Get Emily Hardiman Madison Police Department Form

MADISON POLICE DEPARTMENT APPLICATION FOR SPECIAL DUTY For requests of Madison Police Department Special Duty please complete this application and submit it to the Madison Police Department Attn Emily Hardiman 211 S. Carroll St. Rm. GR-21 Madison Wisconsin 53703 or fax the application to 608 266-4855. PARTY REQUESTING SERVICES Name of Business or Organization Provide FULL LEGAL BUSINESS NAME Please confirm your organization s status before applying. The organization is a Corporation Inc Corp Co. etc* Sole Proprietor Limited Liability Company LLC Partnership Unincorporated Association Individual Other. A non-profit might also be incorporated* DBA if doing business under another name Business Address Please include City State and Zip Code Name and Title of Authorized Signatory Name of person authorized to sign contract and their official title with the organization Name Title Business Phone Number Fax Number E-Mail Address EVENT Name of Event Address of Event Exact Location Date Time Number of Officers Requested the Duration of the Event SCOPE OF SERVICES Please indicate the type of services requested* Example Security Traffic Control etc* INSURANCE When submitting your application please provide proof of Commercial General Liability and Contractual Liability Insurance with 1 000 000 limit* Example Certificate of Liability Insurance. Your insurance should name the City of Madison as additional insured* If you have any questions regarding insurance please contact Risk Manager Eric Veum at 266-5965. QUESTIONS If you have questions regarding this form or police special duty services please call Emily Hardiman at 608 267-8676. PARTY REQUESTING SERVICES Name of Business or Organization Provide FULL LEGAL BUSINESS NAME Please confirm your organization s status before applying. The organization is a Corporation Inc Corp Co. etc* Sole Proprietor Limited Liability Company LLC Partnership Unincorporated Association Individual Other. The organization is a Corporation Inc Corp Co. etc* Sole Proprietor Limited Liability Company LLC Partnership Unincorporated Association Individual Other. A non-profit might also be incorporated* DBA if doing business under another name Business Address Please include City State and Zip Code Name and Title of Authorized Signatory Name of person authorized to sign contract and their official title with the organization Name Title Business Phone Number Fax Number E-Mail Address EVENT Name of Event Address of Event Exact Location Date Time Number of Officers Requested the Duration of the Event SCOPE OF SERVICES Please indicate the type of services requested* Example Security Traffic Control etc* INSURANCE When submitting your application please provide proof of Commercial General Liability and Contractual Liability Insurance with 1 000 000 limit* Example Certificate of Liability Insurance. A non-profit might also be incorporated* DBA if doing business under another name Business Address Please include City State and Zip Code Name and Title of Authorized Signatory Name of person authorized to sign contract and their official title with the organization Name Title Business Phone Number Fax Number E-Mail Address EVENT Name of Event Address of Event Exact Location Date Time Number of Officers Requested the Duration of the Event SCOPE OF SERVICES Please indicate the type of services requested* Example Security Traffic Control etc* INSURANCE When submitting your application please provide proof of Commercial General Liability and Contractual Liability Insurance with 1 000 000 limit* Example Certificate of Liability Insurance. Your insurance should name the City of Madison as additional insured* If you have any questions regarding insurance please contact Risk Manager Eric Veum at 266-5965.