2. Applicant Name/Organization Name:
4. Street Address:
6. City:
7. State:
8. Zip:
10. Contact Person at Event:
12. Home Phone:
13. Business Phone:
14. Cell Phone:
16. Email Address:
18. Description of Event:
20. Location of Event:
21. Anticipated Attendance:
22. # of Officers Requested:
24. Date of Event #1:
    Date of Event #1:
25. Time Officers Duties Begin #1:

    {hh:mm am/pm)

26. Time Officers Duties End #1:

    {hh:mm am/pm)

28. Date of Event #2:
    Date of Event #2:
29. Time Officers Duties Begin #2:

    {hh:mm am/pm)

30. Time Officers Duties End #2:

    {hh:mm am/pm)

32. Date of Event #3:
    Date of Event #3:
33. Time Officers Duties Begin #3:

    {hh:mm am/pm)

34. Time Officers Duties End #3:

    {hh:mm am/pm)

36. Date of Event #4:
    Date of Event #4:
37. Time Officers Duties Begin #4:

    {hh:mm am/pm)

38. Time Officers Duties End #4:

    {hh:mm am/pm)

40. Date of Event #5:
    Date of Event #5:
41. Time Officers Duties Begin #5:

    {hh:mm am/pm)

42. Time Officers Duties End #5:

    {hh:mm am/pm)

44. Type of assistance needed from the Police Department {Check all that apply):

    1. Traffic Control
    2. Pedestrian Control

    1. Security
    2. Parking Control

    1. Crowd Control

    1. Road Closure
46. Area of Road Closure (if applicable):
48. Will alcohol be served?

    1. Yes
    2. No

50. The fees for City Services are listed in Wheaton City Code Appendix B-Fee Schedule (see below)

    The undersigned acknowledges the following terms and conditions:

52. #1. I accept responsibility for the payment of all City Services fees associated with the event specified above. Payment for City Services shall be made directly to the City of Wheaton Finance Department no later than thirty (30} days after being invoiced.

54. 1. I agree with term & condition #1 above.

56. #2. I agree to make the payment based on the number of officers hired multiplied by the number of hours worked. There is a one-hour minimum charge for City Services. If City Services are provided beyond the time specified above, I, as the applicant, shall be responsible for payment of City Services provided to the nearest quarter hour at the base rate listed in Wheaton City Code Appendix B-Fee Schedule, in minimum increments of one-quarter (1/4) hour/per officer.

58. 1. I agree with term and condition #2 above.

60. #3. In the event of cancellation, I shall be responsible for paying the entire contracted fee in the event that I fail to provide the Wheaton Police Department with twenty-four (24) hours' notice of cancellation.

62. 1. I agree with term and condition #3 above.

64. #4. The undersigned represents that the Applicant/requesting Organization understands that in the event a Wheaton Police Officer is unavailable for this assignment, the Wheaton Police Department, in its sole discretion, shall decide if an on-duty officer shall be assigned or if the event will go unassigned with no cost to the Applicant/requesting Organization.

66. 1. I agree with term and condition #4 above.

68. #5. To the fullest extent permitted by law, I, agree:
    
    (1) to indemnify, defend and hold harmless the City of Wheaton, including its agents, employees, officers, and elected officials, from and against any and all claims, damages, expenses, loss or liability of any kind or nature whatsoever arising out of, or resulting from, the alleged acts or omissions of the Applicant, its officers, agents or employees in connection with the City's provision of the City Services requested by Applicant above for the event specified above; and,
    
    (2} that during the use of any public area, the Applicant shall not exclude any person from participating in, deny anyone the benefits of, or otherwise subject anyone to discrimination because of race, color, gender, national origin, or handicap.

70. 1. I agree with term and condition #5 above.

72. BY SIGNING BELOW, I HEREBY ACCEPT AND APPROVE THE TERMS AND CONDITIONS OF THIS REQUEST AS INDICATED ABOVE, I AGREE TO REIMBURSE THE CITY OF WHEATON AS INDICATED ABOVE, AND I CERTIFY THAT:
    
    (1) THE REPRESENTATIONS MADE IN THIS APPLICATION ARE TRUE AND CORRECT;
    
    (2) I AM OVER 18 YEARS OF AGE AND I AM FULLY COMPETENT TO SIGN BELOW;
    
    (3) I AM AUTHORIZED TO EXECUTE THIS CITY SERVICES REQUEST FORM AND;
    
    (4) I AM AUTHORIZED TO MAKE OPERATING DECISIONS FOR THE REQUESTING APPLICANT/ORGANIZATION NAMED ABOVE.

74. Authorized Signature:*
75. Date:*
    Date:
79. 
    

    8-5 City Services Fees
    	Regular Hourly Rate	Overtime Hourly Rate
    1. Police Department			Per hour, one-hour minimum
    a. Lieutenant	$64.30	$96.45
    b. Sergeant	$57.81	$86.71
    c. Detective	$48.54	$72.81
    d. Patrol Officer	$47.94	$71.91
    e. Community service officer	$29.75	$44.63
    f. Community service officer (Part-Time)	$23.00	$34.50
    4. Other City personnel, Vehicles, equipment	Rate as determined by finance director	Current vehicle rate, $16.05 per hour

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81. 1. Receive an email copy of this form.
82. Email address

    This field is not part of the form submission.

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