The URL can be used to link to this page

Home My WebLink AboutCAG2018-0352 - Original - Premier Motor Escort, LLC - Authorized Emergency Vehicle Permit Application - 03/13/2018 AUTHORIZED EMERGENCY VEHICLE PERMIT APPLICATION DATE APPROVED: VALID UNTIL:__ CAPTAIN: WASHINGTON STATE PATROL EQUIPMENT& STANDARDS REVIEW UNIT GENERAL ADMINISTRATION BLDG PO BOX 42600 For Department Use Onl 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) Premier Motor Escort, LLC. i Address PO Box 55634 _ City Shoreline State WA Zip 98155-0634 Phone (206)542-4763 E-mail PremierMotorEscort(comcast.net 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. We provide motor escort services to local Funeral Directors and 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. RC W 46.37.194 Chapter 204-36 WAC WAC 308-330-466 WAC 204-36-050(3) 3000-323-006(R 6115) Page 1 of 6 AUTHORIZED EMERGENCY VEHICLE PERMIT WSIF 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. 1f 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 2006 4D9116 ®SIREN Whelen JWPAI 12 MAKE MODEL ® LAMP(S)(location/colors) Ilonda STI3001A Front: Red/Clear Whelen 1400-1 LIN/_6 t• VIN Sides: Red/Clear Whelen I500 +-I.INZ6 J 112SC 51706M400268 REGISTERED OWNER ® OTHER EQUIPMENT: Rear! Red/Clear Whelen I-IR3 i V4RRRR DC13a1-tulm'I'homas P Clear Strobe 3M[r)dcom 792H VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2017 9208LEM ® SIREN Whelen W11A 112 MAKE MODEL ® LAMP(S)(location/colors) I I-D FLI ITP Front: Red/Clear Whelen 150O 2• VIN Sides: Red/Clear Whelen 1500 LIti; I I I I)I FMC 131111643262 REGISTERED OWNER ® OTHER EQUIPMENT: Rear: Red/Clear Whelen SOU Parniczky,Julius Clear Strobe NovaPG VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2017 7F8101 ®SIREN Whelen ,SD21OR MAKE MODEL ® LAMP(S)(location/colors) 11-1) FI.I ITP Front: Red/Clear Whelen ILINZ6 Array 3•�VIN Sides: Red/Clear Whelen �00+LIN3 I 1 II)1 FMC I XI IB655974 .. ............ . REGISTERED OWNER ❑ OTHER EQUIPMENT: Rear: Red/Clear Whelen 5[H) 1 Ivbrid�;e.,lobo VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 3000 2D8902 ® SIREN Fennix Storm Pro MAKE MODEL ® LAMP(S)(location/colors) Kawamki K71000 Front: Red/Clear Whelen 4• VIN Sides: Red/Clear Whelen JKAKLCP24YB518 386 REGISTERED OWNER ® OTHER EQUIPMENT: Rear:Red/Clear Whelen Nishl. nri, Kenneth W. 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 0115) Page 2 of 5 AUTHORIZED EMERGENCY VEHICLE PERMIT Ccwmrnm APPLICATION WID,_r 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 WAG 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 MODEL 2017 90161,EM ®SIREN Whelen WSSIIA30 MAKE MODEL LAMP(S)(location/colors) I-D FL11'1'P Front: Red/Clear Whelen 1INZ6 Army 11•1VIN Sides: Red/Clear Whelen �LINZ6 1111D I FMC I311B643830 REGISTERED OWNER ❑ OTHER EQUIPMENT: Rear: Red/Clear Whelen f LINZ.6 Radlbrd, Farl Stanley Jr VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2005 6C4291 SIREN Code 3 3950 MAKE MODEL ® LAMP(S)(location/colors) 13MW RI150RT Front: Red/Clear Code !PSFI-EDF12 2. VIN Sides: Red/Amber Code 3 PSFLEDF12 W1310499A85ZE96222 REGISTERED OWNER ❑ OTHER EQUIPMENT: Lear: Red/Clear Code 3 1PSE .L13F12 Ro ycr.serge VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2006 I F4256 ®SIREN Whelen 'SA314 MAKE MODEL LAMP(S)(location/colors) Ilunda STI300 Front: Red/Clear Whelen ILINZ6 Array 3. VIN Sides: Red/Clear Whelen 1'IR6 ,1I 12SC517 16M400294 REGISTERED OWNER ® OTHER EQUIPMENT: Rear: Red/Clear Whelen fl'IR3 + D4RRRR Krin gle, David S. I I Clear Strobe 3M Opticom VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL �_] SIREN MAKE MODEL ❑ LAMP(S)(location/colors) 4. VIN REGISTERED OWNER ❑ 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. 