Form DPS-693-C-1 "Request and Cancellation Form for State Police Traffic Services" - Connecticut

What Is Form DPS-693-C-1?

This is a legal form that was released by the Connecticut Department of Emergency Services and Public Protection - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2012;
  • The latest edition provided by the Connecticut Department of Emergency Services and Public Protection;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DPS-693-C-1 by clicking the link below or browse more documents and templates provided by the Connecticut Department of Emergency Services and Public Protection.

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Download Form DPS-693-C-1 "Request and Cancellation Form for State Police Traffic Services" - Connecticut

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S T A T E O F C O N N E C T I C U T
DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION
Special Duty Coordinator’s Office
To:
All Contractors
From:
The Special Duty Coordinator
Date:
Effective July 1, 2017
Re:
Employment of State Police Personnel at Outside Overtime Assignments
The employment of State Police personnel for outside assignments shall encompass the
following conditions:
1. Requests for State Police personnel must be made in writing at least one (1) week
in advance through the Special Duty Coordinator’s Office via facsimile (860)
706-1407 or emailed to
specduty.clerk@ct.gov
and will only be accepted on
the form provided. Regular business hours are Monday through Friday 0730 hours
(7:30AM) to 1730 hours (5:30PM). Requests will be accepted only during the hours 0730
hours 1730 hours (5:30 pm) Monday through Friday. All requests submitted after 1630
hours (4:30PM) may not be filled until the following business day.
THERE IS NO GUARANTEE THAT ANY REQUEST MADE WITH LESS THE 24 HOUR
NOTICE TO THE START OF THE JOB CAN BE ACCOMIDATED.
2. Please be reminded that all time requests must be made in military time. (Example:
01:00 PM = 1300 hours - 08:00 PM = 2000 hours)
3. A minimum of four (4) hours for each Trooper/Sergeant assigned will be billed, unless
the Special Duty Coordinator’s Office or State Police Message receive notification of
cancellation at least twenty-eight (28) hours in advance of the scheduled start
time.
A. During regular business hours Monday through Friday 0730-1730 hours,
cancellation notifications must be made in writing directly to the Special Duty
Coordinator’s Office via facsimile (860) 706-1407.
B. After regular business hours, weekends or holidays, cancellation notifications
must be made in writing to the State Police Message Center via facsimile
(860) 685-8346 or via email dps.messagecenter@ct.gov.
Telephone: (860) 685-8420 Fax: (860) 706-1407
1111 Country Club Road
Middletown, CT 06457-2389
An Equal Opportunity Employer
S T A T E O F C O N N E C T I C U T
DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION
Special Duty Coordinator’s Office
To:
All Contractors
From:
The Special Duty Coordinator
Date:
Effective July 1, 2017
Re:
Employment of State Police Personnel at Outside Overtime Assignments
The employment of State Police personnel for outside assignments shall encompass the
following conditions:
1. Requests for State Police personnel must be made in writing at least one (1) week
in advance through the Special Duty Coordinator’s Office via facsimile (860)
706-1407 or emailed to
specduty.clerk@ct.gov
and will only be accepted on
the form provided. Regular business hours are Monday through Friday 0730 hours
(7:30AM) to 1730 hours (5:30PM). Requests will be accepted only during the hours 0730
hours 1730 hours (5:30 pm) Monday through Friday. All requests submitted after 1630
hours (4:30PM) may not be filled until the following business day.
THERE IS NO GUARANTEE THAT ANY REQUEST MADE WITH LESS THE 24 HOUR
NOTICE TO THE START OF THE JOB CAN BE ACCOMIDATED.
2. Please be reminded that all time requests must be made in military time. (Example:
01:00 PM = 1300 hours - 08:00 PM = 2000 hours)
3. A minimum of four (4) hours for each Trooper/Sergeant assigned will be billed, unless
the Special Duty Coordinator’s Office or State Police Message receive notification of
cancellation at least twenty-eight (28) hours in advance of the scheduled start
time.
A. During regular business hours Monday through Friday 0730-1730 hours,
cancellation notifications must be made in writing directly to the Special Duty
Coordinator’s Office via facsimile (860) 706-1407.
B. After regular business hours, weekends or holidays, cancellation notifications
must be made in writing to the State Police Message Center via facsimile
(860) 685-8346 or via email dps.messagecenter@ct.gov.
Telephone: (860) 685-8420 Fax: (860) 706-1407
