HomeMy WebLinkAboutContractCAG-23-225
AUTH ORIZED EMERGENCY VEHICLE PERMIT
APPLICATION
6.Certification: This application for an Authorized Emergency Vehicle Permit will not be accepted unlessCERTIFIED by the chief law enforcement officer or fire chief (if the vehicle is to be used for firefighting
purposes) of each primary jurisdiction in which the vehicle(s) are to be used as authorized emergencyvehicles (see part 4 of this application). If the application is made by the chief of a law enforcement agencyor fire department, it must be CERTIFIED by the head of the political sub-division. The certification must
include the following language:
"I hereby certify that I have reviewed this entire application; that I am aware that the applicant intends to use
the vehicle(s) and emergency equipment listed in part 2 of this application, for the specific purposes listed in
part 1 of this application; that a need exists in my jurisdiction for the listed vehicle(s) to be used as
authorized emergency vehicles and that the applicant has the appropriate authority as described in part 1 of
this application to operate such equipment; and I know of no reason why this application should be denied."
Pl.ease type o�-(.
Signature _)
Name d 0 L ( I{-.(Please Print) C5Yl '::)(_,, V)U Q._,
Phone (% )'430· 755S
Restrictions
Date 1.t/Zb/Z5 Title CJ0<�� c� ti> \tc.e
Jurisdiction Renton, City of
E-Mail JSC..HULID\ <e> f2�-kmwA,�OV
Note: This page may be copied if additional certifications need to be added to the permit. Any additional
sheets attached must provide the certification information in the same format as above.
3000-323-006 (R 8/15) Page 8 of 8