Citizens Use Permit Form - Garden City Police Department printable pdf download

GARDEN CITY POLICE DEPARTMENT

CITZENS USE PERMIT

(SEE INSTRUCTIONS ON REVERSE SIDE)

I, __________________________ hereby request a Citizens Use Permit for the purpose stated below, within the limits of Garden

City, Ada County, Idaho.

Organization: ________________________ Business Phone: ____________Other Phone ____________ Fax: # ___________

Contact person (at event): ______________________________ Mailing Address: ___________________________________

EVENT NAME _________________________________________________________________________________________

(Parade, Demonstration, Street closure, Runs, Walk-a-thon, etc.)

Location (Provide Map): _________________________________ Date: _____________ Time (From)________ (To) ________

Said use to consist of approximately the number of following persons: __________________ vehicles: ____________________

Floats: _______________ unlicensed vehicles: _______________ other entries: ______________ volunteers: ______________

Floats may require inspection by North Ada County Fire and Rescue.

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INSURANCE:

We hereby agree to replace the premises satisfactorily to the original condition prior to the event at our expense.

We shall not hold the Ada County Highway District, the City of Garden City or the State of Idaho responsible of any damages or

expenses caused by, or in connection with, the use of said property. We also acknowledge that the cost of returning premises to

original condition will be ours and not the Ada County Highway District, the City of Garden City or the State of Idaho.

A liability policy (attach to application) must be in effect prior to approval of this permit and cannot be less than $1,000.000 combined

single limit. Garden City and Ada County Highway District must be listed as Additional Named Insured Parties. Insurance

requirements may be increased upon demand by the Garden City Risk Manager, or the Ada County Highway District.

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ADDITIONAL REQUIREMENTS:

ESCORT SERVICES / PRIVATE SECURITY:

The following declaration of intent to furnish escort services or private security must be signed by a representative of the licensed

escort or security service before this application is returned to the Garden City Police Department for the signature of the Chief of

Police (Escort/Security Officers are required from the time the event starts until all traffic obstructions have been cleared and

spectators have been safely disbursed).

I, _____________________________ of (Escort/Security Service) __________________________ have entered into an agreement

with (Applicant) _______________________________ to furnish the ______________ Escort/Security personnel and/or

________________ vehicles to the above mentioned applicant for which this application was made. Said function is to occur on

(Date) ________________________________ (Time) ______________________.

Signed by: _____________________________________

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APPLICANT ASSURANCES:

I have read and do fully understand the requirements and responsibilities set forth by this permit.

Applicant Signature: ________________________________________

Date: ____________________________

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Chief of Police ____________________________________ by (Designee) _______________________________________

Transportation Manager, ACHD _____________________________________

District 3, Idaho Transportation Department Representative _______________________________________

City Risk Manager: Approved ______ Disapproved ______

Citizens Use Permit Form - Garden City Police Department