Incident Police Report

INCIDENT POLICE REPORT AND INCIDENT REPORTING SERVICES AGREEMENT

Parties and Recitals

This Incident Reporting Services Agreement is entered into by and between:

Reporting Provider Name:

Provider Address:

Requesting Party Name:

Requesting Party Address:

WHEREAS, Reporting Provider maintains personnel and systems qualified to prepare official incident reports and to conduct preliminary incident documentation and investigations; and

WHEREAS, Requesting Party requires documented incident reporting and evidence handling for incidents occurring within its operations and desires to retain Reporting Provider to prepare and deliver incident reports, statements, and associated documentation on the terms set forth herein.

Scope of Work

Payment Terms

Term and Termination

Effective Date:     Termination Date:

Either party may terminate this Agreement for material breach by the other party if the breach is not cured within the notice period set forth above. Termination does not relieve either party of obligations accrued prior to termination, including payment for services rendered.

Confidentiality

Each party shall keep confidential all non-public information obtained in connection with the services, including incident details, witness identities, evidence descriptions, and investigatory notes. Confidential information shall not be disclosed except as required by law, court order, or with the prior written consent of the disclosing party.

Governing Law

This Agreement shall be governed by and construed in accordance with the laws of:

Entire Agreement

This Agreement, including all attachments and incident reports produced pursuant hereto, constitutes the entire agreement between the parties with respect to the subject matter and supersedes all prior and contemporaneous agreements and understandings. Any modification must be in writing and signed by authorized representatives of both parties.

Incident Report — Administrative Details

Incident Date:     Time:

Theft    Assault    Vandalism    Property Damage    Other:

Reporting Officer / Investigator

Persons Involved

Witness Statements

Evidence, Property, and Observations

Injuries Observed:     Medical Assistance Provided:

Narrative / Incident Description

Administrative Notes and Certifications

I certify under penalty of law that the information contained in this report is true and correct to the best of my knowledge and belief, and that any evidence collected was logged in accordance with established chain-of-custody procedures.

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