1111 Country Club Road
Middletown, CT 06457-2389
An Equal Opportunity Employer
4. A rate of $128.14 per hour per Trooper assigned or $162.18 per hour per Sergeant
assigned for OPA (Other Project Assignment) overtime with a four (4) hour minimum will
be charged. These rates include costs associated with the uniformed personnel, cruiser,
equipment and meals. The mealtimes will not be charged to the employer. These rates
are effective until June 30, 2018.
5. Assignments of State Police personnel are made on a rotating basis by computer
regardless of rank (Trooper or Sergeant), in accordance with department policy and
applicable labor contracts.
6. A Sergeant is assigned for every four (4) Troopers assigned to any one (1) project on the
same workday and time. (Example: 4 Troopers = 1 Sergeant or 8 Troopers = 2
Sergeants) In these cases, the Sergeant will act as the supervisor as well as control
traffic post(s) and provide the relief of personnel.
7. Assignments will include ½ hour of travel time to job site and ½ hour of travel time from
the job site per Trooper/Sergeant assigned.
8. The wishes of the contractor shall be given full consideration at all times by assigned
personnel, however, it must be understood that the assigned personnel are not under
the command or control of the contractor.
9. It is the contractor’s responsibility to make sure that the site foreman or authorized
designee verifies the hours worked and signs the DPS-693-C form (HCP or OPA Project
Overtime Report) for each Trooper/Sergeant assigned and retains the contractor’s copy
of the DPS-693-C form.
10. Forms are to be signed by the Foreman or his designee, at the completion of
the assignment.
S T A T E O F C O N N E C T I C U T
DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION
Special Duty Coordinator’s Office
REQUEST AND CANCELLATION FORM FOR STATE POLICE TRAFFIC SERVICES
Trooper $128.14 Per Hour
Sergeant $162.18 Per Hour
RATES THROUGH JUNE 30, 2018
OPA
Company Name: ________________________________________________________________
Meeting Location: _________________________________________ Town: _______________
(Existing Request)
(Existing Request)
NUMBER OF
CHANGE NUMBER
DATE(S)
TIME
TROOPER(S)
TIME CHANGE
OF TROOPERS
CANCEL
1.
FROM
TO
FROM
TO
2.
FROM
TO
FROM
TO
3.
FROM
TO
FROM
TO
4.
FROM
TO
FROM
TO
5.
FROM
TO
FROM
TO
6.
FROM
TO
FROM
TO
7.
FROM
TO
FROM
TO
8.
FROM
TO
FROM
TO
9.
FROM
TO
FROM
TO
10.
FROM
TO
FROM
TO
Is this a new Job?
Yes
No
Contact Person/Foreman____________________________ Cellular Number (___) _________________*
Subcontractor Information________________________________________________________
Email_____________________________________________________________*
I have read and understand the Department of Public Safety Division of State Police rules for Special Duty Overtime assignments.
Signature on DPS-693-C form states hours worked are correct and company will be billed for those hours.
*THE SPECIAL DUTY COORDINATOR’S OFFICE WILL BE UTILIZING AN EMAIL NOTIFICATION SYSTEM TO
COMFIRM REQUESTS HAVE BEEN RECEIVED AND TROOPERS ASSIGNED.
THERE WILL BE A FOUR (4) HR MINIMUM CHARGE WITHOUT A TWENTY-EIGHT (28) HR CANCELLATION NOTICE
_________________________________________________
__________________
(Signature and Title of Company Representative)
(Date)
DPS-693-C-1 (Revised 10/2012)
Telephone: (860) 685-8420 Fax: (860) 706-1407
1111 Country Club Road
Middletown, CT 06457-2389
An Equal Opportunity Employer
S T A T E O F C O N N E C T I C U T
DEPARTMENT OF EMERGENCY SERVICES AND PUBLIC PROTECTION
Special Duty Coordinator’s Office
CONTRACTOR BILLING INFORMATION
FOR STATE POLICE TRAFFIC SERVICES
Trooper $128.14 Per Hour
Sergeant $162.18 Per Hour
RATES THROUGH JUNE 30, 2018
OPA
Company Name:
Address:
Billing Address:
City/State/Zip:
Telephone:
Facsimile:
Contact Person For Billing:
Federal Employers ID Number:
Social Security Number:
Tax Exempt Number (if applicable):
I have read and understand the Department of Public Safety Division of State Police rules for Special Duty Overtime assignments.
Signature on DPS-693-C form states hours worked are correct and company will be billed for those hours.
*THE SPECIAL DUTY COORDINATOR’S OFFICE WILL BE UTILIZING AN EMAIL NOTIFICATION SYSTEM TO
COMFIRM REQUESTS HAVE BEEN RECEIVED AND TROOPERS ASSIGNED.
THERE WILL BE A FOUR (4) HR MINIMUM CHARGE WITHOUT A TWENTY-EIGHT (28) HR CANCELLATION NOTICE
_________________________________________________________
__________________
(Signature and Title of Company Representative)
(Date)
DPS-693-C-2 (Revised 10/2011)
Telephone: (860) 685-8420 Fax: (860) 706-1407
1111 Country Club Road
Middletown, CT 06457-2389
An Equal Opportunity Employer
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