Business Emergency Contact Information Form

The Los Altos Police Department is requesting after hours Emergency contact information for your business. This information will be kept confidential and utilized only in the event of an emergency: doors unlocked, flood, vandalism or a fire, etc. As an emergency responder, the contact person must be able to respond within 20 minuted and make emergency decisions.
Name of Business:
Address:
Zip Code :
Owner/Primary Contact:
e-mail:
Business Phone:
Home Phone:
Cell Phone:
Web address:
Type of Business:
   
EMERGENCY CONTACT PERSON(S):
NOTE: CONTACT PERSON SHOULD BE ABLE TO RESPOND IN 20 MINUTES.
Emergency Contact
Home Phone:
Cell Phone:
 
Emergency Contact
Home Phone:
Cell Phone:
 
Emergency Contact
Home Phone:
Cell Phone:
   
Please include any information that may affect officer saftey when at this address (example: hazmat, animals, locked gate, gardener/housecleaner on specific days, etc.):
1.
2.
   
Alarm Company:
Phone:
Enter Code: