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Home My WebLink AboutCAG2019-0347 - Original - Kent School District - Authorized Emergency Vehicle Permit Application - 04/24/2019'ß1,f;\< AUTHORIZED EMERGENCY VEHICLE PERMIT APPLICATION nnt- ffiËËP Ïhis application must be submitted by the Chief Executive of the firm or corporation making application WASHINGTON STATE PATROL EQUIPMENT & STANDARDS REVIEW UNIT GEN ERAL ADMI N ISTRATION BLDG PO BOX 42600 OLYMP|A WA 98504-2600 DATE APPROVED VALID UNTIL: CAPTAIN: or Use Services Please type or print in ink. Person, Company, Department, orAgency (if a person, must list agency/department representing) Address 12033 SE 256th St., A-200 Kent School District City Kent State WA Zip 98030 Phone (253\ 373-j256 E-mail kimberly.webb(Ðkent.kl2.wa.us 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 emèigency vehicle. The purpose should include the nature and scope of the duties, responsibilities, and intenãed úses of emergency equipment, as well as the statutes that give authority for the listed equipment and uses. New operator(s) added to the AEVP L Victor Ruiz Hermenejildo Vehicle(s) out of service: 1. 2017 Ford Explorer - Plate: 84029C 3000-323406 (R 8/1 5)Page 1 of5 AUTHORIZED EMERGENCY VEHICLE PERMIT APPLICATION F*ç*Rmuær 2 Vehicle lnformation: 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. lf 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 1 YEAR 2009 LICENSE NO 87297C MAKE Chevrolet MODEL Tahoe VIN tGNFKO30X9R202t96 REGISTERED OWNER Kent School District (SP100) VEHICLE INFORMATION 4. YEAR 201s LICENSE NO é^6259C MAKE Chevrolet MODEL Tahoe VIN IGNSK3EC5FR5505IO REGISTERED OWNER Kent School District (SP99) Note: This page may be copied if additionalvehicles need to be added to the permit. Any additionalsheets attached must provide the vehicle and equipment information in the same format as above. EMERGENCY EQUIPMENT INFORMATION INSTALLED MAKE MODEL X srne¡r ls,q: t spWhelen 00 Series LAMP(S) (location/colors) Bar red/white Whelen OTHER EQUIPMENT: VEHICLE INFORMATION 2. YEAR 2009 LICENSE NO 81298C MAKE Ford MODEL Crown Vic VIN 2FAHP7tV49X134774 REGISTERED OWNER Kent School District (SPl01) EMERGENCY EQUIPMENT INFORMATION INSTALLED MAKE MODEL X slne¡.1 Federal Sienal 1500 Series Series LAMP(S) (location/colors) Bar red/white Whelen n oruen ËeurPMENT VEHICLE INFORMATION 3. YEAR 2015 LICENSE NO 1'6260C MAKE Chevrolet MODEL Tahoe VIN 1GNSK3EC9FR552776 REGISTERED OWNER Kent School District (SP98) EMERGENCY EQUIPMENT INFORMATION INSTALLED MAKE MODEL X slnrr.t lse¡ tspWhelen IONR SX Push LAMP(S) (location/colors) Bar red/white Whelen red/wht Whelen OTHER EQUIPMENT Rear red/white Whelen ide LEDS EMERGENCY EQUIPMENT INFORMATION INSTALLED MAKE MODEL X srneru lsa: lspWhelen IONR SX Push LAMP(S) (location/colors) Bar red/white Whelen red/wht Whelen OTHER EQUIPMENT Rear red/white Whelen dominator 3000-323-006 (R 8¡ 5)Page 2 of 5 AUTHORIZED EMERGENGY VEHICLE PERMIT APPLICATION ETI- üËiË 2 Vehicle lnformation: List all vehicles intended to be used as authorized emergency vehicles. For each vehicle, provide-.allvehicle and emergency equipment information as outlined Oélow. Prior approval must begiven before utilizing a new vehicle or a vehicle with equipment installed other than what is althorized under It9."-rltqlt-permit for that vehicle. Proof of insurance for each vehicle must be attached pursuant to WAC204-36-030. lf providing funeral escorts, proof of commercial insurance in Washington State or businGss use exemption must be provided pursuant to WAC 204-36-040. VEHICLE INFORMATION I YEAR 2014 LICENSE NO Ái04207C MAKE Chevrolet MODEL Tahoe VIN l GNSK2EOXERI80797 REGISTERED OWNER Kent School Dishict (SP105) VEHICLE INFORMATION 2 YEAR 2014 LICENSE NO 1.4206C MAKE Chevrolet MODEL Tahoe VIN IGNSK2EO8ERI79468 REGISTERED OWNER Kent School District (SP102) VEHICLE INFORMATION 4 YEAR LICENSE NO MAKE MODEL VIN REGISTERED OWNER 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. EMERGENCY EQUIPMENT INFORMATION INSTALLED MAKE MODEL SIREN l5PWhelenlsa¡ LEDS SX Rear LAMP(S) (location/colors) Bar red/white Whelen red/white Whelen X orHrn EeuIPMENT: Rear Window red/wht Whelen dominator EMERGENCY EQUIPMENT INFORMATION INSTALLED MAKE MODEL SIREN t5PFederalsign lSa¡ IONR SX Push LAMP(S) (location/colors) Bar red/white Whelen red/wht Whelen WhelenRear Window OTHER EQUIPMENT dominator VEHICLE INFORMATION 3. YEAR 2017 LICENSE NO B,4028C MAKE Ford MODEL Explorer VIN IFM5K8AR8H6A17722 REGISÏERED OWNER Kent School District (SPl23) EMERGENCY EQUIPMENT INFORMATION INSTALLED MAKE MODEL X srnr¡r Whelen lsa¡ r sp IONR SX Push LAMP(S) (location/colors) Bar red/white Whelen red/wht Vy'helen OTHER EQUIPMENT Rear red/white Vy'helen dominator EMERGENCY EQUIPMENT INFORMATION INSTALLED MAKE MODEL n srnrru LAM P(S) (location/colors) OTHER EQUIPMENT: 3000-323-006 (R 8/1s)Page 2 of 5 AUTHORIZED EMERGENCY VEHICLE PERMIT APPLICATION ENE_wl¡ffißDEllñfW¡t 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 204-36-040, 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 Gertification Number (if applicable - see WAC 204-36-040)New? Aaron Boeckel BOECKAM256M4 David Can CARR*D35OKD Aron Copeland COPELAWl4lNF Paul Deaton DEATOPJ225PN David Fowler FOWLEDC324QF Matthew Gallagher GALLAMJ2OT}J49 Holly Hoel HOEL*HA335J5 Ronald Howell HOWELRJ2T2OT Eric Kauffman KAUFFERl33P9 Timothy Kovich KOVICTJ3O6PJ Shanon Lanz LANZ*SW394BM Jeffrey Martin MARTIJC265DE Michelle Martin MARTIMK3l3DL Jay Masters MASTEJP352DA Clint Maurer MAURECI275L4 Brian McMillan MCMILBLIT9MG Curt Newton NEWTOCH326Ql Twayne Rawls RAWLSTL359R3 Victor Ruiz Hermenej ildo RUIZHV*O73OO YES Israel Vela VELA*I*385P6 3000-323-006 (R 8¡ 5)Page 3 of 5 AUTHORIZED EMERGENCY VEHICLE PERMIT APPLICATION EE¡Õffiffi 4. Geographic Area: lndicate 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. X City Streets (list all cities)Covinston. Kent X County Roads (list all counties)Kine n State Routes/lnterstates (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. lf 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. ln 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. Signature Title Superintendent (cHr Name Dr. Calvin J. Watts oFFrcER) 3000-323-006 (R 8/15) (TYPE OR PRINT) Date L Page 4 of 5 AUTHORIZED EMERGENCY VEHICLE PERMIT APPLICATION UtrIr- üffirüP 6 Please type or print: Signature - 9g{tl¡*!gn: This application for an Authorized Emergency Vehicle Permit will not be accepted unless CERÏ|FlED 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 appttcq[o1). lf the application is made by the chief of a law enforcemènt âgency or fire department, it must be CERTIFIED by the head of the political sub-division. The certification must include the following language: "l 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 , for the specific purposes listed in part 1 of this application; that a need exists in my ju listed vehicle(s)to be used as authorized emergency vehicles and that the applicant h riate authority as described in part I of this application to operate such