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Home My WebLink AboutCAG2021-133 - Original - Kent School District - Emergency Vehicle Permit - 09/15/2020 Agreement Routing Form • For Approvals,Signatures and Records Management KENT This form combines&replaces the Request for Mayor's Signature and Contract Cover Sheet forms. WASHINGTON (Print on pink or cherry colored paper) Originator: Department: Jalene King Police Date Sent: Date Required: > 3/16/2021 0 Authorized to Sign: Date of Council Approval: Q 0 Director or Designee ❑ Mayor Budget Account Number: Grant? ❑Yes O No N/A Budget? ❑Yes ❑ No Type: N/A Vendor Name: Category: Kent School District Application 0 Vendor Number: Sub-Category: c N/A Original Project Name: enc Emerg y Vehicle Permit E i Project Details:Emergency situations at various schools within the Kent School District c a Agreement Amount:0 Basis for Selection of Contractor: all Start Date: Termination Date: a1 Q Local Business? ❑Yes ❑ No* *If meets requirements per KCC 3.70.700,please complete"Vendor Purchase-Local Exceptions"form on Cityspace. Notice required prior to disclosure? Contract Number: ❑Yes ❑ No CAG2021-133 Date Received by City Attorney: Comments: p1 C n 30 a, •� i � 3 � 40 f0 p� Date Routed to the Mayor's Office: V1 Date Routed to the City Clerk's Office: adccW22313_1_20 Visit Documents.KentWA.gov to obtain copies of all agreements i AUTHORIZED EMERGENCY VEHICLE PERMIT APPLICATION DATE APPROVED.- VALID UNTIL: CAPTAIN: i WASHINGTON STATE PATROL I 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) KENT SCHOOL DISTRICT - SAFETY SERVICES Address 12033 SE 256TH STREET, SUITE A-200 City KENT State WA Zip 98030 Kimberly.webb@kent.kl2.wa.us Phone (253)373-7256 E-mail Timothy.Kovich@kent.kl2.wa.us 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. These vehicles will be used to respond to emergency situations at various schools within the Kent School District. Additionally,the vehicles will be used to assist with school related emergencies at bus stops and on school buses. j Chapter 204-36 WAC and RCW 46.37.190 provides for authority to use school district emergency vehicles for the purpose described above. 3000-323-006(R 6/15) Page 1 of 8 i AUTHORIZED EMERGENCY VEHICLE PERMIT j 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 i 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 2009 87297C Z SIREN WHELEN A31513 MAKE MODEL ® LAMP(S) (location/colors) Chevrolet Tahoe LIGHT BAR red wht WHELEN 500 SERIES 1. VIN — -- 1GNFK03OX9R202196 _ REGISTERED OWNER ❑ OTHER EQUIPMENT: KENT SCHOOL DISTRICT VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2009 _ _ 87298C _ ® SIREN FEDERAL SIGNAL 1500SERIES MAKE MODEL 3 ® LAMP(S) (location/colors) FORD _CROWN VICTORIA LIGHT BAR(red/wht) WHELEN 1500 SERIES 2• VIN 2FAHP71V49X134774 REGISTERED OWNER ❑ OTHER EQUIPMENT: KENT SCHOOL DISTRICT VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2015 A6260C _ _® SIREN WHELEN SA31511 MAKE MODEL ® LAMP(S) (location/colors) CHEVROLET TAHOE LIGHT BAR(red/wht) WHELEN _ LIBERTY SX 3. VIN PUSH BUMPER WHELEN 'LEDS IONR 1GNSK3EC9FR552776 REGISTERED OWNER ® OTHER EQUIPMENT: R.WINDOW red wht)_ WHELEN 4-LIGHTS _ KENT SCHOOL DISTRICT R.CARGO red/wht) WHELEN hIDES LEDS VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2015 A6259C ® SIREN WHELEN A315P _ MAKE MODEL ® LAMP(S) (location/colors) CHEVROLET TAHOE _ LIGHT BAR(red wht_)_ WHELEN LIBERTY SX 4• VIN PUSH BUMPER WHELEN ILEDS IONR 1GNSK3EC5FR550510 _ REGISTERED OWNER ❑ OTHER EQUIPMENT: R.WINDOW red wht WHELEN 4-LIGHTS KENT SCHOOL DISTRICT R.CARGO(red/wht) WHELEN hIDES LEDS 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 8/15) Page 2 of 8 AUTHORIZED EMERGENCY VEHICLE PERMIT MARM 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 MODEL 2014 A4207C aSIREN WHELEN SA325P MAKE i MODEL ® LAMP(S)(location/colors) CHEVROLE TAHOE LIGHT BAR(red/wht) WHELEN (LIBERTY SX 1 VIN -PA ISH-1111MP-ER W14F1_F-hI.�-�______1F-DS 10 hIR sGNSK2EoXERi8o797 REGISTERED OWNER ® OTHER EQUIPMENT: R.