Citizen Use Permit Form - Ada County
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1CITIZEN USE PERMIT
I hereby request a citizen’s use permit for the purpose stated below within the limits of Ada County:
(Please print of type)
FILL IN
Applicant:_____________________________ Bus. Phone:______________ Other: Phone: _____________
Address:________________________________________________________________________________
Name of Organization:_____________________________________________________________________
Event: __________________________________________________________________________________
(parade, demonstration, run, street closure, walk-athon, etc.)
(provide map)
Location: ___________________________________ Date: _____________ Time: ________ to ________
Said use to consist of approximately the following numbers of persons: _________, vehicles:_____________,
Floats:__________, unlicensed vehicles: _____________, other:____________________________________.
Date of Application: ________________________
Applicant’s Signature: _____________________
ESCORT SERVICE
The following declaration of intent to furnish escort must be signed by a representative of the licensed
escort service before the application is returned to the Ada County Sheriff’s Department for signature.
I, ______________________ of ______________________________________ have entered into an
print name
name of escort service
agreement with ______________________________ to furnish an escort for the function for which this
(applicant’s name)
-
application is made, said function to occur on _______________.
date
Signed by: _______________________________
Licensed escort service representative
INSURANCE
We hereby agree to replace said premises satisfactorily to the Ada County Highway District at our own expense and
hold said District and County and City and State harmless from all damages or expenses caused by or in connection
with the use of said property or of restoring the same to its original condition.
A Liability Policy shall be provided with liability insurance therefore in the amount of $100,000 per person and
$500,000 per each accident with the appropriate government entity as a named insured.
Ada County Sheriff
Date
Transportation Manager, Ada County
Date
th
(7200 Barrister Dr.)
(Highway District (318 E. 37
St.)
Chief of Police
Date
District #3 Idaho Transportation Dept.
Date
(8150 Chinden Blvd)
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