City of Rancho Palos Verdes

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Public Safety Reimbursement Program - Individual Application

  1. City Logo PS Reimbursement Individual Applicant
  3. This is my first time applying for a Public Safety Reimbursement*
  4. I have already purchased a device which I am submitting for reimbursement*
  5. Please indicate where on the property the device will be located (i.e. front door, front of garage, back yard, side gate, other).

  6. Please indicate the brand (i.e. Ring, Blink, Google Next, other). Participants are encouraged to conduct their own due diligence in selecting a camera type and vendor.  

  7. Please enter the total cost excluding tax

  8. Up to 50% of the cost, up to $100

  9. Terms and Conditions

    By submitting this form, I agree to adhere to the City of Rancho Palos Verdes’ Public Safety Reimbursement Program (Program) terms, a copy of which are provided herein, and reviewed by me, including each of the conditions of all City issued permits issued in connection therewith. 

    I am the primary signature of the proposed purchase/service and I am responsible for all equipment, service, installation, maintenance, and repair costs. Participation in the Program does not grant any exemptions from otherwise required permitting processes. I am responsible for insurance and indemnification of work. 

    Compliance with the Program terms requires that the Los Angeles County Sheriff’s Department, by way of the Lomita Sheriff’s Station, be provided with access, review, and download of footage from the camera system for crime-prevention and investigation purposes. The City of Rancho Palos Verdes, its City Manager or their Designee, will be provided with access, review, and download of footage for crime prevention and investigation purposes. 

    Once awarded, I shall not apply again for an individual reimbursement of a public safety purchase. The following will be submitted as part of the application to the City of Rancho Palos Verdes. 

    Proof of Purchase and Completion will be required prior to disbursement of funds: • Project Application • Proof of Purchase • Proof of Project Completion (e.g. photo) • Permits/approvals (as required) In no event will the City of Rancho Palos Verdes be liable for any loss of data, property loss, damage, bodily injury, cost of recovery, or other special, incidental, consequential, indirect, punitive, exemplary or reliance damages arising from or in relation to this Agreement, however caused and regardless of theory of liability

  10. Terms and Conditions (cont.)*
  11. Signature and Date

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

  12. Signature*
  13. Leave This Blank:

  14. This field is not part of the form submission.