NEW ALBANY POLICE DEPARTMENT - New Albany, Ohio

NEW ALBANY POLICE DEPARTMENT - New Albany, Ohio NEW ALBANY POLICE DEPARTMENT - New Albany, Ohio

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ADDENDUM C VEHICULAR PURSUIT REPORT SUPPLEMENTAL Officer: Report Number: Description of Incident: Details of Accident: Additional Comments: Reviewed by: Date: PD-99-109 Revised December 13, 2010

ADDENDUM D LOCKOUT/PUSH BUMPER RELEASE FORM Lockout Release Push Bumper Release Report Number: Officer: Date: Time: Location: Requestor’s Information: Vehicle Information: Name: OLN or SSN Address: City: Year: Make: Model: Color: State: Zip: License Plate Phone #: Number: State: Release: I do hereby release and forever discharge, and agree to hold harmless, the New Albany Police Department, the Mayor, the Chief of Police, City Council, and all officers, agents, and employees from all liability, claims, demands, damages, and causes of action whatsoever. This especially pertains to Officers of the New Albany Police Department using lockout tools and/or push bumpers on my motor vehicle, described above, to gain entry into and/or move said vehicle. Requestor’s Signature: Witness’s Signature: Witness’s Name (Printed): Disposition: Entry Gained Entry Not Gained Vehicle pushed off roadway Vehicle not pushed off roadway Other/Additional Information: _________________________________________ _________________________________________ PD-04-101 Revised December 14, 2010

ADDENDUM C<br />

VEHICULAR PURSUIT REPORT SUPPLEMENTAL<br />

Officer:<br />

Report Number:<br />

Description of Incident:<br />

Details of Accident:<br />

Additional Comments:<br />

Reviewed by:<br />

Date:<br />

PD-99-109<br />

Revised December 13, 2010

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