equipment; and I why this application should be denied." Name (Please Prinl) Phone Name (Plêasê Print) Phone (2s3\ 480-2430 Andrew McCurdv ate Title Police Chief Jurisd E-M Title Sheriff Jurisdi E- s'/- / z Title Police Chief Jurisdiction Kent Police Dept. Restrictions Signature Name (Please Pr¡nt)Mitzi Johanknecht Phone eo6\296-4tss Restrictions Signature Rafael Padilla (2s3) 8s6-s888 E-Mail rpadilla(ôkent.wa.gov Restrictions Signature Name (Please Pr¡nt) Date Jurisdiction E-Mail Title Phone ( ) Restrictions Signature Date Jurisdiction E-Mail Title Name (Please Pr¡nt) Phone Restrictions Signature Date Title Name (Plsase Print) Phone ( ) 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. Jurisdiction E-Mail 3000-323-006 (R 8/1 5)Page 5 of 5 Schools lnsurance Association of Washington CERTIFICATE OF COVERAGE rssueDare: 0a/23/20rg KentsD29 THIS CERTIFICATE IS ISSUED AS A MAITER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE MEMORANDUM OF COVERAGE (MOC) BELOW. THIS CERTIFICATE OF COVERAGE DOES NOT CONST ITUTE A CONTRACT BET WEEN THE I SSUING INSURER(S), AUIHOR IZED REPRESENTATI VE OR PRODUCER, AND THE CERT IFICATE HOLDER. IMPORTANT: lf the certilicate holder is an ADDITIONAL INSURED, the MOC musr be endorsed. lt SUBROGATION lS WAIVED, subject to the terms and cond¡tions of the MOC, ærlain coverage may does not confêr to lhe cerl¡ficale THIS IS ÏO CERTIFY THAT THE COVERAGES LISTED BELOW HAVE BEEN ISSUED IO IHE INSURED NAMED ABOVE FOR fHE COVERAGE PERIOD INDICATED. NOT WITHSTANDING ANYREQUIREMEM, TERM OR CONDITION OF CONTRACT OR OT HER DOCUMEM WITH RESPECT IO WHICH fHIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE COVERAGE AFFORDED BY THEMOCDESCRIBEDHEREINISSUR'ECTTOALLTHEIERMS,EXCLUSIONSANDCONDIIIONSOFSUCHMOC, LIMITSSHOWNMAYHAVEBEENREDUCEDBYPAIDCLAIMS. CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED COVERAGE BE CANCELLED BEFORE IHE EXPIRATION DATE THEREOF E WITH THE PROV PRODUCER COMPANIES AFFORDING COVERAGE Clear Risk Solutions 451 Diamond Drive Ephrata, WA 98823 Phone 509-754-2027 Fax 509-754-3406 GENERAL LIABILITY SIAWMunich Re et al AUTOMOBILE LIABILITY SlAWMunich Re et al. PROPERTY SlAWMunich Re, et al. CRIME / PUBLIC EMPLOYEE DISHONESTY SlAWMunich Re INSURED Kent School D¡strict #415 12033 SE 256th Street D,700 Kent, WA 98031-6643 COVERAGES TYPE OF COVERAGE MOC NUMBER MOC ÊFF DATE Moc ÈXÞ DATE GENERAL LIABILITY COMMERCIAL GENERAL LIABILIT Y OCCURRENCE FORM stAw181934025 09/01i2018 09i01/2019 GENERAL AGGREGATE PRODUCT.CO MP/OP AGG PERSONAL & ADV. INJURY EACH OCCURRENCE ANNUAL PROGRAM AGGREGATE $31,000,000 $31,000,000 $25,000,000 $25,000,000 $150,000,000(LIABTLTTY rS SUBJECT TO A $100,090 StR PAYABLE FROM PROGRAM FUNDS) AUTOMOBILE LIABILITY ANYAUTo S|AW'181934025 09/01/2018 09/01/2019 (LIABILITY IS SUBJECT TO A $1OO,OOO SIR PAYABLE FROM PROGRAM FUNDS) COMBINED SINGLE LIMIT ANNUAL PROGRAM AGGREGATE $25,000,000 NONE PROPERTY 514W181934025 09/01/2018 09/01/2019 ALL RISK PER occ EXCL EQ & FL $150,000,000 EARTHQUAKE PER OCC EXCLUDED FLOOD PER OCC (Ercepr FzA&v.wh¡ch¡'¡ruul $25,000,000 ANNUAL PROGRAM AGGREGATE NONE(PROPERW IS SUBJECI TO A $25O.OOO SIR PAYABLE FROM PROGRAM FUNDS) CRIME/PUBLIC EMPLOYEE DISHONESW (cRTMESUBTËcrro rcso,mo ncocnausrc) S14W181934025 09/01/2018 09/01/2019 pER L9SS $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / SPECIAL ITEMS Evidence of Coverage during the school year CERTIFICAÎE HOLDER AUTHORIZED REPRESENTATIVE Kent School District 12033 SE 256th, D700 Kent, WA 98030 0u1k Yh+w,** 3446644 , NOTICE WILL BE DELIVERED IN