Hie Tampa Police Department (TPD). A Customer has ho authority over police personnel and is restricted to providing only a general assignment of duties to be performed by the officer. Those rules never supersede TPD policy or procedures and employers of the extraduty officers should be so advised. Extra-Duty officers remain under the exclusive control of the department and accountable for strict adherence to department rules and regulations. Any conflicting rules of employers of extra-duty officers will be disregarded. The officer shall refuse to perform any duties deemed to be in conflict with the guidelines established by the Tampa Police Department As determined by the Department, officers maybe recalled from extra-duty to on-duty status. This permit is for law enforcement work only and does not exempt Customers from obtaining other necessary permits for this event The City of Tampa Police Department is NQT obligated to provide extra-duty services. A permit will not be issued to any person, firm, or organization whose offices, members, business, or operations are questionable or for any event of a potentially compromising nature. Tampa Police Department officers are NOT permitted to receive cash from Customers for any reason whatsoever.

The undersigned customer agrees, individually and on behalf of the named applicant, to promptly pay for extra duty services rendered. Further, the undersigned agrees, individually and on behalf of the named applicant to pay all costs, expenses and attorneys fees incurred in the collection of any sums due hcreunder.

B. R. Holder Chief of Police I have read and understand the "Extra Dutv Conditions of Permit

Customer - Individually and as Authorized Representative

Federal ID #

Date

Social Security Number

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9/11 Law Enforcement Privacy

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