3000-323-006(R 8115) Page 2 of 5 AUTHORIZED EMERGENCY VEHICLE PERMIT APPLICATION 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 2p4_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 Certification Number New? (if applicable—see WAC 204-36.049) Thomas P DeBa►lolo DEBARTP395B8 395615 - Expires: 02/2021 Twyla R DeBartolo DEBARTR389BJ 377616- Expires: 01/2020 Anthony J DeBartolo DEBARAJ0970E 389487 -Expires: 09/2020 Julius 1? Parnicrky PARNIJ*363Q6 334190- Expires: 04/2018 I John Flybridge HYBRIJ*528JG 360390- Expires: 05/2019 Kenneth W Nishiyori NISHIKW377JA 334246- Expires: 03/2020 Earl Stanley Radford Jr RADFOES465RT 374214- Expires: 05/2019 Serge FE, Royer ROYERSF419DP 346608 - Expires: 04/2020 David Scott Kringle KRIN6DS397RH 389969- Expires: 08/2020 3000-323-005(R ens) Page 3 of 5 AUTHORIZED EMERGENCY VEHICLE PERMIT APPLICATION el Geographic Area: Indicate which types of roads and which speciffs geographic area(s)the authorized emergency vehicles will be used. Certification from each jurisdiction is required under WA(:.204.36-030. Cr-;r tification is covered in section 6 of this application. i City Streets (list all cities) Algona,AuhUrn, Bainbridge Island, Bellevue, Black Diamond, Bonney Lake, Bothell,Bremerton, Brier, I Buckley, Mirien,Carnation,Cle Elum,Covington,Des Moines, DuPont,Duvall,Edgewood, Edmonds, I llenaburg, Enumclaw, Everett, Federal Way,Fife,Gig Harbor, Issaquah, Kenmore, Kent, Kirkland, Lacey, Lake Forest Park, Lakewood, Lynnwood, Maple Valley, Medina, Mercer Island, Mill Creek, Milton, Monroe, Mountlake Terrace, Mukilteo, Newcastle, Normandy Park, Olympia,Orting, Pacific, Port of Seattle, Pot of Tacoma, POUlsbo,Puyallup, Redmond, Renton, Roy,Sammamish,Seatac, Port of Seattle, SEatl:le,Shoreline,Snohomish, Snoqualmie/North Bend, Sumner,Sumner,Tacoma,Tukwila, University Plane,Woodinville. 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). h 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. G. 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. Signature _ Title Owner, P_rcm_ier Motor Escort, I,L(_' (CHIEF E=XEGU-rIV$OFFICER) Name 'four Dcl3adolo Date 02/23/2018 (TYPE OR PRINT) nun:ct:oin lit uic,� �� Page 4 of 5 I AUTHORIZED EMERGENCY VEHICLE PERMIT 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 SIGN or fire department, it must be CERTIFIED by the head of the political sub-division, The certification must Tri E R E 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 pri Signature Date b Title �ln. Name, .r■+��,� �,��t Jurisdiction ] (Please Prm) � v L�VY'Ci!. Phone ( - E-Mails w� ''�'"�,6.0 J Restrictions V-A �'!� Signature _ _ Date Title Name (Please Print) Jurisdiction Phone ( ) E-Mail Restrictions Signature _ Date Title Name Jurisdiction (Plensn Pnnt) __ - Phone ) E-Mail Restrictions Signature Date Title Name (Please Prml) Jurisdiction Phone _( ) E-Mail Restrictions Signature Date Title _ Name (Please Pont) Jurisdiction Phone _t ) E-Mail Restrictions Signature Date Title Name Jurisdiction (Please Print) 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. 3000-323-00C(R 8115) Page 5 of 5