Attendance And Participant Good Faith Estimate Page 25
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32CITIZENS USE PERMIT (STREET CLOSURES)
I hereby request a Citizens Use Permit for the purpose stated below, within the limits of Ada County, Idaho:
Applicant Name
Street Address
Apartment/Unit #
City
State
ZIP
Organization Name
Event Name and Type
(Parade, Demonstration, etc.)
Location (Provide Map)
Said use to consist of approximately the number of following persons
#
Number of Vehicles
#
Number of floats
#
Number of unlicensed vehicles
#
Other
#
Other (description):
INSURANCE:
We hereby agree to replace the 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 (attach to application) 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. Insurance requirements may be
increased up on demand by the Boise City Legal Department, Risk Manager, or the Ada County Highway District.
ESCORT SERVICE:
The following declaration of intent to furnish escort must be signed by a representative of the licensed escort or security service
before the application is returned to the Boise Police Department for the signature of the Chief of Police
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/s) _______________________
(Time/s)__________________.
Signed by___________________________________
on (Date) __________________
APPLICANT ASSURANCES:
I have read and understand the requirements and responsibilities set forth by this permit.
Applicant Signature:_______________________________________
Date:______________________
FOR INTERNAL USE ONLY
Chief of Police
Date
Ada County Sheriff
Date
Transportation Manager, ACHD
Date
District 3, Idaho Transportation Dept.
Date
Updated December 23, 2011
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