jn 04 04 02:34p THMPfl POLICE CIB 8132763652 p.

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) (Company Name)
Phone #: Fax#:
FROM:
Phone #: 9/ll Law Enforcement Privacy

RE:

TOTAL NUMBER OF PAGES (including cover): ( )

COMMENT:

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 CAR USED: YES
(«««« Circle One)
TAMPA POLICE DEPARTMENT EXTRA-DUTY PAY VOUCHER
Please Print
OFFICER NAME RANK ' EMPLOYEE NUMBER PERMIT NUMBJIfe
M.T", P:tffJ'hLi=F XXT / 7 *^3o^- ^1
PERMITTEE . PERMITTEE ADDRESS 1
£v<~r-*f* £ffj ^"#H*b e. &l*+
DAY/DATE SCHEDULED HOURS WORKED UNSCHEDULED HOURS WORKED 'ACTUAL HOURS WORKED
SUN. FROM: TO: FROM: TO: ; FROM: TO:

MON. FROM: TO: FROM: TO: 1 FROM: TO:

TUES. FROM: TO: FROM: TO: I FROM: TO:

WED. FROM: TO: FROM; TO: I FROM: TO:

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TWI1HQ T "* i i »*M FROM: l ( <JO TO: HOO FROM: TO: ( FROM: iVOO TO: \100

FRI. FROM: TO: FROM: TO: I FROM: TO:

SAT. FROM: TO: FROM: TO: ! FROM: TO:

TOTAL SCHED.HRS. (a.O TOTAL UNSCH -n HRS: i TOTAI ACTI.IAI HRS.; ... 4»»0 .-

_, TAMPA POLICE DEPARTMENT OFFICER, HEREBY CERTIFY THAT THE

ABOVE IS TRUE AND CORRECT. Q Please check it substitute

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.

PERMITTEBDESIGNEE'S SIGNATURE

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

ON-STTE' SUP^RVISOR'S/DESIGNEE-S SIGNATURE

TO
TPD 238-EX (8/96) While-Coordinator; Yellow-Permittee; Plnk-Olfitier
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9/11 Law
Enforcement Privacy
 TAMPA POLICE DEPARTMENT EXTRA DUTY PERMIT APPLICATION
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. 9/11 Law Enforcement

I Privacy, §
B^emporary Permit No. r Grid No. District / B average License: |_j ^es \_&tto
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NAME OF APPLICANT (Business. Organization. Function, Customer) C>ESIGNATED REPRESENTATIVE PHONF inav> PHONF (PaiBJaflw)

/.*-, ' Stxx/^/va | / *

ADDRESS OF EVENT ZIP COEE BILLING ADDRESS (Permanent Address) CITY, STATE ZIP CODE 5

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PERMITTED SERVICE DATEfS). DAYS AND HOURS TO BE WORKED OFFICERS REPORT TO: PREDICTED ATTENDANCE ~°

-/7*rHA~K> /L//<#-

DESCRIPTION OF SERVICES NEEDED PERMIT EXPIERATION DATE H

S
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STAFFING REQUIREMENTS AND RATES TJ

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CAPTAIN(S) AT$ 30 PER HOUR / LIEUTENANT(S) ATS x2&7N PER HOUR «

SERGEANT(S) ATS 26 PER HOUR PATROL OFFicER(S) «? AT$ / 24 ) PER HOUR fn
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CRUISERS AT $10.00 PER CRUISER 1-1
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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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ACCORDING TO THE RANK OF THE SCHEDULED OFFICERS. •s]
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I . INDIVIDUALLY AND AS AUTHORIZED REPRESENTATIVE OF AFOREMENTIONED CUSTOMER, HEREBY ACKNOWLEDGE THAT I HAVE READ
(I)
(n
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 01
RESPECTS. AND BE RESPONSIBLE FOR PAYMENT OF ALL SUMS DUE FOR EXTRA DUTY SERVICES PROVIDED. ro

SIGNATURE OF CUSTOMER OR AUTHORIZED REPRESENTATIVE DATE

OFFICE USE ONLY

D GRAN TED THEABOVE 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.
TJ
DATE U)
TPD 226-EX (9/01)
Pagel
•Jun 04 04 02:34 P TRMPR POLICE GIB
8132763652 P-4
9/11 Personal Privacy

TAMPA POLICE DEPARTMENT EXTRA DUTY PERMIT APPLICATION

SHORT TERM SERVICE

Contact Person:.

Name of Business/Customer Contact Phone Number:

™y
Address: Phone:

&*./>
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 #:

Name of applicant: Date:

Authorizing party (please print name)

Authorizing party signature: Title (if applicable):

TPD 226-EX (9/01)

Page 2
Jun 04 04 02=35p TflMPH POLICE CIB 8132763652 p. 5

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 extra-
duty 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 Date

Federal ID # Social Security Number

9/11 Law Enforcement Privacy

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