Fill and Sign the Agreement United States Department of Justice Form

_____________________ (Name) Police Department Confidential Informant Declaration of Understanding and Agreement (Informant is to initial each paragraph if he/she agrees to the statement therein)._____1. I, the undersigned ____________________ (Name of Informant) , hereby release and hold harmless the City of _____________________ (Name of City), the ______________________ (Name of City) Police Department and its Chief of Police, and any of that Department's agents, servants, or employees from any liability relating to any harm or injury sustained by me as a direct or indirect result of my cooperation with that Department in criminal investigations. _____2. I understand that I am not to initiate, or participate in, any investigation of criminal activity unless such investigation is directly supervised by an officer of the _________________ (Name of City) Police Department. _____3. I understand that I must, and I agree to, follow all instructions of the control officer or his designee while assisting in such investigations. _____4. I agree not to violate any laws or commit any crimes while associating with the ______________________ (Name of City) Police Department in the investigation of criminal activities, and I understand that any such violations may be prosecuted regardless of my cooperation with that Department. _____5. I understand that my cooperation with the ___________________ (Name of City) Police Department does not convey to me any privileges or immunities. _____6. I understand that I am under no obligation to provide information to the _____________________ (Name of City) Police Department, and that only information which is obtained legally will be accepted by that Department. _____7. I understand that, while assisting the ___________________ (Name of City) Police Department, I will neither possess a firearm or any other deadly weapon, nor will I be subject to any impairing substance. _____8. I understand that the _____________________ (Name of City) Police Department will make all reasonable effort to maintain the confidentiality of my identity, and of any lawfully obtained information which I provide to that Department. I further understand that circumstances may arise under which my identity must be disclosed as ordered by a court of law. _____9. I agree not to reveal my association with the ___________________ (Name of City) Police Department to anyone at any time, without the expressed consent of the control officer or his designee. _____10. I agree to maintain contact with the ___________________ (Name of City) Police Department, and to keep that Department apprised of my whereabouts, and any changes in address or telephone number. _____11. I agree to immediately report to the ____________________ (Name of City) Police Department any threats made against me, or any injuries sustained by me, as a result of my association with that Department. _____12. I understand that I am not a law enforcement officer, and I agree not to represent myself as a law enforcement officer at any time. _____13. I have entered into this contract freely, voluntarily, and without any duress, and without any pressure or coercion having been used against me by anyone. Witness our signatures, this the ___________________ (date).__________________________________ ______________________________________ Printed Name of Confidential Informant Printed Name of Chief of Police __________________________________ ______________________________________Signature of Confidential Informant Signature of Chief of Police Badge Number: _______________________ ________________________________ ____________________________________Printed Name of Witness Printed Name of Witness ________________________________ ____________________________________Signature of Witness Signature of Witness