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Home My WebLink AboutCAG2018-0336 - Original - Elite Motor Escort, Inc. - Authorized Emergency Vehicle Permit Application - 04/30/2018 t ' Chief of Police It is that time of year for permit renewal and so we are requesting your approval on this permit. We look forward to working with you and the comunity that serve as we have for years to provide safe transport of funeral processions in your jurisdiction. Since time is short we hope you will expedite this asap. Thank You, Leroy Barker ermit Dir or Elite motor Escort ELITE MOTOR ESCORT INC. - -- - -- - -�_- (206) 466-2161 - "Your Safety Is Our Concern" AUTHORIZED EMERGENCY VEHICLE PERMIT K!R APPLICATION [DATE APPROVED: VALID UNTIL: CAPTAIN: WASHINGTON STATE PATROL EQUIPMENT & STANDARDS REVIEW UNIT GENERAL ADMINISTRATION BLDG 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 Address PO Box 66897 City Burien State WA Zip 98166 dave@elitemotorescort.com Phone (206)466-2161 E-mail leroybarkernamsn.com 1. Purpose of Application/Authority: Describe below the specific purpose for which the vehicle(s)will be used as authorized emergency vehicle(s) and what necessitates permitting as an authorized emergency vehicle. The purpose should include the nature and scope of the duties, responsibilities, and intended uses of emergency equipment, as well as the statutes that give authority for the listed equipment and uses. Assist local Funeral Directors and their"families"in a time honored tradition devoted to those that have Passed in procession of their loved ones to a place of internment while keeping the safety of the procession And general public at the forefront. RCW 46.37.194 Chapter 204-36 WAC WAC 308-330-446 WAC 204-36-050(3) 3000,-323-006(R 8/15) Page 1 de AUTHORIZED EMERGENCY VEHICLE PERMIT ILE 9 FAWN-OW APPLICATION 2. Vehicle Information: List all vehicles intended to be used as authorized emergency vehicles. For each vehicle, provide all vehicle and emergency equipment information as outlined below. Prior approval must be given before utilizing a new vehicle or a vehicle with equipment installed other than what is authorized under the current permit for that vehicle. Proof of insurance for each vehicle must be attached pursuant to WAC 204-36-030. If providing funeral escorts, proof of commercial insurance in Washington State or business use exemption must be provided pursuant to WAC 204-36-040. VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE M_OD_EL Lern q I q y --- ❑ SIREN W h�t' N j t ) A 1 1 2- M�`AKE MODEL p ❑ LAMP(S)(location/colors) 1. VIN r { 2[lr — 1 141)1 F&O -1��_�t��-. REGISTERED OWNER ❑ OTHER EQUIPMENT: DftVF- Ea VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2I0� L{'ty-% 74 00 SIREN AeAfN I JAI h 2- MAKE MODEL LAMP(S)(location/colors) or Cr()t_ur4 V)_etOri u e t -tw*r .Sc%ok,p o ,k Ply 000 2. VIN rA ItIcir .3(c, arAFPIi VJI ),xl1-7-10(- REGISTERED OWNER OTHER EQUIPMENT: ear VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL Roo 0 4L D H 7 0 IREN MAKE MODEL LAMP(S)(locatiordcolors) t-ea u,,Oj--rear cote,3 P T Ftf 0 3• VIN, Led :SFI"G e 6id� ir3 LI�_�Zy rw1)1 FMM 149,y�513y F �- _ � .� � .�5v> REGISTERED OWNER ❑ OTHER EQUIPMENT: c�tri L k q0 --\ 1 _ VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YE''AR// LICENSE NO. INSTALLED TAKE MODEL IREN U l e- 1q MAKE, MODEL- LAMP(S)(location/colors) II Igo N 4 rj C-5 4 �} �l 4. VIN Red FRO N r REGISTERED OWNER OTHER EQUIPMENT:00 he-(e-('l �.rres �� 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-ON(R 8/15) Page 2 o% 1 AUTHORIZED EMERGENCY VEHICLE PERMIT �i�!