BODY WORN CAMERA RECORDS REQUEST

SECTION 1: VIDEO/INCIDENT IDENTIFICATION RCW 42.56.240(14)(d)

Phone

Alt. Phone

**Please provide more than one way of contact in case of technical issues.**

Provide as much information as you know about the incident so that staff may locate the relevant body worn camera recording(s) requested:

Name(s) of person(s) involved in incident:

Case #(s) (If known):

Location(s) of Incident:

Date(s) of Incident:

Time(s) of Incident

Identifying Information of Bonney Lake Police Officer(s) Involved in Incident

SECTION 2: VIDEO REDACTION FEE RCW 42.56.240(14)(e)

I am applying for a waiver of the video redaction fee due to the following: Check any of boxes that apply:

1. I am a person directly involved in the recorded incident. ATTACH PHOTO ID WITH REQUEST

2. I am an attorney representing a person directly involved in the recorded incident.

3. I am a person, or his or her attorney, requesting the recording relevant to his/her criminal case.

4. I am the executive director of the Washington State commission on African-American affairs, Asian Pacific American affairs or Hispanic affairs.

5. I am an attorney representing a person regarding a potential or existing civil cause of action involving the denial of civil rights under the federal or state constitution or a violation of a United States Departmentof Justice settlement agreement and seek relief from redactions costs pursuant to RCW42.56.240(14)(e).

6. None of the above; I am not eligible for a video redaction fee waiver. I understand that I will be charged video redaction costs, an estimate will be provided, and a 10% deposit is required prior to processing the request (or installment of the request). The staff rate for redactions is $52.00 per hour.

If you are an attorney, please provide your Bar Association number, state of licensure and contact information:

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If you checked Box 5 above, in addition to providing the above information, you must provide a statement explaining the relevancy of the requested body worn camera recording to the cause of action and specify- that you are seeking relief from redaction costs pursuant to 42.56.240 (14)(e).

SECTION 3: VIDEO DELIVERY METHOD

Please select one of the following options:

I would like the video(s) to be provided through the City’s public record request portal or email.

I would l like to be provided the video(s) on a DVD and will pay $1 per DVD, plus redaction fee(s)and mailing costs if applicable.

My email address is:

Acknowledgements:

I understand that per RCW 42.56.520, the City of Bonney Lake has five business days to respond to my request. If the information will not be available within five business days, an estimated date of completion will be given.

I understand that per RCW 42.56.240 the City of Bonney Lake will charge for video redaction costs, an estimate will be provided, and a 10% deposit is required prior to processing the request (or installment of the request), unless a waiver is applicable. The staff rate for redactions is $52.00 per hour; and that full payment may be required prior to delivery of documents. In addition, per RCW 42.56.120, the City may provide records on a partial or installment basis as they are assembled/readied for disclosure. In that event, I understand that the City may charge for each part of the request as it is provided, and that if I do not claim or review any installment of records requested, the City is not obligated to fulfill the balance of the request.

I understand that my request may contain information that is exempt from disclosure pursuant to specific exemptions contained in RCW 42.56 or other statutes. If this should be the case, I understand I will be notified in writing.

Sign Here for Video Records Request Submission:

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I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.