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HomeMy WebLinkAboutContract © AUTHORIZED EMERGENCY VEHICLE PERMIT "5�'" P APPLICATION RENEWAL WASHINGTON STATE PATROL DATE APPROVED: EQUIPMENT & STANDARDS REVIEW UNIT VALID UNTIL: GENERAL ADMINISTRATION BLDG CAPTAIN PO BOX 42600 (For Department Use Only) OLYMPIA WA 98504-2600 This application must be submitted by the Chief Executive of the firm or corporation making application. Please type or print in ink. Person, Company, Department, or Agency (if a person, must list agency/department representing) Elite Motor Escort Inc. Address P.O. Box 66897 City Burien State WA Zip 98166 dave@elitemotorescort.com/drclark3@ix.ne Phone (206)466-2161 E-mail tcom.com 1. Vehicle Information: List all vehicles being used as authorized emergency vehicles. For each vehicle, provide both the vehicle and emergency equipment information as outlined below. Any new vehicles—or vehicles with equipment installed other than what is authorized on the current permit for that vehicle—must receive prior approval before being utilized under this permit. VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ® SIREN Whelen WPA112 2007 LEM9194 ® LAMP COLOR(S) Red MAKE MODEL LAMP MAKE/MODEL Sound Off Inc EPRO55DBD HD FLHTP 1. VIN ❑ OTHER EQUIPMENT: 1 HD1 FMM 167Y649762 REGISTERED OWNER Dave Eady VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ® SIREN Whelen PA100 2008 LEM9196 ® LAMP COLOR(S) Red MAKE MODEL LAMP MAKE/MODEL Whelen PAR-36 HD FLHTP 2. VIN ❑ OTHER EQUIPMENT: 1 H D 1 FM M 1984607796 REGISTERED OWNER Dave Eady 3000-323-006 (R 12/09) Page 1 of 5 ®■❑ ®® AUTHORIZED EMERGENCY VEHICLE PERMIT W15HINGTON STATE PATROL APPLICATION RENEWAL J_ VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ® SIREN Whelen WPA112 1999 LEM7400 MAKE MODEL ® LAMP COLOR(S) Red LAMP MAKE/MODEL Wheten PAR-36 FORD CVPI 3 VIN ❑ OTHER EQUIPMENT: 2FAF971 W5XX105832 REGISTERED OWNER Dave Eady VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ® SIREN Whenen SD21OR 2012 LEM9907 ® MAKE MODEL LAMP COLOR(S) Red LAMP MAKE/MODEL HD Linear LED Ballast 4 V N FLHTP ❑ OTHER EQUIPMENT: 1 HD1 FMM10CB607827 REGISTERED OWNER Douglas Clark VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ® SIREN UTL 500 2006 843422 ® LAMP COLOR(S) Red MAKE MODEL LAMP MAKE/MODEL Whelen SPC-550 5. V N FLHTPI ❑ OTHER EQUIPMENT: 1HD1FMW126Y601610 REGISTERED OWNER Terry Ketcham VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ® SIREN Whelen WS320/SA350 2008 959804 LAMP COLOR(S) Red MAKE MODEL 2EROOZCR/D8045 HD FLHTP LAMP MAKE/MODEL Whelen 2 6. VIN ❑ OTHER EQUIPMENT: 1 H D 1 FH M 1 X8Y654004 REGISTERED OWNER James Irwin Note: This page may be copied if additional vehicles need to be added to the permit. Any additional sheets attached must provide the vehicle and equipment information in the same format as above. 3000-323-006 (R 12/09) Page 2 of 5 ®®mil AUTHORIZED EMERGENCY VEHICLE PERMIT W®�SNINGTON STATE PATROL APPLICATION RENEWAL ; I `, VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ® SIREN Whelen WS320-SA350 2008 990311 MAKE MODEL ElLAMP COLOR(S) Red LAMP MAKE/MODEL Whelen 09161 HD 3. V N FLHTP OTHER EQUIPMENT: 1 HD 1 FMM 138Y700488 REGISTERED OWNER Roger Sherwood VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ® SIREN Whelen PA100/WPA11 2011 567392 ® LAMP COLOR(S) Red MAKE MODEL LAMP MAKE/MODEL Whelen 700 Series I HD4. VIN FLHTPI ® OTHER EQUIPMENT: Red Pursuit Lamp Halogen H3 SealBeam 1 HD1 FMMIXBB679276 REGISTERED OWNER Sam Dolloff VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL El SIREN 100w STREET 2013 LEM9004 GALL'S THUNDER MAKE MODEL ® LAMP COLOR(S) Red 400 LED/400 5. HD FLHTP LAMP MAKE/MODEL Whelen LINEAR STROBE VIN ® OTHER EQUIPMENT: 1 HD1 FMM1 ODB631210 Red/white Whelen Slim Miser Siller Dash REGISTERED OWNER Red/white Whelen TIR 3x 1 watt LED 5503-11 Red/white Whelen Side Barker, Leroy Marker TIR 1 watt LED 100 VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ® SIREN SHOME 30.2104 2008 4C8470 ® MAKE MODEL LAMP COLOR(S) REDNUHITE LAMP MAKE/MODEL 911 CODE3 PTT 40__ s. V N FLHRPI ® OTHER EQUIPMENT: LEDS,RED LED STROBE E24 1HD1FMM148Y651348 STROBE FLASH,RED WHELEN SPS 660 REGISTERED OWNER PAR 36, RED LED STROBE PL10 Hock, Patrick Note: This page may be copied if additional vehicles need to be added to the permit. Any additional sheets attached must provide the vehicle and equipment information in the same format as above. 