��r��• APPLICATION I 2. Vehicle Information: List all vehicles intended to be used as authorized emergency vehicles. For each vehicle, provide all vehicle and emergency equipment information as outlined below. Prior approval must be given before utilizing a new vehicle or a vehicle with equipment installed other than what is authorized under the current permit for that vehicle. Proof of insurance for each vehicle must be attached pursuant to WAC 204-36-030. If providing funeral escorts, proof of commercial insurance in Washington State or business use exemption must be provided pursuant to WAC 204-36-040. I VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL Q .. 2-00(0 q_i�O C� 1 SIREN _ MAKE MODEL SLAMP(s)(location/colors) Par- 4 VIN 114 J REGISTERED OWNER OTHER EQUIPMENT: 1'I')dVirq C,enfie.r _ . - VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEARp LICE_N O. INSTALLED MAK MODEL �CaQ(j L-I_ l 4.6 SIREN I EY MAK MO EL- ® LAMP(S)(location/colors) eV, ee.�r L G� rn - u,hl�, raaxrr ��Tr VIN 19 rMM X6y Red 3h0.-rnQ_ 1 - goo ms REGISTERED OWNER ❑ OTHER EQUIPMENT: pRv 10 C I Cm-e4u t' VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO_ INSTALLED MAKE MODEL 601 0D7750 SIREN `In I are, MAKE MODEL LAMPS}(location/colors} 7 VIN �S- 3KAUC 21-0851914-7 - REGISTERED OWNER OTHER EQUIP ENT- ed VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 10434 Lern SIREN _ MAKE MODEL qLAMPS) (location/colors) cc� �iirItV r LN'T P ' -e_& � - r .,hf_k- � Par3C C� VIN , e k) t c- gar W �. �i s r� REGISTCRED OWNER Ll O HER EQUIPMENT: rr $[ i e4 0_ i Corm 3 f S O b e- U rr l er 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&15) Page 3 AUTHORIZED EMERGENCY VEHICLE PERMIT ?! ?w4 � APPLICATION uOr. 2. Vehicle Information: List all vehicles intended to be used as authorized emergency vehicles. For each vehicle. provide all vehicle and emergency equipment information as outlined below. Prior approval must be given before utilizing a new vehicle or a vehicle with equipment installed other than what is authorized under the current permit for that vehicle. Proof of insurance for each vehicle must be attached pursuant to WAC 204-35-030. If providing funeral escorts, proof of commercial insurance in Washington State or business use exemption must be provided pursuant to WAC 204-36-040, VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL i l 5� 4 EQ SIREN 0 la MAKE MO EL ❑ LAMP(S)(location/colors) vN r{ rt-H T r wh - eI€r ej 1 if D I--r-rn l X C B� l 'L> REGISTERED OWNER ❑ OTHER EQUIPMENT: [a htuj - VEHICLE INFORMATION_ _ _ EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED� `,,MAKE MODEL SIREN — - -rIEItIV Sly 0 11R MAKE MODEL ❑ LAMP(S)(location/colors) (Jrltv F ► 4TC R d �I7 rear "d e P 7� I VIN 1 .0-DI FM )H06g73 — REGISTERED OWNER ❑ OTHER EQUIPMENT: VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL �S�� ((�� - � _ 9 9&3 0 ( - L&SIREN — � MAKE MODEL LAMP(S) (location/colors) Nr y r- L It Tt�-- -- ijm ':—P �I+D REGISTERED OWNER ❑ OTHER EQUIPMENT: So e'r 5h f-rw C oc) - - - - --- VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR CC'' LICENSE NO. INSTALLED MAKE,, f � MODEL d7 �L? �RENMAKE MODEL (location/colors) - FF q a 73 VIN ht�� fGro en2 _� ' g� REGISTERED OWNER ❑6THER EQUIPMENT: 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. 