\Ly W Led/whtl WHELEN -LIGHTS KENT SCHOOL DISTRICT R.CARGO(red/wht) WHELEN SIDES LEDS VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2014 A42o6C _ ® SIREN WHELEN ISA31SP MAKE MODEL LAMP(S) (location/colors) CHEVROLE TAHOE LIGHT BAR(red/wht) WHELEN _ LIBERTY SX 2. VIN PUSH BUMPER WHELEN _LEDS IONR 3.GNSK2Eo8ERi79468 -- --- --- -- -- _ ---- REGISTERED OWNER ® OTHER EQUIPMENT: R.WINDOWredlwhty WHELEN 14 LIGHTS KENT SCHOOL DISTRICT R.CARGO(red/wht) WHELEN SIDES LEDS VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2015 A626oC SIREN _ WHELEN _ SA325P MAKE MODEL ® LAMP(S)(location/colors) CHEVROLE TAHOE _ LIGHT BAR(red/wht) WHELEN LIBERTY SX _ 3• VIN PUSH BUMPER WHELEN ILEDS IONR iGNSK3ECgFR552776 REGISTERED OWNER ® OTHER EQUIPMENT: R.WINDOW(red/wht)_ WHELEN -LIG TS KENT SCHOOL DISTRICT R.CARGO(red/wht) WHELEN ISIDES LEDS VEHICLE INFORMATION EMERGENCY EQUIPMENT INFORMATION YEAR LICENSE NO. INSTALLED MAKE MODEL 2017 B4028C ® SIREN WHELEN 1SA315P MAKE MODEL Z LAMP(S) (location/colors) FORD EXPLORER LIGHT BAR(red/wht) WHELEN _ LIBERTY SX 4. VIN PUSH BUMPER WHELEN ILEDS IONR 1FM5K8AR8H6A27722 REGISTERED OWNER ❑ OTHER EQUIPMENT: R.WINDOW red whit?_. WHELEN_ T 14-LIGHTS KENT SCHOOL DISTRICT R.CARGO(red/wht) WHELEN SIDES LEDS 3000-323-006(R 8115) Page 3 of 8 AUTHORIZED EMERGENCY VEHICLE PERMIT 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 MODEL 2020 C3466C -® SIREN WHELEN A31513 MAKE MODEL ® LAMP(S) (location/colors) FORD POLICE INTERCEPTOR AWD LIGHT BAR(red/wht) WHELEN LIBERTY SX 1. VIN -- P1 ISH RI IMPFR WHELFN 1FM5K8AB4LGA55671 REGISTERED OWNER ® OTHER EQUIPMENT: R.WINDOW red wht WHELEN 4-LIGHTS KENT SCHOOL DISTRICT R.CARGO red wht WHELEN IDES LEDS 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. VIN REGISTERED OWNER ❑ OTHER EQUIPMENT: 3000-323-006(R 6115) Page 4 of 8 AUTHORIZED EMERGENCY VEHICLE PERMIT ®® 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 MODEL SIREN _ MAKE MODEL ® LAMP(S) (location/colors) — 1. VIN ---- — --- REGISTERED OWNER ® OTHER EQUIPMENT: 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. VIN REGISTERED OWNER ❑ OTHER EQUIPMENT: 3000-323-006(R 8/15) Page 5 of 8 AUTHORIZED EMERGENCY VEHICLE PERMIT i 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 204-36-040, all operators involved in traffic control must be a Washington State i certified flagger, and carry their certified flagger card at all times. Name Driver's License Number Flagger Certification Number New? (if applicable—see WAC 204-36-040) RICARDO BLAND BLANDRH300Q3 YES AARON BOECKEL WDLB9NS6673B DAVID CARR CARR*D*350KD ARON COPELAND COPELAW141NF DAVID FOWLER WDL22SIFOSB MATTHEW GALLAGHER GALLAMJ207M9 JAMELL GOREE WDL629PF913B HOLLY HOEL HOEL*HA335J5 ERIC KAUFFMAN KAUFFER133P9 TIMOTHY KOVICH WDL66P45953B SHANON LANZ LANZ*SW394BM JEFFREY MARTIN MARTIJC265DE MICHELLE MARTIN MARTIMK313DL CLINT MAURER MAUREC12751-4 BRIAN MCMILLAN MCMILBLI79MG CURT NEWTON NEWT0CH326Q1 KENNY ODUM III ODUM*KJO84BL YES TWAYNE RAWLS RAWLSTL359R3 VICTOR RUIZ HERMENEJILDO RUIZHV*07300 ISRAEL VELA VELA*1*385P6 3000-323-006(R 8115) Page 6 of 8 1 AUTHORIZED EMERGENCY VEHICLE PERMIT IRT[N APPLICATION 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) COVINGTON, KENT ® County Roads (list all counties) KING ❑ 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, 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. Signaturekt- Title SUPERINTENDENT H E EXECUTIVE OFFICER) Name DR. CALVIN J. WATTS Date ' ( a (TYPE OR PRINT) 3000-323-006(R 8115) Page 7 of 8 AUTHORIZED EMERGENCY VEHICLE PERMIT o® �,.,. 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 I 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 I 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 print: � �' 7m Signatur ;�F� Date 9/15/20 Title POLICE CHIEF Name (Please Print) ANDREW MCCURDY Jurisdiction COVINGTON POLICE Phone (253)480-2430 E-Mail ANDREW.MCCURDY a,KINGCOUNTY.GOV Restrictions Signature Date / Title SHERIFF Name d (Please Print) MITZI JOHANKNECHT Jurisdiction KING COUNTY Phone (206)296-4155 E-Mail MTZI.JOHANKNECHTa,KINGCOUNTY.GOV Restrictions Signature ,�✓��r--- Date 0&-,p,9r. Title POLICE CHIEF Name (Please Print) RAFAEL PADILLA Jurisdiction KENT POLICE Phone (253) 856-5888 E-Mail RPADILLAOKENT.WA.GOV Restrictions Signature Date Title Name Jurisdiction (Please Print) 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 maybe 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. 3000-32MO6(R 8115) Page 8 of 8