3000-323-006 (R 12/09) Page 2 of 5 1111 AUTHORIZED EMERGENCY VEHICLE PERMIT WASHINGTO`STATE PATROL APPLICATION RENEWAL 71 VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL SIREN WHELEN WPA-1 2006 9A0874 MAKE MODEL ElLAMP COLOR(S) Red LAMP MAKE/MODEL CODE 3 PAR-4 HD FLHTPI 3. VIN ® OTHER EQUIPMENT: RED LIGHTS WHELEN TIR6 1HD1FHW116Y687015 REGISTERED OWNER Centers, Melvin VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL SIREN Whelen PA-100 2007 LEM9488 MAKE MODEL LAMP COLOR(S) Red LAMP MAKE/MODEL Whelen PAR-36 4 HD, FLHTPI n OTHER EQUIPMENT: 1HD1FHN1X7Y717276 REGISTERED OWNER James Wright - VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ® SIREN FEDERAL 2001 9051 LEM SIGNAL Duramax MS100 MAKE MODEL LAMP COLOR(S) Red BMW R1100RT P LAMP MAKE/MODEL FEDERAL GS2 SERIES A 5. VIN ® OTHER EQUIPMENT: WB1041A112C70083 RED LIGHT WHELEN 73 SERIES O GRILL REGISTERED OWNER WHITE LIGHT WHELEN MASTER Buck, Stephen VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ® SIREN Unitol/SanMin 80K S-100R 2001 OD7750 MAKE MODEL [2] LAMP COLOR(S) RED LAMP MAKE/MODEL Whelen PAR-36 6. Kawasaki KZ-1000P VIN ® OTHER EQUIPMENT: RED Truck Life Side Strobe JKAKZCP251 B519147 RED Gall Rear Strobe REGISTERED OWNER Goole, Kenneth Note: This page may be copied if additional vehicles need to be added to the permit. Any additional sheets attached must provide the vehicle and equipment information in the same format as above. 3000-323-006 (R 12/09) Page 2 of 5 AUTHORIZED EMERGENCY VEHICLE PERMIT ®5®GTONS® APPLICATION RENEWAL `l ;)� VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ® SIREN Whelen SA350MH 2014 LEM9834 ® LAMP COLOR(S) Red MAKE MODEL LAMP MAKE/MODEL Whelen 200 PAR36 HD FLHTP 3. VIN ❑ OTHER EQUIPMENT: 1 HD1 FMMIXEB521480 REGISTERED OWNER Matthew Laigo VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ® SIREN Whelen SA-350-MH 2004 LEM9776 ® LAMP COLOR(S) RedNVhite MAKE MODEL LAMP MAKE/MODEL Axixtech Xtreme PAR 36X7 4 V N FLHTPI ® OTHER EQUIPMENT: Winshield Array Whelen MO3LR 1 HD1 FHW164Y728137 Engine Guard Lights Whelen 500 Series REGISTERED OWNER EP 360Star/700 Steinauer, Matthew Tour Pak Lights HDNVhelen Series VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ® SIREN Whelen WS-320 2008 LEM9143 MAKE MODEL ElLAMP COLOR(S) Red LAMP MAKE/MODEL Whelen 6OROOXRR 5. V N FLHTP ® OTHER EQUIPMENT: Red Lamp Ehrir 60ROOBRR 1HD1FMM1X8Y685665 Red Lamp Sho-Me 11.8000SF REGISTERED OWNER Truck-Lite Signall Clement, David Red Lamp Stat 4050 VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL ® SIREN Whelen SA315P • 2006 LEM 9097 MAKE MODEL ® LAMP COLOR(S) Red LAMP MAKE/MODEL Whelen M6 6. Honda ST 1300 PA ® OTHER EQUIPMENT: White Strobe Whelen Linz JH2SC51796M400298 Red LED Whelen Tir 3 REGISTERED OWNER Fisher, Dick Note: This page may be copied if additional vehicles need to be added to the permit. Any additional sheets attached must provide the vehicle and equipment information in the same format as above. 3000-323-006 (R 12109) Page 2 of 5 . I AUTHORIZED EMERGENCY VEHICLE PERMIT WASHINGTONSTATE PATROL APPLICATION RENEWAL war 2. Purpose of Application: Describe the specific purpose for which the vehicle(s) shall be used as authorized emergency vehicle(s) and what necessitates the vehicles' registration as emergency vehicles. Explain the nature and scope of the duties, responsibility, and intended use of emergency equipment. Assist local Funeral Directors and their"families" in a time honored tradition, devoted to those that have passed, in a procession of their loved ones to the place of internment, while keeping the safety of the procession and general public at the forefront. Fiscal Year 3 November 2014 through 2 November 2015 3. Authority: Explain authority outlined under statute (Revised Code of Washington) that allows the vehicles' operators to use emergency equipment for the purpose outlined under part 2 of this application. RCW 46.37.194. Chapter 204-36 WAC WAC 308-330-466 WAC 204-36-050 (3) 4. Geographic Area: Check which types of roads you will be operating on and state the specific geographic area(s) in which the vehicles shall be used