3000323-006(R 0/15) Page AUTHORIZED EMERGENCY VEHICLE PERMIT &.1 ,,,,� APPLICATION 2. Vehicle Information: List all vehicles intended to be used as authorized emergency vehicles. For each vehicle, provide all vehicle and emergency equipment information as outlined below. Prior approval must be given before utilizing a new vehicle or a vehicle with equipment installed other than what is authorized under the current permit for that vehicle. Proof of insurance for each vehicle must be attached pursuant to WAC 204-36-030. If providing funeral escorts, proof of commercial insurance in Washington State or business use exemption must be provided pursuant to WAC 204-36-040, i VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION [—LY—E7AR LICENSE NO. INSTALLED MAKE MODEL E MODEL ® LAMP(S)(location/colors) 2 le.v Ft-H TT i �d Fkwt R ed r C., 0nD- L e-d 3 VI N L-e el f s I -e rz w hi l' I JffW Ve r' L2,Tf R _U4D1 XY 4i REGISTERED OWNER C. HER;EQUIPMENT:Oj Sick—r'car rt4j (GHR4 J hrp k � f i1 , cl- R, i�: t 7 C 'G VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED rrMAKE MOODDE_L ,t d!9 1- ,�_A 0 'ffSIREN 1 I I>?��lv _1 U�` 4�►` _ r�1M1AKE MODEL ❑ LAMP(S) (location/colors) J VIN 1 1401 F O " -7 tl r� REGISTERED OWNER Lj OTHER EQUIPMENT- I _ [ _ .fed �.11?_K/ Q Se r i e e-Ili iq P. i L o 6 o I e- !�' rj L f �! ) C' I VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL . _ Gin —... ❑ SIREN TA — _E ❑EL LAMP(S) (location/colors) 1 VIN_WBIN19 1 a -7-0 083 REGISTERED OWNER) ❑ OTHER EQUIPMENT: VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICIENSE NO. INSTALLED AKE MODEL SIREN ,-'L.k�4 I MAKE M. DEL ❑ LAMPS)(location/colors le , T tDV � - -- Nloco � hEi �� t t s 5 P�.L/oZff5_j q - T ra REGISTERED OWNER ❑ OTHER EQUIPMENT: 41 Yauw 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 8115) Page AUTHORIZED EMERGENCY VEHICLE PERMIT APPLICATION w 2. Vehicle Information: List all vehicles intended to be used as authorized emergency vehicles. For each vehicle, provide ail vehicle and emergency equipment information as outlined below, Prior approval must be given before utilizing a new vehicle or a vehicle with equipment installed other than what is authorized under the current permit for that vehicle. Proof of insurance for each vehicle must be attached pursuant to WAC 204-36-030. If providing funeral escorts, proof of commercial insurance in Washington State or business use exemption must be provided pursuant to WAC 204-36-040. VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED D MAKE MODEL 900 -I�y QF-(3-(j 95 ❑ SIREN M KE MODEL ❑ LAMP(S) (location/colors) C oI VIN -- 1 �71 -- REGISTERED OWNER ❑ OTHER EQUIPMENT: 6)rre-5+ 14 Ur a- f VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO- INSTALLED MAKE MODEL ❑ SIREN _ MAKE MODEL ❑ LAMP(S) (location colors) 2. VIN REGISTERED OWNER ❑ OTHER EQUIPMENT: VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. _ INSTALLED MAKE MODEL SIREN MAKE MODEL ❑ LAMP(S) (location/colors) 3.'VIN _ -- REGISTERED OWNER OTHER EQUIPMENT: VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. _ INSTALLED MAKE MODEL____ ❑ SIREN MAKE MODEL ❑ LAMP(S) (location/colors) 4.1 VIN REGISTERED OWNER ❑J OTHER EQUIPMENT: 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. aooaara oos(R 8/15) Page AUTHORIZED EMERGENCY VEHICLE PERMIT A X w APPLICATION U 3. Operators: Please list all drivers that will be authorized to operate the vehicle(s) listed in this application and indicate whether or not the operator/driver is new since your last application by placing an X in the "New?"column; otherwise, leave this column blank. No drivers should be listed unless they have been approved. Per WAC 204-35-040, all operators involved in traffic control must be a Washington State certified flagger, and carry their certified flagger card at all times. Name Driver's License Number Flagger Certification Number W_ New? (if applicable—see AC 204-36-040) M No— 2 1 r nt YI CA 1 tau CIe.m��" �� (�� .