BAL HARBOUR POLICE DEPARTMENT
MARK N. OVERTON
Chief of Police
EXTRA DUTY POLICE SERVICE REQUEST FORM
Please fill out as completely as possible
Company or Individual to be billed:
Check One: Individual:
Corporation, State of:
Partnership, State of:
Fictitious name registered to:
Attached legible copy of Driver’s License of individual, partner or corporate officer.
Federal Employee Identification Number (EIN) or Social Security Number:
Billing Address of Requestor:
City: State: Zip Code:
Telephone Number: ( ) EXT. Fax: ( )
Email Address:
Requestor will promptly notify the Extra Duty Coordinator of any changes to the above
information.
Address Where Extra Duty will be performed:
Telephone Number: ( ) EXT.
On Site Contact Person: Telephone Number: ( )
Dates Requested:
to
Number of Days
Hours to be worked (Be Specific AM or PM): Beginning Ending
Number of Officers Requested: Type of Service Requested (i.e., Security, Traffic, etc.):
Expected Attendance: _ Alcohol Being Served?
Yes
No
Requestor acknowledges the information herein is correct and assumes all
responsibilities for its accuracy. Requestor also acknowledges that payment for
service rendered will be submitted to the Village of Bal Harbour within thirty (30)
calendar days of receipt of the invoice. There will be a four (4) hour minimum
charge for any Extra Duty Police Service request. The Extra Duty Police Service
rate is $60.00 per hour and $82.50
per hour for holidays. Cancellation of the
Officer within twenty-four (24) hours of
the detail will result in a four (4) hour
minimum charge.
Requestor’s Print Name Requestor’s Signature Date
655 NINETY-SIXTH STREET • BAL HARBOUR, FLORIDA 33154 • TEL 305.866.5000 • FAX 305.993.5153
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signature
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