as authorized emergency vehicles (city, county, etc.). (Certification from each primary jurisdiction is required under part 7 of this application.) ® City Streets (list all cities) Renton ❑ County Roads (list all counties) ❑ State Routes/Interstates 5. Operators: Please list all drivers that you intend to have operating the vehicle(s) listed in this application and indicate whether or not the operator/driver is new since your last application. OPERATOR/DRIVER NEW OPERATOR/DRIVER NEW OPERATOR/DRIVER NEW Centers, Melvin ❑ Wright, James ❑ Buck, Steve ❑ Eady, Dave ❑ Sherwood, Roger ❑ Clement, David ❑ Hyett, Roy ❑ Irwin, James William ❑ Fisher, Dick ❑ Ketchum, Terry ❑ Meyer, Paula ❑ Hock, Patrick ❑ Devlin, John ❑ Laigo, Matthew ❑ Coole, Kenneth ❑ Clark, Douglas ❑ Steinauer, Matthew ❑ Currier, Andy Dolloff, Sam ❑ Barker, Leroy ❑ Herbert, Chance (Use additional sheet if necessary) 3000-323-006 (R 12/09) Page 3 of 5 PATROL APPLICATION RENEWAL TON STATE HI AWSNGTE PA AUTHORIZED EMERGENCY VEHICLE PERMIT ;1`, J _�Jr- ��I® 6. Permit Validation: I certify that: a. All of the information given in this application is correct to the best of my knowledge and provided in its full format to the undersigned chief law enforcement officer or fire chief(if the vehicle is to be used for firefighting purposes) of each primary jurisdiction in which the vehicles are to be used as authorized emergency vehicle(s). b. None of the drivers, to the best of my knowledge in the last year, have been convicted of, nor served any sentences or periods of probation for any felonies, nor arrested and convicted of a drug or alcohol violation or illegal use or possession of drugs, nor been required to register as a sex offender, nor have any of them been adjudicated incompetent or insane. c. Only the vehicle(s) and equipment listed in this application will be used as outlined in this application, and that only the operators listed under this permit will drive the vehicle(s). As the primary holder or executive officer in charge of overseeing this permit, I understand that if the permit is issued, it is my responsibility to ensure: a. No driver listed in this permit uses the vehicle for private purposes unless all emergency equipment is removed or covered. b. No driver other than those listed under this approved permit operates the vehicle(s) listed unless all emergency equipment is removed or covered. If I wish to add a new driver or vehicle to this permit, must receive prior approval before they are authorized under this permit. c. The driver must exercise due care and caution and must obey all traffic laws. I understand that the inappropriate or misuse of authorized emergency vehicles may result in criminal or civil liability as well as cancellation of this permit as outlined under chapter 204-36 WAC. In addition, I understand that it is my responsibility to ensure that a copy of this permit and list of approved drivers are present in each vehicle at all times and must be presented to law enforcement, if requested. Signature Title Owner/Board Of Director (C IEF OFFICER) Name Dave Eady/Douglas Clark Date 10/27/2014 (TYPE OR PRINT) 7. Certification: This renewal application for Authorized Emergency Vehicle Permits will not be accepted unless CERTIFIED 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 vehicles are to be used as authorized emergency vehicles(see part 4 of this application). If the application is made by the chief of a law enforcement agency or fire department, it must be CERTIFIED by the head of the political sub-division. The certification must contain 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 as specifically described in part 2 of this application; that a need continues to exist in my jurisdiction for the listed vehicles to be used as authorized emergency vehicles and that the applicant has the appropriate authority as described in part 3 of this application to operate such equipment; and I know of no reason why this application should be denied." Please type or prints 9 , • Signature �" Date G✓ Title 9 �,, f�--� l G CiIA I P-P c>c Name • (Please Print) K��j� lM(II5vIC k Jurisdiction CAI) 12e Phone (L ) L{ - 150 E-Mail KlAk I eA)(rL.,C rea��-r Restrictions �(JJ 3000-323-006 (R 12/09) Page 4 of 5