�5- o NO :3, C-DID Ut4 eA+1 .-p- C oLeki.5 V- :53 i " ,.3-5-ZozG t-.!o Lf brr1cr ri8(e- ,1 14eNIv urrL.aN3150 j- g ns-zo-w 1J 0 q t a%j ne5ft 33H)-43 C 3 s-Zol 1"16 90 -7 V 1 k 0 fb r're- i-I��c�+ p yR 7/n'� 2�� x� r��4 � zc 0 ` �r1ki 1 I`r 11'y1e,--, P)IGI1Ce- W i Ls� jn�43�'�► ' '-43`d C—x C o3 ZL zL' N 0 Lug vrn a t� L� 376676E 7-q -Z.11I q -- 0 IQ e'157 try-7- 33y:Aq2 Ex . 3-5-Z-026 �vl C) II. Ra rJ Gn rAAtn 19, �a rA f 0 v- 5%5 t, 374ZIq Lx 3`-d3 -2ci9 0 12, Oct Race- , er Ora 500 1 Lxp� J--5-Za-Lb 13 lAdV41 Ti mzsthy lid ori� I--y_1�.�D 35S338 Ex 00 ly, hoc h rgt.,, ANAceL F5. (vch rots 1Sq K 334 - �S ��,3 5-ZCz� Ye-5 15 hL l'l IJ r c-k� 15 EH Ll Y`R 33 Z`t�t L r -wzo -5 3000-323-006(R W15) Page AUTHORIZED EMERGENCY VEHICLE PERMIT APPLICATION «l 4. Geographic Area: Indicate which types of roads and which specific geographic area(s)the authorized emergency vehicles will be used. Certification from each jurisdiction is required under WAC 204-36-030. Certification is covered in section 6 of this application. City Streets (list all cities) . ................ ❑ County Roads (list all counties) ❑ State Routes/Interstates (list all state routes, interstates, and counties) 5. Permit Validation: I certify(or declare) under penalty of perjury under the laws of the state of Washington that the foregoing is true and correct to the best of my knowledge, information, and belief, and 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. 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 any purpose not authorized under this permit 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, I 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 listing all approved drivers and geographic areas authorized, as well as a copy of the vehicle permit authorizing emergency equipment is present in each vehicle at all times and must be presented to law enforcement, if requested. ze Signature •� Title EXECUTIf60fPIdE }� Name f'{'� q C�1 Date (TYPE OR PRINT) 3000-321-006(R 8/15) Page 4 of 5 AUTHORIZED EMERGENCY VEHICLE PERMIT '014 M A,- APPLICATION 6. Certification: This application for an Authorized Emergency Vehicle Permit 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 vehicle(s)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 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." Please type or prin Signature Date Title Name (Please Print) Jurisdiction ;�C"t Phone E-Mail 1A Restrictions Signature Date Title Name (Please Print) Jurisdiction Phone ( ) _ E-Mail _ Restrictions Signature Date Title '�o Name (Please Print) _ Jurisdiction Phone ( ) E-Mail Restrictions Signature Date Title Name (Please Print) Jurisdiction Phone ( ) E-Mail Restrictions Signature Date Title Name (Please Print) _ - Jurisdiction Phone ( ) E-Mail Restrictions Signature Date Title Name (Please Print) _ Jurisdiction Phone ( ) E-Mail Restrictions 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. 3000-323-005(R 8115) Page 5 of 5 Contact information Elite Motor Escort CEO Dave Eady daveeady@msn.com (206)466-2161 BOD Member Doug Clark drelark3@hughes.net (360) 275-5614 Permit Administrator Leroy Barker leroybarker@msn.com (206) 940-0523 ELITE MOTOR ESCORT INC. (206) 466-2161 "Your Safety Is Our Concern"